Finding the One (A Therapist)

Searching for a therapist can feel like dating sometimes.

You meet someone, you find out they’re interested in getting to know you more, maybe you even spend an hour or more getting to know each other and then you find a dealbreaker - leaving you back at square one. Therapy is just like dating, it’s all about the relationship that you build with the other person, but the mental, emotional and even physical effort that you need to put into finding someone that you can go the distance with can be overwhelming and exhausting. 

With therapy widely available online, the pool of options has grown into a sea, which is great news for the growing number of people seeking out therapy. At the same time, sifting through the options to find one that will accept not just you as a client, but your insurance, can feel like a herculean feat. We know it’s hard, so we’ve put together a guide to finding a therapist: 

The practical considerations 

Whether you’re looking for in-person or virtual therapy sessions, your therapist needs to be licensed in the state that you plan to take your sessions in (again, even online). If you live and work in different states, as many in the DMV metropolitan area do, think about which state is most relevant, depending on if you’re hoping to take sessions at home or during your break hour at work. Once you know this, you can decide which format is best for you. 

Next, and perhaps the most important for accessibility, how are you going to pay for therapy?

If you don’t have insurance coverage, you’re most likely going to be looking for places that offer sliding scales. These can be determined by any set of factors; for example, here at New Hope, we offer a sliding scale rate by application to clients based on their annual household income and the number of people in the household. Generally, private practices have more flexibility with their rates, so you might have more luck looking at practices that don’t take insurance at all. Therapists need to make a living too, so there are some limitations, but many are committed to providing accessible care to those in need. 

If you do have insurance coverage, you have two options. One, which will leave you with more restricted options, is sticking with therapists that are credentialed with your insurance. This will require you to look closely at your insurance benefits, particularly what program you are receiving them through, because the plan details can affect your coverage. Most practices will ask for your first name, last name, date of birth and a copy of your insurance card in order to verify that your insurance will pay them for any services they charge. Therapist databases like Psychology Today and Inclusive Therapists will often have filters for your insurance, but profiles are not always up to date, so you’ll want to double check on the therapist’s website to be sure. Your insurance also may have a database of potential counselors, but they might miss some who are not directly credentialed with your insurance, but are still covered by your plan through their practice. Is your head spinning yet?

The second option, which could give you more flexibility in choosing a therapist, requires you to be able to pay for sessions via credit and submit a request for reimbursement with your insurance, which can take some time to process. You’ll need to check your out-of-network benefits and may want to contact your insurance to confirm that they would cover this care, which adds to your workload, but would allow you to see most any out-of-network therapist, most of whom will provide you with a superbill to submit to your insurance. 

Judging a book by its cover

So now you’re flipping through a list of potential candidates and you’re faced with the uneasy feeling that comes along with narrowing down your options based on more superficial criteria: age, gender, race, maybe even sexuality, if they share that information as well as years of experience (see: student therapists). On one hand, these labels may not actually matter as much as their approach or the rapport you can build; on another, shared attributes can help establish safety and build trust, particularly for minority identities. Only you can ultimately decide which of these traits matter and which you could let go of, but the math is pretty straightforward: the more requirements you have, the fewer options you’ll be left with. Trust your gut, but if you find yourself getting to the end of the line and are unsatisfied with the results, consider challenging some of your surface-level judgements. 

Going deeper

The next part of the search is going to involve two layers of specifications that require a bit of psychoeducation to properly apply: your symptoms or diagnosis and therapy treatments. Again, you can ignore this bit if you find your options limited, but others may find these filters useful. 

Anxiety, depression…what’s going on with me?

In the United States, mental health operates largely under the medical model, which focuses on diagnosing patients and treating their symptoms. There is a lot of debate over whether this is the most healthy or even most ethical model of treatment, but the reality remains that this is how the system is built. For some people, getting a mental health diagnosis can be freeing and empowering; for others, it can feel burdensome and stigmatized. With the internet, many people have been able to self-diagnose themselves, which can be both helpful in cases where people are otherwise unable to access care and potentially harmful in cases where people misdiagnose themselves. If you’ve been to therapy before, you might carry around a diagnosis, but you might also feel that you have outgrown it or it doesn’t accurately represent your experience. Ultimately, you are the expert on yourself: if identifying with specific symptoms or a diagnosis is helpful to you, you can use it to narrow down the options. If not, however, keep your options open, because most therapists are able to treat many different conditions and will tell you if they can or cannot treat you. 

