Finding and Choosing a Therapist for Yourself or your Child: Way More than You Ever Wanted to Know
Finding a good therapist who is a match for you and your particular needs can be frustratingly difficult. I often help people find therapists, and have found that most have similar questions about the process. This post is an FAQ for anyone considering, or already looking for a therapist for themself or someone they love. Keep reading for a brief explanation of different types of therapists, finding a therapist with or without insurance, how to choose the right therapist for you, and a couple of other pieces of advice from the perspective of someone in the business. Let’s start with:
Who’s who? There are several credentials that you’ll find in the (Texas) therapist community. A brief list:
- Licensed Clinical Social Worker (LCSW)
- Licensed Clinical Social Worker-Supervisor (LCSW-S)
- Licensed Professional Counselor (LPC)
- Licensed Marriage and Family Therapist (LMFT)
These four all have Master’s degrees, years of supervision working under a more experienced therapist, and are licensed by the state. These therapists might be in a clinic, a non-profit, or in private practice. This is the bulk of who provides therapy in the state of Texas. Other states have similar providers but might use different credentials. The difference between an LCSW and an LCSW-S is that the LCSW-S has taken additional training in order to officially supervise LMSWs towards their clinical licensure.
- Psychiatric Nurse Practitioner (PMHNP)
A psychiatric nurse practitioner has a Master’s degree in nursing, and might offer therapy and/or medication management. They may be supervised by a psychiatrist.
- Psychologist (Phd or PsyD)
Psychologists typically have a doctorate and are licensed. Some psychologists do therapy and some do testing, and some do both. A full psychological assessment is both very handy and resource-intensive (time and money) but can make a very positive difference in complicated or unusual situations, or where treatment isn’t producing the expected results. That said, you don’t need a psychological assessment before starting therapy—all therapists do some level of assessment before starting therapy. People often keep their same therapist but see someone else for assessment—the assessing psychologist typically writes a report and consults with the treating therapist to maximize the usefulness of the assessment.
- Psychiatrist (MD, DO)
A psychiatrist is a licensed medical doctor with a specialty in mental health issues and medication. It’s unlikely that you’d see a psychiatrist for therapy, although some do. Typically people see a psychiatrist for an initial assessment and then much shorter “med checks” every few weeks or months.
- LPC-Intern/LMFT-A/LMSW/Coaches & unlicensed providers
LPC-Intern: Licensed Professional Counselor-Intern. (sometimes inappropriately abbreviated LPC-I.) They are not fully licensed and are typically just a year or two out of grad school. Pros: they are likely cheaper and have more availability. Cons: lack of experience and everything that goes with that. That being said, everyone was new once.
LMFT-A: Licensed Marriage & Family Therapist-Associate. This is similar to an LPC-Intern but with a few administrative differences.
LMSW: Licensed Master Social Worker. This is a fully licensed social worker, but they aren’t clinically licensed—this means that to provide therapy they must be under someone’s supervision, and this should be clearly noted. These are often also early career professionals.
Coaching, or anyone without a license, is a completely ungoverned profession. You may end up with someone who is a fantastic provider (I know some,) but you can just as easily end up with someone who was in a different profession yesterday, hung out their shingle today, and thinks that a romantic relationship is an appropriate outcome for services. Buyer beware.
Other letters!?! (SEP, EMDR, LPC-S, PACT, LSOTP, RPT, etc)
With any primary professional therapy credential, you’ll find therapists who have additional certifications, trainings, modalities, and extra letters behind their name. Many have the word “supervisor” or “-S” somewhere, which means that they are certified to be supervisors of early-career therapists in their field. All therapists are required to take “continuing education” every year, and some participate in trainings that are more intense and offer an additional credential at their conclusion. This can be helpful to look for IF you already know that a particular modality is important to you, but it is worth mentioning that research shows that the quality of the therapeutic relationship is THE most important factor in determining the success of that intervention (ie, more so than the modality used by the therapist.)
Finding potential therapists–insurance
If you have & want to use your health insurance, start there. Call their customer service and ask for a list of mental health providers at both masters’ and doctorate level. If you can filter that list, ask for therapists who specialize in kids (if that’s what you want) or geographic convenience. Do not start by calling therapists and asking if they take your insurance–that’s going about it backwards, trust me. There are way more therapists than there are therapists who take your insurance. (Side note about geography: therapy is a weekly or bi-weekly commitment for weeks/months/years… ideally the fewer obstacles to keeping those appointments, the better. If you need a specialist you may have to cross town, but at least start by looking in convenient geographic places.)
