The [......]’s Guide to Getting a Therapist: Reaching Out »« A Post That’s Not About Precognition

The [....]’s Guide to Getting a Therapist: Getting Started

Fun fact: searching around for creative commons licensed couches results in lots of couches on fire. Is this a Thing?

Note: For decreasing the amount of language confusion in this post, I’m using ‘therapist’ as a blanket term to mean ‘someone who practices therapy’. In fact, this is not precisely accurate, though it seems to be colloquial use. For sorting between psychiatrist, psychologist, and therapist, take a look at the Terms section.

Part One: In which potential therapists are found, modalities are defined, adjectives are adverb-ed, nouns are verbed, and info is dumped.

I am not a therapist! However, lots of people ask me a lot of the time about getting therapy, and are often willing to keep me updated on what worked and what didn’t. This four-part guide, which is essentially the sum total of every bit of advice I could think of, and a few I didn’t come up with (thank you, proofreaders and feedback-givers!) aims to make the therapist-getting part less mysterious and more accessible. 

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So you’re thinking about maybe seeing a therapist?

Psychology Today has one of the best therapist finders in existence. Enter your zip code, then use the categories on the left to narrow your search by focus, insurance, etc. However, therapists know that this is where many people find them, and capitalize on the search mechanism. This means two things:

  1. Therapists can list a bunch of stuff that they technically ‘have training’ in, without having spent time practicing said stuff. So, just because a therapist lists Cognitive Behavioral Therapy (CBT) doesn’t mean they regularly use it. Asking questions like “How much/what percent of your practice involves [my specific issue]?” can give you a better picture.
  2. Conversely, because therapists also can list a bunch of stuff because it will attract clients, you get opposite problem: don’t necessarily distrust a therapist because they say they’re trained in Rorschach–it’s not unusual for grad programs to teach it, because some people really do want a Rorschach administered.

Lots of therapists practice Cognitive Behavioral Therapy and other things. A therapist you find that lists CBT might not immediately practice CBT on you. You can circumvent this by explaining that you’d like to do CBT. (Telling them you’d also like to know if they think it’s not working or some other modality is better will probably make this request go more smoothly)

CBT is not the only evidence-based therapy, and I actually don’t always recommend it to people if they already introspect and self-CBT regularly. [Here’s a bit about why].

Another way to get a therapist is via referrals. You can ask your medical doctor, friends who have seen therapists, or friends or acquaintances who are therapists. I’ve had more success with the last, but the more recs the merrier! You can look them up on a site like the Psychology Today therapist finder to get specific information like what insurance they take. If some seem like they could be a good fit, you can set up an initial meeting or two. (It may be a good strategy to see several people before picking one who seems the best fit). The next section of this series will handle setting up an appointment.

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Terms

Licensed therapist: Varies by state, but someone who holds a license to practice therapy, but not a PhD. Includes Licensed Social Workers, Licensed Therapists, and Marriage and Family Therapists. Further info here.
Psychologist: Has a PhD or PsyD, has done a one year internship, generally more expensive. I don’t find their practice of therapist to be significantly better–it often seems worse. I’d suggest a psychologist over a therapist for children (because of the amount of developmental psychology training needed) but not otherwise.
Psychiatrist: Has a medical degree. Psychiatrists are quite expensive. As a result of this in combination with their nearly unique ability to prescribe psychiatric medication, (Psychologists may in a handful of states) they’re often seen specifically for this.

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Spend some time thinking about your preferences! Do you think you’d prefer to talk to someone of the same gender? Race/ethnicity? Are there particular parts of your experience that you particularly need a sensitive ear for? For instance, poly people who anticipate needing to discuss and dissect parts of being poly might want to ask a therapist about their knowledge of polyamory. However, if you’re poly but don’t expect it will come up much or be central, you might not need to select for this, and could save yourself some work by not prioritizing it.  Poly, queer, kinky people can find some help for friendly therapists here, as well as here.*

For young people, particularly young people who interact a lot with social media or tech, I sometimes advise finding someone close in age to you–even someone currently working towards a license in psychology–they’ll be used to experiencing life in some way close to yours. Secondly, people in this stage of working usually seem to treat therapy as a collaborative measure. Thirdly, I’ve found that it feels a little easier to question your therapist about the direction of therapy or raise concerns if they are closer in age to you. This by no means means that non-age-matched therapists won’t be helpful, but it’s served as a useful heuristic for some.

But what kind of therapy? There are more types than the ones I list below, but these crop up a lot. Wikipedia has been the best single resource I’ve found for short explanations of those not listed below.

CBT: pretty much what you expect. Working on cognitive and behavioral aspects of issues in question.

