How Do I Find a Therapist?

Where to look

Google

When you google “therapist + near me + keyword that describes your problem” your search results are going to depend on two things: google ads and search engine optimization. Therapists can pay to have their website pop up at the top of your search window, this doesn’t mean they are the most qualified, it means they paid to be there.

Letting google ads guide your search isn’t necessarily a bad thing, therapists who are investing in a marketing plan that speaks to a specific niche probably do have some advanced training, qualification, or dedication to serving that niche.

Search Engine Optimization is a little more complicated. SEO is the process of making your website more visible in search engines like google. It involves trying to understand the algorithms used to rank websites. Writing an article like this, where you hope a prospective patient will google “how to find a therapist” and google will rank your website as legit enough to show up on the first page of search results, is one way that SEO helps therapists and patients find each other.

Directories

Psychology Today: Psychology Today is a website that the vast majority of therapists in private practice will have profiles on. Therapists pay a monthly fee for their profiles, and you can narrow down your search results by town, type of therapy, insurance, gender of the therapist and price. 

Unfortunately, there doesn’t seem to be much rhythm or reason to how Psychology Today ranks the order in which it shows you therapists. There is no way to filter out therapists who say their practice is full, and it can be overwhelming to try to sift through hundreds of different profiles.

Niche-specific websites

There might be other websites that exist to find therapists who specialize in your specific reason for seeking treatment. At the Pomegranate Institute, we specialize in treating folx with erotically marginalized identities. You can find us on our website and psychology today, and we maintain profiles on the Polyamory-Friendly Professionals Directory and Kink-Aware Professionals Directory. 

Asking for recommendations

People are seeking therapy in historic numbers, with some estimates suggesting that as many as 1:4 adults have sought therapy in the last 12 months. On the one hand, this means therapists are seeing a greater number of referrals than ever before, and on the other hand, it means you have a wider pool of people to ask for recommendations.

All therapists will have policies about managing what is called “dual relationships” in treatment, and part of what this means is that they won’t see someone who is closely connected to an existing patient, to maintain appropriate privacy and boundaries. But every therapist will draw this circle a little differently. You probably won’t be able to see the same therapist as your sister, or your best friend, but your cousin? Your hairdresser? That nice lady at the gym who always re-racks her weights?

If someone has an amazing therapist, you can also ask them to ask their therapist for recommendations. Most therapists have supervisors, colleagues, and friends that are also therapists and we’re happy to provide suggestions if we think we know someone who might be a good fit.

Calling your insurance company

If you’re going to try to use your insurance for therapy, you can call them and ask them for a list of local providers. They don’t maintain detailed information about the specialties or availability of these providers, and many patients find that this list is out of date and confusing. The term “ghost network” was coined to describe the phenomenon of insurance companies maintaining what looks like a robust referral list that is actually filled with inaccurate or misleading information, with some advocates alleging this is done deliberately as a cost saving measure.

Speaking of my insurance, why does it seem like no one takes my insurance anymore?

An increasing number of therapists have stopped taking insurance. Reasons include:

• Failure for insurance reimbursement rates to keep pace with expertise, inflation and cost of rendering services
• Administrative hassle: the paperwork required to submit insurance claims is extensive and time-consuming and it can take months for insurance companies to pay claims even when the paperwork is submitted the same day as the patient is seen
• Privacy: there are certain situations where your insurance company can request to audit your therapist’s records to ensure they are following the rules. Some therapists choose not to take insurance to offer their patients an increased degree of discretion.

If you can’t afford the out-of-pocket costs of seeing a therapist, some therapists have what is called a “sliding scale” where they will offer one or two slots a week at a deeply discounted rate to people who cannot otherwise afford their services. Not all therapists advertise this, so you may need to ask to see if this is an option.

Community mental health centers may have grants to support sliding scale therapy on a broader scale, and may even extend this coverage to people who have health insurance, but have a prohibitively high deductible. Open Path Collective is a not- for-profit that matches therapists willing to offer deeply discounted ($40-70 per session) treatment with prospective patients.

If you feel overwhelmed looking at the options, here are some considerations that might help narrow it down. 

The kind of therapist:

The letters immediately after someone’s name will tell you what kind of license they hold, examples include:

• LCSW/LICSW: Licensed Clinical Social Worker and Licensed Independent Clinical Social Worker
• LMFT: Licensed Marriage and Family Therapist
• LMHC: Licensed Mental Health Counselor
• MS, MA or MSW: this indicates someone has a master’s degree in a therapy-related field, but they don’t have a license. This most likely means their degree is new (less than two years).
• PsyD/PhD: Clinical Psychologist, a PhD involves a training program that is slightly more research oriented, whereas a PsyD program is more clinical. PhD programs tend to be more competitive and PsyD programs are a newer kind of degree.

The staff at The Pomegranate Institute are Licensed Independent Clinical Social Workers, meaning they have a master’s degree in social work, and have practiced for at least two years under the supervision of a more senior social worker and passed two exams and are now licensed to practice independently. Social work is a kind of therapy that tends to emphasize a social justice stance and the importance of understanding someone’s mental health in the context of their environment.

Level of licensure

Some therapists have master’s degrees in their field, and some have doctorates. A doctorate doesn’t necessarily mean a therapist has more clinical experience than someone with a master’s degree. Doctorate programs often include considerable training in psych testing or research, so it’s important to consider how long someone has been in practice in addition to their degree.

