You've made the decision to go to therapy and are ready to share the most intimate details of your life, but how do you do that with a complete stranger? Where do you start? What if you've had a terrible experience in the past? Below are 11 steps that will help you make an informed decision and find your best fit.
1. Who's Who
There are a lot of differences between therapists. If you choose a therapy search engine like Psychology Today, you will feel overwhelmed with all the letters after names and descriptions of what each particular therapist offers. It's important to start to understand who they are and how they fit your needs.
Counselor: Typically short or long-term talk therapy, has a graduate degree in clinical mental health counseling or social work.
Psychologist: Offers testing (diagnostic) and possibly long-term therapy
Psychiatrist: Prescribes medication (medical degree) and sometimes offers short or long-term talk therapy
Social Worker: Provides community resources for an individual and may provide short or long-term talk therapy.
Psychotherapy: short or long-term talk therapy
Counseling Intern/Masters Level Clinician: In the final stages of the graduate degree and providing counseling under supervision.
2. Understand the Alphabet Soup
You'll see letters after a therapist's name that signifies their degrees and schooling. Here are some basics below to help you sort through them all.
LPC/LMHC/LCPC/LPCC/LCMHC: licensed professional counselor, licensed mental health counselor, licensed clinical professional counselor, licensed professional clinical counselor, licensed clinical mental health counselor.
All the same schooling, graduate degree, different states-all alphabet soup! Additionally, all counselors are required post-graduate licensure hours and often are titled associated or pre-licensed counselors. Each state is different; Georgia state where I reside, requires 2 years and 3,000 hours of post-graduate supervised work (think of this as a residency that an MD student would have to take part in before becoming a fully licensed Doc).
LSW: Licensed social worker. It can also be titled LCSW. Receives a graduate degree in social work.
PsyD or PhD: Doctor of psychology or another area of counseling.
LMFT: Licensed Marriage & Family Therapist (graduate degree)
CADC: Certified Alcohol & Drug Counselor. Schooling is dependent on the state.
3. Focus & Fit
It's important when you're scouring the internet for a counselor that they are a good fit; you need to do more than swipe left or right if you think the therapist looks good. (We know you do this. It's not Tinder y'all).
Each therapist will share more about their approach to therapy on their profile or website. It's important that you take the time to understand the different models or theories that counselors practice and decide if it works for you.
There are five general categories of therapy (for this article, we will keep it short and sweet, be sure to search the counselor's theoretical orientation if it isn't listed here).
Psychoanalysis: ie. Freud This approach is long-term. Typically psychoanalysis is expected to last years. The focus is on changing problematic behaviors, feelings, and thoughts and looking to the unconscious for the reasons behind the behaviors, thoughts, and feelings.
Behavioral Therapy: ie. Pavlov & Thorndike
This approach focuses on learning new behaviors to eradicate abnormal behaviors. For example, the grandfather of Behavioral therapy is Ivan Pavlov (remember learning about the dogs that drool when they hear a bell?) In classical approaches, conditioning of behavior takes place through repetition. Homework is routinely prescribed.
Cognitive Behavioral Therapy ie. Beck, Ellis, & Burns
This approach assists individuals to think rather than do. Therapists work to identify faulty thinking that leads to problematic moods and behavior and change the thought to change the feeling and behavior. Homework is routinely prescribed.
*This is my approach, and I have practiced it for over 20 years.
Humanistic Therapy: ie. Kierkegaard, Sarte, & Buber
In this approach, therapists focus on the individual's capacity to reach their full potential. The approach includes client-centered (therapist isn't the expert, you are), Gestalt (becoming aware of the here and now), and Existential (focus on free will and self-determination).
Integrative or Holistic Therapy: Many therapists do this instead of following a singular approach. Often, different approaches are applied to an individual to ensure a holistic approach to their treatment. For example, with clients, I often describe my foundational approach, which is always present, as CBT (cognitive behavioral therapy), but I also introduce some other approaches like compassion-focused, dialectical behavioral therapy, mindfulness, attachment theory, and vagal activation (Third Wave CBT).
Now that you have a general idea, what seems to be the best fit for you? Do you want a more direct approach? Try CBT. Do you want to talk without a lot of back and forth with the therapist? Try psychoanalysis. Do you prefer philosophical dialogue, try existential. (** these are all very general typologies!)
4. Motivation to Change
Ask yourself if you are motivated to change. Are you ready to commit to therapy? We understand it's intimidating to start therapy. But, if you're not ready, you'll find yourself frustrated because you don't see the change you want in one-off sessions every other month. Committment takes 1 session per week to begin. Around session 6, I assess with clients if they've met goals and what they'd like to do next. Typically, my clients with moderate distress utilize 8-12 weekly sessions; then, they move to booster sessions either bi-monthly or monthly.
The most important question to ask is:
Am I ready to commit right now and dedicate time to visit my therapist every week? Not sure; look at this graphic; it helps to formulate where you are in committing to counseling.
5. What's This Going To Cost?
Other than the time commitment to therapy, the next question is routinely, "What's your rate?"
It's important that you first determine what you can afford in your budget. Next, does the practice/therapist bill your insurance? If the therapist doesn't bill insurance, will they provide you a superbill every month to turn into your insurance for reimbursement? Ask the therapist if they provide a sliding scale fee. Average sessions range anywhere from $60-$250 an hour, depending on location, years of experience, and education level. Important Note: Cost does not determine the value of care. At a previous practice, I worked at the intern/master's level clinician rate (the lowest of the low, think below minimum wage). Often, clients would wrinkle their noses when they learned where I was in schooling. However, when they did their due diligence (you'll learn more about this below), they found I have been in the field for over 20 years and have extensive training and certifications in CBT by well-known experts.