Finding potential therapists–private pay
If you can pay full fee, you are in the fortunate position of having far more options. You can ask others for referrals, or you can look on online directories like the NASW’s Help Starts Here, Psychology Today, Good Therapy, Network Therapy, etc. Some of the online directories will allow you to apply different filters in your search–very helpful. You can also just Google; try searching for “therapist” and your zip code or city and state.
Interview potential therapists!
Once you have found a few potential therapists, it’s time for a pre-interview. This step is important. Call 3 or more and have a 10-15 minute conversation with each before scheduling an initial appointment. In this brief call:
- Clarify deal-breaker issues that you couldn’t determine online like: are they accepting new clients, fee, location, insurance, hours, etc. Do this before going in to your personal details.
- Share a little about why you are seeking counseling and what you are looking for.
- Ask the therapist a few questions about their practice, too. Does that therapist think you sound like a match for them and their practice? Does the therapist have experience with your situation/problem/lifestyle/age/etc? If you have any super-important beliefs or preferences, mention that and ask if the therapist is very comfortable working with that thing. Your therapist doesn’t necessarily need to live/believe as you do, but being able to resonate with you despite not being “same” does matter. Does the therapist use a directive or non-directive approach—ie, who leads the session? (this is a question for both adult and child therapists, and there isn’t a right or wrong answer really—it’s personal preference.)
- Feel free to say that you are talking to a few therapists before you schedule, and that you’ll circle back if/when you want to make an appointment. This will not hurt the therapist’s feelings–a good therapist recognizes this as appropriate due diligence.
- After you get off the calls, ask yourself how the call felt. Did conversation flow? Was it easy or hard to talk with this therapist? How well did they ‘establish rapport’ with you? This matters a lot.
- It’s also the reason I recommend calling several potential therapists—you’ll be able to compare/contrast that rapport much better after having had essentially the same conversation with 3 different people.
A few more random thoughts
I hate to say it but: some therapists are bad. There are therapists out there who probably shouldn’t be practicing. You can sometimes avoid them by getting recommendations from people you trust, so consider asking around if you haven’t already. (doctor, friends, co-workers , family, neighbors, lawyer, guidance counselor—lots of people might be a source of referral.) If you do use someone’s referral, they probably would appreciate hearing back from you later with your feedback on that referral (I definitely do.)
Even if a therapist is a great therapist, it doesn’t mean that they are a great therapist for you. If you come in for a first appointment with someone and it doesn’t feel right, it might indeed be that they aren’t actually a match for you. It’s ideal to tell them that in session; they ought to process it with you and give you referrals who are likely to be a better match. (And if you find yourself rejecting multiple therapists, by the way, it might not be the therapist. Just sayin’.)
There are a lot of different kinds of therapy, and FYI if you’re looking to do deep work, the intake, assessment, and initial relationship-building process will take multiple sessions. (which means that evaluating whether the therapist is right for you might need more than an initial session, too.)
A person who is a good therapist may not be a good businessperson/practice manager. The skill set is very different. You might encounter great therapists who are a little slow to return calls (sorry) and who don’t have nice websites… or even any website at all!
Couple of thoughts about insurance: It might be helpful to know that insurance companies pay therapists a contracted rate that varies between companies, and if you are having a hard time finding someone on your insurance, it may be that their reimbursement rate is so low that experienced therapists aren’t willing to work with that plan. Additionally, ask your insurance if they offer “out of network benefits.” If they do, you might be able to see a therapist not on their list and file yourself with the insurance company for partial reimbursement. Know, too, that the insurance company may only reimburse for particular diagnoses (and a diagnoses is required) and may also limit the number and frequency of sessions.
One note regarding therapy for kids: kids don’t typically do “talk therapy” until around adolescence–most therapy for kids is play therapy. There are different kinds of play therapy, too, including both directive and non-directive types. (Picking the ‘right type’ of therapy for kids is its own post for another day.) It often takes longer for kids to move in to the “working phase” of a therapeutic relationship. Expect sessions where “all” your kid does is play (board games, with toys, throw a football, etc.) Trust that the therapist wants therapeutic growth for your child and is working to make that happen in the way that they believe is most effective.
So. More than you ever wanted to know about how to choose a therapist. Let me know if it’s helpful and/or if there’s something good to add to this!
