Once you’ve generated a list of potential therapists, the next challenge is to narrow it down to a specific therapist with whom you can work. Below are some points to help guide you through the screening process, ideally to connect you with a positive therapeutic experience. Begin by considering what you want from a therapist and therapy. There are a number of questions on which you can reflect. You can then see how your responses compare to the approach and philosophy of the therapists who you may consider.
What do I want to accomplish in therapy? What are my goals? What would I like to be better or different? When answering these questions, try to focus on the aspects of positive growth rather than adopting a negative “stop doing this” mentality. A therapist can assist you in this reframing process, helping to identify the areas that you would like to change and the ways you can change them. It’s okay not to know what you want or to have mixed feelings about approaching therapy! Give voice to your ambivalence, it’s okay. These reservations can be brought up with prospective therapists as discussion points. You and your therapist will develop a treatment plan, but it can be helpful to give the therapist some general ideas of where you would like to go. Then, through the course of therapy, this plan can be developed, assessed, and fine-tuned to help you reach these goals.
How important is it that the therapist has similar values/spiritual beliefs/sexual orientation/life experience to mine? Some people feel very strongly that their therapist needs to be similar to them if they are going to truly be able to understand them. Someone who is struggling with chemical dependency may feel that only someone who has gone through similar struggles could provide effective treatment. People sometimes feel more comfortable talking with someone of the same gender or ethnicity because they are more likely to have a shared thread in their lives. This could be a significant factor, depending on if the reason for seeking services relates to one of these elements.
What’s my financial situation? Do I need to use insurance to offset the cost of therapy? Therapy is a commitment of time, energy, and money. The number of sessions may vary. According to a 2010 study published in the American Journal of Psychiatry, 42 percent of people in psychotherapy use 3 to 10 visits for treatment, while 1 in 9 have more than 20 sessions. If the average is 12-15 appointments, that can add up to a substantial financial investment. This isn’t to say that you should only consider therapy if you are wealthy and have a significant amount of disposable income. Rather, be honest about your financial standing and how therapy will fit into your budget. If you are stressed and overwhelmed because of overextending yourself financially for services, you may feel resentful of the therapy and ultimately create rather than resolve more clinical issues.
How much time can I invest in therapy? As therapy is generally a weekly commitment, consider how much time you’re willing to invest on a regular basis and what times work best for your schedule. Traveling two hours each way may be feasible for a single appointment but can you do it on a weekly basis? It may be well worth the time and travel if you’ve got a positive connection with a therapist and feel your therapeutic needs and goals are being met.
There are some specific questions to ask each prospective therapist:
What are your areas of expertise? Do you specialize in the specific issues that bring me for therapy? Not every therapist is an expert in every clinical issue. Ask if the therapist has received any focused training relating to the specific reasons for your seeking services. There may be a credentialing process that denotes a level of education or expertise. For example, the International Obsessive Compulsive Disorder Foundation (IOCDF) offers a Behavioral Therapy Training Institute (BTTI) that provides an intensive 3-day training in Cognitive Behavior Therapy for the treatment of OCD and related disorders. While not all who specialize in treating OCD have completed this training, it can be assumed that those who are BTTI graduates have met a standard in understanding and treating OCD. Asking a prospective therapist about training and expertise is opening up an opportunity to discuss why this therapist would be particularly suited to work with you.
How long have you been treating these issues? The assumption is that the longer a therapist has been practicing, the better qualified that therapist is. This may be the case, but is not necessarily true. A therapist who has been in the field for some time is likely to have honed his or her clinical skills by working with a number of clients in a wide range of situations. On the other hand, a younger therapist who hasn’t been practicing for as long and is fresh in the field will likely be more current on the latest research and treatment interventions. This question and your follow-up are another opportunity for the therapist to explain more about his or her experiences and expertise.
What is your approach to therapy? How will you go about addressing my issues and helping to create change in my life? There are a multitude of perspectives when it comes to conceptualizing the human experience – psychodynamic, behavioral, cognitive-behavioral, biological, humanistic – each with their own strengths and weaknesses. While you can’t be expected to be conversant in these different schools of thought, consider the things you’ve heard about therapy and what appealed (or did not appeal) to you. Ask the therapist about his or her approach to therapy and why the therapist thinks one particular approach may be best suited for you. See if this makes sense to you and if it’s something you’re willing to try. If something isn’t clear, ask for an explanation so that you have a good understanding of what the therapeutic work will entail.
