The Seleni Guide to Finding a Therapist
Where to look and what to ask to find therapy that works for you
Taking care of your mental health and well-being is one of the best things you can do for yourself and your family. We all deserve support managing the challenges – both big and small – of life. But it can be hard to know where to start. Once you understand what options you have based on your health insurance and budget, there are several important considerations to finding a therapist who is a good fit for you. This guide can help.
Do I have to know what I want to get out of therapy?
The short answer is no. It’s enough that you think you will benefit from professional help at this time in your life. But even if it’s difficult to identify specific goals for therapy, it can help to take the time to get a general sense of why you would like professional support. Perhaps you are looking to relieve specific symptoms such as anxiety, or boost emotions like motivation. Maybe you want to change a certain behavior or get support with a very difficult life experience. Or maybe you want to get to know yourself a little better and identify your goals so you can work toward them effectively. Having a general idea of why you are seeking support will help you and potential therapists determine whether their approach will serve you well. One responsibility of your therapist will be to help you figure out what you want to achieve together, so don’t feel you need to have a specific plan for therapy. All you need to know is that you’d like to try work-ing with someone to feel better.
HOW DO I START LOOKING FOR A THERAPIST?
Often the best way to find a therapist is to ask trust-ed friends and family for recommendations. But if that is not comfortable for you, or if you don’t know anyone who can recommend a therapist, you have many other options. Other good sources of referrals include:
Your primary care provider, OBGYN, or pediatrician
Your company’s Employee Assistance Program (EAP)
Psychology Today’s “Find a Therapist” feature
The American Psychological Association’s Psychologist Locator
Your insurance company
Academic institutions, which often offer counseling services that provide either free or low-cost counseling or referrals to other professionals
When you contact a potential therapist, don’t be afraid to ask specific questions about his or her experience in the area in which you need help. A therapist can also give you a referral to an expert or another practitioner when appropriate.
CONSIDER THE EXPERTISE AND SPECIALTIES OF POTENTIAL THERAPISTS
Both you and your therapist are likely to have more confidence in the process if you trust that he or she is in familiar territory. There are hundreds of emotional and personal challenges as well as psychiatric disorders, and many psychotherapists specialize – through training or over the course of their practice – in one or several areas. So as you consider the specific issues you hope to work through, look for therapists with experience or training in those areas. Some common specialties include:
Couples and family therapy
Reproductive psychology
Grief
Infertility
Eating disorders and body image
Depression
Anxiety
Substance abuse and addiction
Sexuality or sexual dysfunction
Divorce
Anger management
Post-traumatic stress disorder
Career counseling
Child and adolescent psychology
Domestic violence and abuse
LGBT issues
Psychosis
What kinds of therapy are there?
PSYCHOTHERAPY
Psychotherapy is a general term that refers to a wide range of talk therapy techniques. In psychotherapy, a client talks about his or her thoughts, feelings, behaviors, and life circumstances with the support, guidance, and feedback of a professional psychotherapist. A practitioner may identify as a “generalist” or “eclectic psychotherapist” and draw from a number of psychotherapy styles or identify as a provider specializing in one or more of the specific psychotherapy styles listed below.
INTERPERSONAL THERAPY
IPT is based on the idea that emotional distress is often rooted in, and perpetuated by, problems in interpersonal relationships. IPT focuses on clarifying and strengthening a client’s relationships with other people and on improving communication in these relationships.
COGNITIVE BEHAVIORAL THERAPY
CBT is based on the premise that the way a person thinks about situations impacts the way that person feels and behaves. CBT helps clients recognize thought patterns that lead to distress-ing feelings and actions, explore how and when these problematic thought processes developed, and actively challenge such thinking through a variety of therapist-directed thought exercises and plans to change behavior.
DIALECTIC BEHAVIORAL THERAPY
DBT has two main goals. First, it helps clients learn to manage difficult feelings (rejection, guilt, or anxiety) with-out resorting to self-defeating coping behaviors, such as drinking too much or returning to unhealthy relationships. DBT also promotes a client’s capacity to move through and past these difficult feelings by building interpersonal and self-care skills.
PSYCHODYNAMIC PSYCHOTHERAPY
The goal of psychodynamic therapy is to help clients identify and explore how unconscious emotions and motivations can influence behavior, rather than to explicitly try to change thoughts, feelings, or behaviors. Sometimes ideas from psychodynamic therapy are interwoven with other types of therapy (such as CBT or IPT) to treat various types of mood and anxiety disorders.
PSYCHOANALYSIS
The goal of psychoanalysis is to bring unconscious feelings into your conscious thought. The theory is that developing insight into your past conflicts and defense mechanisms will help you resolve the challenges you face today. In classic psychoanalytic treatment, the client reclines while the psychoanalyst sits out of view and listens to the cli-ent’s thoughts. The goal is to help the client reorganize his or her thoughts and insights based on the analyst’s interpretations. Treatment often consists of multiple weekly sessions for a number of years.
