As someone who is fairly open about her chronic mental health issues, I get this question all the time:
“Do you know a good therapist?”
The last thing you want is to feel like you need to go on a bunch of “blind dates” trying to find which therapist is “the one” at a time you’re probably overwhelmed and decision fatigued anyway.
With a little research upfront, you can save a lot of time and energy (and money) trying various options that might not work. If you’ve never been to a therapist or psychiatrist before, then this will also be a helpful background to guide you at the beginning of your journey.
This article is long, but that’s only because I *really* break it down.
Step 1 — Do You Need Psychiatric Medications?
This determines whether you actually need a psychiatrist instead of a therapist. Only psychiatrists can prescribe medications. Therapists and psychologists cannot.
If you’re new to the whole mental health space and you’re not sure about medications, then the first person to talk to should be your primary care physician (PCP). Many basic psychiatric medications (including anti-depressants and anti-anxiety meds) can be managed with the help of your PCP, and these doctors are often the best first line of defense of mental health issues. An additional benefit is that your PCP knows you best and is often way easier to get an appointment with. Many patients who do need to be referred to a psychiatrist return to their PCP for maintenance after a working medication regimen is sorted out. Your PCP will often tell you when you need to be referred to a psychiatrist if you’ve never seen one before.
If you do need a psychiatrist, then you should have correct expectations of what a psychiatrist does and how it differs from a therapist. There tend to be two types of psychiatrists: those who specialize solely in treatment/medication management, and those who incorporate psychotherapy into their practice (“one-stop-shop”).
Traditional psychiatrists specialize in all the latest mental health treatment options (medication or otherwise), side-effects, contraindications, and stay up to date on research. Sessions with these doctors will usually be short and very focused on discussing desired results and side-effects. Good ones know ALL the options and ALL the new medications and often work closely with the patient’s therapist if they have one.
The “one-stop-shop” psychiatrists who practice both medication management and talk therapy are a blend of a psychiatrist and therapist. The convenience is that you have one person who is managing your entire health story, and someone who can understand on a deeper level and with a longer session. The downside is that they are often generalists in both areas (since both take multiple years to specialize in individually). They tend to be rarer and are also often harder to get appointments with (because with longer sessions, they can see fewer patients).
The one-stop-shop stereotype is why I think psychiatrists are often confused with psychotherapists, and why people are often disappointed when their sessions are shorter and more medication focused than they expected.
Step 2 — What Type Of Therapy Are You Looking For?
Just like there are medical specialties (Cardiology, Gynecology, etc), there are psychotherapy specialties. While there are a TON, I’ll focus on some that are more common (especially in the Bay Area) that you may not have heard of.
- “Psychotherapy” “Coaching” “Family Therapy” — These are the “primary care” equivalent for therapy. It’s also likely what you think of when you think of therapy. Sitting across a couch with your therapist, and talking it out. This is still the basis for all specialties below, but I’m calling it out because you might not need a specialist, especially if it’s your first time seeing a therapist.
- Cognitive Behavioral Therapy (CBT) — Best for those dealing with mild depression and stress. Learn better ways of coping by identifying and changing negative thinking patterns.
- Emotionally Focused (Family) Therapy (EFT) — Best for couples/families. Learn ways to have healthier relationships by creating a correct, secure attachment with others.
- Dialectical Behavioral Therapy (DBT) — Best for difficult-to-treat cases, or those wanting to “build a life worth living”. Learn how to reach your goals more effectively through a combination of behavior modification and mindfulness. DBT is much more skill and goal-focused than other practices but still helps you learn how to both regulate and tolerate your emotions. It was originally designed for those struggling with Borderline Personality Disorder (BPD) or suicidal thoughts.
- Eye Movement Desensitization and Reprocessing (EMDR) — Best for PTSD/trauma. A non-traditional type of therapy specializing in diminishing the effects of trauma through a series of eye movement exercises. (And yes, you can have PTSD even if you were not in the military).
- Acceptance and Commitment Therapy (ACT) — Best for the goal-focused. An action-oriented approach (like DBT) that focuses on accepting where you are and moving on to problem-solving, vs necessarily focusing on the underlying why or how.
- Neuro-Linguistic Programming (NLP) — Best for those with harmful self-talk. Increase self-awareness of how you view the world and change how you feel about it by changing how you talk about it.
- And many more… If none of these are speaking to you, you can check out a much more complete list here: https://www.psychologytoday.com/us/types-of-therapy
Step 3 — Getting a List of Providers
By now that you’ve maybe identified one or two types of therapies you’d like to try based on your goals. This is the hardest and most frustrating step — finding available therapists.
- If money is no object, search for your specialty through https://www.psychologytoday.com/us. Every therapist I’ve talked to has pointed this out as the most exhaustive list of providers. The downside is that many of these may be out of network, which means they may be only partially covered by insurance (or not at all).
- Call your insurance company. Ask them for a list of therapists with your chosen specialty. The benefit is these will be of much less (or perhaps no) cost to you. The downside is these often have a much longer waitlist. Your insurance company may have agreements with some who guarantee seeing patients within a week if you need someone urgently.
- Call your HR department. Many companies (especially in the Bay Area) also have a separate agreement with “mental health management” companies as a wellness benefit and may be able to hook you up without needing to go through insurance. Do note that I’ve often found fewer specialists are available through this program, and the customer service is often a poorer experience.
