How To Find a Therapist
The insider's guide to specialties, modalities, red flags, break up scripts, and more
Editor’s preface: I’m Carmel—I’ve been editing Every behind-the-scenes in recent months, while Kate Lee is on maternity leave. You may have met me in my past lives at Figma (the early years) or as a startups reporter (at Recode, Gigaom, and Pando). Despite my tech and media background, my friends always joke I should've become a therapist. Human psychology is a favorite subject of mine, and I’ve been inspired by Every's recent mental health essays to publish a few of my own posts on the topic.
Below is a guide for vetting therapists that I initially wrote during the pandemic (for my old colleagues at Figma). I always meant to expand it and publish it publicly, and Every feels like the right audience for it! Would love to hear about your own experiences therapist hunting in comments.
Therapy has been having its mainstream moment in the wake of the pandemic. The shark has been jumped. I realized it when high school friends from home started dropping words like “codependency” and “EMDR.”
But despite its rise in popularity, anyone new to therapy still faces a daunting job getting started. It’s hard to know how to go about finding therapists, let alone evaluating whether they’re the right fit for you. Good therapists practice some witch’s brew of experience and intuition. People’s needs evolve over time, so the therapist that works for them at first may not be a fit a decade later.
In the wake of the pandemic I’ve had a lot of friends and colleagues ask for advice on navigating through this maze. I’ve seen a lot of therapists through the years, so I learned how to find new ones through trial-and-error. It was a process of blood, sweat and tears (mostly tears).
I wrote this guide based on my own experiences and suggestions—it covers everything from consult call questions to red flags to etiquette for therapist break ups. I’m not a doctor or a therapist myself so take it all with a grain of salt.
Step 1: Reflect on what you want in a therapist
It helps to have a sense of what you're looking for, everything from what you want to work on in your life to how active you'd like your therapist to be in the room. If you've never done therapy before, it may take some testing to figure it out, so don't be afraid to just get started and try sessions with different people (more on that later). Here are some of the things to consider upfront.
- Challenger: Do you want someone to challenge and push you in therapy?
- Listener: Or would you prefer someone who holds space and asks questions?
💥 Note: If you're new to therapy, sometimes the latter can feel safer, whereas if you're more experienced you often need the former.
There are different styles of therapy that inform the types of questions the therapist will ask or the way they'll focus their conversations with you. Some focus far more on reprogramming present thought patterns than past or childhood experiences, for example. Others focus on processing emotions and experiences somatically—through your body—to avoid getting stuck in your head or intellectualizing your feelings.
Many therapists blend multiple modalities, so don't get too hung up on picking the right one. The following list will just give you a sense of the language used by therapists on their websites or Psychology Today profiles. (This is by no means an exhaustive list.)
- Cognitive-behavioral: Not past focused, more reprogramming thought patterns. Great for some things (anxiety) less great for others (trauma).
- Eye Movement Desensitization and Reprocessing Therapy (EMDR): This therapy involves audio tones or light to help people access, process, and release feelings they may have suppressed. It helps people suffering with PTSD, like veterans, but it’s becoming more and more common for people from all walks of life to use this method with difficult memories.
- Relational therapy: Focuses on relationships in one’s life and sometimes will involve analyzing what comes up between therapist and patient in their own provider-client relationship. (For example, the therapist might ask the client, “How did it feel when I asked you that question?” And then they’d discuss it.)
- Art therapy: Often relies on visual exercises like drawing, sculpting etc to access and process emotions, memories, etc.
- And more
In addition to modalities, therapists will also have specialties — the mental health areas they have the most experience or interest in. This can be everything from mental health conditions to questions of identity. If you know what you’re looking to address in advance, specialties can help narrow down the search.
(That said, therapy can be beneficial for everyone, regardless of whether you have a mental health diagnosis or a particular challenge in life you’re tackling.)
Again, not an exhaustive list:
- Social anxiety
- Neurodivergence (autism spectrum, ADHD, etc.)
- Marriage & family counseling // Couples counseling // Children & adolescents
- LGBTQ experiences
- Racial identity
- Therapists with background in alternative lifestyles like polyamory
- Group therapy: Processing groups (like grief or alcoholism)
- Many more
It's also worth considering demographics—would you feel more comfortable seeing a therapist who is the same gender as you? What about race or ethnicity? Age? Sexuality? Religion? Therapists work with people from many different types of background, but your personal comfort levels should factor into your decision.
