Amid all the choices, your relationship with your therapist – and the right fit for you – is what matters most.
How do you go about finding a therapist?
The answer starts with another question, says Ryan Howes, a practicing psychologist and professor at the Fuller Graduate School of Psychology in California (https://www.psychologytoday.com/experts/ryan-howes-phd-abpp): Why seek it?
“If someone is feeling depressed, if they're feeling anxious, if they're having problems in relationships, or problems with communication, difficulties with finding their purpose, or their meaning in life,” Howes says, “these are all great reasons to try out therapy.”
Those reasons will also help you wade through the numerous approaches to therapy and counseling, which can be confusing.
Ultimately, Howes says, choosing a provider boils down to just one thing: how well you get along. “Research has shown time and again that it’s the quality of the relationship that actually has the best predictor of outcome” — more so than even a therapist’s experience, degree, or level of training.
To begin your search, check out listings of providers online from sites like Psychology Today (https://therapists.psychologytoday.com/rms/prof_search.php) or Goodtherapy.org (http://www.goodtherapy.org/). Providers will describe their specialties and treatment approach and often post a photo. You can ask friends or family if they work with a therapist they like — their therapist may be able to provide recommendations. A spiritual leader — from any tradition — can also be a good resource, Howes says. “They're not necessarily trained in psychological issues and want to be able to help, so they probably have a list of folks that they like to refer to.”
As you’re evaluating options, consider these questions:
Do you want short, focused help, or more long-term guidance? Cognitive behavioral approaches tend to be short term and focus on changing your thoughts about a problem — say, you’d like specific guidance on how to stop worrying about your teenagers when they’re out at night. Psychotherapy explores the roots of a problem (you want help resolving anxieties that seem to crop up often). There’s a lot of evidence that both approaches work, so the choice may be a matter of preference. Some providers combine elements of both.
Do you care about level of training or price? Some therapists work with a master’s-level degree, such as family and marriage counselors. Others, often psychotherapists, have doctoral degrees, such as a PhD in psychology, while psychiatrists have been to medical school (which allows them to prescribe medicine).
In addition, many health insurance plans have significant deductibles. A therapist’s fee will count against the deductible — meaning you’ll pay for care out of pocket until you hit the limit. If price is a factor, community clinics often offer good free or low-fee programs. Teaching hospitals and therapy institutes in large urban centers may also offer low-cost consultation.
Paying more doesn’t necessarily mean better care, Howes says. However, “typically people working for free or very low-fee clinics are oftentimes trainees, people who are just getting started or just learning the trade, and the people with the higher-end practices tend to have more experience.”
What are your beliefs? Therapists are as varied in their beliefs and approaches as the human race itself. Providers work from a variety of spiritual traditions, from Buddhism to Christianity, and incorporate varying philosophies to solving life’s problems, from existentialism to the 12 steps of Alcoholics Anonymous. Of course, you don’t need to agree with a therapist on everything — but It can help to work with someone who shares your spiritual, philosophical, or religious beliefs, particularly when addressing issues like motivation or depression .
When you have a few providers in mind, Howes suggests taking a test drive. Many will offer a free initial consultation or first session. Then, trust your gut, he says. “You really have to just kind of say, how do I feel? Do I feel comfortable talking with this person? Do I feel like I can be myself? … That sort of data right there is the most important, more so than the number of degrees on the wall.”
When you do visit or speak with a therapist, look for someone who balances guidance with reflective listening. He or she should be focused on helping you make specific, concrete changes in your life and discovering what may be holding you back from achieving your goals. But they’re not there to judge or condemn, and they should follow stringent ethical guidelines. If they overshare personal information, violate physical boundaries, or show a pattern of other inconsistent or inconsiderate behavior (such as being late to appointments), try another therapist.
Finally, congratulate yourself. “Mental health is a big part of physical health,” Howes points out. “When people have healthy relationships and they're emotionally healthy, they're going to seek out medical services less frequently.” In seeking help, you’ve put yourself on the path to a happier, more fulfilling life.
March 04, 2015
Christopher Nystuen, MD, MBA