OTHER APPROACHES
Although the styles listed here represent some of the best-researched and most widely available therapeutic techniques, there are many other strategies, with varying degrees of research supporting their effectiveness. These include Emotion Focused Therapy, Motivational Interviewing, Somatic Experiencing, Creative Arts Therapies, and EMDR, among others. When interviewing a therapist, it’s perfectly acceptable to ask for an explanation of why he or she believes a particular type of therapy is a good match for your concerns and goals.
What kinds of therapists are there?
PSYCHIATRIST
CREDENTIALS
MD, DO
REQUIRED POSTGRADUATE TRAINING
Four years of medical school, focusing on biological and pathological human functioning
Four years of residency (supervised practice in a hospital setting), focusing on medication and psychotherapeutic treatment of psychiatric disorders
ISSUES & CONDITIONS TREATED OR SERVICES PROVIDED
Psychiatrists are trained to provide support for a wide range of issues, from interpersonal challenges to mood and psychotic disorders. Some psychiatrists provide psychotherapy and prescribe medications, but many psychiatrists now focus only on “medication management,” only, seeing clients less frequently than is typical in psychotherapy. In these cases, clients sometimes see another type of psychotherapist in addition to a psychiatrist. Psychiatrists’ fees are generally higher than those of other psychotherapeutic practitioners.
PSYCHOLOGIST
CREDENTIALS:
PHD, PSYD, EDD
REQUIRED POSTGRADUATE TRAINING
Doctoral degree Minimum one year, full-time supervised internship in clinical practice
Postdoctoral training under supervision
Licensing exam
ISSUES & CONDITIONS TREATED OR SERVICES PROVIDED
Psychiatrists are trained to provide support for a wide range of issues, from interpersonal challenges to mood and psychotic disorders. Some psychiatrists provide psychotherapy and prescribe medications, but many psychiatrists now focus only on “medication management,” only, seeing clients less frequently than is typical in psychotherapy. In these cases, clients sometimes see another type of psychotherapist in addition to a psychiatrist. Psychiatrists’ fees are generally higher than those of other psychotherapeutic practitioners.
CLINICAL SOCIAL WORKER
CREDENTIALS:
LCSW, LICSW, CSW (VARIES BY STATE)
REQUIRED POSTGRADUATE TRAINING
Two years graduate training, focusing on psychosocial human functioning
Two yearlong supervised graduate internships providing direct, clinical social work services
Two or three years postgraduate, supervised clinical experience
Licensing exam
ISSUES & CONDITIONS TREATED OR SERVICES PROVIDED
Clinical social workers are qualified to assess, diagnose, and treat a wide variety of mental health concerns and relational problems. Clinical social workers emphasize working with the “person in the environment” to explore and address the impact of social and environmental stressors (like occupational stress, financial strain, and family issues) on a client’s thoughts and feelings. Social workers are also skilled at connecting clients to outside resources (such as legal services, job training pro-grams) to address these types of social and environmental concerns.
PROFESSIONAL COUNSELORS
CREDENTIALS:
PLC, LMHC, LCPC, LPCC
REQUIRED POSTGRADUATE TRAINING
Master's degree
Supervised internship
Postgraduate training hours under supervision
Licensing exam
ISSUES & CONDITIONS TREATED OR SERVICES PROVIDED
Mental health counselors treat individuals with concerns about their emotional health, relationships, career, lifestyle, and other issues. They typically emphasize sharing developmental and preventive behaviors to help clients set goals and identify solutions to issues.
MARRIAGE & FAMILY THERAPISTS
CREDENTIALS:
MFT, LMFT
REQUIRED POSTGRADUATE TRAINING
Master's degree in a mental health field (such as social work, psychology, or mental health counseling)
An additional qualifying program in marriage and family therapy
ISSUES & CONDITIONS TREATED OR SERVICES PROVIDED
Marriage and family therapists work with individuals, couples, and families to strengthen relationships by improv-ing communication. They help couples and families talk though challenges and identify causes of and solutions to problems.
ADVANCED PRACTICE PSYCHIATRIC NURSES
CREDENTIALS:
LICENSED OR CREDENTIALED
REQUIRED POSTGRADUATE TRAINING
Master's degree or clinical doctorate in psychiatric and mental health nursing
ISSUES & CONDITIONS TREATED OR SERVICES PROVIDED
APRNs can diagnose and treat simple and complex psychiatric and mental health problems from adjustment dis-order to schizophrenia, bipolar disorder, major depression, and anxiety dis-orders. In most states, they are licensed to prescribe medication.
Should I contact more than one potential therapist?
Absolutely. It’s important to find some-one you feel comfortable working with. A good therapeutic relationship is a genuine partnership and collaboration. Start by making phone calls and then schedule initial appointments with the therapists who seem promising to you.
