Therapy 101: How to Find a Therapist

In the Therapy 101 series, we’re covering the basics of what you should know before going to see a therapist. This post looks at finding a new therapist and the nine factors to consider when deciding to commit.

Finding a therapist can feel like online dating. It usually begins with a search- therapists near me, counselors near me, therapy for depression, best counseling group. You scroll through bright, happy websites full of professional photos of well-lit, smiling people. They all say pretty much the same thing. You’re stuck and I can help you. They have lots of buzzwords. Change. Transform. Holistic. Wellness. Some list a fee or insurance networks they accept. Many don’t. It can seem like there’s no real difference between them. But there is, and it’s not something you can see from a website. It’s their personality.

After all the effort you’ve put into finding a therapist, it’s tempting to pick the first one who calls you back. But it’s worth it to find someone who really gets you. Studies of the effectiveness of therapy show that it’s the relationship you have with your therapist that’s the biggest predictor of change in your life. It’s not the methods- results show that the therapy method doesn’t matter so much even though they seem so different.

Treat the first session like a date- it’ll probably be a bit awkward and you don’t really know each other but you’re trying to see if it’s a good fit and trying to make a positive first impression while being authentic about your experiences and struggles.

Many therapists offer a free initial consultation so you’re not dropping a hundred dollars on someone you don’t want to see again. But many don’t offer a free first session or do a free consultation on the phone only, so you may have to make a bit of an investment in finding the right person.

Here are nine signs you’ve found a good therapist:

*note: many of these signs reference California legal and ethical standards for therapists with a state license and may not apply in other states.

  1. They’re above board from the start. Your therapist should go over things like fees, cancellation policies, confidentiality, mandated reported requirements, and other boilerplate details with you. If they don’t mention any of these things, that’s a sign they’re uncomfortable talking about difficult topics, but it also indicates that they either don’t know the law or are purposely ignoring it. Not a good trait in a therapist.
  2. They can explain the process of therapy to you. Every therapist does therapy a bit differently, but the time you spend in therapy generally has a beginning, middle, and end. If the professional therapist can’t tell you what to expect in therapy, watch out! They might not know what they are doing or they might want to bring you in with no defined end so you’re in therapy for years (and paying every week!).
  3. They listen to you. After the required details are taken care of, the therapist should ask you why you’re coming to therapy. Depending on the therapist’s methods and the nature of your problems, they might ask about your childhood, your relationships, your sleep habits, or even your current thoughts and feelings. No matter how they direct the conversation, you should expect to spend a good amount of time talking about yourself and your experience. Stay away from the therapist who hears “I’m depressed” and doesn’t ask more- it shows they don’t really care about your side or how your personal history has shaped the current issue.
  4. You feel heard. Some therapists listen but you’re not quite sure they’ve really understood what you were saying. It’s a good sign when your therapist reflects back what they heard you say and asks if they’ve got it right. That shows they’re actually trying to get your perspective accurately and are willing to ask for clarification.
  5. They ask about your end goals. There are a few ways they might ask about this. Phrases like “if the problem was gone, what would be different” and “how would you like things to be with your spouse” are indicators that your therapist is looking for specific, measurable goals so they know when you’re heading for the end phase of therapy.
  6. You feel comfortable in the room. Therapy takes a while. You should be comfortable on the furniture, feel safe parking your car or taking transit to the office. This may seem like a small thing, but if you don’t feel like you can relax in the room, it’ll be easier for you to skip sessions later when it’s hard to get out the door.
  7. You like the look of your therapist. It can seem shallow to judge someone by their appearance, but it’s actually pretty important. If you feel attracted to them, you might not be completely honest about the weird parts of your past. If they seem too young, too old, or too close to your own age, you might not feel able to trust their judgment. Some people need to see an older therapist who reminds them of their grandparent. Couples may prefer to see a married therapist. Teens often like therapists who are either younger adults or older adults- not someone parent aged. A person who has experienced sexual assault may want to see someone completely different in race and gender from their attacker.
  8. The therapy style seems like a match. If you’re more analytical, look for a therapist who can explain your anxiety in a more technical way. If you’re a creative type, steer clear of the technical therapist and look for someone who will do process art, dance therapy, or music therapy with you. A good therapist can be both- they’ll mirror the way you talk and match their style to your personality and way of thinking.
  9. You’re comfortable with the fee. Most people aren’t comfortable talking about money, especially when it comes to admitting that something is too expensive. If you really feel like this is someone you could work well with, ask about sliding scale fees or suggest a fee you feel comfortable with as long as it’s similar to the current fee structure. It’s no fun for anyone to have a mass of unpaid bills collecting.

