The Guide to Getting a Therapist, Pt 1
This post appeared at a previous blog I owned. It has been edited and revised for clarity.
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So you're thinking about maybe seeing a therapist?
Psychology Today has one of the best therapist finders in existence. Enter your zip code, then use the categories on the left to narrow your search by focus, insurance, etc. However, therapists know that this is where many people find them, and capitalize on the search mechanism. This means two things:
Therapists can list a bunch of stuff that they technically ‘have training’ in, without having spent time practicing said stuff. So, just because a therapist lists Cognitive Behavioral Therapy (CBT) doesn’t mean they regularly use it. Asking questions like "How much/what percent of your practice involves [my specific issue]?" can give you a better picture.
Conversely, because therapists also can list a bunch of stuff because it will attract clients, you get opposite problem: don’t necessarily distrust a therapist because they say they’re trained in an approach you hate.
Lots of therapists practice Cognitive Behavioral Therapy and other things. A therapist you find that lists CBT might not immediately practice CBT on you. You can circumvent this by explaining that you’d like to do CBT. (Telling them you’d also like to know if they think it’s not working or some other modality is better will probably make this request go more smoothly)
CBT is not the only evidence-based therapy, and I actually don’t always recommend it to people if they already introspect and self-CBT regularly.
Another way to get a therapist is via referrals. You can ask your medical doctor, friends who have seen therapists, or friends or acquaintances who are therapists. You can look them up on a site like the Psychology Today therapist finder to get specific information like what insurance they take. If some seem like they could be a good fit, you can set up an initial meeting or two. (It may be a good strategy to see several people before picking one who seems the best fit). The next section of this series will handle setting up an appointment.
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Terms
Licensed therapist: Varies by state, but someone who holds a license to practice therapy, but not a PhD. Includes Licensed Social Workers, Licensed Therapists, and Marriage and Family Therapists. Further info here.
Psychologist: Has a PhD or PsyD, has done at least one year of internship, and [usually] a one year post-doc. Generally more expensive. I don’t find their practice of therapy to be significantly better than someone with a Masters, but they do have more standardized levels of clinical experience.
Psychiatrist: Has a medical degree, and is generally seen for psychiatric medication. Psychiatrists are quite expensive. As a result of this in combination with their nearly unique ability to prescribe psychiatric medication, (Psychologists may in a handful of states) they're often seen specifically for this.
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Spend some time thinking about your preferences! Do you think you’d prefer to talk to someone of the same gender? Race/ethnicity? Are there particular parts of your experience that you particularly need a sensitive ear for? For instance, poly people who anticipate needing to discuss and dissect parts of being poly might want to ask a therapist about their knowledge of polyamory. However, if you’re poly but don’t expect it will come up much or be central, you might not need to select for this, and could save yourself some work by not prioritizing it. Poly, queer, kinky people can find some help for friendly therapists here, as well as here.*
For young people, particularly young people who interact a lot with social media or tech, I sometimes advise finding someone close in age to you—even someone currently working towards a license in psychology—they’ll be used to experiencing life in some way close to yours. Secondly, people in this stage of working usually seem to treat therapy as a collaborative measure. Thirdly, I've found that it feels a little easier to question your therapist about the direction of therapy or raise concerns if they are closer in age to you. This by no means means that non-age-matched therapists won't be helpful, but it's served as a useful heuristic for some.
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But what kind of therapy? There are more types than the ones I list below, but these crop up a lot. Wikipedia has been the best single resource I've found for short explanations of those not listed below.
CBT: pretty much what you expect. Working on cognitive and behavioral aspects of issues in question.
DBT: Dialectical Behavioral Therapy. Mindfulness based therapy. CBT meets awareness and acceptance training, as well as distress-tolerance. Here’s a great summary.
REBT: Rational-Emotive Behavioral therapy. Created by Albert Ellis. Philosophy meets CBT. The Wikipedia article is excellent. You can see demonstrations at the Albert Ellis Institute in NYC.
ACT: Acceptance and Commitment Therapy. Often the right fit for people who find CBT unpleasant. *
One of the best predictors of therapy succeeding is something called the therapeutic alliance—the sense of collaborating together, both working on a problem, sharing, caring, etc. In essence, do you ‘click’? If you don’t feel like you click with a therapist, this is a great reason to go find another. You can even tell them that you don’t think the therapeutic alliance is working out—this is the ‘code word’ for a specific way of things not working. Knowing this can also make it feel less stressful to explain why you don’t want to see said therapist; it’s a great script. (Therapists who respond badly to this are not good therapists on the whole.)
*CBT often involves cases of questions or lines of questioning or roleplaying that can feel silly. I usually frame this as something that can feel weird, but is intended to get your emotional and intellectual reactions into place. You might know intellectually that no, all your friends don’t hate you, but still have panic attacks. The point of the exercise is less about knowing in an intellectual sense and more about installing habits of thinking that will prevent the panic or anxiety your emotional brain is doing. Some people can get into this paradigm easily, some find it hard to suspend their annoyance at obvious questions.