Pursuing therapy can be a big decision. If you’re struggling to get by day to day, finding a therapist can seem like an overwhelming challenge. If you want to take the next step forward in your life, finding the right person to support you really matters. It might be frustrating that it can take weeks or even months to find someone who you like and can afford, not to mention someone who has an open appointment time that fits your schedule with a convenient office location.
Given all of these challenges, here are some recommendations about this process from my own experiences as a client as well as a therapist. I’ve also gathered tips from many of my friends and colleagues. I hope this three-part guide will give you more information about therapy and be helpful on your journey to working with the best therapist for you.
Here’s an overview of the information below:
- What style and type of therapy is best for you?
- What type of person do you want to be your therapist?
- What is your budget? Why can the fees seem so high?
- Considerations if you have insurance
- Ask around, search online databases and contact agencies
- Sliding Scale Therapy Agencies in the Bay Area
- What are the differences between Private Practices and Agencies?
- Look them up online and then talk to them
- Interview questions
- Evaluating the therapists
- The first sessions
- What if it’s not working out?
There are as many types of therapists as there are people. Finding the right therapist for you isn’t necessarily about finding the “best” or most experienced therapist. There are many types of challenges we face in life and many types of therapy. No therapist is experienced with everything or everyone.
As a queer social justice-oriented therapist, I hear many of my clients say they feel much more comfortable with someone who has a lived understanding of where they’re coming from and what’s important to them. There are multiple studies that conclude that the relationship between client and therapist (not the method) is the most important ingredient to successful therapy.
There are also numerous schools of thought and theories about change and wellness, so not every therapist approaches therapy the same way. For example, an increasing number of therapists like myself are using somatic (body and energy-based) healing methods. Working somatically, we use breath and physical practices to bring more awareness to the innate healing wisdom our bodies possess. We can then use this awareness to guide us.
Instead of focusing on symptoms alone, I believe it’s more important to understand your desires and aspirations and ways you have healed from past experiences so you can continue to transform. In my work, I acknowledge that we’re all impacted by the social and economic systems we live within rather than diagnosing my clients as individuals with isolated problems that need to be fixed. Our struggles have just as much to do with living in our particular society– what’s around us and how we’re treated– as anything else. Together we build resources that help us live as authentically and ethically as possible amidst ongoing social inequality.
So how the therapist views our challenges and strengths matters a lot. It is important to understand and believe in they way your therapist approaches the healing process because this will shape all of your work together. It’s up to you to decide which person you entrust with your healing and growth process.
Where to start: prepare to prepare
When I first began to study and practice therapy, I realized how much the business of therapy and how therapists work was a mystery to me! Finding the right therapist for you may be more successful if you take some time before embarking on the search to gain clarity about what you want, gather information about your options based on your budget and needs, and then spend time shopping around to find the right fit.
“Be discerning, make a list in advance of what is important to you in a therapeutic relationship and what you’re working on. If possible, go before life gets hard,” suggests Healer Stella Lawson. Here are five questions that will help clarify who to look for and that can save you time and money:
1. What type of therapy makes sense for you right now?
Though most people opt for individual therapy once a week for 50-60 minutes, there are other options. There are benefits to couple, family and group therapy. Sometimes people want to come in a few times a week or choose to do some individual sessions as well as group, couple or family therapy.
Individual therapy is the most common type and is focused solely on your needs and concerns. It can be a wonderful way of getting to know yourself on an intimate level in a confidential relationship and really focusing on an issue or change you want to make.
Couple therapy usually takes place once a week with both or all partners involved. This type of therapy can be useful if you are struggling in your relationship dynamic or experiencing a big change together. Any stress you both are experiencing whether due to something going on for one or both of you such as financial, parenting or opening up your relationship can all be addressed in couple therapy. The therapist can gather a lot more information by observing you together and supporting the relationship as a whole. Family therapy can be useful when there are issues with children. It can also help in situations where a family is affected by an issue, especially when everyone is or was close or living together. Siblings and roommates can also access this type of therapy to work on issues together.
