How to Find a Good Therapist
How Could Finding a Therapist Be Hard?
When you look for a therapist, it’s tempting to pick the person closest to your home or workplace who takes your health insurance. I’ve done that – for example, when I felt like the only option I had was to see someone during my lunch break.
The issue with this approach is that you could easily be introducing a new problem in your life: having an incompetent therapist, one that’s a bad match, or even one who could do psychological harm.
How I Found The Therapist Who Wanted to Maul My Face
This is a story about why it’s not the best idea to just choose a therapist and jump right into treatment.
During one of the most vulnerable, scary, and dangerous periods of my life, I began seeing a new therapist. I had an HMO that severely limited my access to therapists, psychiatrists, and testing.
I was limited to one visit every four weeks, and didn’t even get that. At minimum, you should meet with your therapist every other week. Absolute minimum.
Very fortunately, my HR department was able to get me on one of the other insurance plans a full month after open enrollment was over, and it was time to find a new therapist.
The Therapist of Convenience
I found a someone right away on my new insurance whose office was walking distance from my workplace, so I could go to appointments during lunch. She felt off almost immediately, though. She told me she saw other people who worked at my company, which I thought was not appropriate for her to say. Worse, she would interrupt me, sometimes to talk about herself at length.
I felt I had no other option but to see her, though – I worked until six, and I couldn’t imagine that I could find someone who would see me at six thirty or seven at night.
Things Turn Darker
Time went on, and my symptoms got worse. Meanwhile, she would say things to me like that I was resisting treatment – when really I was simply too messed up to be able to do CBT at that moment. Not that it would have been appropriate to say that under any circumstances.
Some more time passed, and things got even worse again – I felt constantly agitated, irritable, anxious, unable to focus, and deep in a black depression. The scariest times were waiting for the train in the morning. I was terrified that if I was close to the edge of the platform I might impulsively throw myself in front of the train as it pulled in. I would back myself all the way up against the wall, as far as possible from the tracks. The platform was high above a parking lot. While that was also unsettling, it was at least a high wall…
I Stop Seeing The Therapist
Anyways, on a day during which I had spent part of my morning staring fearfully at train tracks, the therapist exclaimed with frustration and anger (prompted by God knows what) “I just want to rip your eyeballs out!” I stood up, walked out, and slammed the door behind me as hard as I could.
It was chilling to think of the effect that might of had on me if I had been actively suicidal instead of “just” plagued by suicidal thoughts and terrified that I’d impulsively do something sudden.
A few months later, when the idea of seeing a therapist started to feel like a good idea again, I found a therapist who could see me at 7pm – plenty of time for me to get out of work and travel to her office.
How to Find a Good Therapist
It takes longer, wastes time and money, and is discouraging to have to end treatment that didn’t help you than it is to spend extra time finding the right therapist at the outset.
There’s an easy-to-follow plan for finding the right therapist for you – the approach is to create a shortlist of therapists you can see, and basically interview them.
Prepare For What You Need
Start by writing a list of problems you want to work on in therapy. Also make a list of concerns you have, special considerations, and questions for the therapist. Make sure that you especially write down things that make you uncomfortable, are hard to talk about, or that you think might be issues or points of conflict. Definitely write down things you need to talk about that you worry might make the therapist uncomfortable.
If relevant, plan to ask about their experience with racism, disordered eating, trauma, abuse, PTSD, addiction, individuals on the autism spectrum, disabilities, transgender people, self-harm, divorce, adoption, parenting, cancer, school, sexuality – that’s by no means an exhaustive list. Keep working on this list while you do the rest of the steps.
Gather a List of Therapists
- Your health insurance provider should have a list of contracted providers that’s available online. Find the ones who are close to you, and print out a list.
- If you can, consult with someone you trust in the community – ask them if they would go over it. You could ask someone from a local university or medical school. Many people will be happy to have a meeting with you even if they’re not being paid for it. This could point you towards good providers, and steer you away from bad ones.