6. What Do I Need?
Next, you need to consider your specific issue. You may have multiple; that's ok. Most therapists will work with you to prioritize which issue to tackle first. If you're looking for a "release valve," this is great to acknowledge as well. Everyone has different needs. The counselor is there to support you in solving your problems and releasing tension. The more you know about your issues, the easier it will be for the counselor to help identify them succinctly and come up with a plan.
Important Note: Do you want to know what exactly your steps are? Ask your therapist. We all learned how to create step-by-step treatment plans in school but often don't use them. I hear from clients that they value seeing an outline of the steps to take, and it affords them some relief. If the counselor shares they don't provide a treatment plan, assess if this is a necessity or not.
7. Ready? Set. Search. Below are some helpful websites to assist you in your search. Be patient, and comb through the counselors. Legend has it that it takes 6 therapists to "kiss" before your frog becomes a prince. Taking your time with these steps will decrease kissing those frogs and increase your success in finding the right therapist for you.
Theravive Google search: "therapist near me," "counselor near me." Ask your church pastor, a friend, or a trusted colleague.
8. Due Diligence
Earlier, I shared about some of my clients that made it to their initial intake session, did their due diligence, and didn't allow their preconceived notions about grad students to fog their choice of me as a therapist (they're so wise.)
It's very important that you interview your top 5 choices. Yep. Some therapists may offer a free 15-minute consultation, others, it may mean you're out of pocket for their hourly rate. But, it is absolutely imperative that you prepare to have a face-to-face interview with your therapist (video is OK, but phone calls are tough to evaluate). Get a feel for them. Check out their office. Is their parking lot accessible? Do they offer refreshments? Where is the bathroom? How does it smell (yes, this is really important!)? Next up, ask these questions: 1. How long have you been a therapist? Tell me more. 2. What are your credentials?
3. What are your rates?
4. Do you take insurance or offer a sliding scale?
5. What are your office hours? Do you offer evenings or weekends?
6. What type of therapy do you use? How long have you been using it?
Can you give me an example?
7. What or who do you specialize in? (teens, elderly, trauma, eating disorders, etc.)
8. What are your thoughts on spirituality integration?
9. What is the cancellation policy?
10. Do you prescribe homework? How much time will that entail?
11. Do you offer after-hours calls/texting? Emails?
12. What is your ideal client/counselor relationship? (We never get asked this, and it helps to reveal the heart of that therapist!)
DOWNLOAD a free copy of these interview questions below!
9. Review After your interviews, it's time to review all the information that you have found. How did you feel about the therapist, the answers to your questions, and the way they spoke to you? How do you feel about their credentials and fees? How did you feel about them? Were you comfortable?
Review is key to your finding a great therapist. It's best to take these steps and determine if all the boxes you need to be checked are!
10. Let's Go!
If you found "the one," it's time to set up your initial intake. Complete the necessary paperwork and head on into the session. Your first session is all about the therapist covering their HIPAA bases and asking you questions. Don't get discouraged! We know you want to dig into the pains you're feeling, but we must do our due diligence to ensure we give you the best care and know exactly what we are working toward. After the initial session, you'll dive right in.
11. Reassess
Consider where you are in therapy (around sessions 4-6) and ask yourself how you feel about your progress. Do you still have that feel-good feeling about you and your therapist's efforts? Have you become discouraged because you don't feel heard?
Be truthful with your counselor!
If you're feeling out of sorts and unsure. Tell your therapist. If you feel like your therapist isn't "getting you," let them know.
The goal is to have authentic communication in partnership. If you decide the counselor is no longer a good fit, don't give up. Tell them why and buh-bye and try again. You have all the tools above.
Piper Harris is a Level One T.E.A.M. C.B.T. (cognitive behavioral therapy) clinician through the Feeling Good Institute, an International Coaching Federation Credentialed ACC Life Coach, S.Y.M.B.I.S (Save Your Marriage Before It Starts-faith based) certified counselor, and graduate student in Clinical Mental Health Counseling. She empowers her clients to overcome anxiety, depression, relationship issues, weight gain, lost motivation, significant life changes, intimacy issues, navigating boundaries, and more. Piper has over 20 years of experience in counseling and life coaching.
Piper works with individuals ages 21 years and older, and couples, through a foundational C.B.T. approach. Simply put, thinking affects feelings which create behaviors. Through the C.B.T. approach, Piper partners with her clients in seeking to discover how distorted thinking has created emotions and behaviors that are keeping them stuck and in pain.
Additionally, Piper uses an integrative approach to understand attachments and utilize vagal activation techniques. Piper believes healing and growth are seen through the challenge of change and invites clients to partner with her in discovering wholeness and vitality. Visit piperharris.net or exhalecounselingsvcs.com
References
American Psychological Association.(2023). Different approaches to psychotherapy. https://www.apa.org/topics/psychotherapy/approaches
Shaffer, Jonathan. (2013). Stages of change model. Encyclopedia of Behavioral Medicine.https://link.springer.com/referenceworkentry/10.1007/978-1-4419-1005-9_1180#:~:text=DiClemente%20and%20Prochaska%20initially%20identified,(4)%20maintaining%20new%20behaviors%20