Group therapy can be more cost effective and may be great for reducing isolation and shame around many issues such as depression, disability, sexual assault, HIV/AIDS, transphobia or health issues. It usually takes place with 5-10 people for 90-120 minutes once a week ongoing or for a set amount of time like two or three months.
For more information about types of therapy and their advantages and disadvantages, read this article by therapist Ben Butina who authored the book How to Find a Good Therapist.
Reflecting on your own personality and preferences, as well as your goals, are important in choosing what type of therapy will work best for you and your concerns.
Most types of therapy involve exploring the impact of your family upbringing, early experiences and relational patterns for the purpose of improving your relationship with yourself and others in the present. Traditional western therapy is usually called psychodynamic or depth therapy and explores the impact of your childhood caregiver relationships, as well as unconscious material, in order to alleviate confusing behavior and emotional suffering.
Here are a few types of therapy that are popular:
- Emotionally focused therapy (EFT) concentrates on attachment or relationship dynamic styles and is often used with couples.
- Expressive arts therapy is for artists and everyone else who wishes to use visual arts as well as drama, dance, music and play. Arts therapies can be used to access deep material and find creative solutions to problems.
- Hakomi is a body-centered style that using mindfulness or present moment inquiry of thoughts and body sensations.
- Somatic therapy works in the present moment and can heal the impacts of trauma and social inequality by engaging the body, mind and spirit. Be aware that some types of therapy such as “somatic” therapy are called by the same name yet are practiced very differently. Depending on the type, it can range from exploring present moment sensations and gestures to touch work. Generative Somatics, the lineage in which I am trained, also utilizes standing practices based on Aikido, a peaceful Japanese martial art, in addition to somatic bodywork. Many of my clients find it useful if they’ve experienced trauma and tried talk therapy to understand their issues, yet still don’t feel like they’re getting where they want to be.
For more on some other popular types of therapy such as art, CBT, EMDR, Narrative and more see this section of Butina’s article.
Therapists are usually trained to be aware of and minimize their judgments and biases from impacting their work with you. However, no matter how introspective and aware, we all have things we are not aware of due to our exposure and life experiences or lack thereof. For this reason, some people choose to work with someone who shares an identity with them, hoping they might be more aware or compassionate. However, just because someone is a lesbian, for example, they might have very different views than you about gay marriage or polyamory.
If you are seeking someone with a similar identity or life experiences, consider a person’s values just as much as their identity on issues that matter to you. Some examples are feminism, anti-racism or their attitude towards assimilation around disability, religion or immigration. Sometimes asking about beliefs can be a more assured way to find out about someone’s worldview rather than assuming based on their identity or perceived culture or physical ability. [More on this in the section on interviewing under the question: What are their personal and collective identities that matter to you?]
Age is not always a determining factor. Some older therapists are in practice as a second career. Some younger therapists may actually have more experience in the field than older therapists. Stereotypes can get in the way too. Some older therapists may be more open-minded to new ideas. A younger therapist with less experience might be trained in more cutting edge techniques and more enlivened earlier in their career.
Choosing someone who you feel comfortable around is paramount. If the therapist reminds you of your cruel mother or ex-boyfriend, you could choose to use this to work through that relationship or steer clear and start without that baggage. What matters most to you? Ask these questions of yourself and your prospective therapist.
Therapy can cost anywhere from $20-200 or more per session and can be paid for by you, your insurance company (if you have coverage), government benefits or a combination of these.
Ask yourself: How much can I invest in feeling better and transforming the challenges in my life? It’s great to spend some time with this question before you make contact with potential therapists. You might think therapy just costs a certain amount and will be a financial strain or put you into debt when you could possibly find something more affordable. Or you could miss working with a wonderful therapist because you unintentionally prioritized daily lattes and extra clothes over your health. Take a serious look at your budget and come up with a range that’s both realistic and honors your financial and emotional wellbeing as well as your therapist’s need to make a living.
