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.

When is Medicating Your Child a Good Idea?

It’s hard to know when medication is the right step for you and your child. This guide will walk you through the main issues to consider.

Mental health is a delicate balance of the holy trinity- biological, psychological, and social factors. Medication acts primarily on the biological side.

If only it were that simple. Mental health medication is still highly stigmatized. I’m sure we’ve all heard horror stories of the kid who was put on something that turned him into a blank zombie. Sure, he wasn’t bouncing off the walls anymore, but he also lost his personality.

On the other side, maybe you’ve seen the kid whose parents chose to give her only natural medicine for her ADHD. She’s completely unable to focus in class and she’s falling farther and farther behind grade level each year.

Or maybe you know a kid whose medication is helping him get through seventh grade. For the first time, he’s able to be present and participate in class. Too bad it couldn’t have happened earlier. His parents have been trying different meds and combinations since kindergarten. Between the nasty side effects and ineffective dosages, he’s been held back already, and he’s missed a lot of school.

Here are some guidelines I use when suggesting that medication might be the next step in mental health care:

  1. You’ve tried therapy. Therapy can be great. As a therapist, it’s my go-to solution. But therapy should show progress after a few months of consistent sessions with a person your kid has a good relationship with. This is why it’s important to set concrete goals with tangible benchmarks- so you’ll know if there’s change.
  2. Your child is not able to perform normal tasks of daily life without assistance at a level compared to other children of the same age. They should be able to follow a string of logical instructions- for example, asking your child to finish their bath, brush their teeth, change into pajamas, and then come tell you they’re done so you can read a story. If you need to remind your child of their tasks every few minutes, there’s a problem.
  3. They’re falling behind in school. This is the most important reason I recommend medication. Being held back affects a child’s self-esteem, their peer group, their reputation, and their sense of self-efficacy. It’s one of the most damaging and devastating experiences at that age. Many of my adult clients who have been held back listed it as a pivotal event, even as young as kindergarten.
  4. They are isolated from friends. Kids who have dramatic outbursts from ADHD, bipolar, psychosis, and other disorders tend to attract labels, and not very nice ones. This keeps them from normal social activities with peers and may make them a target for bullying- or turn them into a bully if loneliness shifts to anger.
  5. They recognize there’s a problem and want a solution. Lots of kids I’ve talked to over the years have told me they want to be able to sit down and concentrate on their work but they just can’t. This is the big difference between the class clown’s acting out and the disruptions from a mental disorder. Most children don’t want to interrupt, do poorly, or fail classes. When there’s a problem, they know.

Medication isn’t all-or-nothing. It’s possible to give your child a dosage that will take them through the school day and wear off in the evening. Many kids take medication holidays when school isn’t in session. Some kids need the additional help so they are able to try therapy and are able to stop the medication once things are under control.

But advice from the internet can only be vague. I don’t know your child or your situation. The best way to find out how medication could work for your family is to talk to someone in person.

The first person I always suggest is your pediatrician because they know your child and they know about normal child development. Doctors aren’t as well trained in mental health as a therapist or psychologist, but they can diagnose and prescribe psychiatric medication. You can ask during your child’s routine appointments, and this is usually covered by insurance.

The next person to talk to is your school’s psychologist, if your child qualifies for services through a 504 or IEP. These services are usually free through the district. Although the school psychologist won’t prescribe medication, they can assess your child, describe the diagnosis, and discuss the possibility of medicating.

The last person I recommend is a psychiatrist. This is because most communities have very few psychiatrists, so it can take months to get an initial appointment, if you can get one at all and aren’t placed on a waiting list. When you get there, the psychiatrist likely doesn’t know you or your child, so you have to explain the history of the problem. And if there are any issues with the dosage or side effects, it can be a while before you can get in for a follow up appointment.

You can talk to your regular therapist about medication too. Therapists in California are trained in psychopharmacology- knowledge of medications for mental health issues. But therapists can’t prescribe medication or even suggest medication. They’re available for you to talk about your thoughts or feelings about medicating your child, and they can help you find local referrals for doctors, psychologists, or psychiatrists.