How to Choose a Therapist

Wondering if you could use some therapy? Well, you probably could.

This doesn’t mean anything is wrong with you. Many people have a misunderstanding that being in therapy means you’re “crazy” or so weak-willed you can’t solve your own problems. Nothing could be farther from the truth.

Big problems are hard to solve on your own. Being in therapy means you’re smart enough to recognize you could benefit from the professional insight of another person.

What can therapy help with?

Anything and everything. But more specifically, problems with relationships (problems forming or maintaining relationships, repeating negative patterns in relationships, always falling for the wrong guy or gal, etc.), problems with self-esteem, problems with feeling stagnant or stuck in life, problems with work, problems with play, problems with anxiety or depression, problems coping with a major life transition (leaving home, getting married, parenthood, kids leaving home, retirement), problems dealing with loss (losing a job, death, divorce)…

The single most important factor in choosing a therapist

There are many different types of therapy (I will discuss them later), and it’s easy to get caught up in finding the “perfect” therapy or therapist with all the right credentials and experience. But do you know what studies have demonstrated is the most important factor is predicting how successful therapy is?

The most important factor in determining if therapy helps you is how much you like your therapist.

It’s not what type of therapy they’re doing, or how many years experience they have, or what degree they have, or anything else like that. These things can be important, but not as important as your rapport and relationships with the therapist. You don’t necessarily need to want to be their best friend (in fact, it’d be kind of weird if you did), but you should be able to trust them, you should feel they are competent, and you should respect them.

And the second most important factor? It’s how strongly your therapist believes he or she can help you.

Therefore, when choosing a therapist, do not settle for the first person you come across because of insurance or convenience or whatever else. Shop around. If you’re not sure after the first session, go to a couple more. If after three sessions you’re still not getting a great feeling, find someone else. They won’t take it personally.

Do not settle until you find a therapist whom you like and who instills confidence in you.

Now, there is one exception. Some people seek therapy because they have problems relating to others. Whatever problems you have in your interpersonal relationships will most certainly repeat themselves in your therapeutic relationship. Therefore if you tend to dislike and be judgmental toward everyone, you’ll probably dislike and be judgmental toward your therapist, too. Find someone who at the very least you believe is competent and stick with them, or you’ll be searching around for a long time.

How do I find a therapist and how do I pay for it?

Finding a therapist and cost issues can be inextricably related for many people. Therapy isn’t cheap (fees can range from $100-400+/hour, depending on the therapist’s credentials, years of experience, and what geographic area you’re in) and concerns about cost keep many people out of therapy. However, there are ways around the cost.

First, while most therapists don’t accept insurance, you could go directly through your insurance to find a list of ones that do. Be extremely prepared to shop around and go to a lot of first meetings with this approach because there is a huge variety of quality and competence of therapists out there.

Don’t have insurance or want to go to a therapist that doesn’t accept it? While rarely advertised, almost all therapists work on a sliding scale, and will be willing to decrease their fee if you explain that you can’t afford it. Some will slide more than others, but it doesn’t hurt to call up and ask.

Be tactful and polite with this approach, because the last thing you want is to come across as rude or obnoxious, which will quickly lead the therapist to suddenly no longer have room in their schedule to accommodate you.

A third option is to take advantage of therapists-in-training at academic institutions, who provide extremely discounted or free therapy. At UCLA, where I am a resident, there are dozens of extremely bright, compassionate and competent doctors who provide therapy for $25/session, or free if $25 is too expensive. You can also look for trainees in marriage and family therapy, social work, and psychology programs.

The downside of this approach is you will have a therapist with less experience. This is not necessarily a bad thing if the #1 important factor is met – that you like your therapist. However, do not under any circumstance settle for a a therapist that you don’t like and who you don’t feel is competent.

If you can afford it, I would try as much as possible NOT to make cost an issue. Like most things, you get what you pay for. An experienced therapist can accomplish quite a bit in a few sessions and you may find you don’t need years and years of expensive therapy to improve your situation.

Is cost not an issue? Great! I recommend asking around and getting a personal referral from a friend you trust. Many therapists also now have websites and you can also shop around and choose someone based on their website.

A quick note about degrees: Therapists tend to either be marriage and family therapists (MFT), social workers (LCSW), clinical psychologists (PsyD), research psychologists (PhD), or less commonly psychiatrists (MD). The latter three have more training than the former two.

Now, I’ve had a few therapists in my day and the best therapist I ever had was an MFT. I have nothing against MFTs or LCSWs, and have worked with many extremely talented mental health professionals with these degrees. However, the training to become an MFT or LCSW is shorter than to get a PsyD, PhD or to be a board-certified psychiatrist, and the training programs are typically less competitive. Just something to be aware of when you’re shopping around.

What type of therapy should I get?

While there are many different types of therapies, most therapists practice a “hodgepodge” approach combining techniques from several different therapeutic styles. This is perfectly find for most people. For general problems with life transitions, work issues, or relationship problems, the specific type of therapy you get is less important than your relationship with the therapist.

However, there are some general guidelines you can use to help point you in the right direction:

If your primary issue is an anxiety disorder like Social Anxiety, Generalized Anxiety Disorder, Post Traumatic Stress Disorder, or Obsessive Compulsive Disorder… try Cognitive Behavioral Therapy (CBT). You need a therapist who is experienced with helping patients face their fears, instead of just endlessly talking about them. This type of therapy is proven to reduce anxiety in a relatively short (often 3 month) period of time.

If you have been diagnosed with or think you have Borderline Personality Disorder… try Mentalization Based Therapy (MBT) or Dialectical Behavioral Therapy (DBT). You’ve got a big problem and you need an approach that’s designed for your specific issue.

If you like getting to the root of your issues and having lots of time and space to explore… try psychodynamic psychotherapy. Your therapist will dig into your past and help you understand how certain problems developed, so you can begin the process of untangling from bad habits.

If you have tried talk therapy before but found it too meandering and without direction… try CBT. CBT is a very goal-oriented, collaborative type of therapy.

If you’re depressed… try CBT, Interpersonal Therapy (IPT) or psychodynamic psychotherapy. All of them can help for depression. If you find one particular style doesn’t suit you, try another.

If you’re having a problem in your primary romantic relationship… try couples therapy. Sounds obvious, but many people assume couples therapy is reserved for couples in deep trouble. It’s not. I think it should be mandatory that everyone get couples therapy before getting married (maybe there’d be fewer divorces?)

Happy Therapy-ing! (Did I just make up that word?)

What about you? Considering therapy or had a positive or negative experience with therapy in the past? Let me know your thoughts in the comments.