How to Choose a Psychotherapist

Often I get asked what to consider when you’re trying to find a psychotherapist.  People ask about what the initials mean, what the training is, and how to find someone who is a good therapist.  To be honest, it can be pretty confusing.  Here are a few of my thoughts.

First, consider what you are looking to accomplish.

Do you want to:

• Learn coping skills
• Understand unconscious patterns
• Communicate better in relationships
• Get support
• Grieve a loss
• Or just feel you are living your life to the fullest

Most people can benefit from having a safe space to talk openly about their feelings and thoughts.  However, your intention and hopes can affect what kind of therapist with whom you’d work best. 

Let’s go over some other considerations when choosing a therapist.  Which of these is important to you?

Experience:

Currently, in Illinois you can see psychotherapists who are not clinically licensed.  These include:

• a Master’s level student or a Master’s level graduate who is working but has not yet become clinically licensed:
• LSW  (Licensed Social Worker) LPC (Licensed Professional Counselor) 
• Ph.D. and PsyD doing a post-graduate clinical internship The above titles usually practice under the license of a supervisor.

Fully licensed psychotherapists include:

• Ph.D./PsyD (Doctor of Philosophy in Psychology/Doctor of Psychology) after their 2 years of clinical experience
• LCSW (Licensed Clinical Social Worker)
• LCPC (Licensed Clinical Professional Counselor)
• LMFT (Licensed Marital and FamilyTherapist).

Licensed therapists can range from 2 years of post-school experience to someone in the field for over 50 years!

Also, note that different training programs (e.g., Master’s in Social Work or Master’s in Counseling) may focus differently on how to help clients. 

Area of expertise:

Psychotherapists have basic training in most issues, but often we have specific expertise in certain fields of mental health.  Some therapists have additional training in codependency, addictions, trauma, family issues, attachment issues, depression, or anxiety.  You might think about what knowledge you would like your therapist to possess.

Specific theoretical orientation (or techniques):

There are many, many theories, and most therapists will integrate at least a few:

• Psychodynamic –  Often focuses on repetition of unconscious patterns and how these impact current life. Emotions are important in addition to insight regarding how the past influences current behavior.
• Cognitive Therapy – Includes several schools of thought, including CBT and mindfulness-based techniques.  Often the focus may be on learning to recognize thoughts and beliefs that are maladaptive and determine how to shift these.  The focus is usually more on the present than the past.
• Body-centered – In the last several years, much research has come out about the connection between the mind and the body.  These theories focus on both recognizing/acknowledging the emotions and how they manifest in the body.  It is especially important in working with folks who have experienced trauma.
• Alternative treatments – While not a specific theory, there are many techniques now being used that include a more holistic understanding of the person. These include Heart-centered hypnotherapy, energy work, Reiki, and shamanic practices.

Other important things to think about:

Style:  Active or quiet? Somewhere in between?  In my opinion, a good therapist is one who listens, gives non-judgmental feedback, and helps the client to determine what is best for themselves. Some clients expect the therapist to tell them “what to do”.  But as a therapist in the field for over 30 years, my belief is that it is not a therapist’s job to give advice.  Ideally, psychotherapy helps you to know who you are, and what you want…not who the therapist thinks you should be.

Gender/Age:  Does it matter to you if you see a woman or a man? Or is it important to see someone who understands that gender can be non-binary? Some people are more comfortable seeing someone near their age, and some prefer a therapist who is older or younger!

Boundaries & Confidentiality:   Everything you say in your therapist’s office is confidential, except if you threaten to hurt yourself or someone else.  If you run into your therapist on the street, you should be able to count on the fact that they will not acknowledge you publicly.  If a client says hello to me at an event we are both attending, I will say hi back, but I respect that this person may not want the people they are with to know this is their therapist, and outside of the office is not a place to discuss clinical issues.   In the office, the sessions should be focused on you, and not on your therapist’s needs.  Additionally, some fields (social work being one) prohibit bartering or “dual relationships” (e.g., the therapist being friends with the client outside of the session, or hiring the client for outside work).

Fees:

• Insurance – Many people are only able to attend psychotherapy because their insurance pays most of the fee.  If you need to see someone who can bill directly to your insurance company, you will want to find a person “in network” or “paneled” with your insurance.  To use most insurance your therapist will need to “diagnose” you with a code from the DSM  (diagnostic and statistic manual). Very few insurance companies will pay for “wellness counseling,” although this is slowly changing.  Importantly, I am aware of these diagnoses, in some instances, having an impact on securing long-term care insurance and life insurance.  
• Sliding scale – Some therapists will lower their fee based on extenuating circumstances.  Often this is done when someone has little income, has a high-deductible, or does not have insurance.  This is something you can ask about when you make your initial call.
• Private pay – There are some therapists who do not take insurance (myself included).  You will pay the fee “out of pocket”.   Many of these therapists can offer you a statement once you have paid that you can submit to your insurance for possible reimbursement for “out of network benefits”.   

NOTE: There are several reasons for considering an out of network/private pay therapist:

• Many established therapists are not on insurance panels
• You are not automatically being given a medical diagnosis (unless you request it on a statement)
• Your treatment is confidential (insurance companies can request psychotherapy notes, treatment summaries, or do audits of services at any time).

Non-judgmental:  While no one can be entirely non-judgmental, it is important that you feel a sense of respect and acceptance from your therapist.

Being Present: You deserve to have a psychotherapist who listens closely and is awake.  I’ve heard many stories over the years of therapists who take calls during sessions, allow other interruptions,  fall asleep, show up late for appointments, miss sessions, or who seem preoccupied. If you are uncomfortable with the level of attentiveness with your therapist, you have the right to bring this up and discuss your concerns.

And the most important thing…how it feels to be with the therapist.  Your RELATIONSHIP with the therapist is key.   Research shows that the connection between client and therapist is the number one indicator of successful psychotherapy. 

Speaking with a therapist on the phone and then meeting with them once or twice can give you a sense of how comfortable you will feel working with them. 

It is ok to interview several therapists when you are making the commitment to therapy!  

Starla Sholl, LCSW

Content provided by Women Belong member Starla R. Sholl, LCSW, PC