Six Things to Consider When Choosing a Therapist

In many ways, hiring a therapist is like hiring any other professional. You're (probably) going to be paying a significant amount of money to this person and trusting them with some pretty important things, so you want to make sure that you're making a good decision. Just like a bad plumber, electrician, or petsitter, a bad therapist could waste your time and money and leave you worse off than you were before. (But at least a bad therapist won't cause the pipes in your house to burst. I mean, probably.)

A lot goes into choosing a therapist, so this is a topic I'll be writing about a lot on this blog. But here are some basic pieces of information you might want to use to make your decision.

1. Payment

Paying for services is, of course, a primary consideration for almost anyone who's looking for a therapist, assuming they're not literally rich. It can make or break a potential therapist hire. I still remember finding an amazing LCSW therapist when I was in college and having an introductory session with her, only to find out that my insurance wasn't going to cover it. I couldn't afford the $80+ she'd charge out of pocket. I remember she sent me a really nice email expressing her regret that we couldn't work together since we'd connected so well, and offering some referrals. (That really influenced my decision to go the social work route to becoming a therapist.)

If you have insurance, whether it's private or public (i.e. Medicaid or Medicare), you can use your insurance company's website to search for providers in your area to see which ones take your insurance. However, even if a therapist isn't in your network, your insurance company may still cover part of the cost--you'll just have to pay it yourself up front and receive a reimbursement. Your insurance company and/or the therapist can tell you more about this.

If you don't have insurance, or if your insurance doesn't cover any providers in your area or who are a good fit for you, you have more options than you might think! I'll write more about this in the future, but for now I recommend this excellent article about finding low-cost mental healthcare. Don't forget, too, that if you're eligible for Medicaid or Medicare, the case managers at your local community mental health center can help you apply for it.

The issue of access to mental healthcare is a huge one that I could write many articles about, but I'll leave it at that for now. Assuming you're able to access therapy financially, here are other things to consider.

2. Location, Hours, & Accessibility

This practical stuff can sometimes get in the way of effective treatment as much as the financial side of things. If you've found a great therapist who's all the way across town through terrible traffic, you may find that you're not able to deal with the hassle of getting there. If you have a disability, accessibility is important--can you actually, practically get into the therapist's office with minimal stress? Disabilities aren't just physical--some people with social anxiety may choose to avoid large clinics that have loud, crowded waiting areas. (However, keep in mind that clinics may have more accommodations than you realize--if you ask, you might be placed in a more private, quiet place to wait.)

Timing used to be a huge issue when it comes to mental health appointments, but it's getting better. Many agencies, and many private therapists, offer hours outside of 9-5 to accommodate people who work during those hours and can't leave. However, in my experience at least, my clients' employers have more often than not been extraordinarily accommodating when it comes to getting an hour off each week to come to therapy. In any case, that might be a good thing to address with a therapist in your first session.

3. Experience

How many years of experience does your potential therapist have? Many therapists list this on their website, or you can find out by looking at their credentials and doing some quick math based on the year they got their most recent degree. You can also just ask. If they act weird about this question, they're not a good fit.

However, this factor isn't as simple as people often think. A long time ago when I was looking for a therapist, my parents always told me to find the one with the most experience. I typically saw therapists with 15, 20, or more years of experience, so they were much older than me and tended to think that they had things pretty figured out. If you read my intro page, you already know how that went.

Certainly there are advantages to having many years of experience as a therapist, especially if you're still humble and open to learning. Aside from their many hours of working with clients, these therapists have also been doing their mandatory 30 hours of continuing education every two years. So a therapist with 20 years of experience should have at least 300 hours of additional training, beyond their professional degree and their supervision! 

However, us younger and less-experienced therapists have some advantages too. We went to grad school much more recently, which means we had the chance to learn about the newest research straight from professors. (While newer isn't always better, in the field of mental health, there are a lot of older theories that are not evidence-based and are finally starting to get thrown out in favor of stuff that's based on science.)

And while all therapists should always seek to learn more about human diversity and be open and accepting of all types of people--it's literally in our code of ethics--I know from experience that not everyone does. If you're looking for a therapist who unquestioningly accepts that nonmonogamous relationships can be as healthy and committed as monogamous ones, or that your gender is what you say it is regardless of which medical procedures or legal changes you may or may not have had, more years of experience is not necessarily the thing to look for in a therapist.

Of course, that's a generalization. Plenty of more experienced therapists are wonderfully accepting and affirming, and some less experienced ones are shamefully judgmental or even bigoted. But it's something to consider as you're looking.

4. Identity

 Shared identities may be important, but not necessarily--Tif and I have a strong therapeutic alliance and we're not even the same species.

Shared identities may be important, but not necessarily--Tif and I have a strong therapeutic alliance and we're not even the same species.

The issue of therapist identity is a hot topic in social work right now. Is it better when therapists have the same gender, race, or other important social category as their client? 

There's plenty of research going on to answer those questions, but here's what I think: while a white/male/straight/etc therapist can absolutely be effective with a client who doesn't share those privileged identities, it's okay to be more comfortable with a therapist who does. There are pros and cons to that. On the one hand, a therapist who shares important identities with you may understand things that you'd find yourself having to explain to someone else, and it may be easier for you to trust them and to bring up "sensitive" issues that a more privileged person might shut down or not know how to respond to. Sometimes, it's literally easier to communicate--for example, an African American client might have to use less code-switching with a therapist who's also African American. 