Considerations if you have insurance
If you have insurance or a student health plan through your school, find out what steps you need to take to get authorized for reimbursement or coverage of some or all of the fees, if there are any restrictions on the selection of a therapist, what types of therapy are covered, what your co-pay will be and if there are any limits on the number of sessions per year that are covered. Sometimes they will pay for a portion of the fee if you choose someone outside of their network. Find out if you will need a diagnosis that may go on your record, or a referral from your primary doctor to qualify for benefits for therapy. Who has access to this information on your record and how do they gain access? Some therapists accept insurance so you are only responsible for paying them your co-pay each week or month. Others will ask you to pay their full fee out of pocket and will provide you with a receipt that you can send to the insurance company for reimbursement, which means you’ll need to front the money until the insurance pays you back which may take some time.
Why can the fees seem so high?
Agencies utilize grants and volunteer labor to provide lower fee therapy. Therapists who work in private settings are small business owners with no paid vacation, sick time or health insurance. Unless they have other sources of income, therapists must set their fees so they can cover their expenses such as rent, malpractice insurance, professional memberships, consultation or supervision with other professionals as well as times when business is slow or clients are out of town. Due to the focused attention the practice requires as well as the depth of the responsibility therapists have to their clients, most don’t work 40 hours a week directly with clients in order set aside time to care for their own mental health and thus protect the quality of their work.
5. How far are you willing to travel?
The larger the city, the more therapists from which to choose. More and more therapists offer their services over the telephone and through video-conferencing. For some, this could detract from the relationship and for others it works just fine.
If you have a particular issue or need, the best therapist may not live near you. Or, due to your health or transportation situation, it might make sense to be able to connect digitally from your home. Some therapists, especially social workers (LCSWs or ASWs), will even travel to your home and meet with you there.
There are a few ways to find a therapist who might be a good match to interview. You can start by asking other people you trust, searching online, reading reviews, going through your insurance lists, or contacting community agencies.
Friends (especially those who are therapists or other types of health professionals) may have some people they recommend. They may even be able to ask folks they know without needing to mention your name or details about your situation. Keep in mind that seeing a therapist who also works with someone close to you could present complications down the line, especially if there is a conflict, breakup, etc. Some therapists will not see people within intimate or professional networks in order to prevent such challenges. However, if you know someone who likes their therapist, the person can ask them to refer you to other therapists.
If you have insurance coverage, you can use their website or request a list of providers in your area. You can also ask specific therapists if they take your particular type of insurance. For more information on finding a therapist using an insurance plan see Anna North’s article How to Find a Therapist.
Thanks to the Internet, there are many easy-to-access databases, most of which therapists pay to be included in. Unfortunately, the information and qualifications stated in some of these databases or lists may not have been verified or cross-checked so you cannot depend on the accuracy of the information you find here.
- Bay Area Open Minds (Bay Area kink-aware and poly-friendly therapists)
- Gaylesta (Bay Area therapists for LGBTQIQA folks)
- Good Therapy (international)
- Psychology Today (US and Canada)
What are the differences between private practices and agencies?
Private practice offices tend to be smaller, more expensive and have less waiting room traffic. Therapists in private practice must be licensed or have a master’s degree and be under the supervision of a licensed therapist. Agencies tend to be larger and employ paid and volunteer therapists who may come and go more frequently. If you try to seek therapy at an agency or organization, you can ask if the therapists there are ‘trainees’ (still in graduate school), ‘interns’ (completed graduate school and are working towards licensure) or licensed therapists (who typically have more than 4 years of experience).
There are advantages to each. Trainees and interns tend to have lower fees and are typically getting 1-3 hours of weekly supervision which means an experienced therapist is also reviewing the work and providing input – two heads can be better than one. Licensed therapists have much more clinical experience yet tend to charge much more.
