The truth is, the reason why healthcare access (especially to therapists) is such an endless labyrinth, is because of the financial gatekeepers -- the insurance providers, and the agendas that keep healthcare a for-profit business. When profit is the goal, quality tends to suffer.
IT IS NO COINCIDENCE, then, that reaching out and finding a therapist can be a discouraging process -- sometimes, enough to dissuade anyone from reaching out further.
So I offer this 'blog' page of sorts to you, to illuminate how to find your therapist, questions you might ask them, and what the details of costs and insurances could involve.
Depending on where you live, your therapist is most likely advertised on various networks and search engines, usually with a profile that indicates their specialties (i.e. working with teens, working with cancer survivors, etc.) and, based on their tone and information, you will often decide to or decide not to reach out.
You will want to begin at a directory like these:
www.psychologytoday.com - This is a our country's largest provider list. You can search by age, gender, religious affiliation, insurance status, specialties, and so on.
www.goodtherapy.org - This is another good one.
www.openpathcollective.org - This directory's goal is to make therapy (normally an expensive item) more affordable. So, they list therapists who agree to accept clients at specific low rates. It is highly encouraged that this list be used only for those who cannot afford "market price" therapy.
And there are plenty others! Those above are the lists that I am listed on.
Why so many?
Some directories aim for a particular angle or mission (i.e. low-cost therapy), while others aim to advertise to certain people or specialties. And you'll find plenty of overlap, with multiple therapists listed on multiple directories. Other than that, I don't know why there is so many! Check them all.
Whatever is most important to you -- look for that.
Therapists frequently advertise themselves or use wording to signal what they are experienced or comfortable working with. Because mental health is such a giant field of study, and humans are infinitely complex, plenty of therapists specialize in certain areas over others, and there is a whole new world of vocabulary that mental health professionals use, that are not always accessible or understandable by everyone.
So a specializing in one area might not have the same specialization working with others. This doesn't mean they're not effective or good -- it means they likely more skilled in some things more than others (as we all are) and they leverage those skills to serve people who are best served with that expertise.
Truth is -- generally, most therapists are happy to work with anyone who wants to work together (we like helping people, or else we wouldn't be therapists), but like with finding "your" barber, or "your" doctor, or the car mechanic you always go to after finding the person you like -- its about a proper fit between client and therapist. It doesn't feel any good to get help from someone who doesn't seem like they want to help you.
Ok, so how to find that fit? It's a chore -- but the best way is to call or e-mail them to ask. And if they get back to you, you can skip to the questions part and interview them.
But ultimately, finding a fit means you find a therapist...
... who might 'understand you' (i.e. they share a spiritual similarity with you, or cultural similarity).
...who uses techniques and strategies that 'work' for you (i.e. if you prefer more mindfulness/acceptance approach to health, or if you prefer more active thought-challenging work).
...or then again, you might also decide that none of that matters, and you just want a LGBT-identified therapist, regardless of any other factor.
In any case, what you're looking for will help you from the outset, so you aren't tossed back and forth between emails, voicemails, listings, rinse and repeat -- wondering all the while which direction to take.
After looking through the issues and specialties, you might see information about what sorts of "modalities" or techniques the therapist uses primarily. Some therapists specialize (i.e. in "Cognitive Behavioral Therapy), and others are more broad and eclectic (like me). And others are certified experts in techniques aimed to treat certain problem spots in our functioning.
By researching some of these modalities, you might get an idea of what you want to explore therapeutically.
Essentially, you are hiring your therapist to serve your needs as best as they can, which means you are interviewing them for the position. And yet often, we don't know what to ask a therapist, because maybe its our first time, or maybe we aren't even sure how to describe what we're looking for. Your therapist can even help clarify some of this for you over the initial call.
That being said, be sure you ask...:
You may want to know what sorts of clients, issues, themes that the therapist most frequently works with, or specializes in. For example, you may specifically be seeking support for your teenager -- you may want to then see if they have experience with teens.
Get personal and ask why they specialize in, or what brought them to their specific field in human services.
As mentioned above, therapists use a variety of skills -- some are broader and more flexible, while others specialize in a very specific niche of approach; and sometimes, those approaches are what you need, and sometimes you might work best under a more broad or mixed approach. You may enjoy lots of reading and mindful introspection; or you might prefer a more 'confrontational' therapist that will challenge you. In any case -- ask to be sure, and search those therapy styles online!
Therapists set their own schedules, and many of them see the same clients each week, or multiple times per week, over periods ranging from just a few months (considered short-term or brief therapy) to a lifetime.
This means each therapist has their own scheduling -- some are more available in afternoons and evenings; others are weekends; and some are very flexible and open to scheduling changes (i.e. you work shift work where your schedule changes often), and others are more tight on their time and require a more consistent rhythm from week to week.
If, for example, you tend to always be working 8-5 Mon-Fri, you might prefer a lunch hour (midday) availability, or you might prefer weekends only. Sorting this out beforehand will help you control for any schedule misunderstandings or mishaps (therapists, like many other service providers, may charge you for no-show appointments; others are more flexible on a case-by-case basis).
How long have they been licensed? What brought them to psychology as a profession? Do they have any personal experience with whatever your issue is? What sorts of people do they most often work with? What insurance (if any) do they take?
Seriously -- ask the questions that might help you get a better understanding whether this is someone you can trust, feel safe with, and get along with enough such that you feel that you can 'do the work' with or if you'd rather check other options first.
Health insurance aims to make services more affordable to you. You pay a fee, and they provide you a network of pre-chosen doctors and people you go to, and they agree to pay part or all of your bill.
The advantages can include not paying a full bill and only paying a fraction when its due. You may also have access to clinics and doctors that you wouldn't otherwise have.
Health insurance companies do not work for you -- they work for profit. And they do not work with health providers, whom they reimburse. It is a business model based on profit, and the product they sell is access to healthcare.
So the health insurance companies want to be sure they are profitable -- so they must ensure that their dollars are well-spent and can justify their investments. So, health insurance companies REQUIRE a diagnosis after one therapy visit, and this initial visit could result in your health records marked with a pre-existing condition (which can disqualify you from other privileges or benefits).
And because it is their money mostly on the line, they will often require your therapist or treatment provider to follow a certain protocol or measured, standardized rubric for treating you (so, you'll often see CBT, an insurance company favorite, used in 6 or 12 week treatment periods).
They will sometimes also outright argue with your therapist or clinic about your treatment or diagnosis -- their opinion may differ from the person helping you. And they won't pay them. Which is another issue -- privacy. Ethically and legally, a therapist's notes and conversations with you are confidential when outside the realm of imminent harm or danger to life... but not when a 3rd party (insurance) is involved.
And all that aside, it's a huge pain for private therapists to do all that paperwork, phone calling, appealing, answering letters, getting billed suddenly, and all that noise. A larger clinic or team of therapists might have an administrative staff who handle that billing, but one private therapist working with you directly can get overwhelmed by the amount of approvals and hoops to jump through, just so that they're financially afloat enough to continue working with you at a set price.
You and your therapist will agree upon your first session date and time.
Whether they accept payment via card, cash, check, before or after session, and whether they provide remote/distant therapy (telehealth) or work from an office that you'll hold your sessions at -- these are all details worked out with and agreed upon between you and your therapist.
THERE. You've made it. Now for the rest of it...