So many acronyms 

One major area of specialty that differentiates therapists is their approach to treating mental health conditions. Certain approaches require unique training, licensure and certification, such as art therapy or table-top role playing groups, while others are more informal, such as talk therapy. Many therapists will refer to the names of popular theories and techniques, particularly evidence-based practices, which some people prefer. One of the most common ones is Cognitive Behavioral Therapy (CBT), which is a goal-oriented and structured approach to therapy built on the premise that your thoughts, feelings and behaviors can all influence one another. In the modern era, CBT is the basis for most counseling programs and talk therapy as a whole, but some practitioners lean more behavioral in their approaches, meaning that they primarily focus on behavioral changes. Others, however, may take a less strict approach. Ultimately, as with all therapies, the label can tell you something about the therapist and how they might seek to help you, but there is a lot of diversity in practice, so don’t let it scare you away from what otherwise might be a great fit or blind you when you’re seeing red flags. 

Glossary

Psychotherapy - Talk therapy based in psychology 

Acceptance and Commitment Therapy (ACT): A third-wave (read: modern) psychotherapy that focuses on accepting and adapting to your circumstances without judgment.

Dialectical Behavioral Therapy (DBT): Another third-wave (read: modern) psychotherapy that focuses on managing your emotions

Eye Movement Desensitization and Reprocessing (EMDR): A technique that uses your eye movements to process traumatic memories or experiences. 

Internal Family Systems (IFS): A psychotherapy that conceptualizes your inner self as a system of parts. 

Mindfulness-based Therapy - An approach to psychotherapy that builds awareness and acceptance of your inner thoughts, feelings and bodily sensations. 

Now what?

So you think you’ve found the one, but how do you know? Just like a first date, many therapists offer free consultations in the form of 15-30 minute phone calls to make sure that you’re a good fit - in both directions. 

Am I being interviewed?

This might sound scary, but ultimately, it’s for your own benefit. Some of the considerations may be practical - see the sections above about location, licensure and insurance. Additionally, therapists might be assessing you to make sure that they are able to provide the level of care that you need. If you are actively in crisis, you likely need more support than an outpatient therapist is able to give you and they’ll often do their best to refer you to other services if that is the case. You’ll likely be asked about your symptoms, past mental health history and what you’re looking for - and then it’s your turn. 

What should I ask?

The consultation is also for you, so take some time to think about what you need to know before moving forward. In addition to practical questions, you’ll want to learn more about their approach to treatment and what you can expect to get out of therapy. Don’t be afraid to ask direct questions here, because this is your care. Below are some sample questions: 

What would an average session look like? 

What would your approach be to treating my symptoms?

What is your experience with my population? 

Decision time

Ultimately, your final decision when picking a therapist may come down to availability or how quickly they responded to you. After all this searching, however, it can feel devastating to start the process and find an unexpected roadblock, whether your verification of benefits comes back to reveal that you aren’t covered or you start meeting with your therapist and realize that you actually aren’t a good fit. When it comes to the former, take a moment to feel your frustrations about how inaccessible mental health care can be, because those feelings are valid. If you can, confide in your support system or reach out to a warmline, a peer-run phone line that can offer support, and recruit their help. It’s ok to need help.  

If you start sessions with a therapist and don’t immediately click, don’t panic. Sometimes it takes a bit of time to settle in and, as long as you don’t feel unsafe, sticking it out for 3-4 sessions can give you a better sense of the relationship. If it still isn’t working for you and you feel comfortable, talk to your therapist about it. Chances are, they might be feeling it too and could have some suggestions to adjust and improve the relationship. If not, they could have referrals for you that are a better fit. Unlike dating, therapy is a professional setting and clinicians are ethically-bound to treat you with respect even when you’re breaking up with them. 

It can be daunting to get back out there after all this, but remember, you’re never at square one. Regardless, you’ll have learned something about yourself, what you’re looking for in a therapist and even what you’re not looking for. Not all therapists are the right fit for you, but you only need one to make all the difference.