How To Choose a Therapist
“How should I choose a therapist?” is a question I get quite often, generally accompanied by “how do I find someone who will really match with me” and “what if I don’t wind up liking them?” The truth is, no one matches with all therapists. Ideally there is an interview period where you ask as many questions as you need to ascertain whether or not a therapist might be someone you could imagine working with. Here are some of the questions I like to recommend potential clients ask, if the therapist on the line hasn’t already answered them:
“What is your approach to therapy?”
A well-educated and thoughtful therapist will know what psychotherapy theories they subscribe to and how they incorporate them into their practice. An empathetic and relatable therapist will know how to break these theories down into concepts that make sense, even if those concepts are quite new to you as a client. For instance, I am an integrative therapist who works with an assortment of psychodynamic and humanistic theories and who incorporates a social justice approach. But in explaining what I do to a new client, I will add that essentially what I believe in is that we all exist in context, societally and socially, so nothing that is going on for us emotionally/psychologically is ONLY going on internally. Internal suffering is almost always influenced by external factors, and I take that into account in my work. I also believe that we all have strengths that we can use to build more coping skills and strategies, and that working collaboratively is much more successful than me sitting across from you and telling you what to do to become more healthy. You want and need a therapist who knows themselves and can explain themselves to you clearly, so that you can decide for yourself if what they believe is a match for what you believe about mental health.
“For how many sessions do you typically meet with clients and how often do you meet?”
I am a therapist who believes in meeting with clients on an ongoing basis, creating an oasis in one’s week together that can be a place to process past trauma and to handle life’s current upheavals, but sometimes you are looking to do a chunk of work (say, 10 sessions) and get back to a therapy-less schedule. Whatever your preference or feeling for what type of therapy you’d like to pursue, you want to know what your therapist thinks about short or long term therapy, what they think about weekly meetings versus other less or more frequent meetings, and generally what their stance is on timing and duration. Many therapists, myself included, work with clients on a weekly basis because we have situational (this isn’t the word, it’s our own experience vs research) knowledge of how much more work can be done when meeting on a weekly basis. That said, I and many others work with some clients on an every-other-week basis as needed, and have some success with being more of a touchstone. I also work with clients on a bi-weekly basis, which can create more of a therapeutic container and promote more opportunity for deep diving into trauma and fostering growth. You may not know what will work for you, if you haven’t experienced therapy before, but it’s still good to know what your potential therapist believes about how much time you’ll be spending together.
“Do you diagnose?”
This question is for those of you who struggle with anxiety, depression, PTSD, mania and other salient psychological conditions. You will want to know if your therapist uses diagnoses in their work, either in their personal notes or in medical records. If a therapist uses diagnoses in their thinking, you will be most comfortable with them if you find yourself soothed by the idea of naming/labeling psychological experiences. If the idea of being told that you have Major Depressive Disorder, for instance, feels like it could be a relief to know, then you will respond well to someone who can analyze and interpret symptoms. If the idea of someone giving you a diagnosis makes you uncomfortable, you will want to work with a therapist who will consider diagnoses but take them with a grain of salt. For instance, in my practice I work with people who feel some relief around diagnoses, and since I believe in collaboration I believe those clients and respect their experience of diagnosis, but I do not think diagnostically most of the time. When someone presents with symptoms of depression, we work with depression as a concept, not as an inherent aspect of that person. Narrative therapy, one of the theories I employ often, believes that when we inscribe a diagnosis on someone we are digging down into a narrative that does not have to exist. Whatever your personal feelings about diagnosis, it’s important to know how your potential therapist thinks, so that you know whether they will be able to meet your needs on this topic.
“Do you take health insurance?”
Health insurance coverage for therapy is a much richer topic than I can speak to in this post, so I will save it for a later date. What I can say is that you will want to know, if you are going through insurance, if the therapist is in-network for your insurance and what the processes are around getting compensated for sessions. If you do not plan to go through health insurance but have a health insurance plan that covers some out-of-network therapy expenses, a good follow up question is to ask the therapist you’re interviewing whether they can supply an invoice with all sessions dates and fees. In my practice, I am not on any health insurance panels and therefore do not take any insurance, but I do give a number of clients a monthly invoice that they then turn in to their health insurance companies for a refund of some percentage of the fee. If you intend to take this route, contact your health insurance company before calling therapists to determine what they will cover. Leave plenty of time for this, by the way. Insurance companies do NOT make it easy to find this answer.
“What is your fee?”
Therapists often do not advertise their fees on their site because sometimes session fees can seem prohibitive, and some therapists offer sliding scale fees that they can offer once they’re speaking with a potential client. The interview is the appropriate time to determine what a therapist charges and, only if it is needed, whether or not they have any flexibility in sliding down from that fee. You may hear from a therapist that they do not currently have any sliding scale sessions, which means that they do offer such sessions but those are full, and that means you will be offered sessions at the therapist’s full fee. Before going into a phone interview with a therapist is a good time to determine what you have available to you financially so that you know what fees will work with your life.
Finally, after you have asked all of the above questions and any others that come to mind, and after the therapist has let you know what they can about themselves and their methods of psychotherapy, take the time to check in with yourself about how the dynamic feels to you so far. If you feel certain that this therapist would be a good place to start, go ahead and book an appointment. If you need more time to interview more therapists, it’s all right to let the therapist know that you will get back to them as soon as you decide who to go with. The important thing is that you feel comfortable, you feel heard and you feel excited about beginning the work. Then, when you sit down together for the first session, you and your new therapist can start building trust from an authentic place.