Finding a therapist in 2022 may be tougher than finding toilet paper in 2020—and yet, just as essential.
When the American Psychological Association (APA) followed up last year on a survey initially conducted several months into the pandemic, practicing psychologists unsurprisingly reported increases in demand for treatment of anxiety and depression, as well as longer waitlists, and low capacity for new patients.
I discovered this firsthand because, while I was miraculously among those minimally affected by the pandemic, I had suffered an intense personal trauma that led me back to therapy. This wasn’t my first rodeo; I’ve had eight therapists spanning two decades in my lifetime, and my semi-pro career as a mental health patient has given me a lot of insight into what may be the most crucial part of therapy: Finding the right provider.
For most people, especially now, that means one who takes your health insurance (if you’re lucky enough to have it) and can fit you into their schedule this week. While I appreciate the practicality and speed of that approach—particularly when you’re in a state that requires a mental health professional—there’s a good reason you shouldn’t limit your search to purely practical parameters.
“People who don’t do their due diligence and research upfront won’t always get everything they should out of therapy,” says Lonnie Barbach, PhD, a clinical psychologist in private practice in Mill Valley, California, and co-author of Going the Distance.
There’s still a widespread perception, thanks to pop culture representations like The Sopranos, of therapy as purely analytic, with a patient lying on a couch talking about their feelings. The reality, says Barbach, is that there are many different approaches to therapy, and no single provider will be trained in them all. Finding what works best for you and your situation is key to recovery. A mismatch can be like seeing a gynecologist for high blood pressure.
I learned this the hard way, through a lot of trial and error. For example, I once knew I had the wrong therapist for certain when, during one of our first sessions, he began quoting a viral internet meme as advice.
What worked for me was approaching my search for a new therapist the way I would a major purchase like a car or a mattress. Start with the inflexible things, like budget or insurance, then research the options, narrow down what’s available, and maybe try a few out. Only then should you commit.
Here are some other expert-backed steps to help you find the right fit:
Step 1: Identify the issue. When it comes to finding a mental health provider, you can either let the problem or the desired solution guide your search, says Lee Blackwell, PhD, a psychologist with a private practice in Huntington Beach, California. If you’re looking for help with a specific issue like anxiety, for instance, focus on finding someone who has experience in that area; if you’re having relationship difficulties, a counselor who specializes in couples is likely your best choice. For other, less easily defined issues, it may be about “the depth of change the patient wants,” says Blackwell. “Sometimes people may not know exactly what the problem is and are trying to search for meaning in their lives and improve themselves,” he says. In those cases, a psychodynamic approach might be better. (Think of psychodynamics as a kind of Freudian approach, which examines your earliest development and its impact on your life.)
Step 2: Research the basic treatment approaches. Most of us have some sense of what kind of doctor to see for what body part. Yet we’re far less familiar with different mental health modalities. From talk, Gestalt, and somatic therapy to CBT, EMDR, sensate experiencing, and hypnosis, it pays to get at least some idea of what each of these entails. You can find some info on the APA website or ask providers to explain their go-to modalities to you. “Sometimes the best therapy is the one you feel most comfortable with, and not what is typically prescribed for your specific problem,” says Barbach. It’s also important to be aware of the distinction between psychiatrists (medical doctors who can prescribe medications), and psychologists (clinicians who can’t prescribe medications but may be better versed in psychotherapy).
Step 3: Try to get a referral. If you want to find a good salon or reasonable plumber, chances are you ask a friend who they used. But asking for help can often be the toughest part of seeking therapy. “There is still a stigma that you’re mentally ill if you can’t take care of everything for yourself emotionally,” says Barbach. In fact, nearly half of the respondents to a 2021 SWNS research study said they believed needing therapy is a sign of weakness—even though the same study found that more Americans than ever before (one in six) have tried therapy since 2020.
We should view therapy as a proactive measure for mental health, as growth enhancement, a tool to make your life better, says Barbach. But if you’re reluctant to do so, you can always say you’re asking for a friend or relative. Better yet, call your doctor or another therapist, describe what you’re looking for, and ask them for a referral.
Step 4: Have a conversation. I recall looking for a therapist a decade ago and being treated like I was nuts for wanting to speak with the doctor before making an appointment. Receptionists told me I’d have to make (and do intake for, and be charged for) a full appointment to even speak with a doctor. Fortunately, times have changed. “A therapist should be willing to have a 5- or 10-minute conversation with you,” says Barbach. “I would not give a second thought to someone who would charge me to talk on the phone.”
So, what should that conversation entail? I recommend having what they call in job interviews “an elevator pitch”: a brief summary of what you’re experiencing and looking for in treatment, no longer than what you could tell someone on an elevator ride. Then, have a list of questions that will help you decide whether this provider will be the person who can help you achieve your goals regarding that issue.
Some to consider:
Have you treated this issue before and if so, what is your success rate? What approach did you take and why? Experience is helpful; success even more so. As Barbach says, “Would you want a surgeon doing their first cataract procedure operating on you?”
How do you feel about medication? Even if the provider is a psychotherapist who can’t prescribe meds, you’ll want to make sure you are both on the same page about when and what medications may be appropriate. The mental health world has seen a huge shift in recent years, with therapies like ketamine, MDMA, psilocybin mushrooms, and microdosing becoming more ubiquitous. If those are things you are interested in, you should make that known and find out if your provider has any experience with them.
How comfortable are you discussing X? If your problem involves a sensitive or controversial issue, you may want to feel out how comfortable a provider is discussing those topics with you. In spite of the cliches, Barbach says, “there are a lot of therapists who are still really uncomfortable talking about sex.” There are organizations that validate expertise in areas such as sex positivity, says Blackwell. And honestly, just observing the reaction to this question can tell you a lot about how comfortable your provider is, or is not, with it.
Is religion or spirituality a big part of your belief system? Some people find extra comfort in speaking with a therapist who shares their fundamental beliefs, whatever those are. As an atheist, I never gave religion a second thought until I started seeing a therapist with strong religious ties. I realized that her approach wasn’t one I could get on board with or found particularly helpful.
How do you plan to go about treating X? It’s perfectly okay to ask for a treatment plan. Sometimes a therapist will need a few sessions to determine the best course of action, but should be able to give you a general idea of how they would address the problem, as well as how long it might take.
Step 5: Try it out. People often feel they have to commit to the first therapist they see, but it’s okay to shop around. Barbach knew a couple who went to four different couples’ counselors and by the last one, they no longer felt therapy was necessary. “They got something different from each one,” she says.
I’ve switched when a therapist didn’t seem to be a good fit, and even once when one seemed to be too good of a fit. “After you see someone for a while, you get into a pattern,” says Barbach. Therapists can become so close to your problems that they don’t continue to push you. When this happens, a fresh perspective can be an enormous help.
Remember, you aren’t looking for a friend or someone who will take your side on issues. It’s more important to find a therapist who will challenge you to work on and improve yourself.
Jill Waldbieser is a journalist with 20 years’ experience in the health, wellness, and lifestyle space. Her work has appeared in The New York Times, Everyday Health, Cooking Light, and on AARP.org, among other places. As the former Food & Nutrition Director of Women’s Health magazine, she developed a love of cooking both professionally and personally and shares her culinary explorations and fledgling food styling/photography skills on Instagram. When she’s not working or eating, she’s hiking with her dog or practicing American Sign Language with her son.