What to Expect in Therapy, Part 1: How to Choose a Therapist

Written by Aleks Stepanenko (they/them)

There is a certain unjust irony in the fact that once a person realizes things have gotten to be too much to manage on their own, they must first manage even more things before they get to talk to someone about it. The steps between, "I should really find a therapist," (or, perhaps, "I should really find a new therapist,") and actually having your first session can be cruelly mysterious. I'd like to offer a rough guide to help demystify the process.

Logistics

You know that therapists theoretically exist out there somewhere, frolicking in the wild listings of Psychology Today -- but how do you even start narrowing down your options? (There are many other sites that provide therapist listings, but Psychology Today is the most widely used so I'll be focusing on it for the sake of simplicity.) First, let's address some constraints of our current reality:

Location

In the United States, therapists are professionals licensed by each state. This means that if you are here in Ohio, you would be looking for therapists licensed to practice in the state of Ohio. If you prefer to see someone in person, you can search for the city or zip codes you would be willing to travel to for your sessions. If you prefer to have online sessions, you can search for "Ohio" in general, which would give you the most options to choose from.

Cost

If you don't have insurance:

Without insurance, you are going to be doing what's called self pay or private pay -- just good ol' exchanging money for services. Consider what you can afford to pay, and how often you would be able to afford sessions. (It's most common to see your therapist weekly or every two weeks, but the frequency can be adjusted depending on financial constraints.)

You can set the price search filter for whatever is within your budget.

If you're not able to afford the standard rates, you can search for therapists that offer a sliding scale. This means that the therapist is willing to offer a discounted rate for those who need it. Exactly how much and for how long depends on each therapist, so it's something you will need to ask them directly. You can also search on Open Path, which is a listing of therapists and therapists-in-training that all offer sliding scale fees.

If you have insurance:

Here, some mystery re-engulfs the process. The quickest way to dispel the mists is, unfortunately, to call the number on your insurance card and ask a person, "What is my co-pay for mental health care?" That is the amount you can expect to pay for each session yourself, as long as your sessions are with a therapist who accepts your insurance. Your therapist will charge your insurance for the rest of their fee.

To find a therapist in-network with your insurance, you can see if your insurance's website has a listing of providers that you can look through, or you can set your Psychology Today search filter to only show providers that take your insurance. Frustratingly and yet somehow unsurprisingly, it's common for both of these to be out of date, so it's a good idea to confirm with the therapist that they do take your insurance.

If you have a type of insurance coverage that doesn't do you much good -- for example, if your co-pay is too expensive or there are too few in-network providers to choose from -- you're considered under-insured and can follow the advice for folks without insurance, above.

Availability

The last step of the logistics trifecta is to find out which therapists are taking new clients, and if the times they have available match the times you're available (particularly if your schedule isn't very flexible). The best way to do that is to ask! Here is a form email you can use to reach out to therapists to get the ball rolling:

Hi [Therapist Name],

I’m looking for an [in-person/online] therapist who is currently accepting new [Insurance Provider Name/sliding scale rate] clients, with availability on [weekday mornings/Thursday evenings/etc.]. Please let me know if you’re available.

Thank you,

[Your Name]

If you want, you can also add a sentence about yourself to help the therapist have an idea of what you're looking for and what inspired you to reach out to them in specific.

Vibes

"But Aleks," I hear you cry, "Why did I reach out to them in specific? There are a billion therapists in my area who take my insurance -- how do I actually know which ones are any good? Is it the ones trained in the most correct treatment approaches? The ones with the most letters after their name? The ones with the cheekiest smile?"

The Research

The answer, which may be in equal parts both soothing and alarming, is that there is no right answer. While the field of psychotherapy research has continued to eke out evidence for the effectiveness of various therapeutic approaches with one promising but inconclusive study after another, there remains a lot of art to the science. Ultimately, as long as a therapist has some qualifications and is using an approach generally supported by the field, studies have repeatedly found that the most important factor in a client's improvement is the strength of the relationship they have with their therapist. This holds true regardless of if the therapy is in-person or remote and regardless of the therapist's years of experience. (Unfortunately, there have been no studies on cheekiness of smile as of yet.)

Essentially, therapy will probably go well if you like your therapist, if you feel that they like you, and if it seems like you're on the same team and have the same plan. It's easier to have a strong relationship with a therapist that you feel is trustworthy, confident, open, and respectful -- if you feel that the vibes are good. This is something that you get to decide.

The Deciding

You can get a pretty good sense of the vibes by looking at the therapist's photo, reading their little blurbs, taking a look at their website, and then checking in with yourself. Even through the porridge-like sameness of most therapist bios (I know, I know! I apologize on our behalf), you may still feel particular ones resonate more clearly. Are they speaking your language? Does something about them give you an extra spark of hope? Send them that email!

Usually, most therapists will then offer a short, free call during which you can ask each other questions to figure out if this therapist is the right person for the job. Think about what questions would help you feel like you could build that strong relationship together. What is important for you to know about them? You may be looking for someone with lived experience in the same communities as you, or someone who has really seen it all so that you don't have to worry about shocking them, or someone with similar spiritual or political perspectives. You may also not have any questions at all, and simply see how you feel while they're talking. Having no objectively right answer about how to decide means that there is no wrong answer, either.

If you choose to work together, remember that you get to keep deciding how you feel. It's okay to decide that you want something different after a few sessions, or even after a few years of sessions. Considering that it is the relationship itself which so often does the healing, it is well worth it to find a good fit.

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