Theoretical orientation

Theoretical orientation describes what kind of therapy a therapist practices. Some therapists will say they are “eclectic” meaning they do a little bit of everything, and some will specify expertise in a specific kind. Modalities you will see frequently include:

• CBT: Cognitive Behavioral Therapy is a type of therapy that focuses on the relationship between situations, thoughts we have about a situation, and how we feel. CBT assumes that distortions in our thinking can have a negative impact on our mental health, and treatment focuses on evaluating these distortions for accuracy and helpfulness, and trying to identify and modify their underlying core beliefs.

• EMDR: Eye Movement Desensitization and Reprocessing is a kind of therapy that was developed to treat how traumatic memories are processed and stored in maladaptive ways as part of disorders like Post-Traumatic Stress. EMDR involves watching a ball bounce back and forth on a computer screen, or holding vibrating paddles (among other strategies) while targeting specific experiences.

• Psychodynamic: Psychodynamic psychotherapy involves exploring the connection between past significant life events and present functioning. This treatment assumes that this insight is incredibly therapeutic and will help you change your behavior moving forward.

       Since Smith College School for Social Work is psychodynamically oriented, it’s a popular modality in the Pioneer Valley, where the         Pomegranate Institute is located.

• DBT: Dialectical Behavior Therapy was developed to treat Borderline Personality Disorder. It involves 4 modules: mindfulness, balancing the dialectic of acceptance and change, improving distress tolerance and interpersonal effectiveness.

• Somatic Therapy: Somatic Therapy focuses on the connection between mind and body and emphasizes the use of body-based strategies for healing.

• IFS: Internal Family Systems involves exploring the different parts (exiles, managers and firefighters) and the relationships between the parts are core self (protection, polarization and alliance)  

Generalist versus specialist

 In school, most therapists are trained to provide basic interventions to a wide range of people, and most entry-level jobs will focus on doing the same, providing standard therapy to the widest range of people possible. Some therapists will continue to stay broad in their focus, and other therapists will pursue advanced training in working with specific patient populations in specific ways. How important to you is it that your therapist is well-rounded versus an expert in something in particular?

The Pomegranate Institute focuses on treating patients with erotically marginalized identities, like people who are LGBTQ, have kinks, fetishes, are involved in sex work or practicing ethical non-monogamy. 

If I find a therapist with openings, what questions should I ask to determine if they’re the right provider for me?

“What experience do you have treating people with my specific reason for seeking services?”

This will help narrow down whether you are seeing someone who has an awareness or expertise in treating the projects that bring you to therapy.

“How many years and what kinds of experiences as a therapist do you have?”

Knowing that your therapist is experienced is helpful, but it might also matter to you that your therapist is of your same generation, has lived experience with the project that brings you to therapy, or shares certain marginalized identities with you. Some therapists will make this an explicit part of their marketing, and some will be more reserved about disclosing this information.

“Do you have someone that you see for supervision, consultation, or your own personal therapy?”

It might not be a full blow red flag if the answer is “no” but we consider some kind of professional support to be an essential component of good therapy. Do you really want to work with someone who makes recommendations they don’t road test in their own life?

“What steps will you take if I experience a psychiatric emergency?”

All therapists have a legal obligation to intervene in cases where their patient is at risk of imminently ending their life, someone else’s life, or their patient discloses knowledge of child abuse, elder abuse, or the abuse of a person with a disability. This mandate supersedes their obligation to protect patient privacy, and they may take steps like calling the police, calling your emergency contact, or calling the applicable state agency.

Understanding how a therapist handles crisis situations, how comfortable and familiar they are working with people who experience suicidal thoughts or have a history of suicide attempts will help you determine if this therapist is the right one for you.

“What is your cancelation policy?”

Requiring 24 hours’ notice if you need to cancel or reschedule is fairly standard. Some therapists will charge their full session cost for sessions canceled outside of this window, and some will charge a reduced fee. Some therapists will make exceptions for unavoidable emergencies, and some will not. It’s not uncommon for a therapist to say “I won’t charge the cancelation fee if we can reschedule for something that same week.” 

“What does your rate cover and not cover?”

Does the therapist charge extra for between session phone calls? Consultation with your former therapist? Collaborating with your couple’s therapist? Or are these things included in the session rate? 

“What kind of availability do you offer in-between sessions?”

There are privacy laws that govern how therapists can communicate with their patients outside of session, but there’s some wiggle room in how the particulars happen between providers.

We have a patient portal that allows our patients to send us secure messages in-between sessions, we utilize this rather than email or text message. We are happy to discuss scheduling or progress on the week’s action plan over portal message but may suggest a phone call or extra session when it seems warranted.

“What kind of access to my medical record will I have?”

New rules like Disincentive Penalties for Information-Blocking Providers and the Cures Act have increased the access that patients have to their medical records, but therapists will have different processes for facilitating this access.

We choose to send our patients the progress notes we write after each appointment so we can make sure there is consensus about what we discussed and what we’re recommending. We think reading these progress notes helps reinforce the insights our patients gained during their appointment, and this way, they can focus on the session itself, rather than trying to take their own notes.

At the end of the day…

As much as we love a good spreadsheet, nothing beats meeting someone (virtually or in person) and sussing out whether they are someone you could see yourself building a relationship with.

Researchers call the relationship between therapist and patient the “therapeutic alliance” and there’s some good data to support the notion that the strength of this alliance is not only a good predictor of therapy outcomes, but might actually matter more than other variables like type of therapy or therapist experience.

If this article has peaked your curiosity about whether or not our staff would be a good fit for you, and you live in Massachusetts reach out! We offer a free 30-minute consultation so prospective patients can ask questions like these and get to know us.