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Fundamentals of Therapy #2: Finding a Therapist

Choosing a therapist: Trust your gut.

Choosing a therapist is no easy task: there are about a million in the U.S. alone. From all those willing prospects, you'll select a professional with the training, experience, personality and style to provide the help you need. But you're also forming a relationship with this person, whether it's for two sessions or 200. It's important you feel comfortable and safe as you disclose your private matters to another human being.

I'll hit some of the major points here, but for further reading you may wish to check PT's How to Choose a Therapist or Carl Sherman's excellent book How to Go to Therapy.

The research on therapist selection has some interesting results. The 2004 survey I referred to last week reported:

The most common factors cited in the choice of a mental health professional include: recommendation from a doctor (28%), whether the therapist is part of the individual's health-plan network (26%), proximity to home or work (22%), and cost (17%). In contrast, the factors ranked as most important in making therapy successful include: the therapist's listening skills (63%), the therapist's personality (52%), the personal connection with the therapist (45%), the therapist's being active in the session (38%), and the cost (38%).

It's something they tell therapists early in our training: it's all about the relationship. A clinician with a wall full of credentials and 30 years experience may seem to have the edge on paper, but if the 24 year-old trainee has a better connection with the client, it may provide a better outcome. Referrals, degrees and demographics matter, but the quality of the relationship appears to matter more.

I suggest clients make a list of potential therapists based on the factors below, then get a feel for them during an initial consultation or brief interview. "Test driving" potential therapists will provide a sense of the therapist that may not be conveyed through their curriculum vitae. Here are a few initial factors to consider when making your list:

Referral: When people first contemplate therapy, they usually talk it over with someone they trust: a friend or family member, their physician, a religious leader or a teacher. Helpful as this may be, it doesn't always result in the best match. The referral sources may know the therapist socially or professionally, but don't know how the therapist works in session. Even if they do, there is no guarantee their style will work best for you. Certainly gather these referrals from trusted sources, but don't make your final decision based on referral alone.

Age/Ethnicity/Gender/Sexual Orientation/Religion: Generally speaking, people tend to choose therapists similar to themselves in these areas, with the belief that someone with shared demographics will better understand them. Are these similarities necessary or important for you? Also, are the issues you want to address related to any of these traits? For example, if you are seeking help for a fear of flying, how important is the age of the therapist? Probably not very important. Or if you're a woman who wants help relating to men, would you feel more comfortable discussing this with a woman, or might working with a man be beneficial? That's worth thinking about.

Cost: Fees for therapy vary widely, from free (or nearly free) at some community clinics to $250+ in elite private practices. It is an investment of not only money, but time and emotional energy, so it's important for you to honestly assess your resources. Therapy can be expensive, but consider how much money we spend on other things (new clothes, fine dining, entertainment) to help us feel better, but don't produce a lasting change. Fees tend to rise with levels of therapist experience and training, but not always. Also, therapy is one of the few modern professions that will sometimes employ a sliding scale - where the fee is based on your income level.

Insurance: Many licensed therapists are registered with major health networks which cover most, if not all therapy fees. If you'd like to see someone out-of-network, insurance may reimburse a portion of your fees when you submit an itemized receipt from the therapist. Some clients choose not to use insurance because the therapist may need to share treatment details with the insurance company. You can check with your insurance to determine how payment works and get a list of clinicians.

Location/Availability: How flexible are you here? Some therapists offer evening and weekend appointments, but these tend to fill up quickly.

Degree: Many paths lead to the field of psychotherapy. Psychiatrists have an M.D., tend to focus on the biological elements of behavior and may or may not conduct psychotherapy. Psychologists have a Ph.D., Psy.D. or Ed.D., typically conduct psychotherapy and may have training in psychological assessment. Clinicians with a Masters in Social Work provide therapy with an emphasis on the client's social system. Marriage and Family Therapists or Marriage, Family and Child Counselors hold a master's degree and specialize in relationship issues. Licensed Professional Counselors have master's degrees and conduct general psychotherapy as well. Again, cost and areas of focus vary widely among these professionals.

Experience: Clinicians with years of experience have seen and treated many people with a variety of issues; they know what has helped and what hasn't. Newer clinicians are closer to their training and potentially equipped with the latest techniques and theories. More experience usually means higher fee.

Therapeutic Orientation: These approaches to therapy (also called treatment modalities or theoretical orientations) influence how therapists understand and treat your problem - even how they relate to you. There are hundreds of therapeutic orientations, but they tend to fall in a few major groups that help explain our thoughts, feelings and behaviors. The categories are based on the environment and experiences that formed us (psychodynamic), our patterns of thought and belief (cognitive), achieving our human potential (humanistic), or the influence of family dynamics (family systems). Some therapists use several theories, which we call being "eclectic."

Expertise: Through their training and/or experience, most therapists focus on a few areas of clinical interest. Some therapists have written books on the topic, published articles, spoken at conferences or received special training.

That's a lot of information to sort through. The good news is, all this information is easily obtained through Psychology Today's Therapy Directory. By entering your zip code, you can find all this data, read personal statements from the therapists and even see a photo. Hopefully, by using your referral sources, your insurance provider and/or The Therapy Directory, you'll be able to gather a good list of potential candidates.

I suggest a test-drive of the two or three top choices from your list. Call them up and arrange for an initial consultation - some therapists will even offer this for free. Or if you'd like to get started quickly, ask for 10 minutes of their time over the phone to ask some questions. It's fine to let them know you're interviewing several therapists.

When you speak with the candidates, ask them to elaborate on any of the points above you're not clear about. The therapist should be able to communicate their experience, style and approach in a way that makes sense to you. Tell them about your problem and ask how they would proceed with treatment. Feel free to ask whatever you'd like to know - they are applying to work for you, after all.

Trust your gut. The research is pretty clear: the therapist's ability to listen, their personality and the connection you feel are vital components of successful psychotherapy. Your subjective experience of the therapist is just as important as their credentials. Were there any red flags during your interviews? With whom did you feel the strongest connection? If you don't find a match in your top three, keep moving down your list - a decision as important as this has to feel right.

More from Ryan Howes PhD, ABPP
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