But how can you tell if you should see a therapist? And how do you begin looking for a good therapist who’s ideal for what you’re doing through? Unfortunately, finding the right therapist and treatment isn’t always easy, especially if you’re at an emotional low point. Google “psychotherapy” and you’ll find a confusing alphabet soup of acronyms—ACT, CBT, and DBT, to name a few—for the various types of treatments. Even if you know what type of therapy you want, it can be hard to access it: 51 percent of counties in the U.S. do not have a psychiatrist, 30 percent do not have a psychologist, and 67 percent do not have a psych nurse practitioner. Only about 43 percent of those with anxiety disorders, for example, receive treatment, according to the Anxiety and Depression Association of America (ADAA). The good news: If you do see a qualified therapist, chances are you’ll find it helpful. Many talk therapy treatments are backed by reams of rigorous clinical trial data. In fact, studies have shown that, for conditions like anxiety and depression, talk therapies are generally as effective as psychotropic medications, with fewer side effects and longer-lasting impact. (That said, many patients benefit greatly from taking medication or from combining meds with therapy.) Therapy isn’t only for those who might be experiencing a mental health disorder. A therapist can help with relationship problems or challenging moments—say, a career shift or the loss of a loved one. Honestly, you may benefit from therapy if you simply need an objective person to talk to as a sounding board—especially if you’re one to sit and stew and let problems build up in your own head (or if you have no one else you can turn to at the time). This is how to get started.
The First Steps to Finding a Therapist
Figure out what type of therapy you could benefit from by doing some research.
It helps to spend some time figuring out what issues you want to tackle. Are you looking for some guidance on a major life change? Or do you think you could be struggling with a particular mental illness? If it’s the latter, consider reading up on mental health issues to get a better sense of what you might be dealing with. You can find helpful glossaries online from the American Psychiatric Association (APA), Anxiety and Depression Association of America (ADAA), and the National Alliance on Mental Illness (NAMI). Then ask friends and family, or your primary care doctor or ob-gyn to recommend therapists they think would be helpful for your situation. If you’ve had therapy before, mull over what you liked about the experience—and what you didn’t.
Pick a therapist who’s the right fit (think of this process as somewhat analogous to dating).
The best therapist for you depends on your personal preferences, the convenience level and cost of visits, and the provider’s specialty or training (more on that below). Look for therapists who are members of a professional organization, such as the APA, ADAA, the National Association of Social Workers, or the Association for Behavioral and Cognitive Therapies. These groups offer continuing education and hold conferences where attendees learn about the latest research in their fields. So if a therapist belongs to one of these groups, she’s likely staying on top of the advances in psychotherapy research and practice, says Beth Salcedo, MD, president of ADAA and medical director of the Ross Center, a mental health practice in New York City and the D.C. area. Most of these groups’ websites have databases that let you search for members near you—a great way to find practitioners if you haven’t gotten any personal recommendations.
What to Ask a Prospective Therapist
When you’ve found someone promising, request an informational phone call or a meet-and-greet before you dive into therapy sessions. Ask whether she’s treated other patients with your particular issues, as well as “how she would go about treating you, whether there’s evidence for that approach, about how long it will take, and how you both will know when you’re done,” says Lynn Bufka, PhD, associate executive director for practice research and policy at the American Psychological Association. If you’re looking for someone with expertise in a particular type of therapy, such as cognitive behavioral therapy (CBT) for anxiety, ask how long her training lasted. (You may not want to see someone who only completed a daylong workshop, for example.) Ideally, you’ll meet with a couple of therapists and then pick the best fit. “I jokingly say to people that it’s like buying a pair of jeans; you may have to try on a few before you find the one that works,” Salcedo says. You should also feel confident about your therapist’s skills and comfortable with the idea of her challenging you, notes Bufka. And while you don’t necessarily need to pick someone you’d want to be friends with, it is important that you feel you can be open and honest with your therapist—and that they respect you.
How Much Does Therapy Cost?
