It can be daunting to make the choice to reach out to a professional for help. And it can be confusing to know which professional to reach out to. Not knowing where to turn for help can sometimes be enough of a hurdle to further delay getting started. Hopefully some of the information below can help you know where you can turn so that you can start on your path to healing.
Now, I should probably begin by mentioning that there is no such thing as an ideal counselor. BUT, there may be someone (or several prospective someones) who is the ideal counselor for you. Your ideal counselor is likely to be someone who:
- You feel safe and comfortable with and that you “click” with
- Specializes/has experience and success in treating the issue that you are seeking help for
- You can afford to see
The ideal is to find a professional who meets all three criteria. And sometimes that ideal is available if you know how to find it.
Finding someone who you feel safe with and who you “click” with
Because everyone comes to counseling services with different needs, and because everyone has different personalities, one person’s perfect counselor might not be your perfect counselor. If you’ve had the experience of going to someone that was recommended to you and you didn’t have a positive experience, don’t give up hope. Change and healing is still possible. Research has shown that the therapeutic alliance (how well the client and therapist click) is the number one predictor of therapy being effective. If your past counselor wasn’t a good fit for you, or if they simply didn’t have the background and training for your specific needs, that doesn’t mean that they are a horrible counselor, and it doesn’t mean that you are broken and beyond hope. It simply means that it wasn’t a good fit. So let’s figure out how to find someone who is!
Ask for recommendations
Your starting place should be to figure out what your options are. Many individuals will start by asking for recommendations from friends or family members. A friend of mine recently posted on Facebook asking for recommendations of therapists specializing in working with children on a specific issue. Health professionals such as PCPs generally have mental health professionals that they can refer you to. Similarly, ecclesiastical leaders often have mental health professionals that they are aware of that they can suggest. Referrals from others can be a helpful place to start. If you do not have individuals in your social network that you feel comfortable disclosing your need to counseling to, you may find it easier to use the internet to find local therapists. This is a great way to find many therapists who may be a good fit for you. If you want to cast an even broader net, you can go to the website for the state’s Board of Behavioral Health Examiners (or equivalent) and pull up a list of all licensed professionals in your city or state.
Learn about your options
After identifying some potential options, one of the best ways to figure out if any of these therapists are a good fit for you is to learn about them. Many counselors have websites, and many more have online profiles that provide an image and write up about them and their areas of expertise. If from these resources you find a few prospective counselors that seem promising, the next step is to talk to them.
Talk to prospective counselors and ask questions
Most therapists will offer a free phone consultation where you can talk with them via phone and ask them questions. This is an opportunity for you to get a good feel for them. You can hear their voice, get a sense for what they are like, and you can learn about them and their approach to therapy.
Of course, the best way to get a feel for a prospective counselor as a person and for their therapeutic style is to schedule an appointment and meet with them. If you feel uncomfortable with your counselor after a few sessions, then it may be time to find someone who is a better fit for you. It is perfectly acceptable to discontinue services if you consider them ineffective. But, you may first want to express your experience with that counselor and together you may be able resolve the source of your discomfort, or they may be able to refer you to someone who will be a better fit.
Also, many individuals will feel naturally more comfortable with individuals who are familiar with the culture they identify with. For individuals who identify with a minority culture, be it religiously, ethnically, or relating to sexual identity, finding someone who understands that culture often allows for a shared vocabulary and more comfort in discussing issues that may be relevant. It is important to note that it is possible to find counselors who understand your culture without belonging to your cultural group.
Finding someone who specializes
There are certain therapeutic issues that require a specialized skillset to treat. For example, if I had experienced a major trauma and were experiencing trauma-related symptoms, I would want to find a therapist who specializes in trauma treatment, and perhaps someone who is trained in EMDR. An otherwise good therapist without background in trauma could potential do more harm than good because they are not trained to work with those complex issues. Similarly, if a couple is seeking marital counseling, seeing an excellent individual counselor may not be effective in resolving relational problems because they lack the training and specialization to work systemically. They will see the problem and the process of healing it differently than someone with training in couple work.
In order to find someone who specializes, it can help to know where to look. A good starting place is online directories. One of the most established is Psychology Today. It offers search filters that allow you to seek out therapists by location as well as by specialization. But be warned, a person can claim an area of specialization simply by saying that they specialize. Many on Psychology Today claim a dozen different specializations. Realistically, a counselor may have competence in working with many different presenting problems, but are unlikely to have more than a few areas where they truly are specialized. For this reason, it is important to ask good questions in the initial phone conversation (more that this another day). It can also be helpful to find online directories on websites associated with professional organizations. For example, ICEEFT, an organization for individuals trained in Emotionally Focused Couples Therapy, provides a list of therapists who have completed various levels of specialized training. By going to their website, you can find local EFT therapists who have completed an externship, an extensive core skills training, or who are fully certified EFT therapists.
