With all of the hardships of modern living, many people have restored balance in their lives by finding a competent psychotherapist.  But psychotherapists are just like any other kind of professional: with a thorough search you can find the superb, the mediocre, and the subpar.  Experiencing an encounter with one of the latter two, the result can be not only wasted time, money, and effort, but also innoculation against an effective means to improving your life.  In this post, I suggest some strategies that could help you save hours of time, thousands of dollars, and unnecessary headaches in your search for the help you need.

1. Establish a geographic perimeter.

The first step in finding the right therapist is winnowing down the options.  Therapy first and foremost relies on regular meetings and repeated investment of effort.  Relaxing your criterion for geographic proximity could mean setting yourself up for failure.  A great therapist who is hard to get to will make both consistency and persistency more of a challenge than it will already be with someone local.

Think of therapy as a place to do work.  While psychotherapy can indeed be gratifying, it can also be trying.  Start with the assumption that all of the following are true: psychotherapy will be difficult, rewarding, and could very well scale up in frequency as you make new discoveries about yourself.  Ask yourself, how far am I willing to travel twice per week before or after work?

I saw a brilliant psychiatry attending working on becoming an analyst 4 times per week for 2 years at a rate of $10 per session.

2. Narrow the search by taking an honest look at your insurance.

Much of what was said about geography can also apply to insurance.  When the going gets tough, balancing your budget can make dropping a productive treatment seem like a wise decision.  Be realistic with what you can afford and determine whether insurance is a way to make competent psychotherapist’s fee a sustainable expense.

Health insurance providers vary in their helpfulness in longterm psychotherapy treatments.  As a student, my insurance (AETNA student health plan) paid for 90% of my therapist’s fee for twice-weekly therapy, costing me $12/week for two 50-minute sessions with an experienced, skilled, and deeply invested psychoanalyst.  Other insurances develop such a bad reputation with psychotherapists that no competent provider would ever accept them. If you value the premium insurance plans to pay the extra expense, or are lucky enough to have the luxury plan through work, staying in-network is usually the way to go.  In fact, if you have a plan like I had, my humble opinion is you have no reason NOT to be in therapy.

Conversely, if you have opted for a budget health plan and don’t have tons to spend on a weekly full-fee treatment, good options are limited but not completely unavailable.  Training clinics and teaching hospitals can be decent options. As a resident of New York City, I am perpetually shocked by the fact that so few take advantage of the plethora of psychoanalytic training institutes.  NYPSI, IPTAR, William Alanson White Institute, NYU, and Columbia are all well-reputed institutions that train licensed professionals who are seeking to specialize in psychoanalysis. Becoming a training case for an aspiring analyst is a big commitment (often 4x/week), but can both be an incredible value and a life-changing experience.  I saw a brilliant psychiatry attending working on becoming an analyst 4 times per week for 2 years at a rate of $10 per session. Admittedly this was an extraordinarily rare opportunity, but good value can most certainly be found by working with analytic training candidates. Other major cities besides New York also have training institutes, although not nearly with the same abundance as the Big Apple.

If finances are tight and mental health problems are overtly interfering with your capacity to increase your earning potential, many therapists will offer a generous sliding scale and/or pro bono work.  This may take some scouring of psychology today as well as extra phone calls and consultation sessions, but many psychotherapists allot a certain number of slots in their private practice for individuals with strained finances.  Remember: mental health professionals enjoy helping and are most definitely not in the field for the money!

3. Determine what kind of help you need right now.

A high percentage of people I’ve worked with have entered into treatment thinking they needed  a quick tune-up, only to develop a deep appreciation for how deep and complex their symptoms truly are.  I suppose these are the type of people most likely to seek me out. Others however have little interest in learning more about themselves but need desperately to resolve a maddening fear of public speaking, anxiety over bedbugs, or panic attacks while flying, to use a few frequent examples.  While these individuals would undoubtedly benefit from a longer course of treatment, at the time they arrive in a therapist’s office, they demand it be a pitstop rather than a full restoration (my secret hope with these individuals is that their experience in therapy piques their curiosity sufficiently to revisit therapy when they are not in such a hurry).

If it’s your first time in therapy, it can be difficult to predict which one of these sketches best portrays you.  And at the risk of being redundant, I could easily describe many other common types of therapy-seekers. Presenting yourself with the following forced choices could help figure out which type best describes you:

If you agree with more of the statements on the left, a short-term, time-limited treatment, such as Cognitive Behavior Therapy/Cognitive therapy, Behavior therapy (such as exposure and response prevention, flooding), or Acceptance and Commitment Therapy, could be good places to start.

On the contrary, if the statements on the right resonated with you more, then a longterm, insight/depth therapy, or psychodynamic therapy/psychoanalytic treatment would be more appropriate and rewarding (other psychologists are sure to have other opinions, but this is mine).

Plenty of resources exist on the web to explain the types of treatment I referenced, but any provider you speak to on the phone should be able to tell you if they favor behavior therapies or insight-oriented approaches.  If you receive the response of “I take a more integrative approach,” press for which kind of interventions they use more.

While this is the most complicated step of this article, it may be the most important in sorting out a good fit from a mismatch.

4. Figure out if gender matters.

It’s very common to seek out a particular gender as a therapist based on comfort level and past experience with men and women.  In my own therapy, I have only worked with men, as having a male therapist has helped me to find the optimal amount of discomfort.

Many therapy-seekers will ask specifically for a female therapist due to incidents with abusive men in the past, or vice versa.  Comfort is important, but it is wise to remember that confronting fears and anxieties is a major component of change. If you are just dipping your toe in the water with psychotherapy and have strong negative reactions to women, then starting with a man might be wise.  However, if you have a great deal of experience in therapy and have only worked with men, perhaps leaning into some discomfort could be the catalyst you need.

Having no preference whatsoever can also be helpful as flexibility on this dimension allows you to pick from the best fit in other areas and/or the most highly recommended.

5. Don’t be intimidated by a high fee in the beginning.

While it may seem like I’m contradicting earlier advice, there is in fact a way to reconcile the disparate remarks.  If you can afford one session with a high-priced therapist, you may save a ton of money down the road if you are truly able to use it as a consultation session.  Pricey, highly-regarded professionals typically have large networks and can be helpful in finding a reputable option in your budget–that is if you can’t convince the consulting therapist to meet for reduced fee.  Many clinicians are not flexible with fee, but plenty others will accommodate the right fit. A face-to-face meeting is a great way to plead your case.

Summing Up

The world of psychotherapy is a unique culture that often feels strange and uncomfortable when you have no experience with it.  These tips along with a face-to-face meeting (and asking lots of questions!) will help demystify the psychotherapy world, and hopefully even get you excited about the journey on which you are about to embark.