Another important thing to know before you start: how much the therapist charges and if they takes your insurance. Some therapists use an income-based sliding fee scale. While most insurance plans offer some therapy coverage, many therapists don’t participate in any insurance programs. To get coverage for those therapists, you need to have out-of-network benefits; you’ll likely pay up front and then be reimbursed for whatever portion of the fee your plan covers. Therapy can be expensive—a session is often $100 or more. But there are affordable options. Some therapists offer group therapy at lower rates. Community health centers often provide free or low-cost mental health services. Also, check out the graduate psychology or social work programs at your local university to see if there’s a clinic where trainees offer treatment. Online therapy is another option. Companies like Talkspace and BetterHelp connect users with therapists through a variety of methods, including text, audio, and video chat. Aubrey Williams, 33, of the Nashville area, started online therapy with Talkspace when she was struggling to get pregnant. She says she appreciated the price tag and the accessibility. “If I had a thought or a question at 2 a.m., I could just leave it for my therapist,” says Williams. “I was leaving messages for my therapist while nursing, sitting in the car, or at the office.” Studies have found that, in general, online therapy is about as effective as in-person treatment. NAMI also has a helpline (800-950-6264), and many local NAMI affiliates have free peer support groups. If you’re in crisis, call the National Suicide Prevention Lifeline (988). You absolutely don’t have to let cost prevent you from getting much-needed help.
What to Expect During Different Types of Therapy
What happens in sessions can depend on the type of treatment—and many therapists combine elements of different approaches.
Cognitive Behavioral Therapy
One common type is CBT, which is one of the most research-backed treatments for anxiety disorders and depression. It’s based partly on the idea that distorted thinking is a main cause of mental distress. Say you’re in therapy for depression. If a friend didn’t stop to chat at school drop-off, you might think, “She must hate me. I’m worthless.” During CBT, a therapist would help you identify these unhelpful thoughts, challenge them, and replace them with more realistic ones. She might encourage you to instead think, “My friend was probably busy and had to dash out.” For anxiety issues, CBT also usually involves “exposure,” in which you gradually expose yourself to the things you’re afraid of. So if you have an elevator phobia, you’ll work with your therapist to feel more comfortable in and around elevators.
Acceptance and Commitment Therapy
If your therapist recommends Acceptance and Commitment Therapy (ACT)—which research suggests is effective for anxiety, depression, and even chronic pain and substance abuse—you’ll likely learn various mindfulness techniques and exercises. (ACT is based on CBT but includes a strong focus on mindfulness and values.) ACT patients are taught to notice and accept challenging thoughts and feelings.
Dialectical Behavior Therapy
There’s also dialectical behavior therapy (DBT), an in-depth treatment that combines CBT with other approaches and addresses suicidal and self-harm behaviors, borderline personality disorders, eating disorders, and substance abuse problems, among other issues. Or you might try psychodynamic therapy, in which you learn to define your problems and understand how your history and past relationships may be influencing your current behavior.
General Counseling
If you’re having problems at work or in your relationships or are just feeling “blah” about life, a licensed professional counselor might be a good person to start with. Counseling doesn’t usually focus on treating severe mental health issues but helps people “figure out the factors that get in the way of being happy,” says David Kaplan, PhD, chief professional officer at the American Counseling Association. Counselors aid in identifying “what is keeping you stuck and can help solve problems so you can be more fulfilled and better enjoy life,” Kaplan says. Marriage and family therapists specialize in working with couples and families.
What About Meds?
Most therapy providers aren’t allowed to prescribe medication. You’ll usually need to consult a psychiatrist (with an MD), your family doctor, a nurse practitioner, or your ob-gyn for medications like antidepressants. But your doctor should collaborate with your therapist to make sure you’re getting the most appropriate treatment. If you think you might benefit from medication, discuss it with your therapist. They can direct you to someone with prescribing authority.
What Type of Therapist Should You See?
The practitioners below are licensed by the states they practice in and must work a certain number of hours under the supervision of more experienced clinicians before seeing patients solo.
Psychiatrists
These MDs are generally the priciest practitioners to see and the hardest to find, due to a nationwide shortage. Patients may go to a psychiatrist on occasion for prescriptions and another type of provider (one who’s more affordable and accessible) for therapy, though some psychiatrists do offer therapy.
Psychologists and Social Workers
The former usually have PhDs or PsyDs; the latter have at least a master’s degree. Both are trained to treat specific mental illnesses, such as anxiety and depression, and may use several different forms of therapy, such as CBT.
Counselors
Holding at least a master’s, they often guide clients through problems like whether to stay in an unhappy relationship or at a lackluster job.
Marriage and Family Therapists
They have at least a master’s and are particularly helpful when you’d like to see someone with your family or partner.
