Finding and Choosing a Therapist for Yourself or your Child: Way More than You Ever Wanted to Know
HAYSTACKS! PHOTO: JOHN PAVELKA CC
Finding a good therapist who is a match for you and your particular needs can be frustratingly difficult. I often help people find therapists, and have found that most have similar questions about the process. This post is an FAQ for anyone considering, or already looking for a therapist for themself or someone they love. Keep reading for a brief explanation of different types of therapists, finding a therapist with or without insurance, how to choose the right therapist for you, and a couple of other pieces of advice from the perspective of someone in the business. Let’s start with:
Who’s who? There are several credentials that you’ll find in the (Texas) therapist community. A brief list:
- Licensed Clinical Social Worker (LCSW)
- Licensed Clinical Social Worker-Supervisor (LCSW-S)
- Licensed Professional Counselor (LPC)
- Licensed Marriage and Family Therapist (LMFT)
These four all have Master’s degrees, years of supervision working under a more experienced therapist, and are licensed by the state. These therapists might be in a clinic, a non-profit, or in private practice. This is the bulk of who provides therapy in the state of Texas. Other states have similar providers but might use different credentials. The difference between an LCSW and an LCSW-S is that the LCSW-S has taken additional training in order to officially supervise LMSWs towards their clinical licensure.
- Psychiatric Nurse Practitioner (PMHNP)
A psychiatric nurse practitioner has a Master’s degree in nursing, and might offer therapy and/or medication management. They may be supervised by a psychiatrist.
- Psychologist (Phd or PsyD)
Psychologists typically have a doctorate and are licensed. Some psychologists do therapy and some do testing, and some do both. A full psychological assessment is both very handy and resource-intensive (time and money) but can make a very positive difference in complicated or unusual situations, or where treatment isn’t producing the expected results. That said, you don’t need a psychological assessment before starting therapy—all therapists do some level of assessment before starting therapy. People often keep their same therapist but see someone else for assessment—the assessing psychologist typically writes a report and consults with the treating therapist to maximize the usefulness of the assessment.
A psychiatrist is a licensed medical doctor with a specialty in mental health issues and medication. It’s unlikely that you’d see a psychiatrist for therapy, although some do. Typically people see a psychiatrist for an initial assessment and then much shorter “med checks” every few weeks or months.
- LPC-Associate/LMFT-A/LMSW/Coaches & unlicensed providers
LPC-Associate: Licensed Professional Counselor-Associate. (Used to be called LPC-Intern.) They are not fully licensed and are typically just a year or two out of grad school. Pros: they are likely cheaper and have more availability. Cons: lack of experience and everything that goes with that. That being said, everyone was new once.
LMFT-A: Licensed Marriage & Family Therapist-Associate. This is similar to an LPC-Intern but with a few administrative differences.
LMSW: Licensed Master Social Worker. This is a fully licensed social worker, but they aren’t clinically licensed—this means that to provide therapy they must be under someone’s supervision, and this should be clearly noted. These are often also early career professionals.
Coaching, or anyone without a license, is a completely ungoverned profession. You may end up with someone who is a fantastic provider (I know some,) but you can just as easily end up with someone who was in a different profession yesterday, hung out their shingle today, and thinks that a romantic relationship is an appropriate outcome for services. Buyer beware.
Other letters!?! (SEP, EMDR, LPC-S, PACT, LSOTP, RPT, etc)
With any primary professional therapy credential, you’ll find therapists who have additional certifications, trainings, modalities, and extra letters behind their name. Many have the word “supervisor” or “-S” somewhere, which means that they are certified to be supervisors of early-career therapists in their field. All therapists are required to take “continuing education” every year, and some participate in trainings that are more intense and offer an additional credential at their conclusion. This can be helpful to look for IF you already know that a particular modality is important to you, but it is worth mentioning that research shows that the quality of the therapeutic relationship is THE most important factor in determining the success of that intervention (ie, more so than the modality used by the therapist.)
Finding potential therapists–insurance
If you have & want to use your health insurance, start there. Call their customer service and ask for a list of mental health providers at both masters’ and doctorate level. If you can filter that list, ask for therapists who specialize in kids (if that’s what you want) or geographic convenience. Do not start by calling therapists and asking if they take your insurance–that’s going about it backwards, trust me. There are way more therapists than there are therapists who take your insurance. (Side note about geography: therapy is a weekly or bi-weekly commitment for weeks/months/years… ideally the fewer obstacles to keeping those appointments, the better. If you need a specialist you may have to cross town, but at least start by looking in convenient geographic places.)