Finding someone you can afford
For a lot of people, finding a specialist often feels inaccessible because of cost. Some specialists who are well-established and well-branded can charge over $200/hour. And, since the course of therapy can often take a dozen sessions or more, the price adds up fast. Here in Mesa, Arizona, the current average for a counseling sessions tends to average around $120-$150/hour. This represents a big financial sacrifice. And, while you and your well-being are absolutely worth it, it makes sense to find more economical options when they are available. For many, the most economical options available to them is to find a counselor covered by their insurance.
For those who have health insurance, there is the possibility of finding a therapist who is covered by your insurance provider. If your insurance does cover counseling, a good starting place is to call your insurance company or visit their website in order to find a list of approved providers. From there you can see if any of them have online websites or profiles before making calls to try to find options who are accepting new clients and who feel like a good fit. Another approach can be to start on Psychology Today and use their search filters to see what local therapists claim to receive your specific insurance. If you do this, be sure to follow up in your initial phone consultation to make sure they are still accepting your insurance. You may also want to check your insurance policy to see if there is a limit to how many counseling appointments your insurer will cover annually.
You may have the experience of finding a therapist that you want—someone who is a good fit for you, someone who specializes in your issue, or someone recommended highly to you from someone you trust–who is not in network for your insurance. If they are not covered by your insurance, there is sometimes an option to receive partial reimbursement. You would want to first check with your insurer, but many insurance agencies will provide partial reimbursement when seeing an out-of-network provider. In these instances, it is the responsibility of the client (you) to find out your insurer’s policy and to do the legwork to get reimbursed. The therapist should provide what is called a “superbill” with all the information that your insurance company will need from you. This option requires you to be able to pay your therapist upfront, and will require some work from you to get repaid. It will be up to you to assess if the amount you are reimbursed feels worth the effort.
Choosing to Not Use Insurance
It is also important to note that some individuals with insurance will choose to forgo using it to pay for services in order to avoid a diagnosis. There are also situations where a client is experiencing stress that is not explained by a formal diagnosis or where their presenting problem is not covered by their insurance. These individuals will need to pay for services themselves and are often motivated to find more affordable options.
Also, for those without insurance, or those who decide to pay out-of-pocket to receive services from a therapist who does not receive insurance, you can ask a potential therapist if they offer a sliding scale. Some counselors are able to offer an adjustable rate based on a client’s income.
Another option for finding more cost-effective counselors is to reach out to schools or training programs. When, as a Masters and PhD student, I worked at community clinics staffed by graduate students who were being trained, costs to clients were as low as $15/session. In these situations, you might not have the benefit of a therapist with as much experience or specialization, but your therapist will have supervisors helping ensure high-quality therapeutic services. When your therapist is an intern or is associate licensed, their rate will often be considerably lower that independently licensed therapists. If you are looking for a more affordable option, consider calling local schools with programs in counseling fields to see if their program has a community clinic or to ask where their students participate in their clinical internships.
Best Two Out of Three?
So what if you can’t find someone who meets all three criteria: Good therapeutic alliance, specialist, affordable? Well, it depends. In my mind, if I had to cut one of the three, the affordable aspect is the one I would be most willing to sacrifice if I was truly in need. And this is coming from an incredibly cheap person! But I’m an incredibly cheap, money-conscious person who recognizes the value of good therapy. Going in for affordable therapy that isn’t helpful isn’t helpful. I worked for several years at an agency that received individuals who were not required to pay anything out of pocket. To meet the demands of the agency’s business model, therapists where given unreasonable workloads (up to 150 clients). This didn’t allow clients to come in regularly, nor did it allow therapists more than 10 minutes of time per client for preparing to work with that client. Far too often, session time was spent helping the client process their frustration with the agency rather than focusing on the issues that brought them to the agency. Many such clients would have been better served if they had found ways to pay out of pocket and received regular services to help them meet their goals much more quickly.
If I had to cut another criterion off the list? It depends. Generally, the therapeutic alliance is paramount. Again, research has found therapeutic alliance to be one of the biggest predictors of therapy being effective.
However, with certain presenting problems, and when dealing with a certain severity of symptoms, I would recommend a specialist. If I had a potential client come to me with an eating disorder, severe substance abuse disorders, or PTSD, I would refer them out. Would I want to help them? Of course. Could I help them? Maybe. But not at a level or rate that others who specialize could. To attempt to treat them with presenting issues that are outside my scope of practice would be a disservice to them and would be professionally unethical. I recognize I will do more to help such clients by helping them find someone who specializes in treating their particular issues.
The right therapist for you is the therapist who will help you heal. He or she is someone that you feel safe with and trust. They are someone with the knowledge base and skills to help you with your particular issues. And they are someone that you have the means to see throughout the course of treatment. There are many resources available to help you find the counselors who will help you find the healing, perspective and growth you seek.