How to Find a Therapist – The Ultimate Guide
With all the positives therapy can bring, getting started can be difficult. Navigating cost and insurance, and finding someone you’re compatible with, can be challenging. This guide can help you at every stage of finding quality mental healthcare, helping you save time, money, and hassle.
- Types of Therapy
- How to Pay for Therapy and Deal with Insurance
- Low-Cost Alternatives to Therapy
- Directories of Therapists
- Tips for Selecting the Right Therapist
- Preparing for Your First Therapy Appointment
- Conquering Stigma Around Seeing a Therapist
Types of Therapy
There are many different types of therapy. Learning a little about each can help you decide which approach will likely work best for you.
You may see a therapist say they practice “Eclectic” or “Integrative” therapy. This simply means that they use more than one type of therapy in their practice, combining them in some way.
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy (CBT) has been around for over 30 years and has the most evidence supporting its effectiveness. For depression in particular, it’s considered the gold standard in psychotherapy, and is beneficial for a multitude of other mental health issues.
CBT is largely focused on the present, as opposed to the past. It has the following characteristics:
- CBT uses ‘homework.’ Because CBT is about teaching the client skills, rather than relying on the skills of the therapist, CBT utilizes extensive out-of-session assignments, asking the client to apply and practice concepts and follow through on plans made in-session.
- CBT is short. Compared to other therapies, CBT is usually remarkably short, usually between 10 and 20 sessions. This is partly because of CBT’s goal and skill-oriented nature, and partly because of its reliance on homework.
- CBT believes healthier habits can be learned. CBT follows the principle that behaviors, thoughts, and emotional responses are learned, and therefore, healthier methods can be learned through specific techniques and activities.
- CBT is more focused on the client than on the client-therapist relationship. While a good relationship is necessary for CBT, CBT is more focused on helping the client learn the skills to overcome their challenges themselves, and therefore the relationship with the therapist is of secondary importance. (This is one reason CBT is such an excellent therapy for use in online depression apps, like UpLift.)
Therapies Closely Related to CBT
Interpersonal Psychotherapy (IPT) IPT focuses on your relationships with others, which can include difficulties with communication or coping with bereavement. There’s some evidence that IPT can be as effective as antidepressants or CBT, but more research is needed.
Behavioral Activation (BA) BA focuses on the activities and behaviors that worsen depression (like avoidance) and others that improve your mood. BA is also a central component of CBT.
Problem-solving Therapy (PST) PST helps you generate and apply creative solutions to your problems. CBT treatments often include problem-solving strategies.
Acceptance and Commitment Therapy (ACT) ACT helps you improve thoughts, feelings, memories, and physical sensations that are feared or avoided. Acceptance and mindfulness strategies are used to teach people to focus on the present and engage in positive behaviors even in the midst of difficult thoughts or situations.
Mindfulness-Based Cognitive Therapy (MBCT) MBCT is similar to ACT in that it incorporates mindfulness practices to help you become more aware and accepting of your emotional reactions. In MBCT, formal meditation practices are a much larger focus.
Humanistic therapy believes that humans are essentially good and positive, and focuses on the struggle to become your ‘real, true self.’ It emphasizes responsibility for one’s choices in terms of thoughts, behaviors, and emotions, and pays less attention to outside influences. (This is in contrast to psychoanalysis, below, which tends to see people as shaped by influences from their past.)
Humanistic therapy tends to focus on questions such as acceptance of various parts of one’s self, and being authentic in one’s relations with others.
There are several sub-branches of humanistic therapy:
- Gestalt Therapy, with a special focus on being in the here-and-now.
- Existential Therapy, with a focus on free-will and the search for meaning.
- Client-Centered Therapy, which emphasizes that the client is the greatest source of knowledge about themselves, and sees the therapist as more of a guide for the client in their journey towards solving their own problems. (The word “non-directive” is used to describe this concept of a therapist’s role.)
When many people think of “therapy,” as represented in popular culture, they are actually thinking of psychoanalysis. This type of therapy is one of the oldest forms and was developed by Freud.
Psychoanalysis focuses on:
- The role of the unconscious Unlike humanistic therapy, which believes humans are essentially good and positive and tries to achieve one’s ‘true nature,’ psychoanalysis believes that mental well-being comes from controlling unconscious desires, many of which are negative or destructive.
- The origin of a person’s thoughts, behaviors, and personality in early childhood experiences Psychoanalysis believes that many of the problems a person encounters in their adult life are the result of early childhood trauma.
