Therapy 101: Choosing a therapist
One of the benefits of being an expert in an industry is that knowing all of the ins and outs can benefit you and your loved ones in a big way. For example, if you work in the airline industry, maybe you know the intricacies of price fluctuations and how to navigate airline policies.
In the above example, this can be a nice bonus, but not exactly essential. But when it comes to the medical industry, experts have practical knowledge that should be accessible to all.
This 'Therapy 101' series was created in an attempt to shorten the gap between the critical knowledge that experts in the mental health world have and the average client trying to receive competent care. The series aims to empower you with the knowledge and tools you need to confidently navigate the mental health care system.
Ahead we’ll explore how to find and choose a therapist, gain insight into the therapeutic process, learn about cost factors to consider, and finally we’ll empower you with the knowledge you need to protect your rights.
Stop 1 of 4 in the series is arguably the most essential: choosing a therapist.
Choosing a Therapist
Realizing you're ready for therapy is a big step and one that can be life-changing. Preparing for what comes next, however, can feel daunting in the best of times—let alone when you’re not at your best.
Ahead we'll explore the confusing world of therapist credentials, understand different therapeutic approaches, and learn practical tips for finding a therapist who is a good fit for you.
What type of therapist do I need?
What do all of those letters mean behind therapists’ names? Like many different healthcare professions, there are tiers of different types of mental health professionals depending on specialty and amount of education and training. Read on for a brief explanation of the different types of mental health professionals available to you.
Social Worker
Social workers take a broad "person-in-environment" perspective, considering the impact of social, economic, and environmental factors on an individual's well-being. They address a wide range of issues, including poverty, housing, healthcare access, and social justice, in addition to mental health.
To become qualified to provide psychotherapy, social workers achieve a master’s degree (MSW) and complete many hours of supervised clinical experience in order to become licensed (LCSW).
Mental Health Counselor
Mental health counselors primarily focus on mental and emotional health. They are trained to diagnose and treat mental health disorders, using various therapeutic techniques.
Mental health counselor’s achieve a master’s degree (MA or MS) and thousands of hours of supervised clinical training before being eligible for a license to practice. Each state’s education and training requirements can be different, as can be the credentials they use.
For example, licensed counselors in Washington State use the credentials Licensed Mental Health Counselor (LMHC), while it is common for other states to use Licensed Professional Counselor (LPC).
Counselors that have achieved their graduate degree, but have not yet completed their supervised clinical training receive an associate license (e.g., LMHCA).
Some counselors choose to specialize in family and intimate relationship dynamics and you might see their credentials as Licensed Marriage and Family Therapist (LMFT). These counselors can also see individuals (just as a LMHC can see couples or families), but their training and coursework focused more on relational dynamics.
There are a couple of other specialized options to note. If you or a loved one need care for substance use or are looking for a sex therapist, it’s generally a good idea to find someone who has specialized certification through an accredited organization such as the NAADAC or AASECT, respectively.
A good general rule of thumb: If you have a fairly niche issue, try to narrow your search by finding therapists that specialize in it.
By specialization we mean that the therapist has a higher level of education and/or training in that area.
Psychologist
There are many different career paths available to someone pursuing a doctorate in psychology. Typically the branches that are pursued for practicing therapy are clinical, counseling, or school psychology.
A psychologist’s training and education will look very different depending on the type of doctorate pursued. Generally speaking, practicing psychologists with a Ph.D. have focused on conducting original research with additional training and licensure to practice. Psychologists that have a Psy.D. focused their schooling on clinical practice and application of psychological principles in lieu of conducting original research.
Not all psychologists practice therapy, but any type of psychologist, regardless of the type of doctorate pursued, is able to become licensed to practice with the appropriate training. For example, you may find a psychologist with a doctorate in psychology education (Ed.D.) that is licensed to practice.
Psychiatrist
Psychiatrists are medical doctors (MD) who have completed medical school and specialized in psychiatry during their residency. They are trained to understand the biological and medical underpinnings of mental health disorders and prescribe appropriate medication when needed.
Some psychiatrists provide psychotherapy, but most provide medication management only. Some require psychotherapy in addition to medication prescription.
If you’re unsure which type of mental health professional is right for you, here are a few factors to consider: Generally speaking, the more education a mental health professional has,
the more specialization they will have in certain area(s),
the higher severity of cases they take on and,
the higher their rates will be.
What kind of therapy do I need?