- Web databases can also help you research and create your shortlist. Take the information with a grain of salt though. Most therapists have a profile on Psychologytoday.com. You can get some sense of their background and specialties, but often the information is incorrect – especially about insurance coverage. Sites like vitals.com and healthgrades.com allow people to rate and review all kinds of medical providers. You can get some useful information there too, but keep in mind that people are most motivated to leave a review when they’ve had – or think they’ve had – a bad experience. Healthgrades also has sections for board certifications, as well as malpractice claims, sanctions, board actions, and awards & recognitions.
- Call the therapists on your shortlist and ask to schedule a consultation. One or two of them may not be taking new patients, but that’s why you have a list. Try to make appointments with at least 3. They may schedule you for an initial appointment at no cost. If they won’t, hopefully all you’ll have to pay is a copay (depending on your insurance). Schedule an appointment with everyone on your shortlist who’s taking new patients.
The next step is essentially to interview each therapist. By now the list of what you want to work on will be done. Arrive fifteen minutes early so you have time to ground yourself before the appointment.
- When the appointment starts, start by asking about their experience with your diagnoses or symptoms. If you have a diagnosis, ask them about their experience treating it and what methods they use. If you don’t have a diagnosis, you probably have symptoms you’re aware of – anxiety, depression, trouble focusing, delusions – you can ask what strategies they use to treat those symptoms, and what their process is for coming to a diagnosis. If the therapist seems to take offense or be suspicious of the way you’re asking questions, or sees it as a symptom, that’s a bad sign. Of course, it’s unlikely they won’t be at least a little confused, because they won’t be expecting this.
- If you’re aiming to do a specific type of therapy, ask why they were interested in studying it. The best answer I ever got to this question was from a therapist getting licensed in psychoanalysis, who said “I thought it was the best way to help people.” At this point you will probably have a pretty good read on the therapist – they might answer your questions effortlessly, suggesting competence, or could be caught wrong-footed, or be reluctant to engage with you – bad signs.
- Bring up the hard stuff, since you have both now been through some awkwardness anyways. I think the least acknowledged shortcomings a therapist might have are dealing with problems involving race, racism, ethnicity, ethnic discrimination, and religious identity and discrimination – overt or systemic. This isn’t screening for competence as much as for discrimination and prejudices, which the therapist is or isn’t consciously aware of. Hopefully from their reaction to these questions and the conversation that follows, you’ll be able to at least rule out people that you can’t work with. You really don’t want to find yourself in the 10th week of treatment with someone, talking about the problems with systemic racism you’re having at work, and have them all but say you’re imagining things.
Choosing the Therapist
Each therapist has likely seemed at least a little surprised or confused. They aren’t used to people asking questions, and it’s much more common for new patients to just become new patients right after they make an appointment over the phone. Surprised or confused is OK, but undesirable reactions will stick out to you. Judgement, disgust, defensiveness, over-interest, ignorance, bias, or bad practice (like if the therapist talks about themselves a lot or interrupts you) will hopefully have shown themselves. After the appointment, you might want to jot down your thoughts about the encounter.
After you’ve been to all of the appointments, there will probably be one therapist who stuck out as the one you’d like to work with. All you have to do now is call and make a second appointment.
What if I Can’t?
Depending on where you live and what your life circumstances are, you really may not have much of a choice when looking for a therapist. If you have low income, if you are under-insured or uninsured, if you have a certain type of HMO plan, or if you live in an area with few providers, you might have literally one choice – maybe zero choices. If that’s the case, then this article won’t be much use to you, but I do want to stress that there are almost certainly resources available to you. If nothing else, you can get support online, and even find therapists who meet online.
Tell Me Again, More Quickly
To sum up:
- Make a list of things you want to work on, your symptoms, and your concerns.
- Gather a list of therapists, make a shortlist, and schedule appointments.
- Interview each therapist.