- The importance of the skill of the therapist The success of psychodynamic therapy is thought to largely rest on the ability of the therapist to listen to the client extensively, and then interpret what they hear to derive insights about a client, which allows the client to see their behavior in a new light.
The term “psychodynamic therapy” is basically a more modern term for psychoanalysis.
How to Pay for Therapy and Deal with Insurance
Paying for therapy is one of the biggest obstacles for many people. In the US, a single session of in-person therapy can cost anywhere from $60-$300, though the average is closer to between $80-$120. If this is more than you can afford, don’t give up yet! Whether you have insurance or not, there are many options to explore that may help you pay for therapy.
Paying with Insurance
If you have health insurance, all or part of your visits to a therapist may be covered; or, they may not. It can be difficult to tell. There are three ways to find out; you may need to pursue more than one.
- Ask your therapist. The first and simplest step is to ask your therapist if they accept your insurance. If they do, that’s half the battle; the other half is finding out if your insurance has co-pays or limits on coverage. If your therapist is experienced with your insurance company, they may be able to help you figure out what the insurance company is likely to cover, and what you’ll be responsible for.
- Look at your plan’s Description of Benefits. If you have a “Description of Benefits” from your insurance company, look for “Outpatient Psychotherapy” or “Outpatient Counseling”—this means any therapy that doesn’t require being admitted to a hospital, and is what going to a therapist will be counted as for billing purposes. If you don’t have a copy, insurance companies are required to provide you with a “Summary of Benefits and Coverage,” a concise statement of what the plan does and does not cover. You can contact your insurance company and request one.
- Call your insurance company. You can ask your insurance company for a list of in-network therapists in your area, or ask if they’ll cover a specific therapist you’d like to work with. Some insurance will still cover part of the cost even if you want to see an out-of-network therapist. You can also ask your insurance company about co-pays and whether there are limits on the number of visits they’ll cover.
It’s worth checking, even if you’ve been denied coverage in the past, because the Affordable Care Act has significantly expanded the range of mental health services that insurance companies are required to cover.
If you do find that insurance will cover your visits, it’s also good to take the opportunity to ask whether you or your therapist will be required to submit the claim for reimbursement.
If you’re nervous about calling the insurance company, that’s understandable! Here are a few tips:
- You’ll find the number for your insurance company on the back of your benefits card or on your benefits statement. If you can’t find these, you can search by the company’s name online.
- Have your benefits card handy when you call: You’ll need your member number and plan number (often called member ID and plan ID) handy. This information may also be on your benefits statement.
- You may be on hold for a while. Have a book, some knitting, a tv show, or something else you can do while you wait ready.
However you go about it, make sure you’re clear on whether insurance will cover you, won’t cover you, or might cover you, before you start your sessions. If insurance won’t cover it, you’ll have to pay out of pocket, and that’s something you want to know ahead of time.
Paying with Medicaid
Medicaid is a federal and state program that provides health coverage to people with very low income. Medicaid does cover a wide range of mental-health services, and the number has been increasing recently due to policy changes such as the Affordable Care Act. However, the actual benefits vary from state to state.
If you’re on Medicaid, the best thing to do is ask your therapist if they accept Medicaid. A therapist experienced with Medicaid clients may be able to give you advice on what your state will cover. Be aware that, even if your therapist accepts Medicaid, co-pays may apply. To find out, call Member Services for the plan you’re on—the number should be on the back of your enrollment card, or go to the Medicaid web-site for your state.
- Check here for a directory of state Medicaid sites and contact info
- Check here for current info about state-by-state coverage.
Paying with Medicare
Medicare is federally-provided insurance for those 65 or older, or with severe disabilities. It is not dependent on income.
Medicare Part B covers mental health-care, though you will likely have to pay a deductible of 20%. Medicare only covers mental health care when the therapist is willing to accept “assignment,” which means the amount of money Medicare is willing to pay the doctor.
Ask therapists if they work with Medicare clients, or if they’re willing to. You can find more detailed information about Medicare and mental health services here.
Medicare also pays for one depression screening per year from your primary care physician.
Other Ways to Pay
There are a number of options besides insurance for getting help paying for therapy.
Paying Out-Of-Pocket and Discounts If you must pay out-of-pocket, don’t despair! Most community agencies or clinics have sliding scales, which means the cost of a session varies according to your income and number of dependents, etc., and many therapists in private practice do as well. It doesn’t hurt to ask! Be prepared to bring in a copy of a recent tax return or pay stub to verify your income.
