How to Choose a Therapist: Factors you should keep in mind when selecting a therapist

1. Competence and Credentials

Make certain that the therapist you consider is licensed to practice mental health counseling and has both experience in treating the kind of problems or issues you are facing and is regarded (by the therapist, by you, or by the licensing board) as competent to treat the particular concerns you bring.  For example, some therapists treat children, some don’t, and of those who treat children, some but not all work with developmental disorders such as autism.  You simply need to inquire whether the therapist has much experience treating the problem, and is competent to do so.   Some licensing boards define what kinds of services or populations [called competencies] a therapist is “credentialed” to provide, but many do not.  You should ask about the therapist’s education, license, and whether or not he or she is able to treat (i.e., is competent to treat) the particular kinds of problems for which you are seeking help.  If you have been guided to the therapists you are considering by a triage person (or phone screener) at an insurance company, it is likely the therapists’ backgrounds and competencies have already been considered prior to your being given their names.  In any case, you must ask questions yourself to be sure.

 

The therapist’s discipline (e.g., psychologist, social worker) and educational level (Masters or Doctorate) may matter to you.   Whether the therapist is a clinical nurse, a social worker, a licensed marriage and family therapist, a psychologist, a minister, etc. probably does not actually matter a great deal, unless you are looking for a very specific service such as psychological testing.  Much of the research on positive outcomes in therapy indicate that therapists who are well trained and consistent in their methods produce the best results, and that their educational level or discipline matters very little.  Also, research indicates that positive results are associated with whether or not a good rapport or positive impression (e.g., if the client feels comfortable with the therapist) is created early on.  To put it simply, if after the first inquiry by phone or the first face to face visit with the therapist you do not feel that you want to see him or her for services, I would suggest you move on to another therapist.  If you feel a positive connection with the therapist at the beginning, that is a good sign.

2. Treatment Methods

Therapists come in many varieties. The therapist’s treatment orientation may range across a broad spectrum of methods and approaches. You have probably heard of some of these: behavioral therapy, problem-solving therapy, crisis intervention, imago therapy, cognitive-behavioral therapy, narrative therapy, dialectical behavior therapy, solution-oriented therapy, brief dynamic psychotherapy, strategic family therapy, eye movement desensitization reprogramming, hypnosis, schema therapy, psychoanalytic psychotherapy - and that’s a partial list. Sometimes therapists become so enamored of or so tightly affiliated with one particular approach that they call themselves a “(fill in the blank) therapist”. In fact, research on therapy outcomes suggests: most therapists practice a wide variety of methods (are “eclectic”), and the best outcomes are associated with skilled, consistent application of whatever method the therapist uses. The therapy offered should fit the needs of the client; the client should not simply be subjected to whatever therapeutic approach the therapist prefers. As a prospective client, if you have a particular approach to therapy that you are seeking, by all means look for a therapist with that kind of practice orientation. However, if your main concern rests with getting good quality treatment, you may simply need to make certain you are considering an experienced, knowledgeable, competent therapist.

3. Location

Convenience matters. You will probably find it simplest to seek out a qualified therapist who practices near where you work or live. Your phone book can help you narrow down the choices, or you may have friends or associates who have had a good experience with a therapist geographically close to you. Insurance companies also maintain provider directories and extensive databases that can help you limit your search to a vicinity near you.

4. Cost

In an ideal world, you would not have to struggle with the question of whether or not you can afford needed therapy services. The services of psychotherapists, like other professionals, are often expensive. Those with insurance coverage for behavioral health treatment can usually obtain needed counseling or other services by making only a small co-payment. For those without health coverage, services must often be sought through an agency or other resource where services are subsidized, or a sliding fee scale is available. Inquire whether the therapist you are considering is covered by your health insurance as an in-network, or out-of-network provider. Benefit limits will determine how many therapy sessions are allowed, although in some cases additional sessions can be authorized. If you do not have coverage for counseling services, or if you wish to seek help without involving your insurance company, ask up front what the therapist’s fees are, and whether a sliding fee scale based on income is offered.

5. Gender

You may wish to see a male or female therapist, or someone with a particular stripe: an older or younger therapist, a therapist who has a spiritual orientation, a gay therapist, a therapist who has experience with diabetes, etc. Any of these may be important considerations. Gender of therapist may or may not matter to you, and I believe you should simply make a determination based on whether you would feel a great deal more comfortable with a male, or a female, therapist. Typically, gender does not much matter. Again, competence and skill matter more. Still, a strong preference may be worth pursuing. Women who have been traumatized by men tend to have more productive experiences with female therapists; men who have anger issues with women probably would do best to see a male therapist. There are exceptions, of course. Generally, if you are able to trust the therapist, and believe you will be properly understood by the therapist, you should select a therapist based on whatever gender you prefer.

6. Be Picky; You're the Consumer

Therapy experiences can be life-changing encounters, whether brief or extending over months or years. Choose carefully, but do not hesitate to go the extra mile before you decide to work with one particular therapist. Set up an initial appointment with any therapist you are considering and see how you feel afterwards.  Some therapists offer a brief consultation at no cost, to help determine whether there is a good “fit” between you.  In any case, I suggest you not hesitate to ask pointed questions such as, “Do you think we are a good match?”;  “If we decide to work together, what positive things would you expect for me?”; and “Do you see any things that might make working together difficult?” If you and the therapist don’t seem to have a natural affinity for working together, consider other therapists.

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© Douglas Drew