It is often difficult to find the right therapist, one who is a good fit for you. Although discovering your therapist soul mate can be life changing (It certainly was for me), the number of options out there is confusing. If you have never been in therapy, you might not know how what effective therapy looks like and what questions to ask to find the best fit.
In my private therapy practice in Los Angeles, I often notice during consultation calls that many people disregard what they need to assess before they choose a therapist. Some almost seem almost random in how they choose the right person for them. For example, just last week, I received a call from a potential client who, within the first few minutes, asked me specific questions about the techniques I use and my approach. Because she was specifically asking about my theoretical orientation, I thought she was another healthcare provider, looking for a specific kind of therapy, based on extensive research on her needs. Later I realized that she was asking a series of suggested questions taken from an online forum without considering whether they were relevant for her specific need.
Of course, it wasn’t her fault. She was doing the best she could in an environment of limited information on choosing a therapist. We therapists don’t educate our consumers on how to choose the right fit. I will lay out four factors to keep in mind before you book your first appointment.
1) Find a Therapist Specializing in Your Issue
It is important to choose a therapist who has experience and training treating issues like yours. Most choose to initiate therapy to manage or improve one specific area of their lives. Although many therapists claim to work with all types of issues, I highly recommend that you find a specialist in your area of concern if you want to be sure to get results.
Like physicians, many therapists study common mental health challenges during their graduate training; however, in most cases further specialty is needed training to be able to provide effective intervention. If you needed heart surgery, you wouldn’t go to an internal medicine specialist, even if they claimed to have had a rotation in cardiology during medical school.
One of my areas of specialty is the treatment of eating disorders in adults and adolescents. I am often surprised by how many of my colleagues work ineffectively with clients struggling in this area without learning about the best practices in the field. By contrast, I received extensive training in child psychology during my postdoctoral residency, but, given that this is not my area of focus now and my office is not fit to serve this population, I would refer potential clients elsewhere, because there are many therapists more passionate about providing quality service to that population.
What are the negative outcomes of not working with a specialist? Here are a few:
- Your condition might worsen while the therapist is trying non-research based approaches. For example, someone who is struggling with anorexia nervosa might become medically unstable and their lives might be in danger.
- You might give up on therapy because of lack of progress.
- Your condition might become chronic if it’s not treated within a certain window of time.
How can you assess the therapist’s competency?
If you are wondering how to know whether someone is skilled with helping those in your situation, I recommend starting by asking friends, doctors, or in your community. You might be too embarrassed and uncomfortable to confide in your support system. These days, you can find great information on clinicians’ areas of expertise by checking out their websites, podcasts, or vblogs. If they have a special page on their website on your topic that resonates with you, this could give you insight into their specialties and fitness.
Finally, I would ask them during your phone consult about what training and experience they have in providing specific treatment for your condition. Many therapists offer free consults these days, and I recommend you take advantage of this opportunity to interview your potential therapist.
2) Choosing a Therapist with the Right Credentials
Even if you know what specialization you are looking for, an online search will bring up dozens of coaches and mental health providers in your area. Unless you work in the healthcare field, it can be really challenging to understand what the different acronyms mean (like PsyD, LCSW, MFT).
Coaches vs Mental Health Providers
I have recently noticed a significant jump in the number of providers identifying as coaches. Although there might be many great coaches helping individuals reach mental health goals, I most often discourage people from seeking them out, especially if they have never worked with one.
In most states, people don’t need specific training to call themselves coaches. Anyone can open their doors and call themselves a coach. Most coaches do not have a governing body monitoring their work. By contrast, mental health providers follow strict guidelines that ensure that they provide the best possible care, and they continue to receive training as they provide therapy.
Some coaches’ marketing materials might be really appealing. Many claim to have solutions for your problem and guarantee results. A licensed therapist, in most states, cannot legally make promises of treatment success, which might make their marketing materials less attractive. Unless you have worked with a coach in the past and got great results I encourage you to choose a licensed mental health provider instead.
Psychologists vs. Psychiatrists
This is a common point of confusion. Psychologists are doctoral-level therapists with advanced training in certain areas of psychology. In most states, psychologists cannot prescribe medication. Psychiatrists are physicians with a medical school degree and prescription privileges. I have found that most psychiatrists lack training in providing effective therapy, and their strength is in finding the right psychotropic medication to help with symptom reduction.
Unless your condition requires immediate medication, such as thought disorders or bipolar disorder, it is best to consult with a psychologist as the first step. After assessing your challenges and examining your goals, your psychologist will refer you to a psychiatrist if appropriate. In many cases, you could reach your goal and address your symptoms without medication.
Master’s-level vs. Doctoral-level Therapists
There are currently more than a dozen types of therapists in private practice, and it is important to know the differences among them if you want to make an informed decision. The first category of therapists are the master’s-level clinicians. This includes licensed marriage family therapist (LMFT), licensed social worker (LCSW), licensed professional counselors (LPC). These therapists have often completed two years of post-bachelor course work and training. I have worked with many amazing and skilled master’s-level clinicians; however, unfortunately, because many online and unaccredited programs have opened in the last decade, the quality of these professionals may vary, depending on their education and experience.
Doctoral-level therapists usually have a PhD or PsyD. They have completed on average 3 to 5 years of schooling after receiving their master’s degrees. Far fewer schools nationwide provide doctoral degrees in psychology and it can be more competitive to get into their programs. This group of therapists has received extensive training in psychological assessment and treatment of more complicated cases. If you are planning to use your insurance for out of network provider, the reimbursement rate often is higher for doctoral level therapists compared to master level therapists.
But if you have heard a great recommendation of a master’s-level clinician, he or she might be equally effective as or even more effective than a doctoral-level therapist. However, if you don’t have a recommendation from a trusted friend or colleague or are looking for more in-depth work, a doctoral-level therapist might be a safer option, because they have received more training.
3) Having Chemistry is Key
Many people choose a therapist based on who is covered by their insurance or the proximity of the therapist’s office to their home. However, numerous studies indicate that the trust and respect you have for your therapist is a key element that makes a significant difference in the outcome of the therapy. Your therapist might be skilled, but if you don’t like their personality, you may not see much improvement.
Working with a therapist is different than working with a physician. You might not like your physician, but if you take your medication as prescribed, you will probably get better. The healing power of the therapeutic relationship is one of the most useful aspects of the therapeutic work. If you haven’t found chemistry with your therapist after first three sessions, it is wise to move on and find a better fit for you.
Dr. Nazanin Moali is a clinical psychologist who specializes in providing effective therapy for the treatment of eating disorders and addictions. She completed a postdoctoral residency in the treatment of eating disorders in adults and adolescents and currently serves as the co-chair of the education and prevention in South Bay Eating Disorder Coalition board. She has two offices in Los Angeles and serves the Torrance, Redondo Beach, Manhattan Beach, and Hermosa Beach areas.