Be sure to inquire about the “administrative” side of therapy as well. While these details should be outlined, either on the therapist’s website or in new client paperwork, the following are a few important administrative questions to ask a prospective therapist.
How much do you charge per session? Are there other charges that I might incur? While it can be uncomfortable to discuss money, these details are good to know, especially if the therapist is out-of-network (not participating in your insurance plan). A standard therapy appointment is generally 45-55 minutes with a set fee. This fee would be pro-rated for longer and shorter sessions. It is possible that the charge for the initial appointment may be a bit higher as it often requires more administrative time on the therapist’s part once the appointment has concluded. There may be fees for services provided outside of therapy appointments including:
- Phone conversations lasting longer than a specified amount of time
- Consultations with other professionals
- Report writing
- Meetings on the client’s behalf
- Traveling to and from appointments outside of the office (travel fees)
Ideally, the therapist would have a list of these extra service charges and how the fees are determined.
Do you take my insurance? Are there any limitations because of going through insurance? If you’re looking to go through your insurance, it’s a good idea to confirm with the therapist that the listing you got from the insurance company is accurate. There is a possibility that the therapist has stopped working with that particular insurance company. Also, there may be particular services that your insurance company does not consider reimbursable – such as travel fees or sessions conducted over the telephone – or that need special authorization such as two services rendered in the same day or the same service rendered more than once a week. If your therapy will involve more than the “typical” 45-55 minute appointment once a week and you’re planning on going through insurance, it’s advisable that you contact your insurance company in advance to determine what additional steps may need to be taken.
Do you have a cancellation policy? Generally therapists request 24 hours notice if you’re going to cancel an appointment. If you provide less notice or simply don’t show up for your scheduled appointment, there probably will be some charge. This charge might be the equivalent of your co-payment if going through insurance or as much as the full session fee. It should be noted that insurance companies do not normally provide any reimbursement for missed sessions. Charges for missed sessions may be left to the therapist’s discretion and they possibly may be waived when there are extenuating circumstances.
In cases of emergency, do you have an “on-call” system? Psychiatrists and those therapists who work with “high risk” clients are more likely to have a means of communication in case of off-hour emergencies. This might include a cell phone number or a call service. Otherwise, therapists as a standard practice are available during established business hours and will return calls within one business day. If there is a crisis or emergency and the therapist can’t be reached, the general advice is that you call 911 or proceed to the nearest emergency room.
In searching through the list of prospective therapists, the best advice is to temper your initial reaction with some thoughtful reflection. Although you should expect to pay for any in-person appointments, it is worth your while to ask for an initial consultation (over the phone or in person) to assess the mutual compatibility between you and the prospective therapist. Use some of the preceding questions to help guide the conversation and to get a feel for how the two of you would interact. If you’re not comfortable with the person after the initial consultation, don’t force it. Recognize that some of the discomfort you experience may revolve more around the issues that bring you to the therapist rather than the specific therapist. If possible, consider bringing up the responses that you have with the therapist (or with other prospective therapists) to help clarify what may underlie these reactions and how they could be addressed.
As an example, when one individual first started therapy, she had a very negative reaction to the first therapist she met. Some of it was the way in which he asked questions. Some of it was the atmosphere of his office. Some of it was a nebulous feeling that she couldn’t describe. Needless to say, after the initial consultation she never went back to him. A part of her thought she should try his approach but she realized after the first appointment she would be fighting it the whole way. The therapist was competent but he wasn’t the type of therapist that she would feel comfortable disclosing her thoughts and feelings to or talking with. After further research, she found another therapist and, after the initial consultation, she felt comfortable and able to share more of her internal experiences. They agreed upon therapeutic approaches and goals and were able to successfully work together, off-and-on, for several years. Therapeutic relationships are inherently unique and intimate. By increasing the likelihood of finding a compatible therapist, you also are increasing the likelihood of successful therapeutic experience.
– Elspeth Bell, Ph.D.