Finding a good therapist - How to solve this problem thoughtfully and efficiently

by Tom Cloyd - 12 min. read - (reviewed 2023-02-18:2040 PT)

people in group therapy

Photo by Jason Goodman on Unsplash

 

The key to finding a good therapist is YOU - what you know about yourself, what you want to do about it, and how you act to bring about personal change.

While we cannot offer any “sure-fire” formula to solve this problem, there are things you can do that will probably help you significantly in your search.

Your quality of life is the central concern here, so it’s only sensible to proceed slowly and deliberately.

 

Contents of this page…

A good therapist is one who helps you get the changes you want in your life. It’s that simple. Finding that therapist may NOT be simple, however. To help you solve this problem, we discuss here some of the difficulties you will face, and some ways people we know have found to work through these challenges.

The following challenges can make finding and engaging an effective therapist difficult. Each requires different approaches if they are to be well managed.

Challenge #1 - the difficulty of the problem being taken up, as measured roughly by the number of previous, failed attempts to solve it; or by the seriousness of its impact in daily life; or by how early in one’s life the problem was evident - earlier onset often leads to harder problems.

DEAL WITH THIS BY adjusting your expectations about how quickly you’ll get results in therapy, and to what degree. Reasonable, ealistic expectations are easier to live with. More difficult problems usually take longer to treat, and the outcomes may well be more moderate than with less difficult problems. To adjust your expectations intelligently may require consultation with an experienced expert.

Challenge #2 - the presence of active compulsive behaviors. This usually takes the form of habitual and uncontrollable use of alcohol, drugs (street or prescription), or any other substance (including food), or behavior, engagement in which significantly compromises important areas of life (family, friends, work, leisure, self-esteem).

Some therapists will treat people who have simultaneous (“dual”) mental health and compulsive behavior problems; some won’t. Virtually all will require evidence of active, productive work to resolve the compulsivity, as such factors can make mental health treatment rather difficult.

DEAL WITH THIS by entering into active treatment for the compulsive behavior, and by seeking out a therapist who is comfortable working with such dual problems.

Challenge #3 - financial resource limitations. Limited finances can result in limited access to treatment. In addition, many health promotion or health care payment organizations are more willing to pay for physical care or medications than they are for mental health care.

DEAL WITH THIS by being prepared to advocate for active mental health treatment, when it’s needed, and by seeking out qualified therapists who employ a sliding fee scale. If you simply have not the funds for a therapist, seek one out anyway - preferably during non-peak season periods (see section immediately below concerning this problem) and ask directly if the therapist would be willing to take you on “pro bono” - i.e., for no fee. As with other professions, there is an ethical commitment in professional mental to provide a certain amount of pro bono care. You risk nothing by asking if it is possible for you.

Challenge #4 - restricted availability due to time of year of appropriate mental health professionals. There does tend to be a distinct seasonality in availability of mental health professionals.

The most challenging time of year to seek help is the period from late January through the emergence of spring. This is due to the higher numbers of people typically seeking help during the dark days of winter. Two other less challenging times are the periods beginning about three weeks after school lets out for the summer, and three weeks after it begins in the fall.

DEAL WITH THIS by responding early to felt needs for help, if at all possible. If you are looking for help during peak demand periods, get on waiting lists, use emergency hotlines for immediate help when you need it, and practice optimuum self-care whil patiently waiting for your turn to come up, as it will eventually.

Challenge #5 - restricted availability due to geographical constraints. There is little question that health care of all sorts is more diverse and more available in urban than in rural areas, worldwide. Beyond this, urban areas differ significantly. Truly large urban areas will tend to offer almost all sorts of care, and the presence of one or more training resources (usually university-based) in a region will tend to increase the density and quality of care options. Also, significant areas of the country lack sufficient numbers of psychiatrists. Others lack adequate numbers of specialists, especially for children, adolescents, and minority groups.

