How Do I Choose a Therapist?

Guidelines for Choosing a Therapist

There are so many therapists out there, and it can be hard to find the right provider for you. This guide will give you information about how to choose a therapist that provides evidence-based care, including what questions to ask and what to look for.

First – please know that you have certain rights as a patient.

• You have the right to work and make decisions collaboratively with any provider.
• You also have the right to receive care that is informed by the best available research.
• You have the right to receive care that carefully considers your values, preferences, and culture, and tracks progress to determine the effectiveness of care.

To read more about your rights as a patient, please check out the mental healthcare bill of rights, here: https://www.patientbillofrights.org/

Therapy is a relationship between two people – you need to feel comfortable. The best way to figure out if your needs will be met is to ask questions. Don’t be concerned about insulting a new provider with any questions that you may have. If a provider is insulted by you asking, they’re probably not the right therapist for you.

Therapists have different processes for seeing new patients. You may speak to the therapist on the phone before an initial consultation, or, you might speak to an intake coordinator initially, and your first meeting with the therapist will be your opportunity to get all your questions answered.

Treat your first session with a therapist as a consultation – you are not obligated to continue seeing the therapist if it isn’t the right fit for you. At this first meeting, the therapist will likely ask a number of questions to get a clear idea of the problem. The goals in the first session should be to find out whether this particular therapist is likely to be helpful to you and if you feel comfortable and confident with the therapist. During this session you may want to discuss some of the following concerns, described in more detail below:

• Therapeutic Approach
• Logistics
• Fees
• Qualifications and Training

Therapeutic Approach

What is your therapist’s perspective with regard to treatment? What therapeutic approaches do they use? Even within evidence-based treatment and Cognitive Behavioral Therapy (CBT), there is a broad range of approaches. Find out what they do, and how this approach might fit with the problem that you’re having.

One way to determine if a provider is an expert in evidence based practice is to ask what manuals they tend to use in therapy. Manuals are step-by-step guides to specific treatments, and their answer may help you figure out the approach the provider will take to your care.

Logistics

How long will I be in therapy?

Your provider might not have a definitive timeline for when your treatment is considered “complete.” However, they should be able to give you a rough idea based on their accumulated experience.

How long is a typical therapy session?

Most therapy sessions range in length from 45 minutes to one hour. Some therapists will offer even longer sessions.

How often should I expect to be seen?

You can usually expect to meet with your therapist at least once a week. Sometimes, your therapist will recommend bi-weekly or more intensive sessions based on your treatment.

Will my therapist ask me to do homework outside of a session?

It’s typical for evidence-based practitioners to assign out of session work, including additional practice of what you worked on in-session. It is always best to discuss expectations with your provider.

When am I ready to end therapy?

The length of your overall treatment depends on your provider. Some therapists will set an end date after a specific amount of sessions. Others feel it’s best to continue until your goals are reached. Ask your therapist how they approach this situation.

Can I reach my therapist outside of our sessions? What if I’m having an emergency?

Outside of session communication varies from provider to provider. Some feel comfortable texting or emailing out of a session, while others do not. Talk to your therapist to find out if their approach is a good fit for your needs.

Fees

It can be uncomfortable to talk about money, but it’s in your own best interests to have all the information but without this information, it will be difficult for you to decide what is in your own best interests.

Be aware that many therapists practicing evidence-based therapy do not accept insurance. Mental healthcare can be expensive, but there are some ways you can find an affordable quality therapist.

You might want to know:

• How much does therapy cost per session? Is this different for an initial session?
• Does the therapist offer a sliding scale, where they change their fees based on income?
• What is the therapist’s cancellation policy?
• Does the therapist take insurance?
• If a therapist does not take insurance, will they provide superbills for out of network reimbursement?
  If you cannot afford out of pocket mental health treatment, university medical centers are also good options. Typically, they have training clinics where experts will supervise graduate students and junior clinicians. This allows these clinics to offer lower fees than other providers. Typically, externs and interns will have the lowest therapy rates.