For more detail on the types of mental health providers, their degrees and training check out Butina’s article.
Remember that you are hiring a therapist – one who you will be spending a significant amount of time with and investing money in. They may even impact you and the way you live your life. People don’t usually secure jobs without some type of in-depth conversation or even a lengthy multi-interview process. Finding a therapist is no different. Now that you are clear on what you want and have some potential names of therapists, you can interview them in order to find the best therapist for you.
Look them up online
If the therapist has a website or a professional networking profile, such as LinkedIn, you can get a lot of information about them and their work before interviewing them. Websites are good for weeding people out based on location, cost and area of expertise. (Also keep in mind that a website may reflect the lack of website design skills rather than quality of the therapists work!)
Yelp reviews can give you something to go on, but may not be the best source of information to use in your evaluation. Most clients do not post Yelp reviews related to their therapists in order to protect their privacy. Many reviews of therapists tend to be written by tech-savvy clients who absolutely love their therapists or are angry about something that might not really relate to the competency of the therapist or their overall work. The therapist being reviewed could have even asked friends or colleagues to write reviews to help improve their Yelp rating. For these reasons, interviewing potential therapists yourself is important.
Talk to them directly
“Ask for a complimentary phone or live consult beforehand. It’s free and gives you a chance to gauge rapport and make sure they can address what concerns you are coming in with as well as to set up first session” advises therapist Anjuli Sherin, LMFT. You can set up a brief meeting by phone, email or video conferencing. Most therapists charge for the first session so setting up an initial interview can save you time and money. Most therapists offer a free 10-30 minute consultation to assess whether you are a good fit so take advantage of this.
Some therapists do not use email because it is not completely secure or confidential. Phone calls give you the benefit of hearing the therapist’s voice. You can also ask for a video conference consultation in order to be able to see them. Some therapists will offer a brief in-person meeting free of charge if you’re willing to go to their office to find out the basic information.
When you call be ready to leave a message, as most therapists have voicemail only. If you have an email address for the therapist, you might choose to send an email with some of the following points, which can be saved and sent to multiple therapists.
- Your name
- The basics: say you are interviewing therapists and want to set up a time to talk with them if they are taking new clients
- Your budget for therapy so you don’t waste time playing phone tag if they’re out of your range
- Ask if they offer free phone, email or video conferencing consultations prior to making an initial appointment
- Phone number and email address (if that works better for you, although some therapists will only use the phone to communicate with clients for reasons of confidentiality)
- Best times to reach you – be specific about days and blocks of time.
A competent therapist will listen to you, take time to answer your questions and be excited to discuss their work with you. If they seem defensive or rushed, take note of this.
Remembering details about each interviewed therapist might become difficult; you might find it useful, as I have, to make a list on paper or a chart on Google Drive that you can update from anywhere as you interview. The more therapists you talk to, the more blurry it can get about who said what and charges how much and is located where. Some therapists will call back within 48 hours whereas others might take a week or more so it could take time to get all the information together to compare your options.
Here are eight topics you might choose to ask about, with more information about each below.
- How do they see the change, growth or healing process? What does success look like to them?
- What are their personal and collective identities that matter to you?
- What is their experience with the issues you want to work with?
- What is their style and theoretical orientation?
- What is their educational background?
- How do they stay up to date in their training and personal growth work?
- Can they address any personal needs such as physical accessibility?
- What are their fees and policies about cancellations?
1. How do they see the change, growth or healing process? What does success look like to them?
“Ask them what growth, healing or change they see their clients make,” suggests Julia Eden Ris, a youth worker. When asking about what success is, they should reference your own goals for therapy. Otherwise, they are determining success by society’s view or their own personal standard. Simply asking them ‘why did you become a therapist?’ can give you a lot of insight into how the person sees and values their work.
