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A Good Therapist is Hard to Find

Here's some advice on how to find a great mental health match and what to expect as you're getting acquainted.

cartoon image of a blonde woman talking to her therapist
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A young woman with dark curly hair is using mobile phone. Female is smiling while holding smart phone. She is lying on sofa at home.

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Looking for a therapist might remind you a little of dating—you’re ready to throw your hat into the ring, but you’re not entirely sure what you’re looking for or what to expect. It's perfectly normal to be nervous about how the first few meetings will go. So we asked a professional to weigh in on how to find the right therapist for you.

According to Nicholas Forand, PhD, director of Northwell Health Physician Partners Cognitive Behavioral Therapy Practice at Glen Oaks, step one is to push past any jitters you might have about actually making the call for an appointment. Whether you suspect you have a mental illness (or have been previously diagnosed with one) or just feel like you could use some help navigating life's stressors, there's no need to be embarrassed. "Everyone can use someone to talk to, and therapy can be helpful for people with a wide range of problems," Dr. Forand says. Also worth noting: "You're perfectly welcome to try it out and stop if you're uncomfortable. Nothing bad will happen if you go once and decide it’s not for you."

Ready to take the plunge? Ask yourself these questions and follow our expert tips for finding the right mental health match:

What are you really looking for?

If you just have a vague sense that you need help, that's OK. But you'll be more likely to find a good fit if you can get a bit more specific, because therapy is not one-size-fits-all and individual therapists tend to specialize in certain conditions and treatment modalities. Do you need help quitting smoking? Suspect that you're depressed? Want to work through a phobia?

While you can't officially diagnose yourself with a disorder, you probably have some inkling about what might be going on. Dr. Forand suggests perusing this list of psychological issues and clicking on one (or more) that seems most pertinent. When you click through, you'll be taken to a list of evidence-based treatment options, such as cognitive behavioral therapy, which tends to be the best option for depression and generalized anxiety; exposure therapy, which is ideal for overcoming a specific phobia; and cognitive processing therapy, which helps people with post-traumatic stress disorder.

The goal: When you start reaching out to potential therapists, you should be able to say something like, "I'm seeking help with depression. Do you treat depression, and if so, how?"

Along the same lines, you may want to ask how long the provider has been treating this issue and what kind of success they've had with similar patients in the past. It's also perfectly reasonable (and smart) to ask about a therapist's education and training. There are many types of therapists—psychologists, social workers, nurse practitioners, etc.—and there are some distinctions: Psychologists have been through a doctoral program, so they have the most training among the non-MDs, says Dr. Forand. If you think you might need medication, ask if the therapist works with a psychiatrist (a medical doctor) or psychiatric nurse practitioner who can prescribe.

Can anyone introduce you?

It isn’t a great idea to Google "therapist" and call the first number that comes up. So how to know where to start? The best way is to get a referral: Consider asking your primary care doctor (or any doctor you trust) and friends and family to share their recommendations. You may also want to call your health insurance company or head to their website for a list of covered providers. The catch, says Dr. Forand, is that finding a good therapist who takes insurance isn't easy.

"In some places, including New York, a lot of therapists won't take any insurance because the reimbursement rates are so low [and the cost of living is so high] that providers couldn't afford to pay their rent" if they relied on what the insurance companies are willing to cover, he explains.

Which leads us to …

What's it going to cost?

If you're lucky enough to pinpoint a potential new therapist who takes your insurance, your out-of-pocket costs should be minimal (depending on your plan). But if you end up going the private route, don't be shy to bring up cost before your first appointment, says Dr. Forand. If the therapist throws out a number you can't afford (some charge $200-$300 for a 50-minute session), don't panic: Some offer reduced fees to clients on a sliding scale basis, so ask if that's an option.

Are you getting good vibes?

You and a new therapist are finally face-to-face. Now what? There's no hard-and-fast rule about how an introductory session should go, but different therapists have individual styles. "At my clinic there's a fairly standardized intake process, so you'll be asked a lot of questions about the types of problems you're facing, your mental health history, and how you're functioning in everyday life," says Dr. Forand. "Other therapists might have a looser intake process. They might start by asking, 'Why are you here?' then let the client talk, and see where the conversation goes."

One method isn't necessarily better than the other, but you might have a personal preference. If you're a goal-oriented person who expects order, an unstructured approach probably won't be appealing. "If you just want someone to listen to you and offer advice now and then, less structure might be better," says Dr. Forand.

You should also get some initial vibes about the therapist based on how chatty or reserved they seem; again, it comes down to personal preference. After a first meeting—or perhaps a few sessions—you should have a gut feeling about whether or not this is a person you feel comfortable confiding in. And don’t be shy about providing feedback—therapists can change their approach if the path they are taking isn’t working for a particular client.

If the first (or second or third) therapist you meet doesn't turn out to be a good fit, don't hesitate to cut ties and move on. While most therapists would appreciate a call or note to let them know that things aren't going to work out—especially if you've been seeing that therapist for a little while—if doing so would make you super uncomfortable, "you can ghost us," says Dr. Forand. "If someone up and leaves I might reach out a few times to make sure they're OK and see if they want to come back, but if it's not a good fit we understand. It happens all the time; we're not going to take it personally.”

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Published May 14th, 2019
A young woman with dark curly hair is using mobile phone. Female is smiling while holding smart phone. She is lying on sofa at home.

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