On the other hand, a therapist who shares their client's identity might project some of their own issues onto that client, such as assuming that an LGBTQ client needs to come out to their family when that client doesn't necessarily feel the need to do so. (Then again, a straight, cisgender therapist may also make that assumption.) A therapist who shares their client's identity may assume they know what they need to know and understand the subtext, while a therapist who is in a socially privileged position but operating from the perspective of cultural humility may be more aware of how much they may not know.

So, if I were to give advice, I'd say go with what you're comfortable with--and if you can't find a therapist who shares an identity that's important to you, address that directly with the therapist. Their reaction will say a lot about them. I'd never trust a therapist who immediately protests, "But just because I'm straight doesn't mean I can't understand what you're going through." I might trust one who says, "You're right. As a straight person, there's a lot I haven't had to deal with that you have. I'll do my best to check my privilege at the door, but you're always welcome to tell me if you think I could be doing a better job." 

5. Education & credentials

There are many paths to becoming a therapist, and not everyone knows what they all are and what the letters mean. Here's a quick guide to the ones you'll most commonly see:

  • LISW/LCSW: Licensed Independent Social Worker/Licensed Clinical Social Worker. The exact term varies by state, so you might want to Google "social work licenses [your state]" to learn more. These are therapists who completed a two-year Masters degree in social work followed by 2-4 years of supervised employment, during which they met weekly with a supervisor who monitored their work. Now they're considered independently licensed and can run their own private practice or continue working for a clinic or agency. Some of them also have a PhD in social work, but that's more rare.
  • LSW/LMSW: Licensed Social Worker/Licensed Master Social Worker. Again, the exact terms vary. (Why?! I don't really know.) These therapists have acquired their Masters in social work and passed the first licensing exam, but haven't completed their 2-4 years of supervised employment.
  • LPCC: Licensed Professional Clinical Counselor. Similar deal as LISWs/LCSWs above, but their Masters degree is in counseling, not social work. 
  • LPC: Licensed Professional Counselor. Like an LSW/LMSW, it's a counselor who hasn't completed their supervision and become an LPCC yet.
  • MFT/LMFT: Marriage & Family Therapist/Licensed Marriage & Family Therapist. Like social workers and counselors, MFTs/LMFTs complete a Masters degree--in this case, in marriage & family therapy. Their training is similar to that of other types of therapists, except with (obviously) more focus on doing family and couples' counseling. You don't have to see one just because you're looking for couples/family counseling, but it's an option.
  • PhD: Doctoral degree in clinical psychology. Although PhD programs are focused on doing research and writing a dissertation, clinical psych PhD candidates are also required to train in therapy and complete some sort of practicum where they work with clients, often at their school's campus counseling center. PhDs can practice independently and administer psychological testing.
  • PsyD: Doctor of Psychology. A relatively new type of doctoral degree that emphasizes clinical practice more than the PhD does. PsyDs may have lots of training and experience, but because the degree doesn't yet have the prestige of a PhD, it's been a lot easier for for-profit and other low-quality schools to enter that market. Some PsyDs are great; others got their degrees at what's basically a diploma mill, or close to it. 
  • MD: Doctor of Medicine. If you're seeing an MD for therapy, it's probably one of the few psychiatrists who still practice it. Historically, psychiatrists both prescribed medications and provided therapy, and many of our best books and articles on the practice of therapy come from psychiatrists like Irvin Yalom and Viktor Frankl. With the advent of managed care, the financial incentives and constraints for psychiatrists have changed drastically and most of them will now only see you for short appointments to prescribe and monitor medication. But if you're seeing one for counseling, chances are they know what they're about.

All of these different credentials qualify someone to practice therapy, and there are many things in common when it comes to their training. However, here are some differences to consider:

  • If you want to be assessed for ADHD, autism, or other developmental disorders, you'll want to see a PhD or MD (at least for that part of your treatment).
  • If you want someone who can both do therapy with you and prescribe your psychiatric medication, you'll want to find an MD who still does therapy (but I'm told these are getting harder and harder to find).
  • If it's important to you that your therapist be trained in the "bigger picture" when it comes to social issues--structural oppression, power, and privilege--someone with a social work degree is your best bet.
  • If you want your treatment to be very focused on the specific diagnosis that you're given, PhDs and PsyDs tend to focus more on this than other types of therapists.

Other than that, the important thing is that you feel like your therapist is competent and accepting. They can do that (or fail at that) regardless of their degrees and licenses.

6. Therapeutic Approach

This is the thing I get more questions about than anything else. Which type of therapy does your therapist use? This is a huge topic that I'll be writing lots of articles about, but for now, here are some red flags to watch out for:

  • Therapists who stick to one and only one form of treatment, which they believe applies to all problems--unless you're specifically looking for that treatment right now.

  • Therapists who describe themselves as "eclectic" without being able or willing to give any more details about what they're trained in and how they decide which approach to use with which client. Eclectic is good; having no intentionality or direction with your practice is not.

  • Therapists who are very loyal to techniques that are not based on solid evidence, such as psychoanalysis (not the same as psychodynamic therapy, a distinction I'll discuss more in a future article), tapping and other "Emotional Freedom Techniques," hypnotherapy/hypnosis, reiki, gay/trans conversion therapy (run away), attachment therapy, primal therapy, or anything else that sounds fantastical or too good to be true. This article can help you identify pseudoscientific treatments. You can also try Googling a treatment and finding out what websites such as the National Institute of Mental Health, the American Psychological Association, or even Wikipedia have to say about it. (Wikipedia can have its problems, but it tends to be well-sourced for things like this and is definitely still better than CrystalEnergyHealing.com.)

While there can be a lot more that goes into the process of choosing a therapist, these six factors are a good place to start. If you have any questions, please leave them in the comments, and follow this blog to learn more about finding an effective therapist.