Some therapists just won’t answer these sorts of questions because they believe it could detract from your work with them. In traditional western psychotherapy, a therapist is seen as a blank slate with whom we can project whatever we need or want. However, for those of us who do not see whiteness, “professional” dress, or cisgender presentation as neutral, this projection might happen differently. For example, I might assume that someone who appears as non-transgender male and is wearing a suit has a particular gender socialization and makes a certain amount of money and therefore can’t understand me or my concerns.
Since there are some assumptions we think we can make based on appearance or voice such as gender, race, or if someone has a physical disability, there is a lot we cannot tell or might misread. Additionally, a therapist might live and work within particular communities, be partnered with someone who is different from them, or might have been raised in a certain type of family or community. There are varying levels of familiarity with cultures, sub-cultures and personal experiences. This is where deciding what you need and asking for it is important. If the therapist does not answer personal questions you can see how they respond to open ended questions about how they see or work with the identities and issues you want to bring to your therapy.
What is most important is your comfort and that you don’t feel you need to educate the therapist on issues that matter most to you. You are paying them to hear your unique personal experience, not get a primer on what it’s like to have a chronic illness or immigrate to the U.S. I believe it is the responsibility of the therapist to learn about various issues, communities and experiences as best they can through their own social connections, books, trainings and cultural events while also not assuming anything they learn applies to all people of that identity or experience. That being said, some people say they find it healing to work with a compassionate and attuned man or a white person if they’ve experienced gender violence and/or racism. As therapy becomes a more integrated profession, I hope you will get to truly choose who you want to work with.
Asking open-ended questions will get you the most authentic answers. You can ask ‘do you work with anxiety’ to which the therapist will probably say yes. If you ask ‘how do you work with anxiety?’ you might get more information about their attitude and approach to this issue.
What are their views on interracial relationships, queerness, body size or polyamory? Though these are not simple questions, you will quickly be able to get a feel for the therapist’s comfort and general attitude with topics that matter to you. Even if something might not be your focus, you deserve a therapist with whom you can feel whole and include all of the layers of who you are, how it all connects and impacts whatever you’re there to focus on.
3. What is their style and theoretical orientation?
What training have they had and, more importantly, for how long? Online or in person? Therapists often say they are “eclectic” or use a blend of theories. This makes it even more confusing to try to make an informed choice. I recommend asking them what type of therapy they practice and what theories inform their work. Then, of course, you can always look it up on Wikipedia to find out more. However, I recommend also asking them what those methods mean to them, and from there you can hopefully find out why they are drawn to that way of working and learn more about how this resonates with you.
4. What is their educational background and license type?
Anyone can call themselves a “counselor” so check out their education. If the person is not an MFT, MFTI, MSW, LCSW, PsyD (all psychology specific) find out what training backs up their title. There are some counselors out there who have a masters degree in psychology but did not pursue their license for political or financial reasons. Someone might have a PhD and call themselves a doctor, but did they study astrophysics or psychology?
Have they attended a training course since the 90’s? If so, what have they studied lately?
6. Have they done their own therapy?
Surprisingly, most therapists are not required by their training programs to complete any of their own personal therapy. Someone who does their own work is more aware of their own biases and perspectives and how they might influence their work with you. They are also more likely to be self-reflective and display humility in their work. How do they continue to grow as a person and a professional? You can learn a lot by asking such open-ended questions.
7. Can they address any personal needs such as physical accessibility?
Ask about any needs you have during the first contact. Whether they can offer things like scent-free environments, proximity to transit or parking, availability of ramps, elevators or lifts, gender-neutral or single stall bathrooms can be cleared up right away to save as much of your time and eliminate as many frustrations as possible.
8. What are their fees and policies about cancellations?
Ask about their fees early on. I remember almost crying during my 5th interview with a therapist who sounded like a perfect fit only to find out her fee was way more than I could afford as a graduate student. Ask sooner rather than later and before you meet in person so you don’t waste your time talking to someone way out of your price range. Some therapists have a sliding scale fee whereas others have a set amount that all clients pay. Few therapists publish that they offer sliding scale. However, sometimes after they get to know you, and what you want to get out of therapy they might feel inspired to work with you for a fee you can afford that is lower than their usual advertised rates. While their sliding scale space may be full, ask about a waiting list and how long it might take to be offered a space in their practice. Also ask how they handle unexpected unemployment or financial hardship with their clients.
