Lessons From The Couch, About The Couch: How to find a really good, effective therapist. (Or better yet, where’s that darn needle in this haystack)?

This is the second entry in my series entitled, “Lessons From The Couch, About the Couch.”  As we are on the cusp of Mental Health Awareness Month (May, annually), and with the advent of spring, what better way to set yourself up for a new beginning than to set yourself on a path to a New You?  The road to this novelty, for many, begins with psychotherapy. But finding a good therapist can itself be a barrier to seeking services; particularly for people of color.

Finding a good therapist is hard. While therapists abound, (and to be perfectly honest, at times it feels like there’s one every corner), we differ in style, therapeutic   and level of training, treatment paradigms, skill sets, and of course fees.  Here are my tips, from the couch; both as a therapist and having served at times as a client. Here are some things to look for and to be aware of when trying to find a therapist:

  1. Know who you are going to, and what they can offer:  There are various types of mental health professionals, and they each vary in terms of education and training, expertise, and types of professional services they can provide.  Understanding these differences is key.  For example, psychiatrists are licensed medical doctors (MDs) who specialize in the diagnosis and pharmacological treatment of mental disorders. In others words, they can write prescriptions and administer certain types of medical treatments that must be performed by a physician (like ECT). Most psychiatrists only do diagnosis and medication treatment and management; NOT psychotherapy.  Psychologists have either a Ph.D. (doctorate of philosophy) in psychology; this is an academic degree with an emphasis on both clinical skills and research on mental disorders and  psychotherapy, OR a Psy.D. (a doctorate of psychology). The latter is a relatively new professional degree with an emphasis on clinical training; research — not so much.  Many clinical and counseling psychologists directly practice psychotherapy, but we are all trained to do psychotherapy.  Social workers are master’s level practitioners whose training is really more so on the welfare and community services available to families, groups and individuals. Clinical social workers are trained specifically in psychotherapy and the diagnosis and treatment of mental disorders, as are licensed professional counselors (LPCs), another type of master’s level clinician. However, the latter 2 categories have half, if not less than half of the years of clinical training and education than psychologists or psychiatrists; that said, there are many kick-ass, clinically astute social workers. So decide which clinician might be best based upon your issue(s) and potential treatment needs.
  2. Search for a therapist like you search for a babysitter (the parents know what I mean!):  This is a serious matter. You wouldn’t let just anyone care for your kid; do you really wanna just let anyone care for your mind? So here I  appeal to the consumer in each of you, and I encourage the consumer of psychotherapy to take this bull by the horns! Research finding a potential therapist just like you would a babysitter. Be meticulous and detail-oriented in your search. Your therapist should be vetted. This could mean getting recommendations from trusted friends or family members (yes, many of them might currently be in therapy or have been in the past, and may be willing to share resources and experiences).  You can read the online profiles on the therapist’s website, their profile on your health insurer’s website, or on any of the major psychotherapy referral services. This will give you a feel for his or her educational and professional background, areas of specialization, style, etc.  And last, call and engage the therapist you are considering in a brief discussion. Interview the therapist and ask important questions such as how long he or she has been practicing, how many cases of (depression, anxiety or whatever your issue is) has the therapist seen, etc. Get a vibe, and then think about the conversation you just had. Did you feel rushed? Did you feel heard? Were you given an opportunity to ask questions and were your questions answered? This will give you some indicator of therapist professionalism, demeanor, and style.  And this might likely give you some understanding of whether or not this is the person for you.
  3. Use your available resources to find a therapist:  Your medical doctor likely has a vast network of both medical and mental health professionals, and could therefore be a good resource to tap into (especially if you like your doctor, respect his or her professional recommendations, and have developed a good relationship with your physician).  Second, many churches also have direct links to community-based providers or Christian counseling practices. Another untapped resource is the state! Our tax dollars paid to the state go towards vetting, licensing, and regulating the practice of mental health practitioners. Every state has a board of psychologists, social workers, and/or counselors that has a public website whereby you can search for a specific provider, search the status of his/her license, and learn whether there are any active ethical complaints or malpractice suits against that person. I strongly encourage this type of search be done on any potential therapist you are considering employing.
  4. Assess your needs and choose accordingly:  Do you need someone to see your child? Are you looking for a couple’s counselor? Are you a Christian and only wish to see a Christian counselor? Do you think you would feel more comfortable with someone who is of the same cultural background? Did you have previous therapeutic success with a certain type of therapy or intervention? These are all important questions that should absolutely drive your selection of a therapist.  Find someone who has the expertise, years of experience, and training in the area that you are presenting with. For example, if I am a veteran with a diagnosis of PTSD, but I want to see someone outside of the VA system, then I would look for people who are certified in trauma treatment, and who have experience treating veterans and/or those with PTSD. If I need someone to see my child, then I want someone who has vast educational training and experience and perhaps special credentials in working with children (i.e. board certified in child/adolescent psychiatry).
  5. Trust your gut: All too often, we Monday morning quarterback the situation that ensued when we didn’t listen to our initial gut feeling about a situation. The minute a therapist says or does something that makes you feel uncomfortable or fearful, or makes you question his or her ethics, or does not answer your basic questions, it’s time to switch. Now keep in mind, you should feel uncomfortable in therapy — if it is all roses, if you are only hearing what you want to hear, then nine times out of ten you are not being totally open and forthright in the sessions. However, what you should not feel is whether or not this is ‘right,’ sexually hit on, disrespected, or any of those emotions. The therapists office, and demeanor, should communicate safety and compassion. If that doesn’t exist, trust your gut.

Where to look:  Last, there are a number of free referral services that exist solely to help consumers to find local mental health providers in their area, that take their insurance, and which list specific areas of expertise. http://www.PsychologyToday.com and http://www.GoodTherapy.org are the two largest ones that millions of people turn to.  Second, each state’s psychological association has a referral list on their website. Google your state’s psychological association and start there. And lastly, your health insurer’s website will also list in-network providers, by specialty.  However, also keep in mind that you can also pay for you mental health treatment out of pocket, which allows you to be the driver and to be open to see whomever you choose. Flexible healthcare spending accounts can reimburse you; just make sure the therapist provides you with the appropriate documentation. You can also seek reimbursement through your insurer, however, check first to ensure that out-of-network mental health benefits are reimbursed — and at what percentage.

I really hope this helps to demystify the ofttimes gargantuan task of finding a good therapist. And I wish each of you the very best in your quest to change. The more of us that really do the work on ourselves, the better off the world will be.

Be well,

The Good Dr. Nik


Dr. Nik is a DMV-based Clinical Psychologist, prolific blogger, speaker, media commentator and compassionate activist. For more information about her services, go to http://www.TheGoodDrNik.Com, and follow her @theGoodDrNik on FB, Twitter, and Instagram.


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