When people come to see me, it’s generally because they are seeking change. Something isn’t quite the way they want it to be: they want to grow, or help their child grow. That desired change?—it begins in the brain.
Scientists used to think that brains stopped growing after a certain age, but thankfully we now know better. Modern neuroscience has proven that the human brain is “plastic”—it can change and grow throughout life. This is great news, because it means that we can change and grow throughout life—we can change our habits, our beliefs, our expectations, our fears. Understanding and acquiring what the human brain needs in order to learn, change, and grow is a necessary step in the revolution you seek.
Dan Siegel, psychiatrist, researcher, and one of the founders of the Interpersonal Neurobiology movement, identifies 7 fundamentals that are necessary for brain growth.
- Sleep. Sleep is so important, and modern parents (and kids) just do not get enough. I myself often remind parents that sleep deprivation is listed in the Geneva Convention as a form of torture. It’s really important, so make sure your whole family is getting enough.
- Good nutrition. You already know this one—but eating more fruits, vegetables, avoiding highly processed foods, limiting sugar and sugary drinks are all ways to help the body—and therefore the mind—work better. Dr. Siegel also singled out getting enough of the nutrient Omega 3 as particularly important to the developing mind.
- Physical activity. Adults and children need daily exercise and activity, including both weight-bearing and aerobic activity. Exercise is proven to regulate mood and improve focus.
- Novelty. Our brains are quick and smart because they look for patterns—you don’t have to discover how a water faucet works every single time you visit a new bathroom, thank goodness. But the shortcuts our brain takes when it recognizes a pattern actually work against us when we want change. So, try to mix things up, introduce playfulness or humor, or change the scene somehow in order to bring a little novelty into the situation. It will make your brain sit up and take notice!
- Focus of attention. What are you paying attention to? Your focus drives energy and information through certain circuits of your brain. More energy and information=more growth.
- Safety. Without this, the brain doesn’t learn and grow well at all. It is absolutely essential.
- Mindful awareness. This is your mind’s ability to observe as opposed to reacting. I sometimes call this the opposite of the “Whack-a-mole” mode. Instinctual reactions are helpful when you are yanking someone out of the way of a speeding car, but in most parent-child conflicts, that’s not the part of the brain you want running the show. Brain growth is improved when we are able to pull ourselves out of our instincts.
If you want to foster change and growth, prioritize the items on this list. The more of the above 7 elements you can put in to place for yourself or for your children, the easier and longer-lasting growth can be.
I don’t spend much time advising parents on how to punish more effectively. In fact, I tend to tell parents that I am not a big fan of punishment at all. So, a parent rightfully asked me the other day: “Well then, if not punishment, what DO we do?
What a good question! Most parents punish because they believe that’s how to get kids to behave appropriately. (But actually research has proven that more punishments do NOT equal long-term improved behaviors, and can sometimes make things worse.) So here are 3 things that help achieve the goal of cooperative, positive, appropriate behavior more effectively, while helping to maintain a positive and long-lasting parent-child relationship.
- Show kids what you DO want them to do, and support them, encourage them, catch them doing it, praise them. Give them positive options!
- Change the child’s environment so that it supports positive behaviors. Simple example: don’t keep the jar of cookies where your 3 year old can reach them. More complex example: figure out how long of a playdate your kid can handle before falling apart. Keep playdates within that time frame until you’re both ready to experiment with incremental increases.
- Figure out what’s behind the unwanted/negative behaviors. Behavior is a communication, I like to say… what is your child’s behavior saying to you? Hint: it’s usually something along the lines of: “I’m tired and over stimulated” or “I can’t handle this much freedom,” or “I really need more time with you/attention from you,” or “Something’s not right with me,” or “I am not getting enough opportunities to feel powerful and in charge of my life.” When parents understand what the child’s behavior is communicating, they can better meet the underlying need… which generally has a positive effect on the unwanted behavior!
There are many, many more ways of shaping behavior, but these are some favorites, especially the last one. A little understanding goes a long way. :^)
A friend asked recently for an example of a natural consequence, so I shared one that had occurred just that morning in my own life. My older daughter, dawdling endlessly, was just about to make us late for school. As the absolute last minute approached, I told my daughter that if she wasn’t able to walk out the door in 2 minutes, the natural consequence would be that I wouldn’t be able to walk her to her classroom, as she prefers. (The back door that we use to get to the classroom is further away, and gets locked a few minutes before the tardy bell.)
