You probably don’t need reminding that 2020 was a trying year. And you may not be surprised to learn that rates of anxiety, depression, substance use, and suicidal ideation skyrocketed in the wake of the pandemic. But if a silver lining has emerged it’s this: Perhaps more than ever before, people have been acknowledging their struggles as well as their need for support.
Yet actually getting that support in the form of professional mental-health treatment can be a challenge.
If you’ve never received formal treatment, it’s natural to feel wary. Compared with the relatively structured, prescriptive approaches common in medical settings, therapy is far more open-ended and individualized. Moreover, simply finding a therapist — let alone the right therapist — can be confusing and intimidating.
The process may include some trial and error, but it will go more smoothly if you are aware of some key points.
First Things First
Before you contact a therapist, consider the following:
What credentials should I look for in a therapist?
A provider’s bio should include his or her licensure and educational background. Although credentials vary slightly by state, master’s-level therapists include clinical social workers (LICSW) marriage and family therapists (LMFT), and professional clinical counselors (LPCC). The provider can provide a range of services, including couples, individual, and adolescent therapy, but are not qualified to administer certain psychological assessments and cannot prescribe medication.
Doctoral-level practitioners fall into two categories: psychologists (PhD or PsyD) or psychiatrists (typically an MD). The former can administer specialized testing and have more extensive and specialized academic training than a master’s-level therapist. The latter can prescribe medication but often do not provide talk therapy.
How much does therapy cost?
Most insurers are required to cover mental-health services, though the extent of coverage varies from plan to plan. Yet not all mental-health professionals accept all types of insurance, and some will only take pay-out-of-pocket clients — either at a flat rate or on a sliding scale. Ask before you commit and be realistic about what you can afford, understanding that therapy takes time. Expect around 15 to 20 sessions, but know that the duration of therapy varies significantly depending on your goals.
How often do I need to go?
While those with acute or debilitating symptoms may need daily support through intensive treatments, the “worried well” — individuals who can function in most areas of life — typically start with weekly or biweekly sessions, then taper up or down as needed.
What type of therapy should I get?
Some therapists adhere primarily to one approach (see sidebar below), but many consider themselves eclectic and structure therapy based on the client’s individual issues and goals. Review the therapist’s bio to get a sense of his or her theoretical orientation.
Do I need to see a specialist?
Most therapists are equipped to treat prevalent disorders like anxiety, substance use, and depression as well as common concerns, such as career or relationship conflicts. Other issues, such as hoarding or eating disorders, may be better treated by a specialist. Therapists typically provide information about areas of specialty in their bios. Large databases, such as that found at www.psychologytoday.com, allow you to filter by concerns.
How to Find the Right Fit
We all click more easily with some people than others. If you have had positive experiences with a supervisor, mentor, or teacher, you may recognize certain appealing qualities in those relationships and consider those when looking for a therapist. For example, do you respond best to direct feedback, or do you prefer a softer touch? Do you feel more comfortable with someone of a similar age, gender, or cultural background?
No matter which therapist you choose, forging a relationship grounded in trust and respect remains nonnegotiable. Numerous studies show that the bond between therapist and client — known as the therapeutic alliance — plays a significant factor in the outcome of therapy.
Both therapist and client contribute to the alliance in distinct ways, says Kevin Keenan, PhD, a professor at the Michigan School of Psychology and practicing psychologist who contributed a chapter titled “The Good Therapist: Evidence for the Essential Qualities of the Effective Therapist” to the most recent edition of Humanistic Psychotherapies: Handbook of Research and Practice.
“I think the most important quality [in a therapist] is the ability to tolerate uncertainty and see the world from multiple perspectives,” Keenan says. He believes that achieving this requires a unique form of empathy. “It’s not just empathy with the client’s feelings, it’s an empathic understanding of how they experience the people and situations in their lives.”
Effective therapists not only try to see the world through their clients’ eyes, they strive to tailor treatment according to their needs.
“An axiom of good therapy is that the therapist meets the client where they’re at,” says Keenan. This involves eliciting feedback and collaborating toward goals, while ensuring that the client is ultimately the one steering the ship. And that means you, the client, have a responsibility to be honest and vulnerable. “The client’s contribution to the therapeutic alliance is at least of equal importance [as the therapist’s],” he explains.
Ultimately, the only way to know whether you click with a therapist is by talking to that person. Some therapists offer brief, free phone introduction sessions in which you can get a feel for their style and ask questions. Though it takes time for any relationship to form, if something doesn’t feel right, trust your gut — literally.
“[A] client’s gut should begin to feel more relaxed during the first session. If not, that should be communicated to the therapist, and if not improved by the second session, it should be taken as a sign of a poor therapist–client match,” says Keenan.
Even if the fit feels right, miscommunication is inevitable. Paradoxically, letting your therapist know if he or she missed the mark can actually strengthen the relationship.
“Research shows that the therapeutic alliance becomes stronger after a ding has been repaired than if the ding had not happened at all,” he notes. “A repaired alliance is a lesson in how to effectively negotiate conflicts with other people in the client’s world.”
Like anything worth doing, therapy will be uncomfortable at times. You may need to reflect on difficult past experiences, consider how personal beliefs and behaviors contribute to your challenges, and ultimately take responsibility for changing what isn’t working in your life. But a good therapist guides you safely along the path.
Common Therapy Approaches
Below are some of the most common therapeutic approaches. Remember, many therapists practice a range of these techniques.
Cognitive Behavioral Therapy (CBT) is a well-researched and well-supported treatment that involves identifying and changing dysfunctional thoughts and behaviors. CBT can be used to address a range of issues, including anxiety, depression, and obsessive-compulsive disorders.
Dialectical Behavior Therapy (DBT) was developed to help individuals who struggle with extreme emotional reactions. Clients learn to moderate black-and-white thinking, improve dysfunctional relationship patterns, and gain self-regulation skills. Often DBT is practiced in a group setting.
Psychodynamic Therapy is grounded in the Freudian tradition of psychoanalysis but often incorporates newer developmental theories related to trauma and attachment. The psychodynamic lens views present issues through the context of past experiences.
Eye Movement Desensitization and Reprogramming (EMDR) is a specialized technique that may be incorporated into the broader scope of treatment. Using bilateral stimulation (essentially a series of rapid, back-and-forth eye movements), EMDR allows the brain to reprocess traumatic memories.
Creative Therapies, such as art, play, and dance, can be highly effective ways of processing our inner experiences. These therapies are especially helpful for those who may struggle to work through issues using talk alone.
This article originally appeared as “Finding the Right Therapist” in the May 2021 issue of Experience Life.