DEAL WITH THIS by assessing your geographical situation, and adopting realistic expectations from the beginning. Some individuals may have to plan long drives to get to treatment, and to plan on doing two treatment sessions in one day. Some may even want to stay in an area for a series of days, focusing on intensive psychotherapy, until major progress is accomplished. Some therapists will see a client twice a day for a week, when there is no other option. Flexible thinking by both client and therapist will usually resolve these sorts of geographical problems.

Other resource limitations. Lack of access to transportation, or to child care, or limited hours available for access to treatment - all of these can constrain one’s choices.

DEAL WITH THIS by becoming clear about your priorities, and by asking for help and advice from professionals, case managers, family, friends, etc., about particular solutions to your individual problem.

Decide on the financial investment and ancillary support resources you will need. Decide also what you can afford, per session, and for the whole treatment period. Finally, think about the support costs you are willing to bear (transportation time and cost, total weekly time out of your schedule, and so on). Write all this down, so that you don’t have to rethink any of it.

Think carefully about the kind of professional who can best serve you. Some disorders will probably require some degree of involvement with a psychiatrist. Among these are the neurodevelopmental disorders - including autism, ADHD, and learning disorders), schizophrenia, bipolar disorder, moderate to severe depression, and obsessive-compulsive disorder.

Non-medical mental health professionals vary from Masters-level psychotherapists (including psychologists, social workers, and some psychiatric nurses) to specialist PhD psychologists. Most psychotherapy is done by Masters-level professionals.

Locate therapists to consider, using referrals from other health care professionals who serve you, directories made available by professional organizations, or friends. Several studies have shown that there is little correlation between kind or level of degree and licensure and the outcomes of treatment, although one might expect that there could be such a relationship. Much more important is history of success in treating the problem of interest to you. At this stage, you should be open to many different sorts of providers, as long as they all offer psychotherapy.

To locate therapist prospects, consider any of these respected online databases:

  • Psychology Today therapist directory - probably the largest such directory, with listings grouped by state, city and zip code, as well as having separate listings for online therapists, psychiatrists, and treatment centers.

  • National Board for Certified Counselors dataabase - NBCC counselors pass a national certification exam to qualify for this database. (Most counselors are not NBCC certified, but listings in this database may not be in other databases.)

  • EMDR Institute therapist directory - Counselors in this database have been trained by the Institute that originated the best-validated trauma treatment model in existence. They may be located by region, as with other databases. (Listings here are limited - see this note1 for more on this.)

  • EMDRIA Therapist Directory - Counselors in this database are fully EMDR trained and are members of the EMDR International Association, which is a primary source for training and continuing education of trauma therapists.

  • ISSTD Find-A-Therapist directory - In theory, this should be a good place to locate a dissociative disorders specialist. In actuality, this directory probably works best in the largest cities and states, because membership in ISSTD most certainly does not include many therapists who work with dissociative disorders. In addition, a significant number of directory members are not therapists at all. Still, this resource should not be overlooked, as it is a valid source of people with serious commitments to working in this field.

Finally, do consider a straightforward search-engine search for what you’re looking for. The string of search terms you use is critical. Here is an example search string you can adapt for your situation:

“psychotherapist trauma depression addiction anxiety {your region - enclose in quotes, if you need to use more than one word} insurance (use this term with caution - not all therapists accept insurance, although most will accept direct cash payments)”

Example: if I were looking for a trauma therapist trained in EMDR in the Spokane, Washington region, I might use these search terms”

trauma psychotherapist EMDR Spokane

Most important to specify is “psychotherapist” plus your problem type and region.

This is by far the quickest, and least expensive, way to do this. Call each person on the list and find out more about them. Take careful notes, thank them, then call the next person on your list. Make no decisions until you’ve called all persons on the list. Inquire about their success with your sort of problem. Do not be misled by considerations of how likeable you think someone is - that is a rather useless quality. Focus on the question of their likelihood to be effective for you. Consider the degree to which they seem serious, intelligent, experienced, attentive, committed, and eager to help.

