It's Time To Talk To Someone... But Where Do I Start?

You’ve made the excellent decision that it’s time to talk to someone like a therapist or counselor. This is an important step toward self-care, and toward improving your quality of life. At the same time, it’s scary, particularly if you’ve never been in therapy before. It’s hard to be an informed shopper when looking for a service with which you’re not familiar. Reaching out to potential counselors can also be anxiety-provoking. Guidance Teletherapy is here to walk you through how to find a professional who is a good fit, and how to judge whether they continue to be a good fit as treatment progresses.

Interview Prospective Matches

Start by conducting a  search. You can Google providers of therapy in your area, or ask your insurance provider for a list of in-network clinicians. You can also get recommendations from your primary care doctor, family, or friends.

When you get recommendations, check out their websites, read their bios, then pick three to call that look promising. Know that when you first call you’ll most likely have to leave a message. Just leaving a message gives you plenty of insight as to whether the therapist you’re reaching out to will be a good match.

• When you get their voicemail, listen for what they list as an emergency contact, and see if they offer emergency hours. The therapist is expected to leave emergency information on their voicemail so that their patients, or prospective patients, have immediate instructions on what to do in case of an emergency. The most common message is “In case of a psychiatric or medical emergency, please hang up and call 911.” 

•  As part of your evaluation, factor in the amount of time it takes for them to reach back to you. If their voicemail said they will reach back in 24-48 hours, or 2 working days, but you don’t hear back for a week, this is a bad sign. It means that they are either too busy or that they do not check their voicemail often enough. A good therapist needs to be reachable.

Once you get them on the phone, there is specific information you need to obtain. Questions to ask during the initial phone call:

• What’s your training? Ask what state licenses and degrees they have. Ask them to explain how their license may differ from that of other clinicians.

• How long have you been practicing? Inquire how long they have been practicing, both licensed and unlicensed (as an intern or associate). This will give you an idea of the type of experience they have, or if they are new to the field.

• What symptoms, diagnoses, and populations do you love to work with? Who do you specialize in? It’s important you ask this because you want to know if the person you’re reaching out to can help you specifically. Therapists have a specific scope of practice which encompasses their understanding, training, and specialization for work with certain types of patients and patient issues. No therapist has specialization in all areas.

• What is your treatment philosophy? Often we have preconceived notions about how we want treatment to work. These may not match up with the work of the person you’re interviewing to be your potential therapist. Some therapists give mild advice (most therapists give no advice for ethical considerations), some assigned homework, some take on the stance of coach or teacher, while others are more reflective and observant. If you want someone who will give you daily tasks to achieve a goal, then you don’t want to work with someone who is process and present-moment focused.

• I’m seeking counseling for ___. How would you go about treating that? This question allows you insight into how the therapist conceptualizes your issues. Most therapists are trained to create a treatment plan “in-the-moment.” If it’s difficult for them to answer, that means they may not have expertise in the situation you need help with.

• How long do your clients typically stay in treatment with you? This question is designed for you to understand what the therapist considers a typical length of treatment. Some therapists are solution-focused and address issues in as little as 8 sessions. Others are process-driven and can work with their patients for years. It’s important to know what time commitment the therapist is expecting to be able to assist you, versus what you are willing to give.

• How much will treatment cost, and do you take ____ insurance? If you’re planning to pay out-of-pocket, then it’s important to budget what you can afford for weekly self-care through therapy. If you’re wanting to use your insurance, you need to know if the person you’re speaking with takes your insurance. It’s also important to note how much the first session, known as the intake session, will cost (this session involves obtaining a lot of background and medical/mental history and therefore historically costs more than follow-up treatment). Additionally, inquire about policies around cancellation or late fees, both of which therapists typically charge.

If, after the first phone call, you feel heard and have a clear understanding of the therapist’s approach, then they may be the right fit. If you hang up feeling more confused, more agitated, or even angrier than before your call, those are sure signs that this therapist is not the right fit.

First Session

The intake session in therapy often contains a lot of housekeeping. Like attending an initial appointment with a new doctor, there is new client paperwork that needs to be completed, copies of policies and procedures to review, and the discussion of scheduling. This is the time for the therapist to gather the necessary information to help formulate a treatment plan. This is also the time for you to ask questions about the policies and procedures of the practice, and about the payment structure. Make sure you clearly understand what the expectations and culture of treatment are.