💥 Pro tip: There’s a difference between psychiatrists and therapists. Psychiatrists are medical doctors, so they dispense mental health prescriptions like anti-depressants. They don’t tend to offer traditional therapy, although there are some exceptions. Therapists can refer you to psychiatrists and vice versa.
Step 2: Generate a list of options
Once you’ve done some thinking about what kind of therapist you’d like to start seeing, you’re ready to generate a list of options. (We’ll talk about insurance in the next section.)
The number one recommendation I give to people is to ask their friends, family and colleagues if they’ve seen a therapist before who they’d recommend. Obviously use your own judgment about who to ask—stick to people you feel comfortable with or those who’ve been open about their own therapy experiences. It’s ok to see the same therapist as an acquaintance or a colleague you don't work too closely with. But it's not a good idea to see the same therapist as your partner, parent, boss, best friend, or other close connection. It’s a conflict of interest.
Instead, ask the therapist your trusted person sees for THEIR recommendations. Therapists are connected to each other—they have peer group processing sessions and a cohort of friends from graduate school. So they can usually refer you to someone whose modality or approach is similar to their own.
💥 Pro tip 1: A friendly intro goes a long way towards getting on a busy therapist’s calendar as a new client. As your friend if you can name drop them when you call their therapist to check availability.
💥 Pro tip 2: Therapist openings come up unexpectedly and often. If someone you trust recommended someone, but they didn’t have any availability, try them again in a few months!
Not comfortable asking friends/fam?
- Do you have a doctor or wellness practitioner you like and trust? Consider asking them for a referral, they may have a good network.
- Start combing the website PsychologyToday.com. Where you can, cross-reference it with Yelp reviews. I found an amazing psychiatrist by doing exactly this. (After years of seeing bad psychiatrists.)
- Search your health insurance website for in-network mental health providers and go through the list. (If you do this, you need to be fastidious about vetting them upfront, which I cover in Section 4.)
You may be wondering: What about BetterHelp? (It's a virtual platform that helps match people with therapists.) I haven't tried it personally, but my friends have given mixed reviews. It focuses on 30-minute calls, which from my experience is way too short to dive into the type of deep work therapy aims for. But it's worth trying once! Use my vetting questions later in this guide to help decide if a BetterHelp therapist is a good fit.
Step 3: Navigating the insurance morass
For most people, the biggest barrier to seeing a therapist is the cost. It’s recommended to go once a week in the beginning, and it can get expensive, especially in major cities like New York or San Francisco. To help level-set expectations, in SF I commonly saw out of pocket numbers as high as $200 or even $225 an hour. (And it’s generally recommended you see your therapist once a week, at least in the beginning.)
Prices drop in more suburban/rural areas or depending on the state. TherapyDen polled 15,000 therapists and found the median rate in Tennessee to be $125/hour while New York was $185/hour.
Demand for mental health professionals skyrocketed during the pandemic, so the supply-demand curve isn’t necessarily working in your favor. Fees aren’t standardized, so expect to see a wide variety of rates. Financially if you aren't able to front the cost, you have a few other avenues you can pursue.
I’m not going to sugarcoat it—therapy is a nightmare with health insurance in America. Many plans don’t offer these benefits at all. If they do, the benefits are bad—trapped behind high deductibles, and the like.
Even if you do have decent benefits, in my experience many good therapists who take insurance are booked. They’re in high demand and hard to get appointments with. Insurance companies jerk therapists around—underpaying them and burying them in bureaucratic red tape—so a lot of them choose not to partner with insurance at all.
That said, if you've never seen a therapist before, it may be easier for you to find one in-network that you like. There will be a lot of low-hanging fruit for you to process, and you can get a lot of benefit just from finding someone who listens and asks questions. They don’t necessarily need to have the most developed approach to their practice or decades of experience under their belt.
💥 Pro tip 1: I recommend asking friends if they see an in-network therapist they like. If the therapist contracts with one major insurance company, they may work with others.
💥 Pro tip 2: You may also have better luck finding therapists outside of major cities. In the telehealth era, if you’re ok with seeing a therapist virtually, you can spread your wings and search for therapists in other counties. (Licensing requirements usually limit you to in-state though.)
💥 Pro tip 3: Dig into your mental health benefits. You may have decent out-of-network reimbursement, which means you can find a therapist who doesn’t take insurance, and submit your claims to insurance anyway. (At the very least, your therapist costs can go towards hitting your overall deductible.)
Other options for financing
Let’s say you don’t have mental health benefits or the financial means to pay out of pocket. There’s a few other avenues of recourse for you:
Go see grad therapy students.
