By Dr. Danielle Keenan-Miller
Maybe you’re at the place of wondering whether talking to a professional therapist could be
helpful to you. Perhaps you’ve tried making changes on your own but keep getting stuck and feeling defeated. Or other people in your life may have suggested that it would be a good idea to get some outside support. You may be facing a serious illness such as depression or an eating disorder, or you might just have the nagging feeling that something about your life or your relationships isn’t as satisfying as it could be. Maybe you’ve tried working with a therapist in the past or you’re working with someone now but it hasn’t been as helpful as you hoped it would be. You decide to take a leap into finding a therapist-- but how do you get started?
If you’ve ever done an online search for therapists, you’ve probably found yourself overwhelmed. Particularly if you live in a fairly urban area, there are likely to be a number of choices, and it can be hard to tell them apart based on their descriptions on a website. If you’re going to invest your time, money, and emotional energy into talking to someone, you want it to work. But sometimes it seems like you need your own degree in psychology to be able to sort through all of the options. So people often end up choosing based on purely logistical reasons, like location, or based on factors that may or may not be important, like someone’s picture or how nice their website is.
Instead of choosing at random and hoping it works, doing some work upfront to identify the right therapist for you can pay off. The six steps below will help your perfect match:
- Check out the evidence base. The first step in finding a good therapist for you is to understand what types of therapies are likely to work for the problem you’re having. Through decades of scientific research, psychologists have determined which types of talk therapy are best suited for the different kinds of problems that bring people into treatment. There’s no one treatment that’s best for every problem, just like antibiotics that would be helpful to you if you have strep throat wouldn’t be helpful if your problem is diabetes. An easy way to figure out what type of treatment will likely work best is to go to a website where psychologists have distilled down the essential findings into an easy-to-understand format. My favorite ones are https://www.div12.org/psychological-treatments/ for adults and http://effectivechildtherapy.org/ for kids. For example, if you look up Panic Disorder, you’ll see that the treatment listed as having “strong” research support is Cognitive Behavioral Therapy, and you can even click on the link to learn more about what that type of therapy is. For many disorders, there is more than one kind of therapy listed as having strong or modest research support, so you’ll have some choices depending on the type of therapy that sounds interesting to you or that is the same or different from something you’ve tried in the past. If you’re not sure whether you have a particular type of problem or if your concerns are more general, like difficulties at work or conflict with your parents, reading through the different types of therapies might give you some ideas about what would be helpful to you.
- Find therapists who practice that type of therapy in your area. There are multiple ways to find therapists in your area. Unlike most other doctors or healthcare providers, it’s less likely that you’ll find people listed on sites like Yelp. The private nature of therapy makes clients unlikely to post reviews (except for maybe a few angry ones), and therapists often don’t use those sites to advertise. Large aggregators like the therapist listings on Psychology Today are one way to identify providers in your area, but you should know that therapists can list themselves as doing any kind of therapy they want on those sites, without necessarily having any expertise in that treatment, so be wary of practitioners who list too many areas of specialty. A more targeted way to identify people who are likely to be qualified through the website of the relevant professional organization. For example, if you’re looking for a CBT therapist, you could look up the Find a Therapist function on the Association for Behavioral and Cognitive Therapies website (http://www.findcbt.org/xFAT/). Many other kinds of therapies, such as Interpersonal Therapy (https://iptinstitute.com/ipt-directory/ipt-therapists/) and Acceptance and Commitment Therapy (https://contextualscience.org/civicrm/profile?gid=17&reset=1&force=1) have similar options. If cost is a primary concern, you may start by reviewing the list of providers in your insurance network, or you could find a training clinic at a local university where PhD students are learning to do therapy.
- Choose between the available therapists. Perhaps there are only a few people who have expertise in the kinds of problems you want treatment for and who practice a scientifically-supported approach to treating that problem. But if there are many-- how do you choose? First, listen to your intuition. If you know that you’d have a hard time opening up about sexual concerns to a male therapist, choose a woman. If you know that trekking over to the other side of town is going to prevent you from getting treatment on a weekly basis, choose someone closer to home. You may also want to consider the type of degree this person has. Psychiatrists have M.D.s, and they’re the only people who can provide medication. They’re much less likely, however, to provide weekly talk therapy. People with Ph.D.s are generally trained in both the practice and science of psychology, and you may not be surprised to find out that I think that’s an important qualification. They generally have 5-6 years of post-college graduate study, where they learned to provide psychotherapy and contributed to scientific research. People with Psy.D.s and Ed.D.s have similarly extensive training in the practice of psychology, but much less training in the science behind it. People with M.S.W.s, LPCCs, MFTs, etc are generally master’s-level therapists who have more limited training (often 2-3 years) and they may or may not be able to practice without supervision from a licensed psychologist depending on the rules of the state you live in. Choose someone with a level of expertise that makes you feel comfortable and confident in their background.
- Use the first phone call to double check that they meet your qualifications in steps 1-3 above. During that first phone call, they’ll probably want to know a bit about you and give you a chance to ask them questions. This is a good time to ask about their expertise with concerns like yours, make sure they practice the kind of therapy you’re looking for, and address any logistical issues like cost and location. If it sounds like a good fit, it’s time to schedule a first appointment.
- Check for “fit”. Over the course of the first few sessions, you want to pay attention to your intuition about the quality of the relationship you’re building with your therapist. The fancy therapist word for this sense is “working alliance.” You should have a sense that you and your therapist are working towards shared goals, that you both agree on a reasonable way to achieve those those goals, and that you and your therapist like and respect one another. We know from extensive research that this “working alliance” is one of the most important factors in predicting the total amount of progress in therapy, so don’t compromise here. If any of those dimensions feel off to you, bring it up to the therapist. They may be able to adjust their style to be a better fit to what you’re seeking. If not, perhaps they can refer you to someone else that would be a better fit. Ideally, you want someone who both creates a space that feels safe and that pushes you out of your comfort zone so you can grow.
- Look for progress. No matter what your primary reason for seeking therapy is, you and your therapist should be tracking progress towards your goals, ideally on a weekly or at least monthly basis. If it’s not clear to you how your therapist is assessing progress, ask. The two of you should be on the same page so that you both know whether therapy is going in the right direction and so that you know when you might be ready for your course of treatment to be over. It’s normal for therapy to take a while (in research studies, usually at least a few months), and there may be a few brief plateaus along the way, but you should have a sense of progress and be able to talk about it with your therapist if you don’t.
Finding a therapist can feel like a daunting process, but you’re likely to get out of it what you put into it. Investing the time into finding someone that makes you feel understood, gives you new ideas about how to cope with your problems and live a more satisfying life, and helps you make the changes you want is an investment in yourself and your future.