People seek therapy to get help making an important personal change, by their choice or urged by loved ones. Maybe you are being proactive and preparing for a happy event such as a wedding or a new baby, and you want to get off to a strong start. Maybe you are struggling with a relationship, a diagnosis, alcohol or substance abuse. You may be experiencing thoughts and feelings that make it very difficult to get through each day. Regardless of the reason, you want an effective therapist to help you find the insights and new abilities you need.
Here are questions and tips to help you choose a therapist who is both skilled and a good fit for you.
Does a qualified therapist have to have certain credentials?
No matter the discipline, therapists must have some specific education to pass the licensing exam in your state. Licensed therapists have at least a Master’s degree (shown as MA). Some have a doctorate, (for example, PsyD). The American Psychological Association (APA) has a helpful guide to the differences between practitioners such as psychiatrists, psychologists, marriage and family therapists, and social workers. Another excellent article by the Seleni Institute briefly describes the different types of therapists you may find.
Common abbreviations and what they mean
A therapist may list licensing and training credentials with abbreviations such as these (courtesy of this article by Marjorie Hansen Shaevitz):
- Licensed Clinical Social Worker (LCSW)
- Licensed Marriage and Family Therapist (LMFT)
- Licensed Professional Counselor (LPC)
Therapists may or may not display all of their credentials. You can ask the therapist about education and training they took to begin their practice and what licensure they hold. Some therapists (myself included) list the training they have taken on their website.
What is a therapist intern or resident?
You may find a practice that has interns or residents in counseling or therapy working under the supervision of a licensed provider. Supervised professional work is part of a therapist’s requirement to finish their education and become eligible for a license. Therapist interns or residents should be working closely under the supervision of their licensed supervisor.
Of course a diploma or license does not tell you if you and the therapist will work well together. Here are some important things to know about the different approaches therapists can take to support healing and mental health, and some questions you can ask to learn more.
Does a good therapist have to have training in trauma-informed therapy?
Research shows that a high percentage of people seeking treatment for addiction, troubled relationships, or conditions such as depression have a history of trauma. Yet many people do not understand or see their personal experience as traumatic, and do not bring it up in therapy.
As trauma-informed therapists, we know that toxic stress and overwhelming experiences make distinct impressions on the mind, brain and body. Trauma alters the way our brains process our experiences, which impacts how we think, feel and act, even without our awareness. Trauma-informed therapy takes into account the complex nature of traumatic stress in every aspect of working with a client. It allows the person in therapy to safely process their unresolved trauma, knowing they finally do not have to face it alone.
I cannot imagine doing good work as a therapist without bringing this awareness to every part of my work with clients. I believe a good therapist must be trauma-informed. This approach develops the sense of safety that a person in therapy needs. It enables people in therapy to feel accepted where they are, no matter what the difficulty. It enables the therapist to better understand them and to meet them right where they are in life.
Finding a therapist to treat self-harming behaviors and addiction, including alcohol or substance use
There is more than one way to treat self-harming behaviors, and alcohol and substance use. Many therapists use some kind of an abstinence model for these coping strategies. A trauma-informed model looks at the use of self-harming behaviors or addiction as a coping mechanism or strategy. This approach seeks to understand the underlying pain, and to find the client’s personal strengths to help in recovery. The aim is to safely come to terms with the trauma and find healthier strategies to cope with the emotional pain.
Two therapists with different models will both say “yes” to the question, “Do you treat self-harming behaviors or addiction issues?” Which approach gives you the most hope and confidence? To learn more about the approach to treatment, you can ask them, “How do you look at self-harming behaviors and addiction issues?”
Finding a therapist to help you as a couple
Many licensed therapists are wonderful in individual therapy. However, it takes specific training to work effectively with more than one person in the room at a time. Couples therapy is not the same as individual therapy for two people. The therapist needs to understand the partnership as a dynamic system. The relationship also feels the effects of each partner’s experience in other roles. Work relationships, friendships, and the larger family system all have an impact on how the couple functions.
To rebuild intimacy in a strained partnership, specific training allows the therapist to help the couple interact more openly and safely and feel connected. There is no taking sides by the therapist. Each person needs to feel understood to build a more satisfying life together.
The field of marriage and family therapy has changed much in recent years, so there are many possible models that you may hear about. To find out if a therapist has special training to work with couples, you can ask, “What ways do you help couples?” “What model informs your work?” Here are three (among many) well-established family systems approaches which therapists can learn to help couples:
- Emotionally Focused Couples Therapy (EFT)
- Psychobiological Approach to Couple Therapy (PACT)
- Imago Relational Therapy
A good therapist will be glad to answer questions about what approaches they find most helpful.
