Finding a therapist who’s right for you, or your loved one, may not be easy.
Mental health professionals are in especially high demand, as many struggle with the COVID-19 pandemic, economic turmoil, political anxiety, racial reckonings and other traumas, disorders and heartbreaks.
“People are suffering, and we just don’t have the infrastructure in this country to give the amount of support people need, affordably,” said Anjali Alimchandani, a psychologist based in Los Angeles.
It’ll likely take some time and effort to find a therapist with an opening that fits your schedule, who takes your insurance or is within your budget, has experience treating your particular issues and makes you feel safe enough to reveal all your vulnerabilities.
But in some ways, it’s a great time to find a therapist.
In the last several years, there have been movements to normalize therapy, break the stigmas of mental health, educate clients about what they should expect, experiment with technology to make therapy more accessible and create specialized directories to help people look for therapists who share their culture, language, sexual orientation, gender identity and more.
“Therapy can be an anxiety-provoking experience,” said David Rudesill, a psychotherapist who practices and teaches at California State Los Angeles. “But you do it with the hope and understanding that the outcome can be worth it.”
Here’s a breakdown of the process, with some tips from licensed professional therapists.
Table of Contents
Figure out what you want
So it’s up to you to figure out who you want as a partner in that process, she said.
When Rudesill started going to therapy as a teenager, he just saw whomever his family members were seeing.
“I had no clue about their professional background,” he said. “I didn’t know anything about how they worked.”
He remembered one particular therapist who didn’t talk very much.
“Looking back, he must have been trained in a very classic psychoanalytic perspective, where you allow the other person to associate freely,” he said. “But for me, being very anxious, I needed someone to engage me. I needed for them to be a real human being, talking to another human being about human issues.”
Do some soul-searching about what you need help with:
What brings you to therapy: Common issues are depression, anxiety, relationships or adjusting to a new situation.
What type of person you think you’d be most comfortable with: Someone professorial you don’t know anything about or someone trained in social justice who understands your refugee parents.
What type of approach you’d respond to: Maybe you want something more intense and solutions-oriented; maybe just the act of breaking cultural stigmas and getting comfortable being open about your feelings would be a win.
“The research shows that most therapy models are almost equally effective,” said Rudesill. “So the differences between the individual practitioners matter more: the qualities of the individual, what are the specific things they are doing.”
You don’t need to be an expert on all types of therapy. But you want to be able to tell your therapist what you want, so they can figure out if they have the right tools.
“A lot of people choose a therapist because you like them and you want to be their friend,” said Alimchandani. “But if your friend could help you fix this, you wouldn’t be coming to therapy.”
Where to look
Insurance directories: “If a therapist is in network with an insurance plan, the client should only be responsible for the co-pay, no more, across all states,” said Adriana Alejandre, a Burbank-based therapist who started the podcast and directory Latinx Therapy. “If they’re out of network [for those with] PPO plans, every insurance and benefit plan has a different out-of-network deductible.”
This means the client will pay some amount out of pocket before insurance kicks in. Often, a therapist will provide the client with a receipt, or superbill, to send to the insurance company, which will reimburse a percentage directly to the client.
Online directories: Psychology Today, the magazine that’s been around since 1967, hosts the most widely used therapist directory, generating more than 95,000 referrals a day and including more than 165,000 therapists and treatment centers. You can search by location, issues, insurance, gender, types of therapy, age, price, ethnicity, sexuality, language and faith. GoodTherapy has been around since 2007, and in addition to those filters, you can search by evening and weekend availability and wheelchair accessibility.
In the last couple years, there has been a movement to create more specialized directories, said Jeff Gunther, a Portland, Ore.-based therapist behind the national progressive therapy directory TherapyDen. TherapyDen has many more filters to search through, including racial justice, LGBTQ issues, political anxiety, sex-positive and kink friendly.
Alejandre started Latinx Therapy when she saw the demand for bilingual therapists for the Latino community.
“I didn’t think it was fair to have a waiting list, especially for communities of color,” she said. “Many people, from low to medium income, came to me because of my specialty.”
She grew frustrated not being able to provide them with appropriate resources or referrals, so she created her own.
Other directories include Inclusive Therapists, Therapy for Black Girls, the Black Emotional and Mental Health Collective, Therapy for Latinx, the Asian Mental Health Collective, Melanin & Mental Health and the National Queer & Transgender Therapists of Color Network (where Alimchandani is on the advisory board).
For specific needs, you can try reaching out to community organizations, churches or even other therapists for guidance. For example, Alimchandani has directories she recommends specifically for South Asian or Muslim clients.
Location: Portland Therapy Center
One thing to keep in mind, though, is that therapists can be reprimanded if they work with residents outside the state in which they are licensed.
“That’s meant to protect the client,” said Alimchandani, “so if the therapist does something inappropriate, the client can report it to the state’s licensing board. If they live in a different state, they don’t have any right to report.”
Budget: If you can’t afford to pay out of pocket and aren’t finding someone appropriate through your insurance network, you can look for therapists who accept sliding-scale, or reduced-fee, rates.
“Because we know our community struggles, we usually reserve a certain amount of reduced-fee slots,” said Alejandre. “We don’t always promote that, because people sometimes take advantage of it. But people should be asking therapists if they have sliding-scale or reduced-fee slots if therapy is outside of their financial capability.”
“People who don’t have insurance or money often end up only being able to afford a therapist in training, which doesn’t necessarily have to be a bad thing,” said Rudesill.
These are often graduate students in or just out of school, who are accruing hours to qualify for certification. Often, they are working with a supervisor.