In cities, there are often a few places where students are learning to become therapists. As they accumulate a certain number of hours to get their license, they offer sessions on a sliding rate based on your salary. A good place to start your research is psychology masters programs at universities.
I have some friends who've had great success with this, but it is hit or miss. I saw a student once and it was one of the most awkward therapy sessions of my life. If you source from here, DEFINITELY trust your instincts about whether a therapist feels right for you.
Ask therapists whether they offer sliding scale.
Many therapists get into the field because they’re empathetic and care about people. So a lot of experienced therapists offer sliding scale rates to clients—fees befitting a client’s income range—because they don’t want to shut out people who can’t afford it. If you get recommendations for therapists who are out-of-network, it’s worth contacting them to explain your financial situation and ask if they offer sliding scale rates.
Check out group therapy programs.
Another affordable option to look into is group therapy programs. They exist for a range of experiences and specialties, from grief to social anxiety, and some groups are mediated by trained therapists. The group set up lowers the cost for everyone.
12-step programs, known for their approach to addiction, are also a great option and they’re donation-based. You pay what you can each time. They exist for a range of topics beyond alcoholism—from food addiction to gambling behaviors.
If you don’t struggle with any addictive issues, consider checking out “CoDA” which is Codependents Anonymous. You don’t necessarily need to identify as codependent. It’s focused on people processing relationship and attachment issues, which can present themselves in work, family, and friendship. As a result, it’s a much better generalist group for someone wanting to dip their toes in group therapy.
Step 4: Picking your therapist (how to vet)
10-minute consultation call
Once you have a list of a few therapists that pique your interest, either because of referrals, specialties, or their online profile, then call them and leave a message! Most therapists will call back and do a 10-minute consultation on the phone to learn more about your needs and whether they could be a fit with you. Some will schedule it, but most will just hope to catch you when they call you back. So keep your phone ringer on and make sure to answer calls from unknown numbers for the next few days.
If you answer a call and it’s one of the therapists you rang, try to snag some privacy by ducking into a separate room or leaving the building. They may ask you some personal questions, but it won't be a full-on therapy session. They’ll want to know why you want to do therapy, how you found them, and other general information.
On the call, reflect on how the person made you feel. These calls can be awkward — did their demeanor or questions help relax you? Did they say anything interesting or ask any good questions? It can be hard to tell from a 10-minute call, but trust your instincts on whether it's worth an in-person meeting with them.
There are a lot of passive therapists out there who will sit and listen without offering guidance or their own thoughts. Part of that comes with the territory, but they should still help get you situated, especially on the first call! If you felt uncomfortable the whole way through, trust that instinct. (It will save you time.)
This call is also a great time to question them on what their therapy style is like. My big breakthrough in finding therapists hit when I became decisive and assertive on the 10-minute calls, telling therapists: Look I want someone who will push me and challenge me because I need that. I want someone super active in the process, who's going to point out the perspectives I'm missing or the thought patterns that aren't serving me.
Shockingly, 60% of the therapists I told that to on the phone bowed out of the process. They said that wasn't their style and they preferred a more passive approach! That saved me so much time and cut down on the number of in-person sessions I had to do (with therapists who ultimately wouldn’t have been right for me). In other words, being honest about what you're looking for—if you know—can go a long way on the call.
Questions I use to vet therapists on the consult calls:
- What does a typical session look like with you?
- How would you describe your therapy modality or specialties?
- When you listen to a patient how do you figure out the right course of action?
- How much therapy have you personally done in your own life? How has your personal therapy journey helped you?
- How active are you in your sessions? (This is where I’d personally say, “I want an active therapist who challenges me and points out what I'm missing. Does that fit your style?”)
- How old are you?
Reflect on their answers afterward and whether you felt like they fit the bill of what you’re looking for. For example, I’m in my thirties, and I generally prefer people who are within 10-15 years of my age range, because I’ve found there are big culture barriers in working with older therapists. This is a matter of personal preference, so you’ll have to reflect on what feels right for you.
Even more important than WHAT they said though is HOW they said it. Do their answers feel authentic? Do you feel like they're present and engaged in the conversation? Basically, do you think you'd vibe with them? Trust those instincts!
The first proper session
Ok, let’s say you had a 10-minute call and decide to take the first full session (usually 50 minutes). It’s basically a longer term chance to vet the therapist. There's no objective rubric here. Every person is going to need something different. The longer you do therapy, what you need from a therapist may evolve and change!
