Finding A Therapist
On Line Therapy
How To Find A Therapist by Andrea Petersen
September 2018 - Real Simple
Conversations about mental health are finally coming out of the shadows. Celebrities such as Ryan Reynolds, Kristen Bell, and Busy Philipps have shared stories of their anxiety and depression in interviews and on social media. The suicides of Kate Spade and Anthony Bourdain have again moved the issues of psychological pain and suicide into public discussion. Mental health awareness campaigns pepper our social media feeds. And the main message to all us unfamous folks who may be struggling usually goes something like this: Get help. Get therapy.
But how? And where?
Unfortunately, finding the right therapist and treatment isn’t always easy, especially if you’re at an emotional low point. Google “psychotherapy” and you’ll find a confusing alphabet soup of acronyms—ACT, CBT, and DBT, to name a few—for the various types of treatments. Even if you know the kind of therapy you want, it can be hard to access it: 55 percent of counties in the U.S. have no psychiatrists, psychologists, or social workers, and sadly, many people don’t get professional help at all. Only about 37 percent of those with anxiety disorders, for example, receive treatment, according to the Anxiety and Depression Association of America (ADAA).
The good news: If you do see a qualified therapist, chances are you’ll find it helpful. Many talk therapy treatments are backed by reams of rigorous clinical trial data. In fact, studies have shown that, for conditions like anxiety and depression, talk therapies are generally as effective as psychotropic medications, with fewer side effects and longer-lasting impact. (That said, many patients benefit greatly from taking medication or from combining meds with therapy.)
Therapy isn’t only for those who might be experiencing a mental health disorder. A therapist can also help with relationship problems or challenging moments—say, a career shift or the loss of a loved one. This is how to get started.
The First Steps
It helps to spend some time figuring out what issues you want to tackle. Are you looking for some guidance on a major life change? Or do you think you could be struggling with a particular mental illness? If it’s the latter, consider reading up on mental health issues to get a better sense of what you might be dealing with. You can find helpful glossaries online from the American Psychiatric Association (APA), Anxiety and Depression Association of America (ADAA), and the National Alliance on Mental Illness (NAMI). Then ask friends and family, or your primary care doctor or ob-gyn, to recommend therapists they think would be helpful for your situation. If you’ve had therapy before, mull over what you liked about the experience—and what you didn’t.
The best therapist for you depends on your personal preferences, the convenience level and cost of visits, and the provider’s specialty or training. (For more, refer to “Who Should You See?” on the opposite page.) Look for therapists who are members of a professional organization, such as the APA, ADAA, the National Association of Social Workers, or the Association for Behavioral and Cognitive Therapies. These groups offer continuing education and hold conferences where attendees learn about the latest research in their fields. So if a therapist belongs to one of these groups, she’s likely staying on top of the advances in psychotherapy research and practice, says Beth Salcedo, MD, president of ADAA and medical director of the Ross Center, a mental health practice in New York City and the D.C. area. Most of these groups’ websites have databases that let you search for members near you—a great way to find practitioners if you haven’t gotten any personal recommendations.
What to Ask a Prospective Therapist
When you’ve found someone promising, request an informational phone call or a meet-and-greet before you dive into therapy sessions. Ask whether she’s treated other patients with your particular issues, as well as “how she would go about treating you, whether there’s evidence for that approach, about how long it will take, and how you both will know when you’re done,” says Lynn Bufka, PhD, associate executive director for practice research and policy at the American Psychological Association. If you’re looking for someone with expertise in a particular type of therapy, such as cognitive behavioral therapy (CBT) for anxiety, ask how long her training lasted. (You may not want to see someone who only completed a daylong workshop, for example.)
Ideally, you’ll meet with a couple of therapists and then pick the best fit. “I jokingly say to people that it’s like buying a pair of jeans; you may have to try on a few before you find the one that works,” says Salcedo. You should also feel confident about your therapist’s skills and comfortable with the idea of her challenging you, notes Bufka. And while you don’t necessarily need to pick someone you’d want to be friends with, it is important that you feel you can be open and honest with your therapist—and that she respects you.
How to Deal with the Money Issue
Another important thing to know before you start: how much the therapist charges and if he takes your insurance. Some therapists use an income-based sliding fee scale. While most insurance plans offer some therapy coverage, many therapists don’t participate in any insurance programs. To get coverage for those therapists, you need to have out-of-network benefits; you’ll likely pay up front and then be reimbursed for whatever portion of the fee your plan covers.
Therapy can be expensive—a session is often $100 or more. But there are affordable options. Some therapists offer group therapy at lower rates. Community health centers often provide free or low-cost mental health services. Also, check out the graduate psychology or social work programs at your local university to see if there’s a clinic where trainees offer treatment.
Online therapy is another option. Companies like Talkspace (from $49 per week) and BetterHelp (from $35 per week) connect users with therapists via a variety of methods, including text, audio, and video chat. Aubrey Williams, 33, of the Nashville area, started online therapy with Talkspace when she was struggling to get pregnant. She says she appreciated the price tag and the accessibility. “If I had a thought or a question at 2 in the morning, I could just leave it for my therapist,” says Williams, who now has a 7-month-old son. “I was leaving messages for my therapist while nursing, sitting in the car, or at the office.” Studies have found that, in general, online therapy is about as effective as in-person treatment. NAMI also has a helpline (800-950-6264), and many local NAMI affiliates have free peer support groups. If you’re in crisis, call the National Suicide Prevention Lifeline (800-273-8255). You absolutely don’t have to let cost prevent you from getting much-needed help.
What to Expect During Therapy
What happens in sessions can depend on the type of treatment— and many therapists combine elements of different approaches.
