How to Choose the Right Therapist

The Covid-19 pandemic has led to a dramatic rise in the number of Americans needing mental health treatment. Seeking out treatment can be a complicated and often frustrating process. Many begin by speaking with their primary care physician (PCP) about various treatment options and may come away with a therapy referral or more commonly, a prescription for an antidepressant or anti-anxiety medication. Studies show that when PCPs integrate care with a mental health professional, it leads to better outcomes. It's important to speak with your PCP about how they integrate their care.

If you are considering going into therapy, how do you decide between an MD/DO, NP, CSW, PhD, PsyD or MFT? All of them can be psychotherapists but there are real differences you should know about.

Making sense of designations.

Psychiatrists are medical doctors, either MD or DO (Doctor of Osteopathy), specializing in the diagnosis and treatment of mental illness. You should consider a consultation if you are experiencing any of the following conditions:

1. Severe depression with suicidal thoughts
2. Severe symptoms of post-traumatic stress (PTSD)
3. Bipolar mania or severe mood swings
4. Psychotic symptoms such as delusions, hallucinations
5. Difficulty managing anger, violent behavior
6. Severe substance abuse
7. Having a complicated medical-psychiatric condition such as diabetes or chronic pain coupled with depression
8. Advancing dementia

They can provide an accurate diagnosis, therapy and medication when necessary and collaborate with your PCP and therapist. (Psychiatric NPs-Nurse Practitioners can also provide a diagnostic evaluation and medication and often work alongside psychiatrists or alone in private practice).

Of all the therapists, psychologists (PhD, PsyD) have the most extensive graduate training, and while they are therapists, they can also provide psychological testing for developmental disabilities, dementia, ADD (Attention Deficit Disorder) and other conditions when help is required to clarify the diagnosis.

Licensed Clinical Social Workers (LCSW) have a master’s degree and usually advanced training in psychotherapy. They have special expertise in navigating the social services system and can often serve as case managers.

Finally, Marital and Family Therapists (MFTs) have a master’s degree and are trained primarily to provide couples, marital and family counseling. However, with special training, all of the above can also provide group, family and couples/marital therapy.

What type of therapy is best for me?

One very influential yet controversial study performed by Consumer Reports (1995) concluded that all psychotherapists could be effective in producing positive results regardless of the type of therapy they used.

However, some short-term therapies like Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy are proven to be as effective as medication with lower relapse rates for the treatment of anxiety disorders and depression. Even though there aren’t as many efficacy studies done on psychoanalytic therapy, which tends to be a longer-term therapy, this may be more effective for you depending on your condition.

There are also many body-centered psychotherapies that work effectively with trauma, such as Peter Levine’s Somatic Experiencing. Many other well-tested therapies that can be used in a variety of conditions include CBT/Mindfulness, EMDR for trauma, hypnosis and biofeedback. In reality, most therapists are trained to use an “eclectic” approach that combines several methods and they will tailor the therapy to meet your needs.

So what’s the best way to find a good therapist?

Source: Alex Green/Pexels

A very common and effective way to seek out a reputable therapist is to get a referral from a friend or family member. Reaching out to a loved one is an important first step in beginning to overcome the stigma still associated with mental illness.

Another common way is for your PCP to provide you with a few names that participate with your insurance plan. This is very important because your out-of-pocket expenses will be much lower when you use an “in-network” therapist. You need to double-check with that therapist and your insurance company to confirm your benefits and to make sure the therapist is still in-network. Insurance companies provide an online list of therapists that participate with your plan. However, be careful as these lists can be found to be unreliable because they include names of therapists who are no longer with the plan. Insurance issues have been found in many studies to lead to delays in treatment and worse outcomes.

Psychology Today provides an excellent online search engine with bios to help you find a therapist in your area. In addition, you can check with a local psychiatry department at a medical school/university hospital for a referral.

While waiting to be seen, you should make sure that you are living a healthy lifestyle by eating right, exercising, practicing stress reduction and reducing or stopping your alcohol and substance use. On its own, this has been shown to greatly improve mental health.

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In summary, there are significant hurdles to overcome in trying to gain access to mental health treatment, but tackling these upfront will ensure a greater likelihood of success.

Once an appointment is made:

It is normal to feel apprehensive about meeting your therapist for the first time. Many therapists will offer a free initial consultation to gauge whether there is a good fit.

Be sure to ask yourself and/or the therapist the following questions in order to make the right choice:

1. Do I feel comfortable opening up to this person and is there a strong connection? Studies show that this is essential to achieving success in any therapy.
2. Is the therapist empathic and a good listener?
3. Does the therapist seem to have an agenda? Are they trying to have you commit too soon to a schedule before accurately assessing your motivation and the range of options that are available?
4. What are their credentials and level of expertise and have they treated many others with your particular condition?
5. What types of therapy do they offer? They should be able to explain why one type is better than another for your particular condition.
6. How do they manage the fee/billing and do they offer a sliding scale?
7. How do they collaborate with your psychiatrist or PCP as this will greatly improve the quality of care.
8. Do they offer evening and weekends hours and what is the recommended frequency of sessions?
9. Finally, what are the agreed-upon goals and endpoints for therapy?

What to expect during treatment and how to decide when to stop:

1. It is normal to feel worse before feeling better because everything is being brought to the surface. You may feel as though you want to quit but don’t without first discussing this with your therapist.
2. You may experience many positive and negative feelings towards your therapist, which is called “transference.” These are feelings you have for other significant people in your life that are transferred onto the therapist. This is quite common and needs to be discussed as this can lead to you wanting to stop therapy. Understanding this can lead to real progress within your therapy.
3. With some forms of therapy (like CBT) you will be expected to do homework such as journaling, keeping logs/diaries or doing relaxation exercises. If you’re not doing the homework, the therapist should explore your resistance. Understanding and tackling resistance is the key to improving in any therapy.
4. The goal of any therapy is to gain insight into one's self, relationships, and condition. It’s also to have the ability to cope better with your anger/depression and anxiety, to improve self-care and to utilize prevention strategies to prevent a relapse.
5. You should work with your mental health team to successfully taper off psychiatric medications if and when possible. Do not try to do this on your own as there can be adverse reactions.
6. Once you and your therapist feel that you have reached most of your goals, begin to discuss ending therapy. You should also ask your friends/family to weigh in when appropriate to get their perspective on how they think you’re doing.
7. Remember that progress often continues even after therapy has been discontinued.

Overall, navigating the mental health system can be overwhelming and frustrating, and as a result, many are put off getting the help they need. Remember, help is always available, and never give up because nowadays most mental illnesses can be successfully treated.

To find a therapist, please visit the Psychology Today Therapy Directory.