Therapists tend to charge for phone consultations between sessions and charge a prorated based on your hourly fee rate. Because they reserve the time for you, most therapists have a 24 or 48 hour cancellation policy meaning that if you don’t cancel before then, or just don’t show up, you are charged for the missed session. If you use childcare or have health issues, see if they are willing to make adjustments for your needs.
Note both the factual information as well as your intuitive feeling about being with each therapist. Notice how you feel during and immediately after talking with them and jot down some notes. This is your most useful guide. Feeling nervous or excited or awkward is normal. Deepen into your overall feeling. How was their personality and demeanor? Did speaking with them inspire you and uplift you? Did you feel heard and understood? Can you imagine yourself becoming more self-aware in their presence? Did you get a sense they, too, have been on a journey and come out stronger and more authentic on the other side? Do they embody what you want to cultivate more of in your life?
Hopefully after interviewing a few therapists you will have some options from which to choose. If not, don’t hesitate to go back to the search and try a few more. I strongly suggest meeting at least two, but preferably three of the best choices at least one time in person for a session before making a final decision. Someone might seem good or fine until you compare them with someone who feels incredible. Though you will be paying for a few extra sessions, if you’re not in crisis you can space them out over a few weeks, and know you are making an informed decision for yourself. You can also try one for a few sessions and then try another and see who feels like the best fit.
The First Sessions
Read what you sign! Take time to read any information they offer about their work and office policies– most have financial consequences.
The therapist should do more listening than talking especially in the first few sessions. You should feel comfortable but not too chatty or casual if you are paying to be there to grow rather than hang out. Though it might seem tempting, a therapist isn’t there to give advice or try to “fix” your problems. They might offer reflections, insights or ideas but you should never feel like they are pushy or frustrated with you. The therapist’s job is to patiently guide your growth and healing based on your own strengths, desires and longings.
A therapist should absolutely never engage in flirtatious or sexual behavior or ask to meet outside of the office at any time for any reason. Even if you felt an attraction to them, this is considered unethical and is illegal because it can be very confusing and harmful. It is always the therapist’s job to maintain professional boundaries.
Offering feedback to your therapist may seem difficult. However, a good therapist should be compassionate and responsive to what you need in order for you to feel as comfortable as possible and make progress. If you have tried giving feedback or just don’t feel like it’s a good fit it’s okay to end the relationship and try someone new. If you’ve been meeting for more than a month, most therapists recommend participating in a few closure sessions to review the work and your progress and can offer referrals to other therapists if needed.
Health sciences graduate student Harold Burns advises to “always compare notes with friends who are also in therapy. If you start to question the relationship then take a break for a month or two to get perspective. It need not be anyone’s ‘fault’ if things aren’t working, but don’t stick with something that feels wrong. Never stick with someone who doesn’t make you feel hopeful about your healing and transformation process.”
“Don’t be afraid to end the relationship if it’s not working out,” Lawson urges. “Deciding that I didn’t want to see someone weekly was very liberating. Know that your healing gets to happen on your own terms.”
Best of luck in finding a passionate and practical therapist that will be an ally, supporter and inspiration on your path! You deserve it.
Philipe L. Harrington, MFT works with queer, trans & poly individuals and couples who are longing to embody the transformation we need to create social justice. Through somatics and expressive arts therapies, Philipe’s clients heal once useful, yet ultimately limiting, patterns of protection from trauma and social inequality. Philipe supports people to access more choices, creativity, and skills for personal wellness and collective liberation.
Contact Philipe at Philipe.L.Harrington@gmail.com or www.tigerseyehealingarts.com
© 2013 Philipe L. Harrington