Did you know there are over 400 specific types or approaches to therapy? This dizzying array of choices can be overwhelming for the average mental health professional, let alone the average client.
Let’s first define what we mean by type of therapy. You might also hear therapeutic modality; essentially, the mode of therapy.
If psychotherapy is the general term for the treatment of mental health conditions using psychological methods, therapeutic types or modalities are the different methods or styles that therapists can use to achieve that aim.
Each modality is based on a specific set of theories and beliefs about human behavior and mental health, and they utilize different techniques and interventions to address mental health concerns.
For example, Cognitive Behavioral Therapy (CBT) is a therapeutic modality that was formed from cognitive and behavioral theories.
Cognitive theory suggests that our thoughts, beliefs, and interpretations of events significantly influence our emotions and behaviors. In other words, how we think about a situation determines how we feel and how we act.
Behavioral theory suggests that our behaviors are learned and can be changed through various conditioning and reinforcement techniques.
Techniques and interventions are then based on these underpinnings. For CBT, this might look like learning to become aware of thinking patterns that are creating problems, and then to reevaluate them in light of reality (cognitive theory). It might then look like facing one’s fears instead of avoiding them (behavioral theory).
It’s important to keep in mind that when it comes to successful outcomes in therapy, theory is only part of the equation.
You might see two different therapists that use the same modality and you may notice more progress with one over the other. This brings in the importance of fit (more later on that).
Also remember that theories are just that—theories! Great science always starts with a hypothesis and works to disprove the theory, not prove it. For example, every (valid and reliable) study that concludes that CBT is an effective type of therapy adds support to the theories it’s based upon.
What this means for you is that while there can be a lot of evidence that supports a theory, generally making it accepted in it’s field, it doesn’t necessarily make those theories proven and it certainly doesn’t make them the only acceptable option.
Many therapists use what’s referred to as an integrated approach. This essentially means that they use a combination of different theories or modalities and consult with you to determine which approach might be the most helpful.
Below is a useful, though generalized, diagram that simplifies four common approaches to therapy:
Image credit: Dr. K. Kumar, CIRPE
Our minds are incredibly complex. Thoughts, emotions, behaviors, and their underlying biological and social influences are intricate and interconnected. While having so many different types of therapeutic approaches to choose from can be overwhelming, it’s also a good thing to have a wide variety of options to match the wide variety of needs, preferences, world views, etc. out there.
So how do you choose? There are many factors to consider here, but here are some places to start:
1. Understand Your Needs and Goals
Identify your concerns: What are the specific issues you're hoping to address? Do you feel you need specialized care?
Consider your preferred style: Do you prefer a structured, directive approach, or a more open-ended, exploratory one? Are you looking for more of a top-down approach that works primarily with your thoughts, beliefs, and interpretations or for a bottom-up approach that addresses underlying emotional and physical sensations rooted in past experiences (typically more trauma-focused)?
Think about your learning style: Do you learn best through discussion with others (group therapy), hands-on exercises (art therapy), movement (somatic therapy), or reflective practices (talk therapy)?
Cultural considerations: If culturally sensitive care is important to you, look for therapists with experience working with individuals from diverse backgrounds.
Accessibility: Consider factors like location and on-site accommodations available, cost options, languages practiced, access to interpreters, etc.
2. Research Different Modalities
Explore various approaches: Learn about different therapeutic modalities and their underlying principles. Start with this ‘A to Z’ guide to therapy options and then dig further into ones you’re interested in using trusted sources such as the American Psychological Association or Psychology Today.
Read articles or books: If you find a type of therapy that sparks your interest, you can look for books or articles that can help you learn more about it.
Talk to other people: Discuss your options with friends, family, or other trusted individuals who have experience with therapy.
3. Consult with a Mental Health Professional
Schedule an initial consultation: Most therapists offer a brief initial consultation to discuss your concerns and answer your questions.
Ask about their approach: If you find a therapist that uses a modality or two that you’re interested in, use your initial consult time to ask any questions you have as well as what therapy would look like using each modality. Feel free to also ask about the therapist’s preferred style, personality, and/or what feedback they’ve gotten from client’s about what it’s like to work with them.
Where to find therapists
There are hundreds of thousands of mental health professionals in the U.S. Once you’ve narrowed down the type and kind of therapist you want, how do you find them?
The first thing you should be aware of is that each U.S. state has their own education and licensing requirements for mental health professionals. This means that when therapists receive their license to practice, that license is only valid within the state that issued it.