Finding a therapist skilled in working with adolescents and families
Adolescents often come to therapy because of trouble dealing with their thoughts, emotions and behavior. Neurologic changes in the brain and body impact how adolescents see their own experiences. Often the parents are scared. They love their child. The whole family has been trying very hard to cope, and whatever they have been doing has not been working. So parents need support too, not just the child.
It’s important to bring a trauma-informed and family systems approach to working with adolescents. I use specific protocols to assess and work with adolescents and families from a strengths based, trauma informed, systems approach.
How does the family get support from the therapist? This is a good question to ask if you are looking for counseling. Some therapists only work with the adolescents and refer parents to therapists who are dedicated just to them. Others want to engage the family as a team. There has been much research and growth in the field of adolescent mental health and psychology. You can ask the therapist, “What has changed in your work in recent years?” to find out about the approaches they currently use.
Who can help you in finding a good therapist?
Asking friends and family for help can take courage. Sadly, we must still fight the stigma against talking about mental health concerns more openly. It may be hard to admit you are struggling, but reaching out can bring the support you need to get help.
Ask people you trust if they know of a good therapist. If you know someone who works in healthcare, it is very likely that they have a referral list.
Other sources for referrals are:
- School guidance counselors
- Clergy such as a minister, rabbi or priest
- Your family doctor, OB/GYN or internist
- A human resources professional where you work
- Your health insurance provider
Once you find someone to call, the next step is to learn about the person’s approach, background and work.
What are some good questions to ask during your initial contact, either by phone or email?
When you first contact a therapist, these questions can help you break the ice and get a basic sense of how they are to work with:
- Do they treat people with your particular issue?
- Do they have room in their calendar for you?
- Do they have office hours that work for you?
- Do they have any training in trauma-informed therapy?
When you first call, you may get a receptionist, or you may get a recorded greeting and have to leave a message. Even then, ask yourself, does it feel like a warm, safe environment for you to try out? It is important for you to find a therapist who pays full attention and who is someone you can trust with your concerns.
What are some signs that a therapist is a bad fit or a good fit for you?
|Signs of a bad fit||Signs of a good fit|
|You feel judged or ashamed.||You feel heard and even better, understood.|
|The therapist talks about the therapist’s own issues or is multi-tasking.||Talking to you is the priority – no distractions.|
|You feel talked to or at.||The therapist asks questions to get to know you and collaborates with you on your care.|
|The therapist does not seem to take much interest in training or new approaches.||The therapist has special training and experience in the issue that concerns you|
|The therapist seems tired or falls asleep. (Yes, I have heard this has happened for some!)||The therapist is fully present, awake and tuned into you.|
|The therapist seems like a cheerleader, or a critic. They are either approving and happy for you or disapproving and critical of you.||The therapist sees the good in you. They understand your self-destructive behavior as your efforts to cope with life that has been so hard that you have needed to escape the emotional pain. You feel heard, without being judged.|
Notice yourself – how do you feel when you read about them, talk to them, meet with them? What does your gut tell you – is this a good fit?
Once you start working with a therapist, if you don’t feel like it’s a good match – tell the therapist! Talk about what you want verses what you believe they are giving you. See if your concerns can be resolved, since you have already invested some time there. However, you should absolutely not continue to see a therapist who talks to you in a way that feels harmful or abusive. Therapy should not leave you feeling bad or worse as a person than when you started. Good therapy enables you to face difficult emotions in a manageable, supported way. It is important to honor your feelings if you think things could be going better. You have a right to find and work with a therapist who you feel is well suited to help you.
A good therapist is an important ally for your well-being
Working with a good therapist can be deeply healing and empowering, whether you feel you want it or need it. A good therapist is a unique and powerful ally to walk with you on the journey of life and help you fully embrace your well-being and do your best in caring for yourself and your relationships.
The Seleni Guide to Finding a Therapist by the Seleni Institute
Simple Ways to Reduce the Mental Illness Stigma by Robyn E. Brickel MA, LMFT
So You Want to Be a Counselor/Therapist? Let Me Tell You the Different Ways by Marjorie Hansen Shaevitz
Trauma-Informed Care: Understanding the Many Challenges of Toxic Stress by Robyn E. Brickel MA, LMFT
What Can You Do With a Social Work Degree? by Texas State University
What is the Difference Between Psychologists, Psychiatrists, and Social Workers? by the American Psychological Association