One common type is CBT, which is the most research-backed treatment for anxiety disorders and depression. It’s based partly on the idea that distorted thinking is a main cause of mental distress. Say you’re in therapy for depression. If a friend didn’t stop to chat at school drop-off, you might think, “She must hate me. I’m worthless.” During CBT, a therapist would help you identify these unhelpful thoughts, challenge them, and replace them with more realistic ones. She might encourage you to instead think, “My friend was probably busy and had to dash out.” For anxiety issues, CBT also usually involves “exposure,” in which you gradually expose yourself to the things you’re afraid of. So if you have an elevator phobia, you’ll work with your therapist to feel more comfortable in and around elevators.
If your therapist recommends Acceptance and Commitment Therapy (ACT)—which research suggests is effective for anxiety, depression, and even chronic pain and substance abuse—you’ll likely learn various mindfulness techniques and exercises. (ACT is based on CBT but includes a strong focus on mindfulness and values.) ACT patients are taught to notice and accept challenging thoughts and feelings.
There’s also dialectical behavior therapy (DBT), an in-depth treatment that combines CBT with other approaches and addresses suicidal and self-harm behaviors, borderline personality disorders, eating disorders, and substance abuse problems, among other issues. Or you might try psychodynamic therapy, in which you learn to define your problems and understand how your history and past relationships may be influencing your current behavior.
If you’re having problems at work or in your relationships or are just feeling “blah” about life, a licensed professional counselor might be a good person to start with. Counseling doesn’t usually focus on treating severe mental health issues but helps people “figure out the factors that get in the way of being happy,” says David Kaplan, PhD, chief professional officer at the American Counseling Association. Counselors aid in identifying “what is keeping you stuck and can help solve problems so you can be more fulfilled and better enjoy life,” says Kaplan. Marriage and family therapists specialize in working with couples and families.
What About Meds?
Most therapy providers aren’t allowed to prescribe medication. You’ll usually need to consult a psychiatrist, your family doctor, a nurse practitioner, or your ob-gyn for meds like antidepressants. But your doctor should collaborate with your therapist to make sure you’re getting the most appropriate treatment. If you think you might benefit from medication, discuss it with your therapist. She can direct you to someone with prescribing authority.
Who Should You See?
The practitioners below are licensed by the states they practice in and must work a certain number of hours under the supervision of more experienced clinicians before seeing patients solo.
Psychiatrists: These MDs are generally the priciest practitioners to see and the hardest to find, due to a nationwide shortage. Patients may go to a psychiatrist on occasion for prescriptions and another type of provider (one who’s more affordable and accessible) for therapy, though some psychiatrists do offer therapy.
Psychologists and social workers: The former usually have PhDs or PsyDs; the latter have at least a master’s. They’re both trained to treat specific mental illnesses, such as anxiety and depression, and may use several different forms of therapy, such as CBT.
Counselors: Holding at least a master’s, they often guide clients through problems like whether to stay in an unhappy relationship or at a lackluster job.
Marriage and family therapists: They have at least a master’s and are particularly helpful when you’d like to see someone with your family or partner.
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BetterHelp Online Therapy
BetterHelp is an online therapy site that connects users with thousands of licensed therapists across the 50 states. Through the mobile app (available for iPhone and Android) or a web browser, users can exchange messages with their therapist, send voice recordings —useful when thoughts come too fast to type up—, or schedule live sessions by phone, live chat, or video call. Therapists typically reply to messages within 24 hours once or twice a day on weekdays, but some therapists reply more often.
Signing up for the service takes only a few minutes. An onboarding questionnaire asks users to explain what their mood has been in the past few weeks and why they’re seeking therapy. Then, users are matched with a therapist (preferably in their state) who can help them address those issues.
BetterHelp only features duly licensed and certified counselors, including “psychologists (PhD / PsyD), marriage and family therapists (LMFT), clinical social workers (LCSW / LMSW), or licensed professional counselors (LPC).” To see clients through the platform, therapists must hold a valid license from their state’s professional board and have a minimum of three years and 2,000 hours of experience.
Talkspace Online Therapy
Talkspace is the only other major messaging-based online therapy app in the market. Users can speak with a licensed therapist through text and audio messages, as well as send videos and photos, on desktop and mobile app. The company calls this “Unlimited Messaging Therapy”. Therapists reply to messages every weekday. Depending on the subscription selected, users can also schedule 30 minute video chats with their therapist, though this option is only available on the iOS and Android apps.
Teenagers aged 13 to 17 can sign up for Talkspace with their parent or guardian’s consent. State regulations vary, but generally, therapists do not need to share details of treatment with the parent or guardian, meaning therapy can remain confidential from parents, even if they have to give their consent for treatment.
To practice through Talkspace, therapists must be licensed and certified by the appropriate state boards and agencies, have at least five years of experience in their field, and have valid malpractice insurance, among other requirements listed in their Terms of Service. Talkspace says all the information is verified by them.
Talkspace offers three different plans, all of which feature Unlimited Messaging Therapy. The most basic plan only includes messaging and has a cost of $49 per week or $196 per month. The second plan includes one 30-minute live session per month via video-conference for $59 per week or $236. The most advanced plan includes four live sessions for $79 weekly or $316 monthly. Live sessions only work on the mobile app, not on the desktop. Every plan is charged monthly, and discounts are offered when the subscription is paid in advance for 3 or 6 months. Couples therapy is available for a cost of $316 for one month ($71 per week).
To get matched, users go through an onboarding process with a therapist who asks questions about why the user is seeking therapy and enables the payment widget.