It’s also good to ask therapists if they offer a cash-discount. Some therapists will offer a discount if you pay in cash, because of the time and money they save not dealing with insurance.
Some people even find that, if financially possible, paying out-of-pocket gives better results; when you’re paying your own hard-earned money, you’ll be all the more motivated to put in the work to get the results you want. And, you don’t have to worry about when the insurance company thinks you’ve been to enough sessions and stops paying.
Employee Assistance Programs Some employers, usually larger companies or organizations, have Employee Assistance Programs (EAPs) or wellness programs that may cover mental health visits. The programs are often limited—they may only cover a certain number of visits, or visits for a certain reason—but it’s worth checking out. It may cover a significant amount of therapy.
If You’re in School If you’re a college student, you should have access to campus health services, often called college counseling centers, which will typically provide some range of mental-health services at no cost as a part of your tuition and fees.
If you’re in high-school or earlier, you probably have access to tax-funded counseling options through your school district. Your guidance counselor can tell you what resources are available for you.
Health Care Savings Program These are a kind of savings account offered by many employers. They allow you to put money aside, tax-free, to be used for medical expenses, including mental health services. Though this doesn’t directly make therapy any cheaper, it saves you some money by making what you spend on therapy tax-free.
So, if you know you’re going to be paying for therapy out of pocket, or have significant co-pays, and your employer offers these kinds of accounts, it makes sense to set aside the amount you expect to be spending. (Of course, you have to have the money ahead of time to do this.)
Getting Insurance (if you don’t already have it) Getting insurance can be a great help in paying for therapy. Though not all insurance covers mental healthcare, the Affordable Care Act expanded mental health coverage, so the chances of getting covered are better than they were.
One of the first things to figure out when considering insurance is whether you qualify for any reduced-cost options. These are Medicare, Medicaid, and lower-cost premiums on the Health Insurance Marketplace.
- Information on Medicare (you may be eligible if you are 65 or older, or have severe disabilities) (if you meet certain income requirements)
- Information on Medicaid (you may be eligible if you have low-income, have children, are pregnant, or have a disability)
- Information on the Health Insurance Marketplace (you may be eligible for lower-cost premiums)
If those don’t apple to you, you still have a few options:
- Buy health insurance from the Health Insurance Marketplace at Healthcare.gov.
- Buy health insurance directly from an insurance company or through a broker.
- Get health insurance through your employer if it’s offered.
If you need help applying for insurance, try one of these:
- Find an in-person Health Care Navigator: these people are specially trained to help people apply for insurance. Often they are available at local tax-help centers or community organizations. Their help is free.
- Use the Marketplace call center and a live representative will answer questions and help you apply for coverage.
If you’ve been feeling down, it’s worth it to explore your options for feeling better. Quality mental health care is an expense that pays off in the long-run. With greater wellbeing comes greater strength in old age, fewer heart issues, faster recovery after a major medical event, and a longer life.
Besides the health benefits, high wellbeing is a desirable state in its own right. If the above options don’t work, don’t give up! Check out “Low-Cost Alternatives to Therapy”, up next, for more ideas.
Low-Cost Alternatives to Therapy
If you’re unable to afford therapy after exploring the options in the previous section, there are still many avenues you can try! Below is a list of more affordable alternatives to standard in-person therapy.
Lower-cost In-Person Therapy
There are several ways you might be able to get in-person therapy at significantly reduced cost.
- Universities. Check colleges or universities in your area. Many will have “Training Centers” for programs in Counseling or Clinical Psychology, where students will offer therapy at highly reduced rates. These students will be in training, but supervised by qualified and licensed professors and/or therapists.
- Charitable or Religious Organizations. If you’re connected to any charitable or religious organizations, check if they have a list of referrals for low-cost mental health care. Sometimes religious organizations may even provide these services themselves, to their members.
- County Mental-Health Centers. County-level mental health centers will have lists of available low-cost mental health services. You can find the contact info for these centers by searching the internet for them in your area, or looking at your state’s Department of Human Services (DHS) website.
- Call 211. By calling 211, the most comprehensive source of locally curated social services information in the US and most of Canada, you can likely speak to someone who is knowledgeable about low-cost mental health services in your area.
