Have you been tossing and turning at night? Can’t get out of bed in the morning? Are you arguing more often with your partner? Or worried that your one glass of wine after dinner has turned into two or three? Whether you’ve been struggling with mental health issues for a while or are experiencing new feelings and issues because of the COVID-19 pandemic, you may be contemplating therapy for the first time. And that’s a good thing, says Christina Aegerter, PsyD, LP, a licensed clinical psychologist in Denver.
“If you’re noticing any big changes in mood, appetite, sleep — these are times that people should seek out additional help if they’re not able to work through those things on their own,” Aegerter says. “Times of transition — moving, getting a new job, going through a breakup, getting married, having a baby — are also points where people sometimes seek out therapy.”
Talk therapy, as it’s known, is a chance to work with a trained therapist to uncover and change certain troubling emotions, thoughts, and behaviors. During these typically once-a-week sessions, your therapist will use a variety of techniques to identify and treat your issues and decide if medication is appropriate.
But finding the right therapist isn’t as easy as googling “perfect psychologist for me.” It’s often a trial-and-error process that can sometimes feel, well, a bit like dating. You may need to try out a few therapists before finding The One. And with so many options out there, it may be hard to know where to begin.
Understanding the expertise
The mental health professional pool often looks like a big bowl of alphabet soup — from MDs and PhDs to LFMTs and LCSWs. All those initials can be hard to decipher. But understanding a therapist’s educational background and specialties before you begin your search can help narrow your focus.
Keep in mind, you should consider not just the initials after the therapist’s name, but also their specialty, says Erin Lewis Ballard, MS, LMFT, owner of Family Solutions and Wellness Center in Cary, NC.
“The more that your symptoms are impacting your life, the more specialized you want that therapist to be,” she says. “So if you are just having some relationship stress — maybe you had a new baby — maybe any counselor can help you and your partner talk through something. But if you have been fighting for a really long time, maybe there’s some infidelity and you've contemplated divorce, you really do want someone who is very well trained, with many years in the field.”
Here are some of the types of therapists you might encounter:
Psychiatrist (MD) — “People usually confuse psychiatrists and psychologists because they sound very similar,” says Aegerter. “Psychiatrists are medical doctors who went to medical school, and then specialized in psychiatry. They prescribe drugs, psychologists do not.” Psychiatrists don’t typically offer ongoing, long-term psychotherapy (although some do) either, she says. Instead, a session with a psychiatrist will typically be brief and focus on either prescribing or recalibrating medications for conditions like ADHD, bipolar disorder, depression, and more. A psychiatrist may then refer you to see a psychologist or other therapist.
Psychologist (PhD) — A psychologist has a doctorate degree — which means additional years of training beyond the master’s degree training that Licensed Family and Marriage Therapists (LFMTs) and Licensed Clinical Social Workers (LCSWs) undergo. And unlike psychiatrists, they offer therapy sessions, often with an eye toward diagnostic testing, Aegerter says. The main difference between a psychologist and a master’s level therapist, Aegerter says, is that a therapist can’t do a psychological assessment. “If someone wants to get a formal evaluation for ADHD or autism, that can only be done, in most states, by a psychologist.” From there, a psychologist may specialize in pretty much any mental health concern you can think of.
Licensed Marriage and Family Therapist (LMFT) — Just as its name denotes, an LMFT’s focus is on issues between couples and family members. They may see patients one on one, but more often they conduct sessions with two or more participants, Ballard says. “Marriage and family therapists have to do a lot of extra training with couples and families,” Ballard says. “Whether in their program or in their internships, they have to have exposure and see couples and families that have more than one person in the room. And that is a bit different than having just one person in the room.”
Licensed Professional Counselor — These masters-degree level professionals work with a variety of clients with mental, behavioral, and emotional disorders, including substance abuse. They might see clients individually or in group settings. To earn the designation, LPCs must complete a certain number of counseling hours and supervision hours. Many LPCs work in community mental health centers and agencies.
