Let’s be honest, friends. Navigating the mental health care system is an exhausting, baffling process.
I’ve been in and out of therapy most of my life. As a therapist, I oftentimes look back at different counseling experiences and find myself analyzing them critically– especially now that I have a bit more information to understand the nuances of therapy. I’ve had some incredible, transformative counselors and I’ve had some real lousy ones– sometimes bad enough to make me question the field.
But what I find is that the more I know about counseling, the better counselors I pick. Because it’s not rocket science– when we know what we need, we can find the right treatment for it. As a counselor, I could find the counseling I needed. I saved money, time, and energy by getting the right treatment fast.
This is what I want for you. The tools and knowledge to be able to find the best fit.
So let’s look at how to find the right treatment– quickly, efficiently, and successfully:
*Quick note: I can really only speak to the financial end of treatment in the United States. If you live in another country and have recommendations, let us know in the comments below or on Twitter.
Let’s be practical, money is the biggest factor in treatment. Depending on insurance, you have some options. Many places offer sliding scale counseling services, where they will let you pay what you can, even sometimes paying nothing. Generally when it comes to money you have two options:
1. Mental Health Agency: Many agencies provide counseling services based on their area of focus– these services might be insurance-funded or grant-funded. For example, an agency supporting domestic violence survivors may be able to offer short-term, free counseling services through grant funding. Other agencies hire therapists to provide full-time counseling services and charge through insurance.
Mental health agencies are more limited in what sort of treatment you can ask for– but that doesn’t mean you can’t ask. Just be aware that there’s less flexibility.
Pro’s to Mental Health Agencies: Sometimes more accessible, cheaper services
Con’s to Mental Health Agencies: Sometimes working with newer professionals, less choice in your service provider
2. Private Practice: Private Practice therapists are usually independently licensed and work in smaller, individualized settings. When someone is looking for treatment at a Private Practice, they are really choosing the specific person they would like to work with. The downside to this level of customization is that Private Practices can be limited on what, if any, insurances they accept and their prices may be generally higher. Again remember that some Private Practices will still offer sliding scale services based on income.
Pros to Private Practice: More choice in treatment
Cons to Private Practice: On average more expensive
One of the most baffling things about therapists is the licenses. It seems like these people doing the same job can come from totally different backgrounds. It’s important to know that each of these change depending on the state. So let’s break them down, as generally as we can:
Social Workers (LSW, LISW, LCSW): Social Workers are trained to look at clients in micro and macro systems, which means social workers are taught how to help a client individually and how to help a system collectively. Many social workers choose to either focus on mental health treatment or on navigating resource networks. If you’re seeing an LSW/LISW pop up as you search for provider, this means you’ll be working with someone who is educated in mental health and in the larger systems affecting and informing mental health. Depending on the state, a social worker might have a Bachelors degree or a Masters degree.
Psychologists: Psychologists are trained to look at clients clinically, empirically, and oftentimes through a research-lens. Psychologists need a Doctorate degree to practice and might go from a Bachelors in Psychology directly into a Doctorate program. Psychology marries assessments, evidence-based treatments, research, and neuroscience to provide informed treatment. Not all psychologists are therapists and each psychologist can have a vastly different field of focus. Keep an eye open for PhD’s and PsyD’s for psychologists.
Counselors (LPC, LPCC, LMHC): Counselors are trained for focus on client’s mental health and well-being. They balance the middle ground between social work and psychology by incorporating some elements from each field while focusing solely on mental health treatment interventions. This means that while their coursework focuses closely on treatment planning, they likely have less background in macro-systems or in assessments/research. Most mental health counselors have Masters degrees.
Marriage and Family Therapists (LMFT, MFT, MFT-I): These are counselors who are trained to work with couples and families rather than individual clients. While this doesn’t mean MFTs are limited to only family/couple’s work, it does mean they are especially trained in the nuances of working with a unit. Most MFTs have Masters degrees.
Independent Versus Supervised: Once any of these professionals has gained enough experience, they can apply for their Independent License which means they can create treatment plans and provide therapy unsupervised. Regardless of licensure, best practice is that any professional has a supervisor they can speak with at least occasionally. You have every right to ask potential therapists what supervision/peer supervision they receive regularly.
The biggest key here is to work with a therapist who is licensed. There’s a growing trend of unlicensed mental health professionals providing out-of-pocket services. And while this can make services significantly more accessible and make this field more accessible for people who can’t afford higher degrees, the truth is unregulated treatment can be risky and dangerous without a license to monitor ethics, quality of standards, and treatment options. Play it safe, work with someone licensed.
Area of Focus
This one’s especially important, folks! Each therapist specializes in two dimensions: a) client need (ie anxiety, trauma, postpartum depression, etc) and b) type of theory (ex. cognitive behavioral therapy, EMDR, feminist, etc.). While many therapists may advertise a wide range of specialties, look for therapists who have special training in your area. (And stay tuned for a future post from me on a Primer to Therapeutic Theories to help navigate types of styles!)
When you call to schedule an initial appointment, consider asking the agency or practice who they recommend for your specific need. Therapists are ethically required to refer a client if they feel they are not equipped to provide appropriate treatment– it is always okay to ask a therapist for a referral.
Trust between a client and a therapist is key to success. We need to feel like we can trust the person who is helping support us in our mental health. That being said, therapists are not mind-readers. Sometimes we make mistakes or misread a situation. While you should never continue working with someone who is damaging or harmful, I always advise clients to consider being honest about their feelings of discomfort, anger, or hurt with a therapist.
Speaking as a therapist, some of the best therapeutic relationships I’ve experienced with clients were when a client pointed out something I was doing that wasn’t working so I could adapt appropriately. They felt heard, I’m able to offer better care– it’s a win-win.
Like any other field, not every therapist is a good therapist. Watch out for these red flags:
- Causes you physical harm or threatens you
- Attempts to coerce you into something you don’t feel comfortable with
- Doesn’t respect your input or want your collaboration
- Breaks confidentiality
- Doesn’t allow you to see your case files
- Too casual– makes the sessions about themselves
- Invalidates your personal experiences
Making Sure It’s a Good Fit
Questions to ask a therapist on your first appointment:
- What is your experience with my specific mental health need?
- What theories do you use to inform your practice?
- How long have you been practicing?
- What licenses and certifications do you have?
- How often do you reach out for supervision?
- How will you protect my confidential information?
- How do sessions usually run?
- What is your process for creating a treatment plan?
- What is your process for ongoing assessment?
- How do you prepare clients for closure?
As you’re looking for therapists, there are two fabulous resources to navigate:
1. Psychologytoday.com: this lists local therapists by area code, issue of focus, or theoretical expertise. Tip: always read the bios! Many therapists listed click a lot of boxes to make sure their profile shows in a wide range of searches, but the bio will tell you where the strongest expertise is.
2. 211 or 211.com: You can call 211 or visit their website for a list of local nonprofit agencies and resources meeting your needs, ranging from counseling to food pantries. Tip: ask tons of questions. Try to gather a wide range of options. And when you call the first place, ask them questions on what other resources they know. Most people at mental health agencies are aware of their own pros and cons and can help you navigate the system further.
Let us know what you think of these tips! Helpful? Just more confusing? Let us know what areas need more clarification and I’ll be happy to write follow-up articles!