Qualifications and training

What degree(s) does your therapist hold?

CBT is not a degree-specific therapy.  Be aware that there are many different paths to becoming an effective evidence based therapist.

The emphasis on CBT and evidence-based care varies within different training programs. Therapists with a strong foundation in CBT will not mind being asked questions about their qualifications and will freely give you any professional information that you request. If a therapist does not answer your questions to your satisfaction, or refuses to answer your questions, you should consult another therapist.

Therapists with the most graduate training have a doctoral level degree  in clinical psychology (Ph.D. or Psy.D.) from an accredited institution. Therapists may have doctoral degrees in social work or counseling psychology as well.

Many therapists have masters level degrees. Typical degrees for masters level clinicians are masters in social work (MSW), mental health counseling (MHC), marriage and family counseling, and school psychology. These are shorter graduate level training programs and might not focus on evidence based therapy. The therapist might be well trained, but you might need to ask more questions about post graduate education.

Psychiatrists have a medical degree (MD). They typically prescribe medications, and  do not usually provide therapy.  There are, however, some psychiatrists who do provide therapy.

Is your provider independently licensed?

Note that to practice independently, therapists are required to have their own license. In the United States, the process is overseen by a state licensing board. You can look up your provider’s license on your state’s Office of Professions website.

If your provider is not licensed, who will be signing off on your care?

All unlicensed therapists must have a licensed provider signing off on their care. Many graduate students will offer care in the context of their training, and this training extends even after a provider obtains their degree. For doctoral degrees, therapists will have a one year post-doctoral training period before they get their license. For masters level clinicians, this period of training post-degree is longer.

In all these cases, their therapy work must be supervised by a licensed clinician. Ask about their supervision, and feel free to ask for their supervisor’s contact information and expertise as well.
Other questions about qualifications that may be useful:

• What is the specific training they have received to effectively treat the problems that you are dealing with?
• How long have they been practicing?

What to Expect from Therapy

 Initial Sessions:

An evidence-based therapist will spend the first few sessions assessing the extent and causes of the concerns you have. Generally, your therapist will be asking specific questions about the problems causing you distress.

Your therapist will also ask you about your goals, and generally, coming up with these goals is a collaborative process. If you can’t agree on the goals of therapy, you should consider finding another therapist.

As Therapy Continues

Once you decide on goals, you can expect the therapist to discuss with you one or more approaches for helping you reach your goals. Central to CBT is home-based work and out-of-session practice. This practice occurs at a pace that is individual to you.

As you continue therapy, you can expect your therapist to evaluate your progress toward your goals. If you are not progressing, or if progress is too slow, your therapist will most likely suggest modifying or changing the treatment approach. You might what to consider the following:

• Do you understand what your therapist has asked you to do?
• Does therapist’s advice seem relevant to your goals?
• Do you believe that following this advice will help you make progress?
• Has your therapist given you a choice of alternative therapy approaches?
• Has the provider explained possible side effects of this therapy?

When You’re Unhappy with your Therapist

First, talk to your therapist about the problems! A good therapist will be open to hearing your concerns.

You might also consider changing therapists. Good therapists recognize that they might not be the best fit for everyone. If you don’t think you’re moving in the right direction, you have the right to consult another therapist.

How to Find an Evidence Based Therapist:

Here are some suggestions to finding a quality therapist in your area:

• Check out ABCT’s Find-A-Therapist directory, available here
• You can search for a therapist by zip code.
• For child and adolescent therapy, check out Effective Child Therapy
• If you live near a university hospital, check out local university medical center clinics. They are often staffed by trainees who are supervised by highly trained psychologists. They often take insurance or have low fee or sliding scale options.
• Look for telehealth options. If you can’t find an affordable CBT provider in your area, try telehealth. Often, therapists practicing outside urban areas provide therapy at lower rates.