It doesn’t seem fair that people only get to talk to a therapist AFTER the whole ordeal of finding one. Arguably this is the hardest part, and it’d be great to have someone guide you through. Here’s some tips I think will be helpful for anyone seeking out therapy, whether it’s the first time or the fourteenth time. You can do the steps in a different order or skip some of them, whatever meets your needs, but here’s a basic overview.
Step 1. Decide why you want to go to therapy.
You’re likely going to need to give 1-2 sentences to a prospective therapist about what you want, and it’s a good idea to have a basic understanding of this because it’ll help you narrow your search. If you have a simple, concrete reason, such as a recent death in your family, this may be easy to do. If you’re dealing with a lot of feelings at once, try to think about what’s most distressing to you right now, whether that’s an incident that happened to you (being abused, divorce/breakup, COVID-19, losing your job) or your symptoms (not being able to get out of bed in the morning, feeling anxious, panic attacks, flashbacks/reminders of things, having trouble in relationships, thoughts you can’t control).
This will be like your elevator speech when you contact therapists and fill out intake paperwork. It’s also OK if you aren’t comfortable sharing everything right away or writing it on an intake form, you can be vague and say things like “relationship problems” if you’ve been in an abusive relationship, or say “trauma” if you were attacked, raped or molested.
You’ll also want to decide if you want to do family therapy (you and another family member), couples therapy (you and your partner), or individual therapy (just you). If you want to seek out a person who can prescribe you meds or a therapist with a specific type of credentials, make sure you understand what those are as well. Here’s a little guide I wrote on therapist credentials. If you just want individual therapy and all the credentials are overwhelming, it’s ok to just pick whatever therapist looks like a good fit and works with your insurance/budget too. Just know that some therapists cannot prescribe meds and some can.
Step 2. Make your budget and check your insurance (if you have it).
This step can be switched around with Step 3, depending on what works best for you. You may want to look at therapy prices before making your budget so you can be realistic about what’s out there. Therapy can be expensive, but there’s lots of options that exist for low-cost therapy and working around your insurance, as well as ways to get therapy without insurance.
If you have insurance, call your insurance provider (using the number on the back of your card) and ask what your mental health coverage is. They will probably tell you some information about copays and deductibles, and that’ll give you an idea of what you may be able to afford. If those terms are total gibberish to you, check out this resource on basic insurance terms. Be sure to ask them if they cover the type of therapy you want to do – couples, family, or individual. You can also do a search on therapy websites (I’ll list these on Step 3) to see what therapists in your area accept your insurance, and ask them to do a “benefits check” on your insurance to tell you what you’ll likely pay per session. It’s a good idea to both check with the therapist and with your insurance to get the most accurate picture of what you’ll pay. It’s a very normal question to ask a therapist and they should be able to give you some answer.
If you don’t have insurance, there are still plenty of ways to get therapy. If you’re in the U.S. and have low income or lost your job, or qualify for some other public assistance, it’s a good idea to apply for your state’s Medicaid program and see if you qualify, because you may be able to get free insurance that has mental health coverage. Check your county’s website or ask a social worker about how to do this. Even if you think your income is high enough, it’s worth a check since many states have changed their regulations on this with COVID-19.
Depending on your budget and comfort level, there are several options for cheap or free therapy without insurance. You may be able to go to a student who’s in their internship at a local university or college (check the websites of any higher ed that’s nearby and see if they have these programs) or there may be walk-in programs through local nonprofits. Try googling “walk-in counseling” or “low income counseling” to see what comes up, or if you’re connected to a social worker or nonprofit ask them if there are options. NAMI (The National Alliance on Mental Illness) has chapters all across the United States and often has a resources page on their website to help people find therapy and mental health resources. There are more options than ever now for online therapy and groups so even if you can’t find something in your area you can still get help. See Step 3 for another resource for low-cost, cash pay-for-service therapy as well.
Step 3. Search prospective therapists.
The biggest database for mental health therapists is Psychology Today. This website is a great first step to check and gives you the option to search in several countries outside of the United States. There are options to search by type of insurance accepted, issues that the therapist has experience with, and what type of approaches the therapist uses. If you’ve heard of a type of therapy that you want to do, like EMDR, DBT, or IFS, then feel free to search for that type too, but if you don’t know what any of that is, don’t worry.
Another resource similar to Psychology Today is Therapy Den. I like to recommend Therapy Den to people who want to choose a therapist based on the therapist’s identity (racial, ethnic, gender identity, etc) as this website has a better feature for doing that. Some people may want to have a therapist who is their same identity, and some don’t. It’s a personal decision you get to make. Similar to Psychology Today, you can choose your therapist based on geographic area, insurance type accepted, specialty, and therapeutic approaches too.
My go-to for low-cost therapy is Open Path, which is a collective of therapists that have agreed to charge $30-$60 per session for individual therapy and $30-$80 per session for couples. The site only lists therapists in the United States and they often have limited availability. You need to attest that you are low income and cannot afford typical therapy rates, so please use your best judgement on that and do not use a resource you don’t really need.
