How to choose a therapist who will be the best fit for you

By Sandee LaMotte, CNN

A never-ending pandemic: Death, dying, sickness, masks, school is back, but is it safe? Is it a cold or Covid? Job losses, looming evictions, political fur flying — the types of stressors we are facing just keep rising. Have you pulled all your hair out yet?

Or maybe it’s worse — and you are feeling panicked, depressed, even suicidal? If so, STOP and immediately call for help — you can reach the National Suicide Prevention Lifeline at 800-273-8255.

Still managing to keep your life rolling down the road but feeling the rubber on your coping skills running thin? Again, stop — and think about getting help from a licensed therapist.

“You want someone who’s going to push you a bit, but you must feel safe telling them your real story,” said stress management expert Dr. Cynthia Ackrill, an editor for Contentment magazine, produced by The American Institute of Stress.

“Don’t let yourself edit your feelings to be in therapy — and you know a lot of people do that in the beginning they try to make themselves really sound good — but this is part of feeling really safe to be your real self,” Ackrill added. “That’s the point.”

Here are expert-based tips on how to find the best therapy “fit” for you.

1) Don’t wait

First, start the selection process early.

“Don’t wait until you absolutely need it. The moment you start to think, ‘I might need some assistance,’ would be the time to start to reach out to find a therapist,” said Kristen Carpenter, a psychologist in women’s behavioral health at The Ohio State University Wexner Medical Center.

Start by asking your primary care doctor or another doctor you trust for recommendations, Carpenter advised.

“Starting with your physician gets that conversation started, and signals you recognize that your mental state is an important part of your overall health and well-being,” she said. “If you have health insurance, you can also look to see who is in network and what ratings they have.”

Get the whole in-network provider list and then ask friends and family if they know any of the names, or check online ratings to see which therapists get high rankings. One note of warning: Friends may have their favorites, but experts say don’t assume their therapist is going to be a good fit for you as each person’s needs are different.

You can also call psychology or psychiatry departments at your local university for recommendations of people who trained in their program and then compare those names to your in-network providers.

Be sure to check to see if there are limits to the number of sessions your insurance will cover — and at what percentage — so you won’t have any financial surprises.

2) Choose someone with training in that specialty

Just as medical doctors have specialties in surgery, cancer, lung, heart and more, so do therapists.

“Understanding your symptoms and talking with the provider about whether or not that’s within their competence is important,” Carpenter said. “If you have obsessive compulsive disorder, a psychotic disorder, depression, anxiety or if you need sex or family or child therapy, there are people who are well trained and have lots of experience with the evidence based therapies in those areas.

“And so that’s step one — looking for someone who says ‘Yes, I can treat the condition or the kinds of problems that you’re experiencing,'” she said.

What if you don’t know what is wrong?

“If you don’t quite know what you need help with, it’s the job of a therapist to help you figure that out,” Carpenter said. “They will know to help you organize your experiences into a cohesive kind of conceptualization with a clear path forward.”

3) Use a reliable database

You can also search online. A number of psychological associations have complied lists of licensed therapists, that can often be searched by specialty:

• American Psychological Association
• American Association of Marriage and Family Therapists
• The Association of LGBTQ+ Psychiatrists
• National Register of Health Service Psychologists
• Association for Behavior and Cognitive Therapies

Do be sure that you choose a therapist who is licensed by your state. Each state is responsible for making sure therapists are competent to provide their services — only people with proper training are given a license.

Call the therapist on the phone first, and see how you feel about their approach and how easy they are to talk to. Always ask about fees in advance, including any charge for missed sessions, the APA advised. Many therapists do charge for missed appointments, as they consider it part of the patient’s commitment to therapy to keep appointments.

There are different types of therapists you can choose from as well. Psychiatrists are medical doctors who specialize in the diagnosis and treatment of mental or psychiatric illnesses. They can provide therapy and are licensed to prescribe drugs.

Psychologists have a Ph.D. or Psy.D. doctoral degree in psychology and are trained in counseling, psychotherapy and psychological testing. They cannot prescribe medication.

Nor can licensed professional counselors or social workers. Licensed professional counselors have at least a master’s degree in counseling and 3,000 hours of post-master’s experience. They provide therapy for all sorts of mental health issues, including addiction and substance abuse, self-esteem issues, grief and death, depression, stress management, and more.

Social workers also provide counseling on all sorts of interpersonal problems, often in health care settings provided by local and state governments and managed care organizations.

4) Consider a type of therapy

There are also different kinds of therapies you can choose from. Cognitive behavioral therapy (CBT) focuses on helping people find new ways to behave by changing their inaccurate or negative thought patterns, thus allowing them to respond to challenging situations in a more effective way.

Because it focuses on specific, behavioral changes which are measurable, CBT has been a good candidate for studies. It has been shown to be as successful as medication in treating a number of mental health conditions and can also reduce stress, assist with complicated relationships, deal with grief and more.

Psychoanalytic therapy is the traditional Freudian “talk therapy” where you sit with a therapist (and no, you don’t have to lie down on a couch) and discuss your feelings. It’s designed to uncover repressed emotions and experiences and help the patient cope and recover from them.

Acceptance and commitment therapy (ACT) uses acceptance and mindfulness strategies to increase “psychological flexibility.”

“Psychological flexibility means contacting the present moment fully as a conscious human being, and based on what the situation affords, changing or persisting in behavior in the service of chosen values,” according to the Association for Contextual Behavioral Science.

Dialectical behavior therapy (DBT) is a modified form of cognitive behavioral therapy created to treat borderline personality disorder and suicidal behavior. Today, it’s used for anyone with difficulty regulating their emotions or people exhibiting self-destructive behaviors. It’s often used to treat eating and substance abuse disorders and post-traumatic stress disorder or PTSD.

5) How do you feel about the person?

Once you have found a list of people who specialize in your area of concern or a generalist if you don’t know yet, it’s time for the next step — setting up an initial meet and greet. Again, your focus should be on how easy it is for you to talk with that person and how comfortable they make you feel, Carpenter said.

“How does it feel when you’re in the room with the person? We call it the ‘therapeutic alliance’ between patient and provider, which is important in predicting patient outcomes,” she said.

To achieve that alliance, try to establish within that first and second visit a solid understanding of what the therapeutic plan is and “how you will work together to achieve your therapy goals,” she advised.

“If you can agree upon goals, agree upon a plan and if you as the patient have an understanding of where you’re headed in therapy. I think that’s a really good indicator,” Carpenter said. “That’s what the literature tells us about therapeutic alliance.”

Be persistent, experts advise. Don’t expect to like the first therapist you meet — it’s a process. It’s OK to stop after a visit or two and try another person, or two or three, and then decide which one you like. After all it’s your life and your money. Go for the gold.

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