Group therapy is an alternative to individual therapy and is sometimes offered through centers or run by therapists in private practice. Groups vary widely in style and structure, but are almost always less expensive than individual therapy.
In group therapy, a therapist will lead the group, but much of the session consists of discussion amongst the group. You won’t have a therapist to yourself, but you may learn as much or more from the other group members.
It can be intimidating to seek therapy in a group setting, but these groups ensure confidentiality and typically maintain strict boundaries to keep sensitive and personal information within the group.
Group therapy is not the same as going to a support group, though it’s similar. The biggest difference is that group therapy is always directed by a licensed therapist, and, though it’s cheaper than one-on-one therapy, still costs money. Compared to support groups, group therapy offers greater involvement of a therapist, for a more affordable price than one-on-one.
Unfortunately, the terms “group therapy” and “support groups” are often used interchangeably, which can make searching for one or the other specifically difficult. However, you can tell them apart easily enough by whether they cost money and whether they are led by a therapist.
Psychology Today offers a good group therapy directory. It also calls many of its groups support groups, but most are in fact group therapy.
Support groups are a less-formal version of group therapy, in that a professional therapist is not always present and the goal is to provide support, camaraderie and advice from other folks with similar challenges. They’re also a great support system to go alongside traditional therapy.
Support groups are almost always free of charge, and often offer other useful services to their members.
In-person Support Groups Below are links to two organizations that operate or maintain listings of in-person support groups, searchable by location. They offer many different types of support groups, but specific groups for depression are listed.
- Anxiety and Depression Association of America maintains a list of support groups for anxiety and/or depression throughout the US.
- Depression and Bi-polar Support Alliance has affiliate support groups throughout the US. The support groups often have a professional advisor (a psychiatrist or therapist) from the community.
Online Support Groups If you live far from an in-person support group, or prefer to attend a group anonymously, there are many online groups offered as well. Some are moderated by trained therapists. Below are a few options.
- Depression and Bi-polar Support Alliance Groups. On-line versions of the in-person groups run by this association.
- National Alliance on Mental Illness Listings. You may need to create a free account to use this listing.
- Psych Central Forum. These are a number of moderated forums on a variety of topics, from general mental health to depression specifically.
Video therapy is similar to traditional in-person therapy; it’s simply conducted over a computer. It’s sometimes cheaper than in-person therapy, though often the price is the same. Its chief advantage is that it’s very convenient, and allows those who don’t live near many therapists to find one they feel comfortable with.
Although the laws on video therapy are still somewhat unclear, generally the therapist must be in your state to legally offer therapy. However, laws vary from state to state. Here are a few sites that list therapists set up to do video-sessions.
- Breakthrough lists therapists licensed in your state available for video therapy. The prices are similar to in-person therapy, and generally range from $80-$200.
- iCouch lists therapists available in North America and across the world. Prices range from $50-$200. iCouch does allow you to select therapists from any state. Note that some of the therapists listed are coaches, not licensed counselors or psychologists.
- Virtual Therapy Connect This site is not nearly as nicely set up or as helpful as Breakthrough, but can be another source for contact information for therapists who practice video therapy.
- Ask a local therapist if they offer video or tele-therapy. Many therapists offer video or tele-therapy on their own, but are not registered with one of these directories. If you find a therapist licensed in your state that you’d like to work with, but travel to them is inconvenient, ask them if they offer therapy by video or phone.
In text therapy you’re matched with a licensed therapist and communicate with them by leaving messages in a sort of private “chat room,” to which your therapist then leaves responses. It’s sort of like texting back and forth with a therapist.
- Significantly cheaper than either face-to-face or video therapy.
- Generally you get a month of unlimited message therapy for between $130 and $200/month, the price of a one-hour in-person therapy session.
- You can text as much as you want whenever you want. Your therapist will usually respond once or twice a day.
- Counselors are contractors of the company, not employees, and there are a lot of them, so the quality can vary greatly. (But, if you don’t like the one you have, you can switch).
- Sometimes text therapy companies employ “counselors” rather than licensed therapists, so they may not be as highly trained.
- Generally, insurance does not cover these services, though it’s possible that yours might. Most companies don’t have specific policies regarding ‘text-therapy’ yet, so the only sure way to find out is to submit a claim and see if they cover it.
Two of the main companies offering this service are BetterHelp and Talkspace.
