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The Daunting Task of Choosing a Therapist

But does it really have to be so daunting? No! And I can help you with that. Your relationship with your therapist will certainly be more intimate than your relationship with almost any other health professional and has often been compared to selecting a romantic partner, or what I find more palatable, forming a close friendship. The big difference with a therapist versus a romantic partner or friend is that there are professional boundaries, and with that, you don't have to worry about hurting anyone's feelings if it doesn't feel like it's working out. The therapeutic relationship between therapist and client is one of the biggest indicators of whether or not treatment will be successful. It is imperative for you, the client, to feel comfortable with your therapist. Over the years, I have found that clients who are in a group with me, but have a different individual therapist, are often uncomfortable with the idea of giving their therapist feedback or sharing that they would like to work with a different therapist. This often results in unproductive treatment, and after some time, the client eventually terminates treatment without meeting their goals. In this article, I will cover the basics of what to consider when choosing a therapist and what to do if you feel like it's not working out.


Where to Start

Okay. So you've decided it's time to finally get into therapy, but you have no clue where to find a therapist. Like everything else in life, the therapy world has become much more accessible on the Internet. There are three main ways to use the Internet to find a therapist: regular search engines like Google for location/specialty based therapists; therapist search engine websites like Mental Health Match and PsychologyToday; and therapy network platforms such as Headway, Alma, and Octave. In addition, you can find therapists by going through your insurance provider and getting a list of therapists that are accepting new clients near you or via telehealth. The cost of treatment often determines how people are going to search for a therapist.


Investment

Does anyone else sometimes roll their eyes when they see the word "investment" on a website when they are looking for prices? Yeah, me too, but really, when you think about it, therapy is absolutely an investment. An investment in your health, your marriage, your family. Regardless of how you pay for it, you are investing in self care. Most of us do that in a variety of ways anyways, gym membership, massage, healthy food, etc. Don't skimp on your mental health because whether you like it or not, you have feelings and stressors and they impact you and the way that you interact with the world around you.


Therapy services have a wide range of costs. Some unlicensed folks or groups that are focused on providing accessible services to all offer treatment starting as low as $60 per session for those with income challenges. Highly specialized therapists with a very specific niche have been known to charge as much as $350 per session. Copays and coinsurances range from $0 to $50 or more depending on your coverage. The median cash rate in California for master's level therapists providing individual therapy seems to be hovering around $120 per session. If specialty, a comfortable fit, or a "warm referral" (getting a recommendation from someone you know) is the most important part of finding a therapist for you, you may find that paying cash will be the easiest way to meet your needs. If your budget is limited and you can't find any groups or individuals that either provide low cost services or have a sliding scale (fee based off your income), then you may want to use your insurance.


The Pros and Cons of Using Insurance

Historically, unless they are part of a group, many therapists have avoided taking insurance due to how lengthy and demanding the paneling process is; how time consuming and meticulous medical billing can be; and how low the insurance reimbursement rates for therapists are. This has been one of the biggest disadvantages of using insurance to seek therapy, as not enough therapists take insurance because of the problems described above. Also, when you get a list of therapists from your insurance provider, there is often no picture; no information about experience or speciality; and therefore no way to get a feel for who might be a good fit unless you set up a consultation phone call with each provider on the list, which can be quite time consuming and defeating. Thankfully, two of our three internet search methods solve that problem.


Companies like Headway, Alma, and Octave have made it easy for therapists to get paneled with insurances and start seeing clients who otherwise can't afford cash pay therapy. On these websites, as well as therapist search engines like Mental Health Match and PsychologyToday, consumers can search for therapists using multiple filters including insurance type. On all of these platforms, therapists generally have a photo and a profile with information about the services they provide. Consumers can pick a few who feel like a good fit and reach out to see if availability lines up and schedule a consultation. If you just want to be assigned to any therapist ASAP, you can usually get a list of therapists or practice groups from you insurance providers and just go with whoever has the first opening.


Location/Specialty Based

Lastly, you can use Google for location based services, or to find a therapist that specializes in something specific. For either scenario, you can simply enter your search such as "therapist near me" or "therapist for highly sensitive people," and review results. The location based results will likely include some therapists who don't have a website, similar to the insurance search mentioned above and you will have to call to set up a consultation to gather more information. Therapists found in either of these searches who do have websites will often list insurances accepted on their site, as well as their cash rate.


LCSWs, MFTs, LPCCs, PsyD, Alphabet Soup, Oh My!

So you've got a list, or narrowed it down to a couple and everyone has all of these letters behind their names. What do they stand for and why does it matter? We will cover the basics here; there are many acronyms that are earned for specialties and additional certifications that will not be covered in this article. Be aware that private practitioners have to have their credentials and licensure number posted on their website in the state of California. There are three potential reasons why a therapist would not have their license designation and number on their website: they are not practicing in California; their website simply isn't compliant with legal requirements; or they aren't actually a therapist. Every therapist has to have a bachelor's degree. Every therapist has to have a master's degree. Some go on to get a PhD or similar. What do you need in a therapist and how do you tell who has what? So let's start from the top down.


Medical Professionals

Psychiatrists (MD that specifically treats mental illness) and Psychiatric Mental Health Nurse Practitioners (PMHNPs) are the only mental health-specific practitioners in the state of California that can prescribe medication. Therapy training of PHMNPs is out of the scope of this post and will not be addressed any further. Psychiatrists have therapy training; however, in my experience, due to the shortage of psychiatrists and how difficult they can be to access, they often do not have time to provide regular therapy treatment and typically focus on medication treatment. If you have found a psychiatrist that incorporates talk therapy into your treatment and they see you regularly enough for you to be making progress toward goals and feel supported, hold on to that gem for dear life!


