How Do You Choose the Right Therapist?

The pitfalls of in-network therapists.

Posted Jun 01, 2018

How do you know if someone is the right therapist? A patient can choose between many different therapies nowadays and if the patient is not in the mental health field, he/she may not understand what kind of treatment they want or need. Insurance companies prefer short-term symptom-oriented therapies. But the patient has to decide what kind of treatment he/she wants. This is not easy to determine before you have experienced therapy. If you are in pain, you just want the pain to end.

Some people choose therapists by cost, i.e. if the person is covered by insurance. I'm not on any insurance plans, but most of my patients get out-of-plan payments and I have a sliding scale to accommodate people without insurance. But therapists are not washing machines. If you choose a therapist because he or she is on sale, you may not be getting the most experienced person or a therapist who has the ability to help you with your unhappiness. 

Choosing a therapist because you will have a cheap co-pay may turn out to be very expensive. First, you may spend precious years of your life spinning your wheels and not working out the problems that are making you unhappy. Second, I believe therapy only works if the patient makes a commitment to it. There are rough times in therapy when the patient and therapist are working on painful things. The patient may wish to avoid the appointment and not have to deal with those things. Or the patient may be angry at the therapist for saying something he/she did not want to hear or know. If the cost is $10 for the session, it is easy to cancel or miss a session. Cheap in fact! Third, money is often a central problem for patients. In order for the patient to work on issues around money, it has to emerge at some point in the treatment. If the cost is low and the fee is not raised at any point, the patient's issues around money may never come out in the treatment.

For many people, the inability to deal with money is part of the problem that makes them unhappy. Yet, talking about money can be more difficult for some patients than talking about sex. Paying a reasonable fee forces the patient to deal with two important issues: in order to get what I want and need in life, I have to earn money; and the therapist is a professional, albeit a caring one, not my mother or a lover. These issues emerge in the treatment when the patient is paying a reasonable fee and it is increased incrementally over time. The patient may be happy to pay a low fee and never have it increased, but he/she may be missing out on an opportunity to deal with important therapeutic issues.

Many people say "trust your gut" when choosing a therapist. But that might be a problem if your "gut" is what's been getting you in trouble and/or making you unhappy. So you cannot always trust your gut. However, in order to develop a therapeutic alliance (which is crucial in any type of therapy), the patient has to feel some rapport with the therapist and feel comfortable talking to him/her.

Asking friends about their experiences with their therapists is an excellent way of getting a sense of different types of therapy and therapists. Have any of your friends gone into therapy and changed as a result? Those are the friends to ask: Is your therapist a good listener? Does your therapist give advice? Does your therapist talk about the relationship between you or only about outside relationships? Does your therapist have sliding fees? Although it's not always easy to find the right therapist for you, referrals from friends you trust is a much better basis for choosing a therapist than who has the lowest co-pay.

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