WHAT QUESTIONS SHOULD I ASK ON THE PHONE?
What kind of therapy do you practice?
What is your training and background?
How long have you been in practice?
Do you have specific training in the areas I plan to work on?
What is your experience treating clients working through similar issues?
How do you determine whether you are a good match for a particular client?
How do you determine therapy is working well - or that it isn't?
How long does therapy usually last?
Reflect on the answers you receive. Do they match your sensibilities? If you feel comfortable with the answers, set up an initial appointment. If you don’t feel compatible, reach out to other professionals.
WHAT SHOULD EVERY GOOD THERAPIST HAVE?
A professional license from the state in which he or she practices
Advanced training (including fellowships and postgraduate certifications) in areas of specialization; These can include specific areas of mental health (such as reproductive psychology) as well as specific psychotherapy techniques (such as dialectical behavior therapy)
Accreditation or certification from specialized training institutions
The ability to explain his or her approach and whether it is a good fit for your expectations and goals
Willingness to discuss whether other approaches or therapists might be a better fit for your circumstances
Clear communication around policies related to cancelling appointments and clients’ access to records
HOW DO I KNOW IF A THERAPIST IS A GOOD FIT FOR ME?
Many studies have found that the greatest predictor of a positive therapy outcome is the clients’ perception that they and their therapists are a good fit. So what does that look like? Some issues are entirely practical but still important: Is your therapist’s office in a convenient location? Can you arrange sessions that fit into your lifestyle and schedule? Assuming those needs are met and it is not an undue burden for you to prioritize therapy, ask your-self a few questions:
Is your therapist present with you and not rushed or distracted?
Do you feel comfortable talking about your experiences and explaining your point of view?
Do you feel heard?
Does your therapist make an effort to understand what is most important to you?
Does he or she understand you?
Do you feel like you are working together?
Do you feel supported during sessions, even when you are having difficult moments?
Does your therapist make sure you feel emotionally safe and grounded before ending a session?
WHAT ARE SOME SIGNS THAT MY THERAPIST IS NOT A GOOD FIT?
Your therapist talks too much or not at all.
Your therapist doesn’t empathize, is overwhelmed by the issues you are working on, or seems overly affect-ed by your emotions.
Your therapist is not interested in the changes you want to make.
Your therapist is judgmental or critical of your behavior, lifestyle, or challenges.
Your therapist encourages you to blame your family, friends, or partner for everything.
Your therapist cannot accept feedback.
Your therapist makes too many suggestions about what to do, and these suggestions are more like advice.
Your therapist doesn’t remember the issues you are working on from one session to the next.
Your therapist does not seem to be listening to you, gets distracted, or answers the phone during your session.
DISCONTINUE THERAPY WITH A PARTICULAR THERAPIST IF HE OR SHE:
Touches you inappropriately or attempts to initiate a romantic or sexual relationship with you
Discloses your identifying information to other clients (or identifying information about other clients to you)
Tries to keep you in therapy against your will
Confronts you in a way that is aggressive rather than helpful
Should therapy always feel good?
It is normal to have some emotional discomfort in therapy. Exploring difficult memories and changing emotional habits are just a few of the many situations that can trigger tough feelings in therapy. Al-though these emotions don’t always feel good, they can be an important part of the insight development and growth that characterize a healthy therapeutic process.
When emotional discomfort is triggered in therapy, it is important to pay attention to whether you truly feel supported by your therapist. Does your therapist understand what you’re feeling right now, and how and why these feelings came up for you? Does he or she help you understand what you are feeling and why you feel that way? Does your therapist provide you with the tools to work through and cope with any emotional discomfort that arises in treatment? Finally, and perhaps most important, does your therapist check in to make sure the distress you’re experiencing is tolerable?
Part of your therapist’s job is to pace therapy so that difficult insights and feelings arise manageably. Your therapist should regularly and carefully assess that you’re not overwhelmed in the process. Good therapy can be challenging, but it should never leave you feeling out of control, alone, or less hopeful than when you started.
HOW WILL I KNOW WHEN IT IS TIME FOR THERAPY TO END?
Not all therapy needs to end. It’s up to you and your circumstances. Some types of therapy, such as cognitive behavioral therapy, are meant to be time limited. When you’ve reached your goals and are feeling better, your therapist will probably suggest that you stop therapy. Other types of therapy, such as psychodynamic therapy or psychoanalysis, entail a more nuanced decision about when to end.
These types of treatment don’t have a timetable for completion. It makes sense to stop when you feel better and that your life has improved. You could ta-per off therapy slowly, reducing sessions from weekly to biweekly, then to monthly, for example. Some individuals choose to make therapy a consistent tool they use in their life to manage challenges as they come up.
It is perfectly appropriate for you to check in with your therapist periodically (or whenever you feel the need) to find out how you both feel about the progress you are making and how long you are interested in continuing to work together.