Finding the right therapist
Ενημερώθηκε: 21 Ιουν 2018
The right therapist is one you feel comfortable with, and can open up to......
Searching for the right therapist is sort of like dating.
To find The One, you need to date around, “swipe” your way through options and get a feel for who’s out there. In my own hunt, I first searched for therapists online, which led me to feel even more confused than when I began.
Lost and without any leads, I asked my best friend for a recommendation. It felt safe to seek help from a professional who came with character references — the same way I’d scan mutual friends on Facebook before agreeing to a date.
Sadly, it was yet another match not meant to be.
But after three years of on and off “dating” around, I finally found The One, and as with any successful relationship, she was worth the wait. Here’s what I’ve learned on my journey.
Determine the type of professional you need.
If you’re suffering from ailments like panic attacks, depression, post-traumatic stress disorder or obsessive-compulsive disorder, look for a clinical psychologist or social worker rather than a psychiatrist, said Dr. David D. Burns, adjunct clinical professor emeritus at the department of psychiatry and behavioral sciences at Stanford University School of Medicine.
If the issue is something more like bipolar disorder, major depressive disorder, sociopathy, borderline personality disorder or schizophrenia, it’s best to see a psychiatrist or a psychologist with considerable experience in that specialty. The American Psychology Association offers a comprehensive list of options. Depending on your insurance provider, you may be restricted to specialists within your network.
While the role of a psychologist is primarily to diagnose and use talk-based coping strategies, don’t rule out the possibility of medication from a psychiatrist if you continue to experience profound suffering. For many patients, Dr. Burns said, medication can be important and even lifesaving. (Combining regular therapy sessions with medication is linked to more sustained symptom relief than either option on its own — but pursuing that route is a conversation to have with the therapist you choose.)
Look for chemistry.
I learned the hard — and expensive — way that I needed a strong therapeutic alliance with my therapist. I needed someone who was warm, reliable and within my price range, and the people I had seen up to that point were none of those things. Finally, I broke up with my psychologist by text message, and ghosted my eating disorder counselor.
Then, after a nerve-racking phone call, an intake worker at the Montreal Center for Anxiety and Depression played matchmaker based on my needs, and placed me with a clinical social worker.
Angela, my social worker, used cognitive behavioral therapy to help me gain perspective. She didn’t stare at the clock waiting for sessions to end, and often held me back a couple of minutes to compare wedding dresses and engagement rings. I left sessions wondering if it would be a breach of ethics to text her the minutiae of my day just because I knew she understood me. Your therapist doesn’t need to be your best friend, of course, but you should be comfortable with that person, and with sharing your thoughts and feelings. If you’re not, look for someone else.
Treat your first appointment like a date.
No one goes on a first date without checking the other person’s Facebook profile. The same applies to choosing a therapist. Before making your first call, look at a therapist’s online presence on Yelp-like databases like Vitals, ZocDoc and Healthgrades. Watch out for cookie-cutter positive comments like “Good therapist,” or an overwhelming number of four- or five-star reviews.
It’s promising if comments are detailed, said Michelle Katz, a nurse, health care advocate and author of “Healthcare for Less.” So rather than, “Good therapist,” a far more telling review would be: “I had Blue Cross and this therapist really spent the time with me and worked with my insurance. Even when it ran out, they still filled out the rebuttal form and worked with me to ensure insurance covered it for X amount of sessions.” Bonus points if a quick search leads you to any research papers, discoveries in the field, recent workshops or accolades.
Take negative reviews with a grain of salt, Ms. Katz said. Look at the patterns of the person writing the review. It’s a red flag if they’ve written only complaints. Generally, therapists who take the time to respond to comments care about their practice and reputation, Ms. Katz said.
Get the therapist on the phone for a few minutes and ask what he or she enjoys most about counseling. Ask what school the therapist attended, ensuring proper accreditation as opposed to an online certificate. Ask about specialties, noting how comfortable the response is when you share your issue. Ask about licenses and look them up to be sure the therapist hasn’t incurred any infractions (this information is available at state licensing boards like this one in Pennsylvania). Finally, has the therapist ever attended therapy? “Do not get into therapy with someone who hasn’t done her own work,” Ms. Katz said.
“Treat it like a date. You know the difference between nerves and ‘Oh, this is not good,’” Ms. Katz said.
Look for affordable options.
According to a recent survey by the nonprofit Mental Health America, 56 percent of the 40 million Americans suffering from mental health issues do not seek treatment primarily because of insufficient insurance and high costs. But that doesn’t need to be the case.
First, verify what types of accreditation your insurance accepts, what the diagnoses need to be, what kind of documentation you need, and how many sessions it covers. Ms. Katz suggested asking your therapist for a cash rate, because deductibles and other costs can, surprisingly, make insurance more expensive.
“See how close they come to what your insurance will pay, and you might find that paying cash is cheaper,” she said. “Unfortunately, if you pay a cash rate, you may not be able to use that against the deductible.”
On top of that, negotiating with your insurance provider can be complicated even in the best case, so get creative. Look toward nonprofits, which offer many passionate and licensed professionals for less. Colleges and universities often have health centers with student therapists at more competitive rates, as do state or county mental health offices.
Counselors in training often have to put in a minimum of 1,500 hours before getting their license, which means they sometimes offer sessions at a discount while being overseen by a licensed therapist. The same goes for students (supervised by a clinician) at the master’s and Ph.D. level, and after becoming licensed some will even keep their clients at a discounted rate as a form of loyalty.
“They become family to you, so you can ask them to work on a payment plan,” Ms. Katz said.
Frequency and format are also places to get creative with price. Instead of going every week, you can talk about going once a month, or switching your sessions to Skype or email. Similarly, online therapy services like BetterHelp, 7 Cups of Tea, BlahTherapy and Talkspace are effective alternatives.
“Anything is negotiable, and if a therapist is not willing to negotiate with you, especially after you’ve been with them for a while, it’s probably not a good match for you,” Ms. Katz said.
Discuss a timeline.
Seeing a therapist for a while does not necessarily mean it’s a match made in therapeutic heaven. Your relationship or needs may change over time, or the therapist’s career may go in a different direction. Similarly, for some the goal is not to pay for lifelong sessions, but to help you recover from or learn to cope better with the issues that led you to a therapist in the first place, Dr. Burns said. When he used to practice, he tracked feelings of anger, anxiety and satisfaction by issuing a test to patients before and after the session. In doing so, he saw improvements in as little as a couple of hours.
“If my son or daughter were depressed, I’d want them to go to a therapist who can get them dramatic improvements in just a few sessions, not just have them pondering their life for months or years without change,” he said. For others, however, progress is slow and deliberate, and having someone to help over the long term is better. Like everything else, the best timeline for you is the one you discuss with the therapist you choose.
A version of this article appears in print on July 21, 2017, on Page A3 of the New York edition with the headline: Here to Help; How to Find the Right Therapist. Order Reprints | Today’s Paper | Subscribe