If they’ve got all these factors, you’ve found a match! Just remember, first sessions are often like first dates, and if you can afford it, give a maybe therapist a few sessions to get to know you before making a final decision. Of course, a red flag therapist shouldn’t get a second session- get out of there right away if you feel uncomfortable or if they’re clearly doing illegal or unethical things.

What is Mental Health?

How do you define mental health? We use the biopsychosocial method to define mental health with our clients.

It’s important to develop a working definition of mental health because that’s the language we use when we decide that what we’re experiencing has slipped from mental health to mentalĀ illness. Defining mental health also lets us set a benchmark to know when therapy is done.

Here at Makarios, I believe in planning for the end from the first session. To do that, I use the biopsychosocial model for mental health. Just like it sounds, the biopsychosocial model has three parts: your physical biology, your internal psychology, and your external social community. You need to have all three parts in balance to be mentally healthy. Let’s break it down.

Your biology is your physical health, the genes you got from your parents, any physical disabilities you have, the food you use to fuel your body, the drugs you choose to use or avoid, and details like your height and weight.

Your psychology is your self esteem, the way you think about the world, your social skills, your ability to cope with stress, the way you are in relationships with others, tendency toward optimism or pessimism, and your memories.

Your social community is your family, friends, and neighbors. It’s choosing to join a church, synagogue, or mosque. It’s the people you meet taking a painting or welding class for fun on the weekend. It’s any people you interact with in person or online.

Here’s how therapists use this information. When you first come to a session, your therapist will ask you about yourself, your family, maybe a bit about what you do, and your habits. It’s not just small talk- they’re trying to assess for how your biopsychosocial system is functioning.

Let’s say you come in to your first therapy session because you’ve been experiencing symptoms of anxiety and you’d like to go back to the way things were before the symptoms started. Here’s what your therapist would probably ask about:

  • What changed in your life around the time your anxiety symptoms started?
    • Did you start a new medication or start drinking more caffeine (biological)?
    • Did you have an experience that was more stressful than usual or did you go through something traumatic (psychological)?
    • Did you just begin or end a relationship, job, or hobby (social)?
  • What have you tried so far to deal with the anxiety and how has it worked?
    • Did you self-medicate with “downers” like alcohol or marijuana?
    • Have you tried pop-psychology methods like mindfulness, meditation, going gluten free, or tapping?
    • Have you tried therapy before? What methods did you like or not like?
  • Do you have other people in your life you feel comfortable talking to about what you’re experiencing?
    • Some people isolate themselves when they aren’t feeling well
    • It’s important to identify people in your life you can talk to, or to find those people if you don’t have anyone you can trust

I used anxiety as an example because it can come from any one of a number of causes. You could have a chemical imbalance (biological) from substance use, poor eating habits, or genetic predisposition. Or it could come from psychological factors such as a change in the way you think about yourself and others, experiencing a new trauma or being reminded of a past trauma. Anxiety can also stem from social changes like a major loss, an identity shift from job transitions, or a relational rejection.

This is important because where your anxiety comes from shapes how we’ll treat it in session. Anxiety following the death of your favorite grandmother is very different from anxiety that comes from stress or from an overactive brain.

Most people experience stress-related anxiety. That’s why anxiety disorders are more common in people who are going to school or who have high pressure jobs. Stress is a psychological symptom, so the treatment will focus on realigning your psychology through reframing your thoughts. Cognitive Behavioral Therapy is one of the most popular methods because it has been empirically proven to work for most people, and if you’re using insurance to cover the cost of therapy, it’s one of the methods your insurance provider will pay for.

If you have a genetic predisposition toward anxiety, you likely have an imbalance in your brain chemistry. Medication can adjust the levels of neurotransmitters so you have normal brain functioning. People with biological anxiety can also experience anxiety from psychological stress and social factors, so you may need to combine meds with therapy for the best results.

The examples about anxiety are intended to illustrate how therapists use the biopsychosocial model of mental health to evaluate new clients. These examples are not intended to diagnose anxiety or any other mental disorder, and are not intended to suggest a course of treatment. See a qualified mental health professional for a diagnosis and treatment plan.