This was a decent example of a natural consequence: waste time now, lose options later. In theory, by identifying a likely outcome for my daughter in advance, I was helping her to understand the potential consequences of her actions, and motivating her to make different choices.
But, I added, I didn’t feel that good about it.
My daughter was very upset at the prospect of this possible outcome, and the remaining minutes we had together that morning were fraught with drama and upset. Yes, she got out the door on time, but at what cost? I’m pretty sure she didn’t learn anything—although I stayed calm, the (natural) consequence was so big in her eyes that she pretty much came unglued.
My friend asked me: “What do you wish you had done instead?”
Wow, what a good question! After thinking about it for a bit, here are some options:
- Wake up earlier. It takes time to handle behavior problems, and when you run low on time, you also run low on options.
- Slow down and be late. (see above) The idea of being late to school makes me very uncomfortable, but one tardy one time might have been a better outcome than the upset.
- Intervene earlier. I could have put down whatever I was doing, gone to my daughter’s bedroom, and done a little light-hearted micro-managing. I could have playfully put her clothes/shoes/etc on for her. She would have loved it, loved the attention, loved being ‘babied,’ and it probably would have gotten her out the door in time.
- Plan ahead. This was a Monday, and the first day of the week (especially after a long weekend) is often the hardest for kids. They aren’t ready to give up the fun, the parent attention, the relaxation of the weekend any more than we are! I could have seen this coming, and made sure that we all went to bed a little early, with tomorrow’s clothes laid out, lunch packed, breakfast set out, etc. Mornings are always better when I do this prep.
- Understand her. Identify the root cause or causes for her dawdling. Does she want to avoid school? Is she physically tired? Does she need a longer/better transition from home-days to school-days? Is her proverbial cup empty? Does she need of a ‘dose’ of attention/fun/love? Once I identify these causes, addressing them is a wonderfully effective way to prevent future incidences.
- Understand me. Besides the never-ending ‘on the fly’ nature of parenting, what kept me from choosing some of the above options in the moment? Do I need a little self-care? Is something coming between me and enough sleep and the time/space to prepare for our routines?
Numbers 1-4 are basically shaping the environment to accommodate or better manage her needs. These are great tools to have in your toolbox, and frankly, that’s about the best I can do at 7:35 in the morning. Numbers 5 & 6, however, are the black belts of parenting—the kind of responses that allow for an ever deepening relationship between parent and child. Understanding your child, understanding yourself, and acting from that understanding—this is where the rich, cooperative, connected, and mutually respectful relationship that we all want to have with our children begins. So, if this appeals to you, let this percolate in your mind for a while. Look for a moment this week when you can pull those tools out, and see where it takes you.
When I was in graduate school to become a therapist, I remember one of my professors using a metaphor to illustrate what a therapist does for her clients. She encouraged us to imagine that we held a large, uncovered bowl in our laps, and that our job was to hold that bowl while our clients put their fears, upsets, anger, etc in the bowl.
It seems deceptively simple, but trust me–some emotions are awfully hard to “hold.” Someone who is bitterly angry, or wracked with grief, or sick with guilt–is someone who can be hard to be with in the moment. But, that is one of the things that a therapist is there for. A therapist gives you permission to have whatever feelings you are having, and stays with you, peacefully, without her own agenda, and without changing the subject, making a joke, or running out of the room, no matter how big and scary those emotions may seem to be. She keeps holding the bowl for you.
Many years after grad school, I realized that parenting requires the exact same ability. Only parenting is waaaay harder, because those strong uncomfortable emotions are coming from one of the people I am most emotionally connected to in the world, and frequently–the strong uncomfortable emotions are about ME! (aghhh!) But our children need us to be able to handle their strong and/or uncomfortable emotions. They need us to be able to handle their fear, their disappointment, their sadness, their fury or their injustice–without telling them they “shouldn’t feel that way,” or minimizing, or making a joke, or punishing them. They need to know that you are bigger and stronger than their biggest feelings, because those feelings can be frightening or overwhelming to them.
The next time your child is having BIG emotions, take a deep breath and think about your response for a moment. What does your child need? Perhaps what you need to do is Hold the Bowl.