Psychologists

Psychologists are PhD level practitioners and often get a PsyD degree if they plan to work in treatment settings. Psychologists who obtain a traditional PhD in psychology typically intend to spend their career pursuing research and academia. So, when you want to see a Psychologist as a therapist, you will find individuals who have PsyD after their names. Psychologists are regulated by the Board of Psychology in the state of California and have various requirements they must meet and complete to be an independently licensed practitioner. We will cover licensing in more detail in the next section. Psychologists can complete psychological testing and are able to diagnose a wide range of mental health disorders. School psychologists have additional areas of focus that will not be covered in this article, but depending on their place of employment, are often available to provide individual therapy to K-12 students at their school. The average individual seeking therapy generally does not need psychological testing, although it can be beneficial for certain situations in which differentiating a diagnosis is difficult or documentation of a diagnosis is needed. Psychologists have more extensive training than the next set of therapists that will be discussed and therefore often charge more per session.


LCSWs, LMFTs & LPCCs

Master's level therapists come in the form of Licensed Clinical Social Workers (LCSW), Licensed Marriage and Family Therapists (LMFT), and Licensed Professional Clinical Counselors (LPCC). All of these therapists are regulated by the Board of Behavioral Sciences in California. The difference between these three largely comes down to university requirements; internship hour requirements; and graduate program focuses and is all very nuanced. LCSWs have more training in macro practices such as advocacy work; community organizing; lobbying; state and national policies; and other systems based roles, like case management. Not all individuals who obtain a master's degree in Social Work go on to get licensed for individual therapy work and that is why they have a broader foundation in what we call macro work, which was described above. Generally LMFTs have training more focused on relationships and family work and LPCCs are more suited for specific mental health and substance use issues. There are many LMFTs who also go on to become credentialed as an LPCC in addition to their MFT license. Any of the three types of therapist discussed in this section are qualified to work with typical issues that would bring an individual, couple, or family to therapy. It should be noted that none of these of therapists are qualified to diagnose individuals with autism, but psychologists and psychiatrists are able to. Additionally, psychological testing is outside of the scope of these providers.


Licensure

In the preceding paragraphs, I mentioned that therapists are regulated by different governing boards in California, typically the Board of Behavioral Sciences or the Board of Psychology. California state law requires psychotherapists to either be licensed practitioners or registered interns in order to provide mental health treatment. Licensed practitioners can work independently and without supervision, whether they own their own private practice, are part of a private practice group, or other setting in which individuals can receive therapy. They have accumulated a certain number of hours of supervised experienced, passed the licensing exam, and engage in a specific amount of required continuing education courses on an ongoing basis.


Registered interns, associates, or waivered psychologists have completed a master's or doctoral program respectively and are in the process of gaining hours of experience to become licensed. When encountering an unlicensed therapist in your search, you may see ACSW or ASW for Associate [Clinical] Social Worker; AMFT for Associate Marriage and Family Therapist; APCC for Associate Professional Clinical Counselor; or WCP for Waivered Clinical Psychologist. They are always under the supervision of a licensed practitioner and are required by law to discuss their cases with their supervisor on a weekly basis, as well as participate in group supervision as a part of their learning process. Some folks have reservations about seeing interns, believing they are less qualified or not experienced enough to provide therapy, but this is not true. In fact, I urge you to consider the built in safety of the required supervisory component of their status and see that as a complimentary bonus to your treatment. With an intern you have the safety of knowing that at least two (but usually more because of group supervision) therapists are thinking about how to best serve you. Additionally, interns can be a bit more enthusiastic and less burnt out than some licensed therapists who have been practicing for years.


Personal Fit, Feedback & Conclusion

You now have the basic information needed about types of therapists, licensing, insurance, and ways to search to make an informed selection. Like I mentioned in the beginning, treatment outcomes are most influenced by the therapeutic relationship. This means that feeling comfortable and safe with your therapist is more important than their specific degree, level of experience, and cost. Keep this in consideration as you search, regardless of the approach you take. Most therapists offer a free 15 minute consultation phone call to make sure that they are a good fit for the potential client. This is your opportunity to ask the therapist any questions you might have about their process or therapy in general before you get started. Since therapy is a service and treatment for you, please remember you can also ask questions or give feedback along the way. It is our job as therapists, to make sure clients feel safe, comfortable, and heard. We are human and sometimes say things in a way that can be off putting or confusing; you as the client have a right to give feedback to make the therapeutic process go smoother. At the end of the day, if at any point in treatment you feel like it just isn't working out, you can share your concerns with your therapist without fear of scorn or retaliation and they should honor how you feel. If the issue can't be resolved, we have an ethical obligation to provide you with referrals to other therapists, or steer you in the right direction of how to find another therapist that may better meet your needs. Ideally, with the information you learned in this article, you will be able to find a therapist who feels like a good fit; make great use of the 15 minute consultation phone call to ensure the vibe feels good and expectations are aligned; and then provide your therapist with feedback if needed, thereby co-creating a healthy and sustainable therapeutic relationship.


Please feel free to comment below, or contact me directly with any questions or feedback. I hope you have found this information helpful.


Happy processing!


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