It's really hard to trust your gut instinct on these things. If you've never done therapy before, you may find the whole experience a little uncomfortable, so it can be hard to differentiate whether your discomfort is because the therapist isn’t a match or because you’re trying something new.
Good therapists are going to push you out of your comfort zone and challenge your thinking on occasion, which may be triggering and make you feel like they're not the right therapist for you. The best therapists, however, will be able to read when you're ready to be challenged in certain ways.
Red flags I look for on therapist calls:
- ADVICE: Them dictating advice, especially in the early days of seeing them. If they say, "Well you should clearly just do X or Y"—especially when they don't know you that well—that's a big red flag.
- OVERSHARING: Them talking too much about themselves or their personal life. Most therapists will answer a few questions about themselves (and of course will answer qs about their professional background) but for the most part the sessions are supposed to be about you. If they share too many personal details about their life it can hurt the therapist-client relationship.
- JUDGMENT: If you feel judged. Good therapists will call you out on things, but you should never feel like they're judging you.
- GOOD QUESTIONS: If they don't drive the conversation forward at all. Good therapists will often do a LOT of listening and long pauses (to ensure there's space for whatever is coming up for you). But if ALL they do is listen and they don't ask very good questions then they might just be punching the clock (or they adhere to a particular methodology).
- FLAKINESS: If they're flaky and cancel a lot. They'll be flaky in the beginning (setting up the first call or session) until you’re officially their client. But as soon as they’ve seen you in person once, they should be taking the relationship really seriously. For example, unless they get sick or an emergency comes up, good therapists will give at least a month of notice before going on vacation.
It took a lot of trial and error for me to personally gauge my therapist intuition. It took finding someone who felt so 'right' immediately to show me what to look for.
In your first in-person session (or on the 10-minute call), try telling the therapist upfront that you’re going on a bunch of “first dates” with different therapists to help calibrate on your needs. Let them know you will wait to schedule a second session until you’ve had a few days to reflect. That will take the pressure off scheduling a follow up on the spot. (But be aware that if a therapist is popular, they won’t be able to hold the spot in their calendar for you indefinitely.)
Step 5: Breaking up with a therapist
Break up: A newish therapist
Sometimes, you see a therapist for a few sessions, or even months, and you just feel like you're not getting anywhere. Much like with dating, you don’t necessarily need to make a huge deal out of it. You can say, "For whatever reason, I'm feeling like this isn't a fit and I'd like to stop our sessions."
Good therapists know how to handle this, and they say goodbye to patients all the time. If you're feeling like it's not quite jiving for you, they're probably feeling similarly.
If you haven’t been seeing them that long and you’re not comfortable telling them in person, you can leave them a voice mail or send them an email. Alternatively, you can bring it up during a session—just be prepared for them to want to discuss it. Their job is to help you make meaning out of significant moments.
That said, don’t let them pressure you into giving it more time, unless that feels like the right decision for you. If they get defensive or weird, then they probably weren't a good therapist in the first place.
Breaking up: Someone you’ve seen for 3+ months
If you’ve been seeing your therapist for a few months or longer, I highly recommend taking the uncomfortable step of telling them it's not working in person, and analyzing that in session.
I once saw a therapist for eight months who felt like a “meh” fit. Sometimes it worked and other times it didn’t. I couldn’t tell whether I was accurately judging the situation. Eventually, I wanted to call her and end our sessions on the phone to avoid the big confrontation in person, but a friend recommended I talk to her about my feelings first.
It was really hard to do so, but that session led to the biggest breakthrough I had with her, one that made it far easier for me to access and process my emotions in years to come. That therapist still wasn't quite right for me, so my initial instincts were correct, but I’m really grateful I worked through the discomfort and told her in person.
It’s not the end of the world if you do the time tested “excuse” method of ending a therapist relationship. Just text them saying things have gotten really busy at work and you want to put a pause on the therapy for now.
This is a disservice to yourself in many ways, but sometimes that's just where you're at! It’s better to do that than continue seeing a therapist who doesn’t work for you.
Step 6: May hope be with you
If you've lasted with me this long in the post, you're clearly the plucky sort, and that will serve you well in your elusive search. In the last two decades, I persevered. I never saw one bad experience with a therapist—or even several months of a meh experience—as indicative of all therapy. I treated them as learning experiences.
The right fit is worth working for. I'm hoping my suggestions will be of help, and I'd love to hear your therapy tips, stories, and questions in comments or feedback!