Step 4 — Narrowing Down The List
This step is mostly about filtering. Some people have gender or age preferences or want a therapist a certain distance from home or work. You will also likely have a short bio about each therapist, and can further identify who might be a good match.
So let’s say you recently left a former abusive spouse. You probably want a therapist who:
- Specializes in trauma/PTSD
- Trains in a specialty you might be interested in (like EMDR, for instance)
- Has availability ASAP
- Is not the gender of your spouse (if you’re concerned that recounting the event may prompt additional emotional responses)
Once you have a list of ~3–5 providers, next we get to the “dating” step of choosing a therapist.
Step 5 — Contacting Potential Therapists
The introduction call is the most important step in finding a therapist that works for you. If they aren’t able to answer these questions above the basics, it can be a red flag that they might not be a good fit.
The Basics:
- Are you currently taking new patients?
- Do you take insurance / what are your rates?
- Do you specialize in [thing you were looking for]? (This is important in case the info from your search was incorrect or out of date).
Checking for Fit:
- How often do you work with patients who have [your diagnosis/history]?
- Are you currently working with patients who have [your diagnosis/history]?
- How many sessions do you usually work with patients? (i.e. is this acute or ongoing care)
- Can you tell me what a typical session looks like?
- How often do you meet with patients? (if it’s more than once a week, that can be confusing.)
- Will you be able to look at my information before our first session so we can get right into it in our first session?
Working Together:
- How do we evaluate my progress over time?
- What do you think is a reasonable outcome for someone with [my goal]?
- Is there anything else I should know before we consider working together?
To make this simpler, I’ve made a Google Sheet that you can duplicate and fill in yourself.
Step 6 — Evaluate After A Couple Sessions
Once you’ve had a session with a therapist, I’d recommend holding judgment for 2–3 sessions before evaluating if it’s a good match. The first one is mostly paperwork and history gathering, and so it can feel like you haven’t really “gotten into it” until you’ve seen them more than once. Here are some questions you can ask yourself to evaluate how the relationship is developing.
- Do I feel like my therapist understands my goals and is helping me reach them?
- Do I feel respected and heard?
- If I had to miss or cancel a therapy session, would I feel disappointed?
- Am I able to get sessions at a cadence that is helpful to me?
If the answer to any of these is NO, it might be time to go back to your previous list and try another therapist. It is perfectly normal to switch therapists, and it is perfectly normal for it to take a few tries to find “the one”.
Troubleshooting and Common Questions
- Q: I can be seen by a junior therapist earlier / for less money. Are junior therapists “worse”?
Not at all! Often because they are fresh out of school, they may even be more closely up to date to the latest research. Junior therapists who share a practice with other more senior therapists can be the best of both worlds. In this case, ask how closely they will be working with a senior therapist, how treatment plans are discussed, and how feedback is delivered. I’ve had good and bad experiences with junior therapists. - Q: There aren’t therapists in my area…Or, the soonest they can see me is 6 weeks from now. What do I do?
It might be worth a second call to your insurance company or employment benefit coordinator. Some therapists have agreements with insurance companies or benefits providers that they will fast-track seeing new patients if you go through them.
Alternatively, you could look for providers with virtual / televisits, who might not be within driving distance. - Q: My therapist is out of network, but my insurance has some out of network benefits. How do I explore that?
For out of network providers, you pay your therapist at your appointment, and then ask your insurance company for a percentage back as reimbursement. The details can be tricky and depend entirely on your insurance company, so this will take a couple of calls to find out the specific process. The number to call will be on the back of your insurance card.
During the first call with your insurance company, you want to find out both the process is for filing reimbursements and what information the insurance company needs in order to process a claim for reimbursement. Often they will need the provider’s EIN (license #), the ICD codes you’d be treated for, and the CPT codes for the services provided. You will be able to get this information from your therapist.
During the second call with your insurance company, you should provide them with the information you gathered and ask at what rate that would be covered. I really recommend doing this before finalizing your therapist. You’d be surprised…I thought I understood my insurance benefits and had double-checked beforehand (without the codes, so talking about a theoretical visit cost) only to be unpleasantly surprised when I got my invoice with the actual numbers.
Once you get an invoice from your therapist, you can submit it with the above information and get reimbursed by your insurance company. - Q: Can I see multiple therapists on the same day? I want a second opinion before I commit.
Not necessarily! It depends on your insurance and how much money you are willing to pay for faster treatment. When I was getting a second opinion from a psychiatrist, I learned the hard way that insurance often won’t cover the same treatment by two different providers on the same day. Double-check with your insurance company whether this is true. - Q: What’s the difference between a LCSW, LMFT, or Psychologist? Does it matter?
First, breaking down the acronyms — LCSW is a “licensed clinical social worker” and LMFT is a “licensed marriage and family therapist”. Both have gone to graduate school and studied some form of psychology. Neither is “better” in terms of treatment, they just had different courses of study. Similarly, Psychologists are those who have a degree (albeit often a Ph.D.) specifically in Psychology. In general, you are looking for answers to the fit questions over needing specific letters behind their name. Also, as a reminder, none of these can prescribe medications, only psychiatrists can.
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Miss Managed is an engineer, writer, meditation coach, and mental health advocate living in the heart of Silicon Valley. She approaches everything in life with a lot of humor and heart.
She’d love to hear from you if this article helped (or didn’t).