Credentials: Psychiatrists are medical doctors who can prescribe medication. Psychologists, those with a PhD or PsyD in psychology, can do testing and assessments; for example, for cognitive issues, ADHD, dementia or personality assessments. Psychiatrists and psychologists generally charge more money, because they usually have more in-depth and specialized training.
Therapists with master’s degrees can get different licenses — LPC (licensed professional counselor), LMFT (licensed marriage and family therapist), LCSW (licensed clinical social worker) — that all have their own nuances and requirements. There are also psychiatric-mental health nurse practitioners (PMHNP) who can diagnose, conduct therapy and prescribe medications. In some states, including California, they require the supervision of a physician, but Gov. Gavin Newsom recently signed a bill, which goes into effect in 2023, to allow nurse practitioners to practice independently.
The most important thing to confirm is that they are licensed, which means they have completed a certain amount of hours of clinical experience. You can check the local state board to figure out whether a therapist is licensed and whether they’ve been suspended or reprimanded in the past. (Search California-based therapists by name here. In other states, start here.)
Sometimes a client may have both a psychiatrist to manage their medication and a separate counselor to do talk therapy. Others may be able to get their medication from their primary care physician.
Language: More than half of Angelenos speak a language other than English at home, and some may be more comfortable speaking with a therapist in their native language. Alejandre runs a Latinx Therapy Facebook group of almost 3,000 mental health providers, and she said 98% of them speak Spanish. But if you’re having trouble searching for therapists fluent in other languages, consider contacting a local cultural organization that may be able to direct you to resources.
Experience: Alejandre is a trauma therapist. Rudesill works with people recovering from serious mental illnesses like schizophrenia and bipolar disorder. Alimchandani has specialized training working with members of socially marginalized groups navigating intersecting systems of oppression. Guenther does couples counseling and family therapy, with additional expertise in child and family development. Are you struggling with substance abuse, postpartum depression or a gambling addiction? Evaluate whether a therapist’s experience and patient population matches your needs.
Cultural competency and lived experience: According to 2015 numbers from the U.S. Census Bureau, 86% of therapists are white.
Guenther, who is white, remembers when he was training 15 years ago at USC, there was only one cultural competency class. But in the last few years, he’s seen dramatic shifts in what clients are looking for in a therapist, as well as people of color and LGBTQ people emerging as leaders in the field and developing curriculum for continuing education.
“There’s a lot more people being like, ‘This is who I am, and I want to find a therapist that has a values match,’“ he said. “Will they understand my culture, my ethnicity or my generation? Do they accept the choices I’m making? Are they competent in treating someone like me, whether I’m a person of color, transgender or queer, or in a poly or open relationship?”
“Our field has a history of pathologizing people of color, centering whiteness and straightness as a norm,” Alimchandani said. “Anything that isn’t that is a pathology.”
She pointed to gender dysphoria, one of the few psychiatric disorders that’s diagnosed only for transgender people.
“If an Asian person is depressed and anxious because they’re going through all this racism and discrimination, you don’t diagnose them with being Asian,” she said. “When we diagnose gender dysphoria, it says the problem is with your identity, not the symptoms you’re experiencing because you live in a society that doesn’t accept your identity.”
So for some, there’s an extra incentive to find a therapist who either has a shared, lived experience or has training in working with certain marginalized communities.
Technology: Also relatively new and evolving are the platforms in which you can pursue therapy. This includes video therapy from the comfort of your home, popularized by apps like BetterHelp and normalized during the pandemic, and also text therapy, popularized by TalkSpace.
Therapists have varying opinions about whether accessibility translates to effectiveness, though many are open to what technology can do to further integrate therapy into clients’ everyday lives.
Consultations with prospective therapists
Many therapists will offer at least one free consultation, whether over the phone, by video chat or in person.
“Part of my advocacy over the last few years has been trying to educate clients about what they can ask about their therapist,” Guenther said. “The vast majority of clients who are looking for a therapist don’t even know that they can ask anything.”
Don’t be afraid to ask hard questions.
“You want your therapist to answer your questions directly to the point where you’re comfortable and you understand,” said Alejandre. “No clinical jargon.”
On TherapyDen’s blog, Guenther has compiled hundreds of questions he recommends asking a therapist during the consult. Though he admitted getting some pushback from more traditional therapists, who have been trained to not reveal too much to clients, Guenther believes it sometimes helps the clients to ask private questions about a therapist’s beliefs, values, political leanings and their own experiences struggling with mental health.
“I encourage you to ask as many questions as you want,” he said. “They might not answer all of them, but it’s up to you to interview me to figure out who I am as a person. Do you feel comfortable sitting in a room with me, talking about the most vulnerable things ever?”
It’s fine to tell the therapist when it’s not working
Therapists are also trying to assess whether they have the right training and experience to help you, and if they don’t, a good therapist should tell you and refer you to another therapist, she said.
“I do a lot of check-ins, and if something is not working, I just ask them to talk to me about it before ghosting,” said Alimchandani. “Sometimes the thing that’s not working could be related to the issue that you came to therapy to address. That issue is getting triggered, and if we talk through it, we can get to a better place.”
But at the end of the day, you’re the one paying the therapist, and there’s no reason to be stuck with one who isn’t helping you.
“If a therapist doesn’t work out, that doesn’t mean therapy is not a good fit,” Rudesill said. “Find another one. Some people do this for several sessions, or even for years, and then they drop out, they stop going or they make an excuse, and it’s unfortunate, because something didn’t change that they wanted to change.
“It can really take some time to get clarity on what kind of therapy will help accomplish what you want.”
Some help in the meantime
If you need to talk with someone before you are able to find a compatible therapist, here are some hotlines to consider:
And here are some tips on how to manage stress and cope with anxiety during the pandemic.
This story originally appeared in Los Angeles Times.