Once the housekeeping is over, the initial session is focused on rapport building and providing the therapist with an opportunity to better understand your situation. This is the time for you to discuss what your expectations of treatment are, or what your goals are. If you have a specific issue or concern you want to focus on, describe it in as much detail as you possibly can. Talking about situations that are emotionally triggering with a stranger may be uncomfortable, but remember that you sought out a professional to listen to your needs. The more information you can give around your presenting problem, the better the therapist can design a treatment that is tailor-made for you.

At the end of the session, the therapist should be able to articulate the specific steps you both will be taking to address your needs. This includes scheduling another session and the frequency of sessions per week. This also means discussing if referrals are needed (housing assistance programs, psychiatrist, or medical doctor).

Once you leave, if you find yourself feeling heard, understood, and maybe even lighter (as if a weight has been lifted off your shoulders), then continue with the therapist you’ve connected with. If you felt rushed, ignored, or did not get clear and concise answers to your questions, don’t schedule a follow-up visit. Move onto the next person on your list of potentials.

Continuing And Discontinuing Good Therapy

Once you’ve picked the right provider, you and your therapist should be developing a good rapport. You are able to trust them. You begin to notice changes in whatever has brought you to them, and you look forward to treatment. Though every session won’t always be comfortable, and rapport building isn’t quick or easy, you should still feel like you’re doing good work. Continue doing the work with your therapist until you find that you no longer need active treatment.

When you and your therapist believe you’ve addressed the issues that have brought you to therapy adequately, it’s time to discuss discontinuing active treatment. This may mean seeing each other less often, maybe once a month instead of once a week. This may mean only scheduling for check-ins, especially around triggering times (like upcoming court cases, new job interview, or starting college). This may also mean stopping altogether.

Discontinuing Bad Therapy

But what if therapy doesn’t seem to be going smoothly? What if you find yourself not building rapport with your clinician? What if you haven’t found any reprieve via treatment? How do you know if it’s them and not you? Remember, therapists cannot wave a magic wand to solve all your problems. You need to be able to do “the work.” If there are goals that need achieving, but you haven’t made any steps to achieve them, you have to discuss what is holding you back with your therapist.

Of course, if you’re doing the work, and still not feeling the support, then the therapist you have chosen may not be right for you. There are certain red flags to watch out for:

• You feel dependent on the therapist.

• You leave the session feeling unsure of yourself, or doubtful of your skills.

• The therapist has or doesn’t have boundaries that make you feel unsafe, such as hugging you when not asked or dictating where you sit.

• The therapist talks the entire session, leaving you feeling unheard or confused.

• The therapist overshares their problems or personal struggles as if they are seeking help from you.

• The therapist tells a lot of personal stories and anecdotes that aren’t directly related or even helpful to your situation.

• The office has unclear or inconsistent policies (such as fluctuating check-in procedures).

• The office staff is rude, and though you have brought this up to the therapist, it has not been resolved.

• The therapist changes appointments often or cancels sessions frequently (and this was not discussed at intake, such as them mentioning they are Red Cross crisis counselors who may be deployed during disasters).

• The therapist refuses to acknowledge the cultural differences between the two of you or attempts to minimize them.

• The therapist doesn’t attempt to challenge you but instead allows you to say whatever you desire. Remember that a good therapist wants you to grow, and will address and re-address distorted thinking and behaviors, and will not simply allow you to “do as you please,” as that provides you with no growth.

If you notice any of the above, or feel like treatment, in general, is off-putting, then trust your gut! If you feel something is amiss, talk to your therapist about any concerns. It may be “growing pains” from the experience and have nothing to do with your rapport with them. Or, it may be that they are not the right fit. If the conversation around your concerns isn’t illuminating and validating, or the boundaries you have set are not being respected, it’s time to change therapists.

It’s okay to start the process over again and keep searching for the right fit. Again, not every therapist is right for every person. You have a favorite barber, a favorite pharmacist, and heck maybe even a favorite cashier at your local grocery store. You should feel the same genuine connection with your therapist.

All mental health professionals, regardless of their approach, should be respectful and responsive. You should feel that your needs are being met and that you’re growing and learning from treatment. That’s why you sought out treatment in the first place!

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