How do you know who to see?
The majority of people who call to set an appointment with a psychotherapist have no idea who they’re calling. Sure, they’ve looked at a profile on an online therapy directory, and some have read a bio on the therapist’s website, but most have no idea what they’re doing when choosing a therapist. Here’s some of my ideas about choosing a licensed professional to talk to.
Different Kinds of Clinicians
I will very briefly describe the difference among professionals in the psychology field. Feel free to skip this section if you already know.
- Therapist: This is your in-the-trenches, everyday psychology professional that you meet with on a regular basis. Licenses are usually MFT (Marriage & Family Therapist), LCSW (Licensed Clinical Social Worker), or LPCC (Licensed Professional Clinical Counselor—this is a newer license growing in popularity).
- Psychologist: Usually does psychological testing and assessment. A psychologist has a doctoral degree and usually charges more than a therapist. May also conduct therapy like a therapist.
- Psychiatrist: Having completed medical school, a psychiatrist is first an M.D. and then continues with psychiatric training to specialize. A psychiatrist can prescribe medication. Although some psychiatrists also conduct therapy, most prescribe drugs and meet for 15-minute appointments for medication management.
My Three Suggestions
First, and I think most importantly, get a referral to a specific therapist. It’s better if that referral comes from a friend or trusted acquaintance (rather than from another therapist or your doctor). Someone you know has likely had first-hand interaction with someone they suggest. And they’re not going to recommend someone just because they have a business relationship. They will either suggest someone they trust and like or they won’t say anything. On rare occasion, you’ll hear someone tell you who to avoid because the clinician is just that bad. There are two psychiatrist names that I regularly warn clients about—they are some of the only doctors that accept clients on government welfare, but the stories I’ve heard about how they treat their patients would curl your hair.
The biggest obstacle in getting referrals from friends is that you may not want to broadcast that you’re looking for a therapist. And your friends may not want to divulge that they know a great therapist because they want to keep the fact that they’ve been in therapy to themselves. If either of these scenarios are in place, you may need to turn to my second suggestion for finding a therapist.
Second to referrals from friends, I recommend referrals from professionals. Although they may offer names of people they know, they may not be familiar with their clinical work. I know many clinicians through my work with the MFT association, but I’m only familiar with the in-office work of a few of them. I tend not to refer someone unless I know something about the work they do in session and I believe they will be a good match for that client. I’m afraid many clinicians recommend friends, though. I like to network with people, and I offer my clients resources of all kinds besides other therapists: from helpful websites and mobile apps to general contractors and nutritionists.
So what if you don’t have someone to ask? My third recommendation for finding a therapist is the Internet. Search for something like, “Milwaukee marriage counselor” or “Denver anxiety therapist.” Notice how specific I was? If you search for “therapist” or “counselor,” you’ll have so many pages of non-pertinent names that you’ll get discouraged very fast. Even with specific search terms, you’ll likely be shown therapy directories like Psychology Today. This site is glutted with therapists who pay $30/month to have their practice listed (me included). How do you know who to call?
Specialties and Niches Are Important
Look for professionals with specialties. The clinician who says, “I treat individuals, couples, and children to help them solve any problem they may encounter,” usually is so desperate for clients that they’re afraid of missing out on anyone willing to pay for a session. Look for someone who clearly states who they like to work with or focuses on a specialty in their profile. I clearly state that I specialize in helping men with sex addiction and couples who want to communicate better. About thirty percent of my clients come for different reasons because if I’m that experienced to have a specialty, they know I can help with their issue. I also enjoy working with these other challenges, too, but I refer to other therapists when I believe it will be a better match.
Low-fees and Insurance Companies
Also, avoid people who advertise up front that they will take “sliding scale” clients. That usually means they’re willing to reduce their fee because they need any business at all. Many therapists who genuinely care about serving the disadvantaged will reserve a set number of spots for low-fee clients and accept them when they have openings. You must ask if they will reduce their fee—a quality therapist who has a full practice doesn’t have to advertise that they work with low-fee clients.
What about insurance? The last place I recommend people find a therapist is their insurance company. Your list of in-network mental health providers likely contains many clinicians who cannot fill their practice based on the quality of the work they do with clients. These clinicians are willing to accept about half the going rate for therapy sessions, and so they must see almost double the clients to make a living. Often (but not all the time), this is because the quality of their work alone will not fill their schedule with full-fee clients.
I try to inform my clients that when they use insurance for mental health counseling, those visits are recorded permanently with the Medical Information Bureau (MIB). That means that whenever the client applies for health insurance or life insurance in the future, the visits with their therapist will be considered in their approval process. This is another reason I suggest that people don’t let insurance acceptance guide their choice of therapists. I think the insurance companies infringe way too much on client confidentiality.
Ask the right questions
Ask what questions? They differ with each person. “Are you comfortable working with a devout Catholic?” “How would you handle significant political differences between us?” “I’ve never seen a counselor before and don’t know what I’m doing. Will you clearly guide me in my role as client?” Be specific in your questions. Interview your potential therapist on the phone before setting an appointment.
How to Interview a Potential Therapist
Call and interview several therapists.
- Give them a two-sentence background on your situation (Brevity is important here. Example: “My marriage is on the rocks because I carried on with a high-school girlfriend through Facebook, and my wife thinks it became physical, but it was only inappropriate emails, phone calls, and text messages. I know it was wrong, and I need to learn how to regain my wife’s trust.”).
- Ask if he/she is the right therapist to work with you. Weigh how the therapist responds.
- See if they will give you an idea of how they would approach your situation.
- Important: Consider how you feel as you interact with each therapist.
- Ask if they have a good working relationship with a local psychiatrist they could recommend (even if you aren’t considering medication, it’s nice to know how connected your therapist is with other professionals).
- Finally, and this is especially helpful to ask, “if you weren’t the best match to work with me, are there two therapists you’d feel confident referring me to right now?” The more grounded, established, and experienced therapists are going to be well-connected in their community and confident enough in their own clinical approach to help you find the best match. Lean toward seeing that therapist!
Finally, don’t skimp. You want the best therapist you can find. The low-fee therapists are usually just starting out, aren’t worth the going rate, or don’t believe in the value of the help they offer. Does that mean community clinics are bad or ineffective? No! There are some highly skilled and altruistic therapists, including interns (who are working on licensure). My experience is that the majority of low-fee clinicians (not all!) are inexperienced or unable to earn a living without government or insurance subsidies.
So if money is a problem, cut out other things before choosing a cheap therapist. After the initial crisis has passed, spread out your visits to every second or third week instead of stopping your growth efforts altogether. But work with the best match you can find. Be willing to move on if it’s not the best working relationship—the problem may not be you or the therapist. You might see the best therapist in your state, but if the rapport isn’t right between you, it won’t be effective therapy.
There you have it: three ways to find a therapist, factors to consider in your decision (and not consider), and what to say to candidates. You may have to work to convince the really good therapists to see you if they don’t have time (and sometimes pay their higher fee). Otherwise, remember that it’s you who’s conducting the interview. Have confidence and let the therapist audition.