How to Choose a Psychotherapist

Choosing a therapist is an overwhelming task at a time when, by definition, you are usually not at your peak.  But a little bit of effort now can go a long way - research suggests that the relationship you have with your therapist is more important than any other factor, including what type of therapy is done (CBT, psychodynamic, etc). 

The following "steps" are meant to serve as a guideline for this process, but of course remember that different things work for different people.  If you are in a serious crisis, such having thoughts about hurting yourself or others, just get yourself in somewhere as soon as possible.  You can worry later about whether this person is right for you to do more committed work with.

 

Choosing a Therapist:

1.  Self-reflect  What a "therapisty" thing to say, I know.  But if you take a little time and think about what sort of people you tend to feel the most comfortable and open with, it might save you a lot of trouble and heartache later on.  Folks around your age, who will have a little bit of an understanding of where you are coming from?  Or maybe somebody older, who you feel might have more life experience to offer?  How do factors like gender, race and ethnicity play a role for you?

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2.  Consider topic expertise  Many people check in with the first psychotherapist on their insurance panel, only to discover that person may not be well suited to treat the issue they are dealing with.  Some difficulties such as addictions, eating disorders and phobias really are their own animals and are not typically well treated by most generalists.  Other more common or less complex concerns such as depression, anxiety and relationship problems can generally be treated by any good generalist.

3.  Develop a short list:

  • Poke around on sites such as psychologytoday.com and  goodtherapy.org to see what providers in your area seem to work with the concerns that you have.  
  • If you feel comfortable, ask family, friends, your primary care doctor, and anyone else you can think of for referrals - a personal experience is worth a thousand websites.
  • Look at providers' websites critically.  You are looking for a therapist, not a web designer, but there shouldn't be evidence of unprofessionalism such as frequent misspellings or poor grammar.  If they have posted pictures, are they somebody you could envision yourself talking to?
  • Develop a list of about ten names if you can; don't worry - it will likely get pared down throughout the rest of the process.

4.  Check credentials  Make sure the people on your list are licensed professionals.  If they are a psychologist (PhD or PsyD), check the state board of psychology to make sure their license is active and in good standing.  For a LCSW or MSW, look into the State Board of Social Work.

5.  Think about your finances.  The first question here is whether or not you need to use insurance.  I would encourage you to really challenge yourself about this, especially in some areas such as Washington DC, where very few providers are in-network with insurance companies. The old adage "you get what you pay for" is certainly not always true when it comes to psychotherapy - but sometimes it is.  Many therapists offer a sliding scale, meaning that they are willing to lower fees for people who have difficulty affording services under certain circumstances, and it is certainly worth asking about this possibility.  But remember that psychotherapy is generally at least a medium-term commitment, so scratch off anybody you truly can't afford.

6.  Make some calls  This isn't just about setting up an appointment; there are several key questions that you would do well to have answered or confirmed before you commit to a consultation:

 Questions for the Therapist:

1.  Do you work often with the issue I am having?  Do you consider yourself to specialize in that area?  What sort of experiences have you had with people dealing with my problem, or attempting to achieve my goal?

2.  Where exactly are you located?  How easy is it to get to your office?  Are you near public transportation, or is parking available?

3.  How much is the fee per session?  Do people typically pay at the time of the session, or get billed monthly?  If you are an out of network provider, do you give me the paperwork needed for my insurance company to reimburse me?  If needed, do you offer a sliding scale and, if so, how do you determine the fee in that case?

4.  What availability do you have?  Can I have a standing appointment (same time every week)?  If needed, do you offer weekends/evenings?

Questions for Yourself:

1.  Do the logistics of time, place and financials work for you?

2.  Does this person seem knowledgable and competent about the things I'm hoping to work on?

2.  Does this person seem friendly and approachable; somebody I would feel comfortable talking to?

7.  Arrange some consultations  Choose around three of the therapists who you enjoyed talking to and whose logistics work well with yours, and set some appointments to meet them in person.  When you meet with them, pay close attention to how you feel.  Do they seem to be listening to you?  Do they seem to care about what you're saying?  Are they telling you too much or too little about themselves?  Check the books on the shelves to see if their way of thinking about people, health and healing seems to match your own.

8.  Commit with caveats  It is important to be able to work through difficulties in therapy, so don't change therapists any time there is a hint of conflict or disagreement.  At the same time, if you see any red flags such as poor boundaries, bizarre behavior, or not feeling listened to,  it is ok to continue your search.  

 

 

Norcross, J. C. (Ed.). (2002). Psychotherapy relationships that work: Therapist contributions and responsiveness to patients. New York: Oxford University Press.