I know many people that just pick a therapist out of the phonebook, because they think all therapy is the same. In fact, not only is it not all the same — there are many schools of thought and approaches out there — but it really all comes down to how well you connect with the individual therapist (and that's why people who take the phonebook approach often get nothing out of it). If you want to actually get some good work done on yourself, you need to pick someone who’s a good fit for you and then see if you click with them. Since I was a practicing therapist for several years, I have a few tips, translations, and thoughts about finding a good therapist.
What Kind Of Therapy Do You Want?
Med management: This is a physician who will evaluate you and prescribe you medication, generally a psychiatrist. Typically, psychiatrists just don’t have the time to also do talk therapy, so you may have just 15 minutes or so with them a month.
Talk therapy: This is the traditional "sitting in a room and discussing stuff" with a trained and licensed professional. That professional could come from a psychology, counseling, or social work background. This could include couples therapy, family therapy, play therapy, eye movement desensitization and reprocessing (EMDR), empty chair work, and a host of other types of therapy that are done in one-on-one relationships.
Group therapy: Therapy done in a group with other people and one or two professionals. This often helps with problems that often make people feel isolated and alone — such as addiction, eating disorders, domestic violence, and grief.
If you want to actually get some good work done on yourself, you need to pick someone who’s a good fit for you.
Treatment facility (a.k.a. inpatient): You stay at the facility for extended periods of time to focus full-time on your recovery and safety. Not a hospitalization, although many inpatient programs are located in hospitals.
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What Kind Of Therapist Do You Want?
Some mental health professionals are nationally certified, meaning that the whole country of professionals agrees that this is how those professions should operate and the people who are licensed have passed muster to practice all over the country. Some are state certified, meaning that they are only licensed to practice in that state. That doesn’t make them less qualified, it just means that America cannot decide how to regulate them in every state. Here’s a few of the most common types of practitioners you’ll run into when looking for mental health professionals:
Psychiatrist: Has an MD (doctorate), licensed nationally as a psychiatrist, prescribes medication.
Physician’s Assistant: Has an MPAS/MHS/MMS/DScPA (not a doctorate, but a medical degree), licensed nationally as a PA/PA-C/APA-C/RPA/RPA-C, prescribes medication, usually through a general practitioner’s office.
Psychiatric Nurse: Has an MSN/DNP/PhD (may or may not have a doctorate), licensed nationally as an MHNP/NPP, prescribes medication, usually through a general practitioner’s office.
It really all comes down to how well you connect with the therapist.
Doctorate-level Counselor/Psychotherapist: Has a PhD/EdD/DMFT (all doctorate degrees), licensed nationally as a psychologist, does talk therapy.
Counselor/Therapist/Mental Health Practitioner: Has an MA/MS (master's degree) plus a few years of post-graduate experience, licensed by state as an LPC/LCPC/LMFT/LMHC, does talk therapy. (This is what I was.)
Clinical Social Worker: Has a MSW/DSW/PhD (may or may not have a doctorate) and a few years of post-graduate experience, licensed nationally as a LCSW/LMSW/LSW, does talk therapy.
Social Worker: Has an MSW/DSW/PhD (may or may not have a doctorate), licensed nationally as a LMSW/GSW/LSW, does talk therapy, but also is generally more experienced in handling the bureaucracy of mental health stuff.
Expressive Arts Therapist/Art Therapist: Has an MA, licensed as an ATR-BC/MT-BC, does art or music therapy.
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How To Pay
Here’s my advice: If you have health insurance, check your benefits for mental health coverage. If you have good benefits, great, but often, mental health benefits are severely lacking. If yours are lacking and you’re doing outpatient therapy, try to pay out of pocket. Tell the therapist that you don’t have insurance or mental health coverage in your insurance and request paying on a sliding scale. That’s where you pay based on how much you make. Often, it’s just easier to pay this amount than to try to get your insurance to pay or to submit all the paperwork necessary. It’s just a nightmare. That’s my advice.
Often, companies will have Employee Assistance Programs (EAP) that offer free counseling to employees, usually around six sessions. These can’t get you in trouble at work, I promise. I used to work for one.
You shouldn’t feel judged or like you’re a freak show, but you will feel a bit uncomfortable.
I really like Psychology Today's Therapist Finder. I usually recommend that people start with a talk therapist in the Licensed Clinical Social Worker/Therapist/Psychotherapist range (i.e., master's level), and then have that person recommend other forms of treatment if necessary. Master's level clinicians are going to be cheaper than doctorate level.
Since I’m fairly liberal, I check off boxes for therapists that are willing to work with LGBT clients, sex workers, and feminists. Even though I’m only one of those things, I like to know that going in, my therapist isn’t super conservative. Conservative therapists exist, too, and are fine if that’s what you want.
How To Audition Them
When you go to see a therapist for the first time, be aware that it’s supposed to be uncomfortable. You shouldn’t feel judged or like you’re a freak show, but you will feel a bit uneasy at first. It’s an unusual relationship, unlike any other, and it takes a while to settle into it. Still, if you don’t feel like you’re in an emotionally safe space during that first session, don’t go back. Try another therapist. If you felt uncomfortable and weird but not judged or preached to, go back a second time.
You don’t have to tell a therapist why you are no longer seeing them, but if you like, you can let them know it didn’t feel like a good fit. Your therapist has heard worse, I promise. A good therapeutic relationship is based on personalities meshing just as much as anything else, and that’s just a result of trying. Don’t feel stuck with any one therapist, but be aware that any therapist will challenge you and make you feel a hodgepodge of emotions. That’s therapy doing its work.
A version of this story first appeared on Emily V. Gordon's blog, Do You Think You're Pretty?