So you have finally come to the point where you are ready to find a therapist for your mental health challenges. Good for you. The majority of adults dealing with a mental or behavioral health condition go untreated. Indeed, the overall utilization of psychotherapy is low (~10% for depression) despite the fact that it is proven to be effective and is actually preferred as a treatment modality. In addition, most people who seek psychotherapy give up after attending only one session. Finding the right therapist is thus extremely important to getting successful mental health care. So where do you begin your search for a therapist? There are a growing number of resources available online including therapist directories, reviews, and matching sites. However, as a starting point, you should consider the below factors.
Common factors that prevent most people from seeking therapy
Affordability- Over 90% of the U.S. population has health insurance coverage and due to the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, this coverage must include mental health care benefits on par with medical/surgical benefits. However, just as medical/surgical coverage varies widely across insurance plans, mental health care coverage also varies. There are often limits to the number of therapy sessions you can receive annually and the amount of co-pay also varies. In addition, the choice of therapist is often restricted to in-network providers. If this is your situation, you should consult your insurance plan provider directory and cross-reference potential therapists with online review sites. For those without coverage or those who prefer an out-of-network therapist, the costs typically are paid out-of-pocket. In these cases, the choice of therapists extends beyond those provided in-network and may only be limited by availability and accessibility.
Availability- Approximately 37% of the U.S. population lives in areas with a shortage of mental health care professionals. If you fall within one of these geographical regions, your choice of the therapist may be limited. A great solution for you could be the movement in teletherapy. A growing body of evidence supports teletherapy as an effective alternative to in-person therapy and the number of therapists providing teletherapeutic support has significantly increased due to the Covid-19 pandemic. Beyond general mental health care availability, the availability of a specific therapist is also a concern. The national average length of time between a client’s first outreach or referral until their first mental health or substance use appointment is 48 days. Addressing your mental health needs should be a priority, so choosing the right therapist should factor in their current availability.
Accessibility- While for some people, transportation issues prevent them from seeking therapeutic support, for many others the biggest incumbrance to mental health care is time. Therapy sessions may only be accessible during your working hours which might limit your ability to seek help. In addition, in-person sessions must factor in the additional time needed to commute to and from the session. If accessibility issues related to transportation or time are a concern, teletherapy may be the right option for you.
Stigma- Many people who want to seek help never do because of fears associated with the negative stigma surrounding mental health issues. In many cultures, mental health issues have traditionally been viewed as a sign of weakness. Thankfully, the prevailing culture in the U.S. is starting to shift to acceptance of mental health treatment. Celebrity athletes who exhibit mental strength in high-level performance and yet openly share their mental health challenges, accept their own need for psychotherapeutic interventions, and endorse mental health support for others have helped shift cultural attitudes on mental health. While cultural attitudes are shifting, many people still worry about what others will think of them if they seek therapy. If you share similar concerns that are preventing you from seeking the help you need, starting with discreet therapy sessions in the privacy of your own home may be the best solution for you.
Additional factors to consider when choosing a therapist
Specialization- In addition to considering the above factors, you should also consider the expertise of your therapist. Clinical psychology is a broad field with professionals that specialize in the treatment of specific diagnoses with the use of specific interventions. Are you one of the estimated 246 million people suffering from major depression worldwide or one of the 374 million suffering from an anxiety disorder? Or, perhaps you are looking for help with relationship issues, financial concerns, or work-related stress. Maybe your struggle is with less common diagnoses such as obsessive-compulsive disorder or schizophrenia. Whatever mental health issue you are dealing with, you should seek help from a therapist with the requisite expertise.
Evidence-based practice- The American Psychological Association endorses psychological treatments that are considered evidence-based or scientifically justified. In your search for the right therapist, ensure that they use evidence-based practices and measure treatment outcomes.
Credentials- Not all therapists have the same credentials, licenses, or level of education. In finding a therapist, you may want to consider their qualifications and the accreditation of their educational program.
How to determine if you have found the right therapist
The Therapeutic Alliance- After you have applied all of the above factors to narrow your search for a therapist, you will want to meet them and determine if they are the right fit for you. If you are already seeing a therapist, you will want to ensure that they are helping you achieve your treatment goals or mental wellness objectives. Beyond your own personal characteristics such as your willingness to change, the therapeutic or working alliance is the biggest predictor of treatment outcomes. This alliance is built around the development of a supportive relationship with your therapist that includes an agreement on goals and the assignment of tasks. Research indicates that an effective therapeutic alliance forms early in treatment, typically by the third therapy session. Ask yourself the following questions (adapted from the Session Alliance Inventory) after your third session with a new therapist or after your next session if you have already been seeing a therapist for more than three sessions:
Do you believe that your therapist appreciates and respects you and do you respect your therapist?
Are you in agreement on what you need to work on and are you working together on these goals?
Do you feel that your therapist cares about you even when you make poor decisions and engage in negative behavior?
Do you believe in the way that you are working together on your problems?
If you cannot answer “yes” to all of these questions then it is time to move on from your therapist. It is unlikely that your answers to these questions will change much through additional sessions so you should immediately search for a more compatible therapist.
About the author
Dr. Martin is the chief scientific officer for Alter Health Group and co-founder of Mindfuli, a virtual mental health platform that uses technology to enhance human connectedness and the delivery of mental health care.