What this means for you is that in most cases you are going to want to search for therapists inside the state you live in, even if you’re looking for virtual therapy. The exceptions to this are if your therapist is licensed in multiple states or if they are part of the counseling compact.
Also important: license limitations mean that if you are traveling out of your state, your therapist will not be able to work with you while you are outside of the area they are licensed in.
Narrowing down to the state level still likely leaves you with thousands of therapists to choose from. How do you sift through all of them to find what you need?
The easiest way to find the bulk of therapists in your area is through one of the many therapist directories available. Below I’ve listed some of the more common directories to get you started.
Most, if not all of these directories include filter options that allow you to narrow your search down by type of therapist, specialty, concern, language, cost, etc.
How do I know if it's a good fit?
Research suggests that while the specific type of therapy can be an important factor, the quality of the therapeutic relationship and the overall fit between the client and therapist are crucial for successful outcomes.
The following are four important things to consider regarding your therapeutic relationship:
Strong Therapeutic Alliance
The therapeutic alliance is the bond or sense of connection that is built between you and your therapist. The strength of this connection is the most important factor in predicting your success in therapy. To assess therapeutic alliance, ask yourself the following:
Do you feel safe and comfortable sharing your thoughts and feelings openly?
Do you feel valued and respected by your therapist?
Do you feel like you're working together towards common goals?
Do you feel they demonstrate genuine understanding and compassion for your experiences?
Comfort and Ease
Do you feel you can easily express your thoughts, feelings, and concerns without feeling judged or criticized?
Does your therapist actively listen and attempt to understand your perspective?
Does your therapist respect your boundaries, values, and pace of therapy?
Progress and Growth
Do you feel like you're making progress? (E.g., noticing positive changes in your thoughts, feelings, or behaviors or making insights and connections that help change your relationship to the problem)
Are you developing new coping mechanisms and strategies for managing challenges?
Do you feel more in control of your emotions and behaviors?
Open Communication
Do you feel you can openly express any concerns or doubts you have about the therapy process?
Is your therapist is open to hearing your feedback and adjusting the therapy approach as needed?
If any of the above are a clear no, you may try speaking with your therapist about your concerns if it feels safe. Otherwise, it’s probably time to find a better fit elsewhere.
Below are signs that your therapist may not be following their ethical duties, which may also mean it’s time to look for a new one.
Inappropriate Self-Disclosure
Sometimes therapist’s share details about their own lives which can help strengthen the connection between client and therapist while also assisting with the therapeutic process. However, excessive self-disclosure can detract from your needs. If you perceive that your therapist's personal experiences are dominating the sessions, it's important to address this concern.
Lack of Boundaries
Maintaining clear boundaries is crucial for a healthy therapeutic relationship. If your therapist is contacting you outside of sessions for non-therapeutic reasons or develops a personal relationship with someone in your life, you may want to consider finding a new therapist.
Dual Relationships
Therapy is effective because therapists maintain an objective stance, free from personal involvement in your daily life. Accepting social invitations, engaging in personal favors (like babysitting), or requesting work from you blurs professional boundaries. Dual relationships can compromise the therapeutic relationship and potentially negatively impact you.
Non-Compliance with Privacy Policies
Your therapist is legally and ethically obligated to protect your privacy under HIPAA. Disclosure of your personal information (e.g., name, demographics, therapy notes, etc.) without your consent (e.g., signed Release of Information) is illegal; not to mention, a violation of your privacy and damaging to the therapeutic relationship.
Sexual Misconduct
Sexual contact between a therapist and client is illegal and unethical. This includes any form of sexual behavior, regardless of consent. It is a serious ethical violation that can have severe consequences for the client. If you experience any sexual misconduct by your therapist, you have the right to report it to the relevant licensing board.
Telling You What to Do
Therapy should empower you to make your own decisions, not dictate your choices. While your therapist can offer guidance and support, ultimately, the decisions about your life belong to you. If you feel pressured to follow your therapist's advice or experience disapproval for making different choices, this is a significant concern. You have the right to self-determination within the therapeutic process.
Inappropriate Treatment
If your therapist recognizes that your needs exceed their expertise, they are ethically obligated to refer you to specialized care. Continuing treatment beyond their scope of practice can be detrimental to your mental health.
Choosing a therapist is a very personal process, but with the right tools and knowledge, it doesn’t have to be overwhelming. Next up, we’ll dive into the details of the therapeutic process.