There are also options like Talkspace where you can text with a therapist, but I don’t know much about these. I know they are lower cost and some have options where you can see therapists via video, so if this sounds like something you want feel free to check it out. I believe that texting only may not be as effective as a video session since you aren’t getting the same connection with the therapist, but my opinion is that I will never stand in the way of someone getting help, so if this helps you, then that’s great.
Step 4. Decide who you want to contact and request more information from them.
After looking at profiles and narrowing down your search by area, insurance accepted, or other criteria, read the profiles on the therapists and see who sounds like someone you could talk to. If you have a visceral reaction to someone or something about them makes you feel uncomfortable, just move on to the next one, that’s ok. Listen to your body while you’re looking and reading. If you notice you feel more relaxed or “seen” by someone’s statement, then make a note. Make sure you check to see if they’re accepting new clients, it should be written somewhere on the profile. Choose a few of them (I’d say 2-3 for your first time around, then keep going if you don’t hear back) and send them an email or leave a voicemail to learn more.
Feel free to ask questions in your initial email or phone call. Remember that you are shopping for a service, like a dentist or a doctor, and you aren’t required to keep seeing them if you don’t like them. Some typical questions to ask a therapist include “How much can I expect a session to cost?” or “What times during the week do you have available?” or “Can you tell me if you’ve worked with X problem before?”
Usually if you contact 3-5 therapists, you’ll hear back from at least one. I don’t know why some people are horrific at getting back to prospective clients, but some just don’t answer back if they’re caseload is full, so it is unfortunately pretty normal to not hear back from some of them that you contact. Just keep contacting people until someone responds. I personally would give them a week to respond before moving on, because I get irritated about people not having good email etiquette and I know that if they take that long I’d be getting annoyed all the time so that’s my boundary. Other people are different, so just think about your own preferences.
Step 5. Set up appointment(s) and try the therapist(s) out.
If you’ve gotten the info about cost, scheduling, and type of therapy sorted out, you’re ready to schedule a first contact with your therapist. If you feel unsure about which therapist you want to see, ask if you can have a free phone consultation and chat with them about what you’re dealing with and any concerns or questions you may have. Get a vibe for the person and see how you feel after the conversation. This won’t be a therapy session, but you’ll get a feel for if you like the person or feel comfortable with them or not.
If you find two or three therapists you really love and can’t decide between them, you can schedule intakes with more than one of them and test them out. Just know that you may have to pay for each therapist, even if you don’t attend a session with one of them, since some therapists have cancellation fees. Also, you’ll have to rehash a lot of personal information with anyone you do an intake with, so be prepared to do that multiple times. Some therapists say they don’t want you to shop around, I personally do not like this practice and will by default not choose a therapist who tells me I can’t do a test session.
*rant* Yes, I know it does make sense for a therapist to suggest you not see anyone else if the two of you are already working together and doing very specific interventions that could be ruined by another therapist contradicting, but shopping around at the beginning is different than that. If you’re a therapist who tells clients they have to choose between you and another therapist without ever meeting you, please stop restricting clients from exploring their options, it’s not a good look. There is no need to act as though we know more than clients about their own lives and lord our services over them like that because they are adults in charge of their own future and get to make choices. *end rant*
Step 6. What to expect in a first meeting scenario.
Your therapist will probably send you some forms in advance to complete. These typically include release(s) of information, privacy policies, and a statement about the clinic’s rules around payment, scheduling, fees, etc. Keep copies of these if you can, since you may want to reference the policies later. You can expect your session to be a little less than an hour (45-55 minutes typically).
Your therapist will likely ask you a series of questions about why you came to therapy, who is in your life (relationships, kids, parents, family), your family history, some medical information (prescriptions, any disorders you or family members have), demographic information (ethnic background, religion, where you grew up, if money was a problem growing up or if it’s a current stressor), your symptoms (how you feel most days, how long you’ve had the symptoms you have), work, education, and previous experiences with therapy or psychiatry. If you’re nervous, you can always write down some things you really want them to know and bring that to the session. You also get to tell them you aren’t comfortable sharing if you just can’t talk about something yet.
Your therapist may give you some assessments to measure your symptoms or see if you have a specific disorder. Sometimes a therapist will come up with a diagnosis in the first session, and if you want to know what it is you’re free to ask it. A lot of therapists do therapy goals in the first or second sessions too, so that’ll give you a framework for what you’ll do leading forward.
In all of this, remember that if something isn’t feeling right about therapy, you get to talk about it. The relationship between you and your therapist is important and if it doesn’t feel ok you get to change it. If something doesn’t work for you, if you’re feeling uncomfortable sharing, or you can’t seem to talk about what you need to, tell them and see if you can fix it.
I know therapy can be so scary, so just know that it’s ok to be scared and that if you find a good fit, it can be good for you and really help. I wish you the best of luck.