Finding potential therapists–private pay
If you can pay full fee, you are in the fortunate position of having far more options. You can ask others for referrals, or you can look on online directories like the NASW’s Help Starts Here, Psychology Today, Good Therapy, Network Therapy, etc. Some of the online directories will allow you to apply different filters in your search–very helpful. You can also just Google; try searching for “therapist” and your zip code or city and state.
Interview potential therapists!
Once you have found a few potential therapists, it’s time for a pre-interview. This step is important. Call 3 or more and have a 10-15 minute conversation with each before scheduling an initial appointment. In this brief call:
- Clarify deal-breaker issues that you couldn’t determine online like: are they accepting new clients, fee, location, insurance, hours, etc. Do this before going in to your personal details.
- Share a little about why you are seeking counseling and what you are looking for.
- Ask the therapist a few questions about their practice, too. Does that therapist think you sound like a match for them and their practice? Does the therapist have experience with your situation/problem/lifestyle/age/etc? If you have any super-important beliefs or preferences, mention that and ask if the therapist is very comfortable working with that thing. Your therapist doesn’t necessarily need to live/believe as you do, but being able to resonate with you despite not being “same” does matter. Does the therapist use a directive or non-directive approach—ie, who leads the session? (this is a question for both adult and child therapists, and there isn’t a right or wrong answer really—it’s personal preference.)
- Feel free to say that you are talking to a few therapists before you schedule, and that you’ll circle back if/when you want to make an appointment. This will not hurt the therapist’s feelings–a good therapist recognizes this as appropriate due diligence.
- After you get off the calls, ask yourself how the call felt. Did conversation flow? Was it easy or hard to talk with this therapist? How well did they ‘establish rapport’ with you? This matters a lot.
- It’s also the reason I recommend calling several potential therapists—you’ll be able to compare/contrast that rapport much better after having had essentially the same conversation with 3 different people.
A few more random thoughts
I hate to say it but: some therapists are bad. There are therapists out there who probably shouldn’t be practicing. You can sometimes avoid them by getting recommendations from people you trust, so consider asking around if you haven’t already. (doctor, friends, co-workers , family, neighbors, lawyer, guidance counselor—lots of people might be a source of referral.) If you do use someone’s referral, they probably would appreciate hearing back from you later with your feedback on that referral (I definitely do.)
Even if a therapist is a great therapist, it doesn’t mean that they are a great therapist for you. If you come in for a first appointment with someone and it doesn’t feel right, it might indeed be that they aren’t actually a match for you. It’s ideal to tell them that in session; they ought to process it with you and give you referrals who are likely to be a better match. (And if you find yourself rejecting multiple therapists, by the way, it might not be the therapist. Just sayin’.)
There are a lot of different kinds of therapy, and FYI if you’re looking to do deep work, the intake, assessment, and initial relationship-building process will take multiple sessions. (which means that evaluating whether the therapist is right for you might need more than an initial session, too.)
A person who is a good therapist may not be a good businessperson/practice manager. The skill set is very different. You might encounter great therapists who are a little slow to return calls (sorry) and who don’t have nice websites… or even any website at all!
Couple of thoughts about insurance: It might be helpful to know that insurance companies pay therapists a contracted rate that varies between companies, and if you are having a hard time finding someone on your insurance, it may be that their reimbursement rate is so low that experienced therapists aren’t willing to work with that plan. Additionally, ask your insurance if they offer “out of network benefits.” If they do, you might be able to see a therapist not on their list and file yourself with the insurance company for partial reimbursement. Know, too, that the insurance company may only reimburse for particular diagnoses (and a diagnoses is required) and may also limit the number and frequency of sessions.
One note regarding therapy for kids: kids don’t typically do “talk therapy” until around adolescence–most therapy for kids is play therapy. There are different kinds of play therapy, too, including both directive and non-directive types. (Picking the ‘right type’ of therapy for kids is its own post for another day.) It often takes longer for kids to move in to the “working phase” of a therapeutic relationship. Expect sessions where “all” your kid does is play (board games, with toys, throw a football, etc.) Trust that the therapist wants therapeutic growth for your child and is working to make that happen in the way that they believe is most effective.
So. More than you ever wanted to know about how to choose a therapist. Let me know if it’s helpful and/or if there’s something good to add to this!
Originally published 12/2018, updated 7/2021