- BetterHelp offers subscriptions with various combinations of text/phone/video messaging and live text/phone/video sessions, with pricing ranging from $40-$70/week. Read the fine print before signing up, as you may be billed automatically for the first month when BetterHelp’s free trial ends.
- Talkspace allows you to send text, audio, or video to your therapist (so you could take a video of yourself talking). They offer three different subscription levels, which vary by how many live sessions they include. The cheapest option, for around $65/week, has no live sessions; For around $100/week, you get four live video sessions per month. Talkspace has partnerships with some employers and health plans to offer it free; you can check if your company or health plan is included here.
Peer Support Groups
Here are a couple groups where you can voice your thoughts or feelings in a forum and peers can respond. You can also check out therapist-moderated support groups under the “Support Groups” section.
- The Mighty This is an online community plus iOS app designed to create a safe space to express health and mental health issues of all kinds with peers.
- NAMI Discussion Groups These discussion boards are maintained by the National Alliance on Mental Illness. They’re designed to provide users a safe space to express themselves and their challenges, and receive support from other users.
- Facebook Groups. Several Facebook groups exist for people to share their struggles and get peer support, such as Depression and Anxiety Talk. Use Facebook’s search feature to find others.
Mental Health Apps
While most mental health apps lack scientific backing, there are a few quality options out there. For example, programs based on Cognitive Behavioral Therapy have a mounting body of evidence to suggest they work as well as, or nearly as well as face-to-face therapy for depression.
Mental health apps vary widely in their techniques. Costs vary depending on the quality and comprehensiveness of the content offered, from free to about $40/month. Some offer a complete course that mirrors traditional therapy, while others offer a chatbot or individual tools. Here are a few examples:
- Complete Cognitive Behavioral Therapy course: Modify your thoughts and behaviors in ways that reduce negative moods and increase wellbeing. Example: UpLift
- Chatbots: Have a conversation with a bot that can also guide you through techniques or meditations. Examples: Wysa and Youper
- Mindfulness apps: Focus your attention while acknowledging and accepting negative thoughts and emotions. Examples: Headspace and Sanvello
- Mood trackers/thought diaries: Track your moods to better notice patterns in your ups and downs. Examples: Moodnotes and MoodTools
- Other: Well-being techniques and goal setting. Examples: Happify and SuperBetter
Read more tips for comparing mental health apps here.
While traditional face-to-face therapy can be pricey, there are many alternatives out there that can nevertheless provide relief. From group therapy, to depression apps, to a combination of efforts, you can and deserve to feel better.
Directories of Therapists
Finding a therapist in your area, that you can afford and is taking patients, can sometimes be difficult. Here are a few websites with good, comprehensive listings that can help in your search.
You can also ask your doctor for a referral. They likely know the therapists available in the area, and can help you find one that will meet your needs.
- Psychology Today provides one of the most comprehensive listings of therapists in the US and Canada. After you search by location, a menu on the left gives you the options to further narrow your results.
- The National Register of Health Service Psychologists has fewer therapists than Psychology Today, but is still one of the largest directories available.
- The Academy of Cognitive Therapy lists therapists who are members of this Cognitive Behavioral Therapy (CBT) trade organization. Learn more about CBT
- The Association for Behavioral and Cognitive Therapies likewise lists therapists who are CBT-practicing members of its organization.
- SAMSHA.gov lists mental-healthcare providers maintained by the Substance Abuse and Mental Health Services Administration. The list is quite broad, and has everything from psychiatrists to substance-abuse clinics. It also provides information about whether most providers accept Medicaid. They also offer this information via phone: 1-800-662-HELP (4357).
Tips for Selecting the Right Therapist
Selecting a therapist you’re comfortable with can make a big difference, and this process may take time. Here are some tips for finding a therapist you’re compatible with.
Think about what you want in a therapist
Who would you be most comfortable with? Would you prefer to see a therapist of a certain gender/ethnicity/sexual orientation? Remember that you need to be at ease with this person. If there are certain kinds of people you tend to be more comfortable around, it’s okay to be picky.
What do you hope to accomplish? Before you interview therapists, try to write down, as clearly and concretely as possible, what you’re hoping to accomplish. This will be useful in explaining your goals to therapists, so that they can explain exactly how they think they can help you achieve them.
Consider several therapists before choosing one
Get a few good candidates from online directories of therapists, recommendations from friends, family, or a religious institution, or an Employee Assistance Program at work, if your employer has one.
It can be helpful to find several therapists who might be a good fit so that you can compare them and find someone who you could work well with.
