Choosing a Therapist

Some people are lucky and find a therapist that is a good match for them on the first try.  Most people will have to shop around.  It's better if you know this starting out so that you make more informed decisions when you start looking.  It's important not to become discouraged if you do not find your therapist right away.  While you are looking for a therapist you should consider the treatment setting, the therapist's specialization(s), the type of therapy you would like to receive and most importantly, the overall connection you feel with the therapist.  The following information should help you with your search:

Treatment Setting:

Many people do not realize the importance of the setting for the treatment they are receiving.  Different settings (hospitals, clinics and private practices) are designed for different types of treatment and to work with different types of problems.  Sometimes when people are looking for a therapist they are told that the setting they have chosen is not "appropriate."  This of course is not helpful because they do not know how to make a better choice in treatment provider.  Very generally, these are the different types of treatment settings and what they are designed to treat:

  • Private Practice:  This is usually the setting that people have in mind when they first decide they should look for a therapist.  Private practices provide a level of comfort and intimacy that the other treatment settings often do not offer.  Private practice therapists may or may not accept insurance and are often the most costly treatment option.  Therapists in private practice are probably also the most guilty of telling people that they are not "appropriate" to be seen in their office.  Usually what this means is that that particular therapist does not have training in the specialty that your treatment would require (see below to determine whether or not you should see a specialist) or that you should be seen in another treatment setting altogether.  While it can feel personal when a therapist says they cannot treat you, they are actually making a decision based on their ethical responsibility to direct you to the best treatment option.
  • Outpatient Mental Health Clinics: These clinics are a good choice if you want something like a private practice but do not have an insurance that is widely accepted by private practices or need to pay a lower fee.  These clinics also offer an advantage in that your therapist will work directly with your psychiatrist if you are taking medications.  They are well connected to a number of other services and typically have case managers to help you with a wide variety of problems that cannot be addressed in therapy.
  • Intensive Outpatient Programs: These programs come under a number of labels but they all involve multiple visits each week and sometimes ask people to be present for most of the day, every day.  They are a good option for individuals who are just coming out of the hospital or who find that they have been hospitalized multiple times without making sustainable gains in their recovery.  There are some specialized programs that offer intensive treatment for specific diagnoses such as schizophrenia, bipolar disorder, addiction, eating disorders or personality disorders.
  • Hospitals: Obviously, hospitals have inpatient units which are used to help people stabilize when they have a crisis severe enough to put themselves or others at risk.  However, some people do not know that hospitals also have outpatient units to provide regular mental health services.  These outpatient clinics accept the widest variety of insurances and offer access to affordable treatment.  They are also ideal for anyone who has had to be in the hospital within the past year or two because each therapist is connected to an interdisciplinary team and can quickly connect you to any service that you might need (including the emergency room or inpatient service).

Type of Therapy:

There are many different types of therapy.  If you know a specific treatment you would like to try, do not hesitate to ask the therapist if they are capable of providing this type of treatment and if they think it would be helpful given your problem.  If you do not have any specific treatment in mind, think about what sort of person you are - are you driven more by your thoughts or your feelings?  Your therapist should be able to tell you how they would approach your problem (with a focus on thoughts and behavior or with a focus on emotions and meaning), and you can decide if this feels like it would be a good match for your personality.

When to Find a Specialist:

Therapists are a lot like doctors in that they might be general practitioners or they might be specialized in their treatment approaches.  Many therapists have multiple specialties.  You may want to look for a specialist if:

  • You belong to a minority group (race, gender, sexual orientation).  This is especially true if your identity is very important to you or is part of what you need to talk about in therapy.
  • You are looking for treatment for a child, adolescent, or older adult
  • You are looking for therapy to help deal with a medical problem or disability
  • You are coming to therapy for: addiction, eating disorders, severe mental illness, trauma or have been diagnosed with a personality disorder

The Most Important Thing:

According to research, the factor that most determines the success of therapy is the match between therapist and client.  This means you should trust your gut.  Your therapist should be able to provide satisfactory answers to your questions and you should feel some level of connection with him or her within the first three sessions.