Choosing a Therapist and Other Burning Questions

I often hear that the process of finding a therapist is really overwhelming for people who haven't done it before or who have had a bad past experience. I'm here to try to set a few things straight and answer some commonly asked questions.

It's important to keep in mind that the reasons for seeking therapy vary. For example, if you are looking for an ongoing therapist for the purposes of support and exploration, it may be more important to you to find someone you feel deeply connected to and comfortable with.

If you are looking for a specialist for a particular presenting problem (i.e. eating disorders, marriage counseling, loss of a loved one, bipolar disorder, trauma), you may want to focus more on the therapist's experience, expertise, and approach because this may be more of a solution-focused approach you are looking for.

The information below is meant for those who are seeking general, ongoing therapy for personal growth and exploration.

1. What do all of those letters mean? What are the differences between all of the different types of therapists out there? How do I know which one to choose and trust?

I felt the same way when I began looking for my first therapist in my early 20s. I saw the names of psychologists, psychiatrists, counselors, life coaches, social workers, healers, and more. I felt extremely overwhelmed. I ended up asking a friend for a recommendation.

A recommendation from a friend or loved one is a very common way people end up choosing a therapist. The problem with this is that sometimes that therapist may not be the best fit for you just because they were a great fit for your friend or loved one.

Let's start by getting a few of the facts straight in no particular order:

• A Psychologist is a person who has a graduate degree in Psychology. There are LOTS of different types of psychologists. Some psychologists offer counseling. Some are researchers or professors. Some focus on assessments. This type of clinician is required to do continuing education and training to maintain their licensure status.

• A Psychiatrist is a medical doctor who completed medical school and further training. Psychiatrists can prescribe medicine and have formal medical training. Some psychiatrists offer counseling along with medication management, assessments, and so on.

• A Licensed Professional Counselor (LPC) is a person who has a graduate degree in Counseling or a related field. Keep in mind, in some states, the title is different. In Texas, the title is LPC. An LPC can provide counseling, case management, assessments, or a variety of other services. This type of clinician is required to do continuing education and training to maintain their licensure status.

• When you notice "Associate" after the LPC license (LPC Associate) and a note that the person is "supervised by ____," this means this therapist is in their post-graduate clinical internship. They are working on gaining 3,000 hours of clinical work until the "Associate" is removed from their license and they no longer require supervision.

• A Licensed Clinical Social Worker (LCSW) is a person who has a graduate degree in social work. Social workers also offer a variety of different services. Some offer social justice, advocacy services or case management. Others offer counseling. This type of clinician is required to do continuing education and training to maintain their licensure status.

• When you see Licensed Master Social Worker (LMSW), that means this person is in their post-graduate clinical internship working toward obtaining their Clinical licensure as an LCSW. LMSW's who choose this route are also under supervision, similar to LPC Associates.

• A Licensed Marriage & Family Therapist (LMFT) is a person who has a graduate degree in counseling or a related field. Their education is similar to that of an LPC, with a deeper focus on couples and families. This may look different for states other than Texas. This type of clinician is required to do continuing education and training to maintain their licensure status.

• In Texas, when you see Licensed Marriage & Family Therapist Associate (LMFT - A), that means this person is in their post-graduate clinical internship working toward obtaining their Clinical licensure as an LMFT (with "Associate" removed). This person is also required to obtain supervision in order to meet the requirements for full licensure.

• A Life Coach does not require any specific education or licensure. There are some training programs that life coaches participate in, but there is no legal requirement for training in order to call oneself a life coach. Those who have noted certifications in their marketing have likely participated in training to further their skillset.

• When you see an "S" (Supervisor) after the license of an LPC, LMFT or LCSW, this means the person has had years of experience as a fully licensed counselor and has gone through a supervision training program to then mentor and supervise recent graduates through their clinical hours. These clinicians are required to do continuing education and training to maintain their Supervisor status.

Should I trust a person more who has "Doctor" or PhD before or after their name?

This one is up to the client. Those who have "Doctor" or PhD before or after their name have earned a Doctor of Philosophy degree (or a medical degree if a Psychiatrist). This means they have done further research and spent more time in school to fine-tune their expertise. Similar to any other profession, each professional is going to be unique.

What should you look for in a therapist?

My best advice whether you are new to the search or returning from a bad experience is to ask for a free consultation phone call with at least three different therapists. They can have any of the above credentials. Ask questions and get a good feel for their personality type.

Some suggested questions:

1. How do you approach your work with new clients?

2. What can I expect out of a therapy session with you?

3. What types of presenting problems or areas do you specialize in? (This would be a good time to share a bit about what you are struggling with and see if the therapist has expertise in this area.)

In asking these questions, you will get an opportunity to get a feel for their "vibe" and how they speak to clients. It's not necessarily about understanding everything they are talking about when it comes to therapy lingo, but it's more about how comfortable you feel interacting with them. Pay attention to your feelings while you speak. Are you feeling tense? Do you feel intimidated? Do you feel relaxed? Are they saying things that resonate with you? These are signs that will help you decide who to move forward with.

Is it okay to start with a therapist and then change my mind?

Absolutely. If a therapist ever makes you feel pressured that you can't leave, then that's a red flag. Therapy is about the client, not the therapist. It's also very hard to find the "right" therapist for you, and to even know what you want or need when you're first starting out. I would suggest giving it 3 to 5 sessions before making a decision. See how you feel after each session. Are you getting more and more comfortable? Are you looking forward to the next session? Do you feel like the therapist "gets" you? If you're unsure, talk to your therapist about the fact that you feel unsure. That's what they are there for!

What are some good ways to find a therapist?

1. Psychologytoday.com is a great place to start, no matter the city you are in. You can filter by insurance, location, speciality areas, gender, and more.

2. Openpathcollective.org is another wonderful resource in many cities. This is a database of therapists in your area who offer sliding scale fees for those on a budget or who aren't using insurance.

3. Ask a friend who is a therapist in your city for a recommendation. This is a great way to find a therapist. Your friend can't be your therapist due to ethical reasons, but they likely have a vast network of other therapists, or resources where they can ask for referrals depending on what you're looking for.

What is a "normal" fee for a therapy session if I'm not using insurance?

Therapists charge a range of different fees depending on their licensure level, experience, location, speciality area, population, and more. Does it mean a therapist must be extra talented if they charge more than others? Absolutely not. Therapists may charge anywhere from $50-$350 per session. Medical Psychiatrists likely charge more if you are choosing private pay. Find an option that works best for you and choose a budget range that you feel comfortable paying on a weekly basis.

Are therapists who don't accept insurance better than those who do?

Once again, this is all a gray area. Each therapist is different and has a fee depending on a variety of factors.

How often will I need to go to therapy?

Many therapists encourage weekly sessions in the beginning so you can get to know one another and get things moving. Once you reach a goal, a rhythm, or for whatever other reason, you may choose to go less frequently. This is something best discussed with the therapist you choose.

I may be a BIT bias, but finding the right therapist is well worth the research and effort it takes. Once you begin this process, you'll open up an entirely new world for self-exploration, growth, resilience, support, and more. Trust your gut, and good luck!

If there are any questions I didn't cover, or things I missed, feel free to email me!