DBT: Dialectical Behavioral Therapy. Mindfulness based therapy. CBT meets awareness and acceptance training, as well as distress-tolerance. Here’s a great summary.

REBT: Rational-Emotive Behavioral therapy. Created by Albert Ellis. Philosophy meets CBT. The Wikipedia article is excellent. You can see demonstrations at the Albert Ellis Institute in NYC.

One of the best predictors of therapy succeeding is something called the therapeutic alliance–the sense of collaborating together, both working on a problem, sharing, caring, etc. In essence, do you ‘click’? If you don’t feel like you click with a therapist, this is a great reason to go find another. You can even tell them that you don’t think the therapeutic alliance is working out–this is the ‘code word’ for a specific way of things not working. Knowing this can also make it feel less stressful to explain why you don’t want to see said therapist; it’s a great script. (Therapists who respond badly to this are not good therapists on the whole.)
[I wrote some things on the therapeutic alliance here, but they’re not directly relevant to this bullet point.]

CBT often involves cases of questions or lines of questioning or roleplaying that can feel silly. I usually frame this as something that can feel weird, but is intended to get your emotional and intellectual reactions into place. You might know intellectually that no, all your friends don’t hate you, but still have panic attacks.  The point of the exercise is less about knowing in an intellectual sense and more about installing habits of thinking that will prevent the panic or anxiety your emotional brain is doing. Some people can get into this paradigm easily, some find it hard to suspend their annoyance at obvious questions.

Next post tomorrow: contacting potential therapists!


*If your therapist isn’t familiar with non-monogamy and you want backup, this guide is aimed at clinicians. 

I am actively looking for things I’ve left out, so if upon reading any section, you have unanswered questions–even if you think they are trivial or might mean you’ve missed something, please let me know. I would much rather spend time responding with “no, that’s in paragraph two” than have a whole subset of people think they didn’t read properly and not tell me I was unclear. Further, many thanks to Rita Messer for checking over the advice within. 

 

Comments

  1. E says

    Thanks for this series, Kate! I’m wondering if it would turn you off if a potential therapist you found on Psychology Today listed a religious orientation (any, but the ones I’m seeing are all Christian). Given my Bible Belt location, this may just be necessary to attract a critical mass of clients . . . but willingness to declare a “Christian orientation” makes me nervous. Thoughts?

    (I should point out that my Bible Belt location means a substantial proportion of the therapists I’m looking at make a point of calling themselves Christians—it’s not something that’s easily avoided.)

    • Kate Donovan says

      Lots of pieces of answers to your question!

      -I wouldn’t take it as a turn off, no. Especially since you’re in a southern area, it seems possible that the therapists are listing it as an advertising tactic, rather than a regular part of their practice

      However!

      -you might want to check out the Secular Therapist Project (http://www.seculartherapy.org/) to see if there are people in your area. Also, some therapists will do sessions via video chat–I’ve a few therapist friends who do this, and a few friends who see their practitioner that way. It seems to work for them.

      -you could also possibly circumvent this by pointing out (if you’re comfortable) that you’re nonreligious in your opening email. Something like “I noticed you mentioned being able to practice therapy from a Christian orientation on your profile. I’m nonreligious/atheist/humanist. Do you think you’ll be able to work with me absent of discussions of religion?”

  2. says

    Interesting project. My thoughts are a little different from yours.

    Basing your choice on “[my specific issue]” assumes you can correctly identify what your issue is. In many cases, probably most cases in fact, clients don’t identify the issue correctly…and that’s part of the reason they need to see a therapist. So when you use your perception of the issue to choose a therapist, you risk choosing a therapist who will help to perpetuate your problem. People can get stuck in therapy for decades that way.

    Some of your other advice carries similar risks. What you think of as your preferences may be related to your problems in ways that you will only get to understand as therapy progresses. The stronger your preferences, the more likely they are to be related to your problems.

    Therapists who advertise multiple modalities may be “Jack of all trades and master of none”. In this UK practice we only advertise CBT. Even though many other modalities and techniques (even Rorscharch!) are occasionally available here as part of the mix, CBT is the overall approach. A therapist who doesn’t want to commit to any particular overall approach is either very confused or trying to make you confused.

    People who introspect and “self-CBT” are ideal candidates for real CBT. Their “self-CBT” is missing the point because there’s no therapeutic alliance with anyone. And any therapist who tries “stupid questions or silly roleplaying” is destroying the therapeutic alliance, so that’s not real CBT either.

    I agree with you that the therapeutic alliance, whether you click, is very important. It’s also very quick. Don’t give a therapist more than one session to click. If it doesn’t work, there’s no need to explain. A therapist who can’t do therapeutic alliance doesn’t deserve your explanations. Just don’t go back. (Try to recover the fee, too!)

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