Since I am not a medical doctor, I am not permitted to write prescriptions for medicine. However, I have never let this stop me from writing prescriptions for other things. ;^)
There are, after all, lots of non-medicines in the world that have great medicinal value. For example: pedicures, a night out with friends, a nap, a hug, a walk outdoors.
My most common non-medicine prescription is paper plates. I know so many parents who burn the candle at more than two ends… getting things done, supporting their family, caring for children, and more. But sometimes even the most organized, successful, do-it-all mama or daddy gets overwhelmed. (the rest of us, do, too!)
When clients tell me that they feel that they are drowning in responsibilities, tasks, and obligations, I often whip out my prescription pad and send them home to eat off of paper plates. It is as much of a metaphor as it is a real suggestion, because paper plates may or may not be something that makes your life easier. But metaphorically, I am encouraging parents to realize that a little bit of convenience in one area of their world might provide peacefulness, rest, free time, and/or positive energy in another area of the their world.
I like to say: “The earth will not be ruined with the addition of one week’s worth of paper plates, nor is the cost of a $1.50 package of plates going to break your budget.” AND, giving yourself just a 10% shortcut in life might be the very thing that helps you be happier inside and out, more peaceful, more engaged as a parent… and THAT will be the best $1.50 prescription you’ve ever filled.
So where could you take a shortcut this week?
I talk about icebergs at work a lot.
Did you know that the part of an iceberg you can see above the surface of the water is only 1/9th of the total mass? This is where the phrase “tip of the iceberg” comes from. So, I talk about icebergs because the image is a very helpful metaphor. Basically, it all boils down to:
What you can see about another person/relationship isn’t the whole picture.
When we see SuperMom go sailing by, perfectly put together, with her perfect children behaving perfectly… we sometimes judge ourselves, and come up lacking. But this isn’t fair. Even Supermom has her insecurities, her imperfections, her failings… maybe even her own secrets.
You can’t help but learn this lesson as a therapist. Every day, I see people, who, if I only saw them on the street, would probably strike me as so put together, so stylish, so successful. But because of the nature of our work together, they sit on my sofa and speak honestly about some sort of problem or another. It’s a real gift to me, one that I would love to share with every one of you:
You are not alone! It’s not just you! Everyone has something that challenges them, that they struggle with, that they regret! You just can’t see it in them because we all keep our inner lives (8/9th of us, at least!) hidden inside.
So, beware the icebergs ahead… Remember that everyone has more going on than is outwardly visible, and be kind to yourself (and them), since we never really know what’s going on for another.
PS. A related, great phrase–not mine but I don’t know who said it originally: “Don’t judge your insides by other people’s outsides.”
Children, like adults, need and want a bit of control over their lives.
Sometimes adults and children can control things, but more often, we can’t. What to do? Remember:
Predictability is the cousin of control.
So, sure, I would like to control all the messy little loose ends of my life, like: preventing Christmas family drama, or Uncle Jimmy’s tendency to argue about politics, etc, but ever since I misplaced my magic wand, I just can’t. The next best thing, though, is to remind myself ahead of time about what’s going to happen. I can’t prevent it, but I can predict it. It’s amazing how things are less annoying when you remind yourself ahead of time that they are coming.
Here’s how to make this work for you and your family.
- Start by identifying the ‘usual suspects,’ whether they are people (Uncle Jimmy) or situations (when Daddy is on an important call) or triggers (too much sugar, not enough sleep).
- Then think about what usually happens, both on your part, your child’s part, other players, too, and how it generally turns out. (This is also a great opportunity to examine the pattern for any possible interventions, BTW.)
- Stay in touch, so to speak, with your predictions as they come true. It’s just kind of magical how it lessens the sting of the inevitable.
Happily, this little lesson is practically universal and wonderfully transferrable. A few more examples:
- Children turning in to “Wild and Crazy Guys” when traveling
- Morning routines
- How other people will react to our requests/limits/preferences (Do your in-laws take everything the wrong way?)
- Difficulty separating for school/custody
- Doctor visits
- Any kind of unwanted experience that your child will have to endure that can be predicted!
Here’s one final thought about this, that actually deserves its own post (maybe later.) Sometimes, when kids can’t control things like they want to, THEY create the predictabilty that serves as their consolation prize. For example: son wants more positive attention and engagement from his dad, but doesn’t get it, so he provokes his dad into getting mad and punishing him. (and actually, the kid does get a bit of control in that situation, albeit a dysfunctional control.)
Are there areas of your life where you could identify some predictabilty?