Understand their qualifications
There are many different kinds of therapists. To legally be called a therapist and practice therapy, a therapist must have at least a master’s degree in their field.
Psychologists, psychiatrists, social workers, marriage therapists, and pastoral counselors are all different types of licensed therapists.
All of these professionals are qualified to practice therapy. The difference between their education is probably less important than the comfort you feel with a particular therapist and their experience with your particular challenges.
Some people may offer therapy without these qualifications; they may call it counseling, or coaching. Be aware that this is not the same as therapy. Therapy is medical care delivered by a licensed professional with extensive education and training.
Counseling and coaching may certainly be useful in a person’s life, but you should know which you’re getting. If you’re unsure what your therapist’s qualifications are, ask them, or view a list of common therapist credentials.
Read reviews or ask around
It can be helpful to read reviews of therapists before or after talking with them; you can keep an eye out for problems others have mentioned, or if something strikes you as a warning sign, you may be able to verify if it became an issue for other people.
Of course, reviews can be abused, and everyone’s looking for something different in a therapist, so it’s wise to take what you read with a grain of salt.
Unfortunately, reviews of therapists online are fairly sparse. Some of the best sites are below, but if you don’t live in a fairly large city, you may have difficulty finding many reviews for your area.
However, on the flip side, if you live in a small town or city, there’s a better chance that you may know someone who’s been to the therapist you’re researching. Ask around.
- Rate MD’s This site has the most comprehensive listings (though they’re still quite limited), and is user-friendly.
- Zocdoc This site has some excellent features—such as listing available appointments with each therapist—but very limited coverage outside of large cities.
- Vitals Spotty coverage, but better than many.
Interview the therapists
To decide which therapist is right for you, it’s important to talk with the therapist beforehand.
Most therapists will do a quick 10-15 minute phone or in-person consult before the first session. If that’s not possible, send your questions by email.
If all else fails, you can always ask your questions on the first visit—and if you don’t like the answers, you can try another therapist.
You may have to wait a while before a therapist you’re interested in has an opening (up to a couple months, if they’re popular). It’s entirely appropriate to schedule first appointments with several therapists so you don’t have to start the process all over again if your first therapist isn’t a good match. Once you’ve found someone you like, you can cancel the other appointments.
Here are some questions you can ask.
- What their general philosophy and approach is. Just hearing the therapist talk about how they approach their work can help you get a feel for whether you’re comfortable with them or not.
- What methods they use. Different methods of therapy have different levels of evidence behind them. You have the right to be selective, and whatever method you choose, make sure that your therapist outlines their approach for you, and that it’s something you think could be helpful.
- How they handle conflict. Being able to handle conflict well has been linked to better outcomes in therapy.
- Discuss payment. if you haven’t already. While therapy is important and may be worth economic sacrifices, you should make sure you know exactly what you’re getting into financially. If it’s going to be more than you can afford, it’s best to find out now and explore ways to pay for therapy, rather than creating stress by getting into debt.
Watch out for warning signs
There is such a thing as a quack therapist. Watch out for:
- Therapists advertising “miracle cures” or “spiritual transformations.” Therapy can be very helpful, but it isn’t usually miraculous. Anyone advertising it as such is probably unscrupulous.
- Therapists who try to get you to pay up-front for a certain number of sessions, or to sign a contract for a program. While therapy usually takes a series of sessions, and therapists may ask you to mentally prepare for a series of visits, it’s not a good idea to pay for multiple sessions in advance.
- Therapists who try to intimidate you or make you uncomfortable. The therapist is your partner in this therapy, not your boss.
There are also plenty of good therapists who may simply not be a good fit for you. Watch out for anyone who:
- You feel uneasy with. Trust your gut. Whether it’s right or wrong, if you don’t feel comfortable, the therapy won’t be productive.
- Doesn’t seem to be listening to you. The therapist needs to learn about you in order to help you. If they’re not listening to you, they’re not doing that. However, this doesn’t mean that you should expect the therapist to just listen quietly while you go on for hours about whatever comes to mind. Particularly in Cognitive Behavioral Therapy, the therapist will try to keep the discussion to useful topics, and may ask you challenging questions. This is good. Appearing uninterested in you or your struggles is not.
- Spends more time talking about themselves than listening to you. While the occasional reference to their own life may be helpful, a therapist more interested in telling you about themselves than helping you won’t be of much use.
