How to choose a therapist or psychiatrist

Patrick Carey

April 11, 2018

1. Lay out a few treatment goals for yourself

Maybe you’ve spent the past few years really nervous about trying therapy, or sure that you don’t need it. Or maybe you’ve been in therapy before and you just want to do a bit of psychological touch-up because life is always throwing new situations at you.

Whatever your experience with therapy has been, and whichever diagnosis you might have received, the most important thing is knowing what you want to get out of therapy. There’s no point in going just to go, so while your goals will continually change throughout your time in therapy, try to chart out a few main objectives that you can share with prospective clinicians when you give them an initial call.

You might say something like: “Hello, I’m Bob, and I’m 30 years old. I’ve been really struggling lately with social anxiety, and my main goal is to feel more comfortable meeting people because avoiding social situations just ends up making me lonely. I also feel pretty panicked whenever someone disagrees with me at work, so another goal I have is to tolerate disagreement without taking it so personally and so seriously.”

2. Choose the type of clinician you’d like to meet with

You may or may not have preferences about this. The most obvious choice to make is whether or not you want to see someone who can prescribe medication– if so, you would need to see a psychiatrist, who is an MD. Of course, other clinicians can always refer you to a psychiatrist, but know that psychologists, social workers, and counselors cannot prescribe. Often people will see a psychiatrist for medication management and a therapist for, well, therapy.

In these situations, it’s ideal if the therapist and psychiatrist communicate with each other. This is more likely if you get a referral to a psychiatrist from your therapist, or vice-versa. Some psychiatrists also do therapy. 

Primary care doctors—internists, family medicine doctors, or general pediatricians (for children)—also sometimes prescribe psychiatric medications. Although they have less training specifically with psychiatric medications, if you (for example) live in an area without access to a psychiatrist, this might be an option.

Psychologists typically have a PhD or a PsyD. This matters to some people, but not to everyone. Other therapists, including social workers and counselors, have master’s degrees and are also licensed mental health professionals. Another category is psychiatric nurses and nurse practitioners.

It’s alright not to know yet what kind of mental health professional you want to see, or whether or not you’ll want to try medication. But degrees only go so far—master’s level therapists and counselors often have specialized training in treating OCD and other forms of therapy.

The other factors on this list will often be more important than degrees as you determine than which clinician to schedule an appointment with. But your priorities are your own, and it might help to do a little research on the different types of clinicians and decide what matters to you.

3. If there’s a specific type of therapy you want to do, keep that in mind

There’s a bunch of different types of therapy. Although talk therapy is most common, cognitive behavioral therapy, or CBT, has grown in popularity in the US in the past few decades. CBT has been shown to be highly effective for treating specific disorders like OCD, anxiety disorders, depression, and others. But a number of other forms of therapy, among them ACT and DBT, are also worth looking into.

Once again, the type of therapy might not be as important of a factor for you, especially if you’re just starting out. That’s fine– each type can offer you something useful, and each has its drawbacks. But if you’re looking for something more specialized, like Exposure and Response Prevention (ERP) (a type of specialized CBT) for OCD, then you might need to look a bit harder before you find someone who’s been trained in it.

Learn more about specific types of therapy.

4. Decide how far you’re able to travel to see your clinician

This one can be hard to remember when you’re just starting out, but unless you have no choice you’re probably not going to want to travel an hour each way to see your therapist for 45–60 minutes. You don’t want to set up your treatment to fail, so be realistic with yourself, knowing that you’re going to be making the same trip, back and forth, every week for an extended period of time. This also depends on the type(s) of transportation available to you. And the more specialized your needs, the farther you might need to go.

5. Figure out how much you’re able to pay

Unfortunately, many forms of mental health treatment are really expensive. And it usually gets more expensive with each layer of additional training. This also varies by location and demand, but many psychiatrists charge at least $400 per hour. Insurance coverage (see #7 below) can make the cost less overwhelming, but you’ll typically still be paying at least a portion out of pocket.

Specialization tends to make things pricier. Unfortunately, whenever the supply of therapists is lower, the price goes up; there are fewer people trained in ERP, for example, so their appointment books tend to be jammed and they can charge a lot.

I wish I could say cost shouldn’t be a determining factor as you consider mental health treatment, but that would be a bit naïve. Still, there are ways to make things less expensive- more on that below.

6. Decide when you’re free for appointments

Most clinicians work hours sort of similar to the rest of the 9–5 world. Sometimes they’ll stretch out their day in one direction or another, and a few will see patients over the weekend, but if you can find a few ways to be flexible with your own schedule you’ll have more options.

Don’t worry yet about trying to find a time that will work every single week. But go in with a sense of when you’re usually free, and a specific idea of times you could go in for a first appointment. If you’re only free on Mondays at 7pm, you’ll need to jot down quite a few phone numbers.

Some therapists do teletherapy, which can be over video or the phone. Some integrate technology with their treatments, such as with online workbooks, apps, and/or text messaging.