Here’s a general checklist for your telephone calls to potential therapists:

  • Credentials: What are their credentials? Do they have any specialized training relevant to your problem?
  • Years in practice: Skill in most health care professions tends to rise to its highest levels after about a decade of practice. (Costs do as well, so don’t go after more skill than you really need.)
  • Experience: For more difficult problems (see this note2, for more on this), it is probably best to look for a professional who has at least a couple of years of experience using your chosen mode of therapy (if you have a preference) with the sort of problem you’ll be bringing to them. Inquire also about the major focus of their practice. Some professionals profess expertise in a group of areas, while others specialize more narrowly.problem
  • Success: Ask about the success they’ve had with problems such as yours. Look for an answer that sounds realistic, yet promising. It’s ideal if someone you know has had success with a particular therapist, you’ll do well still to ask the therapist about their success. Be wary of someone who reports poor results (although you should check to see if this might be due to the nature of the problem you’re bringing with them - some problems are particularly difficult). Be wary, too, of someone who reports overly good results. After talking with several professionals about this matter of expected success, you’ll be in a better position to evaluate the answer of any one person to whom you speak.
  • Availability: Do they have immediate openings, or do they have a waiting list? Do they have openings on a day and at a time that works for you?
  • Payment: What are their fees? What kinds of payment do they accept? Can you afford at least 12 sessions? (This is a very rough average length-of-treatment for a moderately serious problem.) Do they have a sliding fee scale (if you have limited income)? Do they take pro bono (no-fee) clients?
  • Other costs: An otherwise perfect therapist may be unaffordable to you if costs of access, including time costs, exceed your resources, so note estimates of these costs as well, as you talk with each candidate.

Important tip: If a therapist you speak with has no opennings, get on their waiting list AND ask them for the names of any other local therapists they would like to recommend. This is a great way to add names to your call list and you should always do it!

Keep your notes on all the others, in case your pick doesn’t work out. The main challenge at this point is to consider ALL the information you’ve gathered. People tend to throw away information just to make a problem simpler. Try not to do that. Pick what looks to you like a good bet, but know that your ability to know how good a choice you’ve made is still rather limited until you’ve worked with your “pick” for a while.

This is, in many ways, the most critical part of the process. Remember that your purpose is to get results. Work hard to be clear about the results you want, and to communicate this to your therapist. Listen carefully to their reactions, including any offers they make about modifying your goals. They may well suggest goals you had not thought of, or suggest that you modify your goals a bit. Active, thoughtful consultation at this point will pay off later.

There can be many distractions in this work. You’re the customer and it’s your primary responsibility to see that you get results, so pay attention to what happens in your therapy! Work with your therapist to have goals that are as well defined as you can make them, then check back periodically to see is you’re getting closer to where you want to be.

  • When results are obtained, seek to understand what produced them. This is important information.
  • If you’re not getting results, first of all talk over the matter with your therapist, and if things don’t change, find another therapist.
  • Be realistic: some types of problems are simply very difficult. Every therapist - even the famous ones - have conspicuous failures. None of us are happy about this, but it’s a fact. Generally, if you want to get better, work hard, exercise your full intelligence in relation to your treatment, and have a skillful, knowledgeable therapist, you WILL get better. Statistically, we therapists, on average, get distinctly better results than do physicians. It is reasonable for you to expect to get a distinct improvement.

In mental health treatment, as with any other form of health care, are what matter most. Yest, as physicians know, people’s treatment outcomes can only be predicted up to a certain level. Beyond that, factors we cannot (yet) control or even know determine the results of our efforts. It is the same in mental health care.

Just make sure you do your part, with all the intelligence and energy you possess, both in choosing and in working with a therapist, and you then can know you have done all you could do. Usually, the results will be a real improvement in your situation.

  1. Quality EMDR training is offered by sources in addition to the EMDR Institute and EMDRIA. Individuals graduating from such sources will likely not be listed in either of these directories and must be found by other means. ^

  2. In truth, most trauma problems and all dissociative disorder problems belong to the “more difficult” category”. Consider your problem to be in this “more difficult” category if: a) you have experienced more than one trauma, or b) your trauma occurred before the age of about 12, or c) you have large gaps in your adult memory, or d) you have strong shifts in your sense of who you think you are. ^

 

☀   ☀   ☀