Counseling and Psychotherapy 101: How to Choose a Therapist
This article was written by Elena Davis, LCSW and was orginally published in Colorado Health online magazine in 2016. You may access the original article and more like it online at:
by Elena Davis, LCSW
When struggling with overwhelming life challenges or emotional turmoil, the thought of trying to find a counselor can feel like blindly shooting darts at a moving target. The field of counseling and mental health is laden with confusing acronyms and jargon, not to mention the infinite choice of hundreds of individual counselors (a.k.a. therapists) who practice in most urban and suburban cities. Despite how cumbersome this process may feel, connecting oneself with a skilled counselor to help navigate through tough times can make a huge difference in one’s quality of life and emotional well-being.
The following tips are meant to help explain and demystify the process of finding a good therapist.
Types of Counselors:
The counseling field includes: Psychologists (PhD or PsyD), Licensed Clinical Social Workers (LCSW), Licensed Professional Counselors (LPC), and Licensed Marriage and Family Therapists (LMFT), just to name a few.
In my experience, the specific degree does not matter as much as the individual counselor’s life experience, intelligence, demeanor, compassion and clinical knowledge. I have talked with colleagues from all of these fields and have found in general that within each discipline there are both “good fits” as well as “not-so-good fits”.
That said, don’t worry so much about the degree a potential therapist holds but rather concentrate on the specific personality, style, traits and expertise of that individual counselor. Lastly, if you are looking for medication, you will need to also see a psychiatrist, psychiatric NP (nurse practioner), or a psychiatric PA-C (physician's assistant). Most therapists will be able to provide referrals to reputable colleauges who can provide consultation and medication services.
Types of Counseling:
Therapy can be short term (four to six sessions) or long-term (six months to many years), or anywhere in between.
Individual therapists have various theoretical orientations that guide their practice. Examples include cognitive behavioral, solution-focused, psychodynamic, narrative, spiritual-based, hypnotherapy, and life coaching.
Interestingly enough, research shows that the specific type of counseling received is not the most important factor; rather, the most important predictor for whether or not counseling will be successful is the quality of the relationship between the therapist and client.
That said, focus on finding a counselor whose personal style and philosophy you feel comfortable with rather than focusing on specific techniques or trainings achieved.
If you have health insurance, by all means call them and find out the details of your benefits for “behavioral health” (a.k.a. mental health).
Be sure to find out if you have a deductible, how many sessions per calendar year are covered, what your copay is, and which specific providers the insurance company will cover.
Some therapist have resources to make this call for you, saving you time and simplifying the process. Also, many employers offer Employee Assistance Plans (EAPs), which typically provides three to six sessions to employees and their families at no cost.
The average fee for a private practice therapist is $80-125 per session; the specific fee varies widely depending on the individual therapists’ level of expertise and years of experience in the field.
Health Spending Accounts (HSAs) can often be utilized to pay fees out-of-pocket. In addition, some therapists offer a sliding-scale fee or can help refer you to low-cost counseling services available in your community.
Making the Initial Call:
Be ready to briefly describe why you are seeking therapy (in as little or as much detail as you are comfortable) and to ask specific questions to learn more about the services offered.
Be sure to confirm office location and hours of availability to ensure they will fit your needs. Be proud of yourself for taking the first step, which often times proves to be the most difficult!
The First Session:
Many first-timers worry that they will get into the therapy session and not know what to say, that they will cry uncontrollably, or that they will be judged, blamed, or otherwise misunderstood.
A skilled therapist knows how to guide the conversation, to explain that tears are natural and often a common occurance, to help you feel supported and understood, and to provide a physical space that feels safe and comfortable to begin the counseling journey.
Good communication is essential for successful therapy to occur, and it can speed therapy along if you take the lead on communicating what you would specifically like to get out of the subsequent sessions.
First sessions often include discussions of expected duration of therapy, specific goals and areas of focus, and overall expectations. First sessions feel scary to most people, so when you finally make an appointment (and show up for it!), please remember to give yourself a big pat on the back for taking the next step!
Using the “Rule of Three”:
Three sessions is generally all it takes to assess the “goodness of fit” of a relationship with a specific therapist.
The first session will generally feel a bit awkward and uncomfortable; sharing details of your life with a complete stranger can certainly be a bit awkward and uncomfortable. The second session should feel a bit more comfortable, but there may still be bumps in terms of the therapist not quite understanding you or you not quite feeling totally understood – after all it’s only the second session. By the end of the third session, if there are still difficulties in communication and/or any red flags, it might be time to move on to another therapist.
A "Good Fit" is Essential:
Research shows that the most progress in therapy is made in the first 12 sessions. A good therapist will discuss whether the relationship feels like a “good fit” to you and will not take offense but rather be happy to refer you on as needed. Finding a good therapist “fit” can happen on the first try or it may take many phone calls and initial sessions. Insurance limitations, financial concerns, busy schedules, and fear all limit our willingness and opportunity to seek out counseling support. Regardless of whatever barriers you might encounter, it’s well worth the time and effort to take the steps necessary to connect yourself with a good therapist– one who can help support you through challenging times and guide you in creating the life you want.
Remember: Your health, happiness and emotional well-being are worth the investment of time in finding a great therapist who will provide invaluable support on your journey!