Navigating the Maze of Psychotherapy--And Choosing a Therapist

It can be quite a daunting experience to try to choose a therapist.  It would be kind of like me going to Manhattan to choose an investment banker for a company (if I owned such a company).  I wouldn't be able to tell one investment bank from another.  The bankers would all come with impressive offices and impressive titles, and they would have all graduated from impressive institutions.  I would be out of my league.

I'm sure that it must be much the same for individuals trying to find a therapist.  Where to start?


Let's take a look at some of the obvious practical issues which I think influence people choosing a therapist:

• Are they on my insurance plan?
• What type of therapy do they do?
• How much do they charge?
• How close is their office?
• How often will they be able to see me?  Want to see me? 
• How often can I afford to go see them?

These are the practical issues which I suppose influence people in their decision making.  (I don't know if there has every been a study on what really guides people's decision making.  It would be an interesting study for some aspiring graduate student out there.)
Now, here are the issues which I think are most important

• What is the conceptual framework of the therapist?
• Will you be able to build a therapeutic alliance with them? (Or perhaps the question is will the two of you be able to built a therapeutic alliance together?)
• Will you feel accepted by them and be able to tell them about the parts of yourself that you hide from others?
• How much experience has the therapist had?
• What is their reputation in town?
• How "professional" are they?  Do they have good ethics and good boundaries?
• Are they burned out and tired, or do they still have an energy and zest for what they do?
• Are they able to see problems in only one way?  Or can they work out of multiple frameworks?

These latter questions are very difficult to answer.  Even colleagues that I have known over the years are still a little bit of a mystery to me because I have never had the opportunity to listen in to one of their sessions.  I know how they come across to me, and I have an idea of their conceptual framework, but I have not actually seen them do therapy.  So if someone came to me asking for a referral, it would still not be a slam dunk process for me to decide whom I would recommend.

But nevertheless, in case you are one of those individuals who has made the decision to seek therapy, here are some ways you might go about it.

Many people start by checking the list of providers in network on their insurance list.  That is not a bad place to start, but it is not the sole consideration.  Insurance companies are getting more picky.  If there have been ethical complaints and lawsuits, a therapist may be taken off their list  So being on an insurance list is one consideration, both ethically and financially.

Check with your family doctor.  They may have had experience with referring to a specific therapist, and they know whom their clients have liked and who they haven't liked.  Similarly, ask a pastor, or ask friends.

Place a call to the therapist's office, saying you would like to talk to them and ask questions.  Notice how long it takes to get a call back.  In some instances, you might not ever receive a call back.  If you receive a returned call the same day, that is a good sign that if you had an emergency they would get back to you.  Now some doctors are really, really busy.  And I am not criticizing a doctor who would not return a phone call to a stranger within 24 hours.  But it could still be useful information for you to have.

Ask questions (maybe some of the ones above).  You're not exactly looking for an exact set of answers.  You want some idea to the above questions, but you are also listening to the tone of the person and asking yourself whether you might be comfortable with them. 

Are they defensive about you asking questions?  Or do they take it in stride?  Do they seem sure of themselves?  Unsure?  Cocky?  Dogmatic?

You might also ask if the doctor would be okay with you seeing them a few sessions and then deciding whether to stay in therapy with them.  Again, it's not their exact answer which matters.  It's the way they handle the question that gives you the most information.

So, good luck.  Remember, you know more than the therapist about some things (such as what is going on in your life), and they know more than you do about some things.  So don't be afraid to dialogue with them and ask how it is that they can go about helping you.  Have confidence when you talk to the therapist, and if they make you feel intimidated, well, maybe you need to keep looking.