Licensed Clinical Social Worker (LCSW) — A social worker’s training typically focuses on the social context in which mental health issues arise. Many licensed clinical social workers are employed in mental health settings, but a number go into private practice as well. They focus on assessing, diagnosing, treating and prevention for children and adults with mental, emotional, and behavioral issues.
Specialists — Some therapists and counselors are highly specialized either in the type of therapy they provide, such as art therapy, or the kinds of clients they serve, such as substance abuse counselors who work with people with drug or alcohol addictions. Other specialties include advanced practice psychiatric nurses, and psychiatric nurse practitioners, who focus on patients’ mental health needs.
Getting a referral
Once you know the kind of therapist you need, you’ll want to ask around to find the one best suited for you. There are many potential sources for referrals:
Ask your primary care physician. Primary care doctors are trained to deal with mental health issues and can be a good starting point to discuss your concerns. They can then help you decide if you should seek specialty care and give you recommendations for respected, capable therapists in your area.
Chat up a friend or family member. If you feel comfortable discussing therapy with the people closest to you — especially like-minded friends or family members who share your values and beliefs — ask whom they see and if they’d share their contact information.
Check with your insurance provider. Check your health care plan’s list of in-network providers to find one who will accept your insurance. However, some therapists do not accept insurance, so If you find one you like who isn’t in-network, try calling your insurance provider to see if there are any options available.
If there is a university near you, you may be able to work with a student therapist (for a very low fee), who is fully educated but needs practical hours to finish their degree. Finally, if your employer has an Employee Assistance Plan, that may include free or low-cost therapy. If you have a Health Savings Account (HSA), you may be able to use that money toward therapy expenses.
Search the databases. There are a handful of online portals that allow you to search therapists by location, insurance, and specialty. The American Psychology Association is one of them. To be connected to low-cost mental health services, search the federal government’s Health Resources and Services Administration site or the national nonprofit, Mental Health America.
In an emergency. If you are considering harming yourself or others, or know a loved one who is, call the National Suicide Prevention Lifeline: 1-800-273-TALK (1-800-273-8255) or use the online Lifeline Crisis Chat.
Finding the right fit
Before scheduling an appointment with a potential therapist, do your homework. Look at their website, read their bio, get a feel for the type of services they provide, figure out their availability, check their rates and if they take insurance. Most therapists will offer a free 10-15- minute consultation, so you can not only ask about things like their availability but also get a sense of whether you might work well together.
Come prepared with some questions. The American Psychological Association recommends asking a potential therapist questions that include:
- Are you a licensed psychologist?
- How many years have you been practicing?
- What experience do you have helping people with my specific problems?
- What are your areas of expertise?
- What kinds of treatments do you use, and have they been proven effective for my particular issue?
Once you meet with a therapist and have completed a few sessions, take some time to reflect on the experience and whether or not the therapist is meeting your needs.
“You want to feel both supported and challenged,” Aegerter says. “I'll get clients who have seen people beforehand and they’ll say, ‘It was really nice. I just talked the whole time.’ But then there wasn’t really much else. You want to have that supportive open environment, but also to be challenged. You’re not just there to hang out — we want to help you accomplish your goals.”
Even if a therapist checks all of the professional boxes, you may not be a personality fit. No matter what the issue, bring it to your therapist’s attention. Mental health professionals have many tools in their toolkit and can often craft a completely different therapy approach for you based on your wants and needs.
“Give them that feedback and see if you two can work it out together, because that can be a place, first of all, where you can make a lot of change and grow a lot,” Aegerter says. “That issue you’re having there might be an issue you’re having other places, and it could be a really meaningful thing to work on.”
If the issue can’t be resolved for whatever reason, give them that feedback, too, and let them know you want to see another therapist. They may even have a better fit waiting for you in their Rolodex.
“If anyone comes to me and says that they don’t think I'm a fit, I try to get a little bit more information of what they’re needing and what they're looking for, and I will refer out for somebody that I think might be a better personality fit or more specialized in the certain training that they’re needing,” says Ballard.
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