- Doesn’t agree with your goals for treatment Over time a therapist may suggest other things you could work on, but studies have shown a strong correlation between how much the client and therapist agree on goals for treatment and how much progress the client makes in therapy.
- Makes you feel judged, shamed, or emotionally unsafe While it is a therapist’s place to challenge your thoughts and perceptions, it is not their place to make you feel judged or ashamed. If you feel this way, the therapy won’t be productive, and they’re not a good fit.
- You regularly feel worse after your session. You may feel worse after a session occasionally—after all, therapy is about confronting your difficulties, and delving into them isn’t always fun. But if you regularly feel worse, particularly if that feeling is sustained, then the therapy isn’t doing what it should. You should feel like you’re making progress, even if it’s difficult.
- You have a high amount of conflict right from the start. Once your therapist has gotten to know you, they may challenge you on your views of certain issues. This is part of the therapy process and a good therapist will help you be open to these challenges. Conflict from the start, however, is a bad sign, and indicates incompatibility between you and the therapist.
- You just don’t like or want to talk to them. Therapy is basically opening up to someone and talking to them about your world. If you don’t like them and don’t want to talk to them, this won’t work.
Find someone you’re comfortable with
It’s important you get a sense that you could feel comfortable sharing a deep level of feelings and personal details with this therapist.
Studies have shown a consistent correlation between how comfortable the client is with the therapist and how much progress the client makes in therapy. It’s worth shopping around to find someone you’re comfortable with.
If you don’t feel comfortable with the therapist during your interview, even if you can’t say exactly why, they’re probably not a good fit for you. (Of course, you should make sure you’re not confusing discomfort with therapy with discomfort with a particular therapist.)
If you’re just uncomfortable with the idea of therapy, you may not like any therapist you meet at first. You may need to first conquer worry or stigma around going to therapy.
Preparing for Your First Therapy Appointment
For many people the first appointment with a therapist can be somewhat nerve-wracking. If that’s true for you, remember that many, many people who have been in your shoes have gone on to have productive, comfortable relationships with a therapist. The following tips will help you know how to prepare and what to expect.
How should I prepare?
It may be helpful to write some things down before your first session, such as:
- Questions you have for the therapist
- Reasons for seeking therapy at this time
- What you’d like to accomplish in therapy
- Previous experience with therapy
This is useful because it can be hard to remember everything you wanted to say on-the-spot. Even more importantly, the process of writing these things down may help make your motivations and goals clearer to you.
Consider how you feel about medication It’s also a good idea to think about how you feel about medication before you go to your first appointment. Different therapists feel differently about medication, and some may attempt to steer you towards or away from medication.
Whether you are interested in medication or not, it’s a good idea to know how you feel about it so that you can have a thoughtful discussion with your therapist.
Arrive 15 minutes early On the day of your first appointment, try to get there at least 15 minutes early, so you have time to fill out any intake forms required. Intake forms are very normal just as they are in a doctor’s office. They simply help the therapist get a general sense of what’s going on for you so your first session can be more productive.
What will the therapist ask?
All therapists will ask you for some general information about yourself. This may include:
- Your physical and emotional health
- Your important relationships
- Your current coping strategies
- What issues you’d like to work on
- What goals you’d like to work towards
They may discuss possible medications with you.
Different therapists have different styles. Some may ask more about your background, some may ask about your current situation, and others may simply listen to what you have to say.
What should I tell the therapist?
If you haven’t had a pre-session consultation, then this is your first opportunity to interview your therapist. Learn what interview questions to ask when assessing whether a therapist is a good fit for you.
Share a bit about you In addition, be upfront with your therapist about:
- Things you’re sensitive about
- Things that are important to you
- Things that are difficult for you
For instance, “It’s really important to me that I have time to finish speaking, even if I take long pauses,” or, “My divorce is a really sensitive subject for me, and I’m likely to be very emotional if it comes up.”
This doesn’t mean you should be bossy or demanding—your therapist is a person, too, and your relationship with them also depends on you treating them with courtesy and respect.
Sensitive topics may still come up, but your therapist will be forewarned, and can approach them more carefully.
Share what you’ve learned and liked from past therapists If you’ve been to therapy before, be sure to share what you learned from that experience with your therapist. It can be particularly helpful to share what you’ve learned you do and don’t like in therapy.
For example, if you find role-plays really helpful, tell your therapist. If you hate them, tell them that, too. Let your therapist know what you’ve learned about how you relate to therapy so that you can benefit from your previous experience.