7. Take a moment to find your insurance card (if applicable)

Nobody ever wants to talk about insurance– and, to be honest, I don’t really either. But, even for those fortunate enough to have health insurance, it’s a constant battle for people undergoing mental health treatment. Therapists, and especially psychiatrists, can be difficult to afford for many if insurance isn’t footing at least some of the bill, so it’s good to know what to expect in terms of coverage.

If you don’t have insurance, and paying out of pocket isn’t a viable option, it’s worth looking for providers who offer a sliding scale for payment. This is something you’ll need to discuss with them during your initial phone call or first appointment. Don’t be afraid to ask about payment, because you’re certainly not the first person to mention it.

When you need someone who takes a specific kind of insurance, say Blue Cross or Aetna, your insurance provider might have an online portal for finding clinicians. These will limit your choice, but might save you a headache further down the line. Check out the insurance provider’s website or give them a call to find these resources. 

Let's say you find someone who is “in-network”—this usually means that the clinician will bill the insurance but you will need to pay a (smaller) co-pay. Otherwise, it’s often possible to pay upfront and submit the bill to insurance for partial reimbursement. This “bill” is often referred to as the “superbill” or the “statement.” 

Check all of this ahead of time, or you’ll add a headache on top of your mental health concerns. Also, check your deductible on your insurance plan -- this is the amount you have to pay out of pocket every year before your insurance kicks in and pays the rest.

8. Find a bunch of clinicians, call them, and narrow it down

Once you’ve considered all these factors, do some Googling, look at clinicians’ websites, ask people you know for suggestions, use online directories, and use your insurance provider’s portal, if applicable. Word of mouth is one of the best ways of finding good clinicians. If one mental health professional tells you they’re all booked, ask them if they wouldn’t giving you a few names of people they’d recommend. Calling a good number of therapists or psychiatrists will make sure you’re not stuck without one when you call the first one and something seems off.

What might you look for during an initial phone call? All the things we’ve addressed so far are good topics. If you’re seeking specialized treatment, like ERP, ask if they know what this is (use the acronym—specialized clinicians will know what you’re talking about), how many patients they’ve treated with ERP and for what disorders, and how many they are currently treating. Ask where they got their specialized training.

Unfortunately, there are therapists who claim to know how to administer these treatments, e.g. ERP, CBT, DBT, or ACT, but actually have little training or experience with them. Also, if you have a strong preference for a mental health professional with specific characteristics (e.g. gender, race, political identity) you might be able to discuss these– or discern them– at this early stage. And just make sure there’s nothing that makes you feel off about them after just one phone call. First impressions aren’t everything, but they matter.

9. Now do an initial appointment with one or more of your options

If you find someone who seems like a good match and you have mutual availability, go in for an initial appointment. They’ll probably have you fill out a number of forms and inventories, but you should also get a chance to ask them questions. This is a good time to get an overall feel for the way they like to approach treatment. 

Try to be mindful of the way you feel around this person. Your goal is to have them as a collaborator in your journey toward feeling better, learning more about yourself, and meeting the goals you laid out in Step #1 above. They don’t need to be your friend (not to mention the ethical issues involved), but you definitely shouldn’t dislike them either.

Does their style of questioning make you uncomfortable? Do they speak too much, leaving you feeling more like you’ve just left a lecture? Do they say nothing at all, or do they seem distracted? These could all be red flags for you, and you have no obligation to continue with someone just because you’ve done a consultation, or even a bunch of appointments, with them. 

The nice part about all of this is you get to make your own decisions, and figure out what works best. First impressions are important, but it actually might take a handful of visits to get a feel for a person, if they “get” you, and what their treatment plan for you would look like. Sometimes a viewpoint that challenges your own can be highly beneficial for therapeutic success; similarly, therapeutic approaches that seem initially like a bad match may grow on you. 

Therapeutic modality (the type of treatment), viewpoint (the way they apply this modality to your therapy), and approach (the way they administer therapy) are different, but they interact in many ways and are all important.

It can be a bit awkward to tell someone you’re going to look for other options instead, and it might even feel like you’re letting them down, but if something really puts you off then it’s not worth going back. The nice part is you can do this whichever way feels easiest: phone, email, in person. Usually none of this happens, because there are countless good clinicians out there. But it’s worth mentioning simply because it’s never helpful to feel stuck with a therapist or psychiatrist who isn’t a great fit.

10. Try it out– you’re allowed to change your mind

When you’ve found someone you like enough, you’ll just have to work out a time to come back and start delving deeper. As studies of the relative efficacy of different forms of therapy and countless real experiences continue to demonstrate, the “fit” between clinician and patient is the single most important predictor of treatment success.

You don’t necessarily need to look forward to therapy, but you probably shouldn’t hate it either. Some types of therapy like ERP are challenging, and trauma is often painful to process. But a lot of healing and improvement in quality of life usually result.

Try to go in with an open mind, because new perspectives in your life can arrive with thrilling frequency. Therapy is never a magic potion, but at its best it can help you help yourself much more effectively. It can open you up to possibilities that you’ve always wanted to realize, but could never quite arrive at. Whether you’re trying out medications, just talking with someone, doing a specialized form of therapy, or combining all of it, there’s a lot to learn, and much to gain.

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