Assess your comfort level with them. It’s important you get a sense that you could feel comfortable sharing a deep level of feelings and personal details with this therapist.
If something in particular makes you uncomfortable, bring it up, and see if it can be addressed. If you feel uncomfortable with them by the end of the session, find another therapist.
Be open to new avenues of inquiry that your therapist suggests Your therapist’s years of experience in therapy may help them to see a link between two parts of your life that you might not see at first.
Try to focus on what’s most important to you Remember that your time is limited, and while you shouldn’t hurry through things, if a conversational tangent has led you to something that really isn’t relevant to the issues you want to focus on, feel free to say “I’m sorry, I’ve gotten off track. What I meant to talk about was…”
This is your session, and if you’d like to work on a specific issue, you don’t have to wait for the therapist to ask you. Tell them you’d like to talk about it.
If there’s a specific approach to a problem you’d like to try, share your interest with your therapist.
Your therapist is an expert in their field, but you are the foremost expert on you. Success in therapy will require both of your expertise, so be an active participant in your therapy.
You’ll get the most out of your session if you approach it with an open mind, energy, and forethought.
Conquering Stigma Around Seeing a Therapist
Many people worry about what it will mean or how it will look to others if they go to therapy. There’s a lot of stigma out there about therapy.
Here are a number of things that going to therapy does not mean.
“You have serious mental problems”
Going to therapy doesn’t mean you have serious mental problems. For people who do suffer from serious mental illness, therapy is certainly necessary, and they should be applauded for seeking it. But the majority of people in therapy don’t have a serious mental illness, and many have no diagnosed mental illness at all.
The most common reasons people go to therapy are to address life challenges or significant life changes.
Going to therapy takes courage and dedication—courage to admit that you could use help, and dedication to follow through on the process. Going to therapy is a demonstration of inner strength.
“You’re in crisis”
People go to therapy for all kinds of reasons; often, it’s to work on goals for themselves and deal with challenges in their lives. Someone doesn’t need to be in crisis to go to therapy, and, in fact, therapy can help to avoid crises.
“You’re wasting money”
Some people think it’s silly to spend money on mental health, but look at some of the other things people commonly spend money on—gym memberships, physical trainers, exercise equipment, and medical care for physical ailments.
Why should your mental health be less important than your physical? Think of going to a therapist as hiring a trainer for your mind.
Look at it from another angle: therapy as an investment. You might save to go someplace special on vacation, and feel it well worth the money—often quite a lot of money. Wouldn’t it be worth an investment to help yourself be calmer and happier on that vacation? Come to think of it, wouldn’t it be worth an investment to help yourself be calmer and happier all the time? Therapy is an investment in your mental health and your happiness.
“It won’t work”
It’s true that seeing a therapist isn’t a magic pill. It will take time to see an effect, and you may see less effect than you’d hoped. But, in a poll conducted in 2004, an estimated 59 million people had sought therapy in the past two years, and 80% found it effective. Those are pretty good numbers.
“You’ll be in therapy forever”
Therapy doesn’t take forever. It’s not an immediate process, but depending on what a person is seeking to address through therapy, they might accomplish what they need in just a few sessions.
Progress in therapy is often made within three months. But more complicated issues may take longer, even years.
The type of therapy makes a difference, too. Cognitive Behavioral Therapy tends to be shorter-term than many methods, while psychoanalysis or relational therapy tends to take longer. Regardless of the type of therapy you seek, the more work you put in during and between sessions, the faster you’ll make progress.
Some people do stay in therapy for years, because they find that it’s a part of their life that they value and enjoy. Often, clients will see a therapist weekly or monthly at first, but after a while will come in less frequently, perhaps once every few months. Some people continue to visit their therapists once or twice a year, just to check in and talk about any new issues that have come up or old ones that have resurfaced.
In a given year, around one in every four people experience a mental health issue. Seeking treatment doesn’t mean you’re unique because you’re affected by a mental health issue; it means you’re unique because you’re doing something about it.
- Call 1-800-273-8255; it’s the number for the National Suicide Prevention Lifeline.
- Text START to 741741, the Crisis Text Line.
- Download the MY3 app to plan a way to stay safe when you’re having thoughts of suicide.
- For emergencies call 911.
- Visit Befrienders Worldwide for hotlines and other resources available throughout the world.
- Use your local emergency services.