With everything happening within the country and the world, many of my friends/family members have come to me asking for advice about how to begin counseling. After conversing with one of my friends, she said, “Well, it’s not like you can ask someone this stuff. You’ll seem crazy.” Even outside of the military, the stigma of receiving mental health counseling runs deep. Continued misconceptions of therapy do not help contribute to a helpful narrative. A different friend said, “I can easily go to work and ask who has a good dentist. I can’t go to work and ask who has a good therapist.” Those who are finally brave enough to confront their demons can be disheartened when they are sitting across someone who 1) should have never become a mental health professional or 2) is not a good therapeutic fit. Due to misconceptions and a lack of information, people often are not sure what to ask, what to expect, and what to look for when beginning counseling. I hope to establish a guide for those finally ready to start a counseling experience. This is such a vast topic, so I will discuss it over the next couple of weeks, including questions to ask, differences in credentials, and red flags.
Before Meeting Your Therapist
An excellent place to start is by contacting your insurance and asking them to see which providers in your area accept your insurance. If you don’t have any insurance or have questions about your insurance, a previous post of mine covers that: https://braveheartcounselingtx.com/blog/fallintocounseling
Some people don’t want these encounters documented due to their career (i.e., military, special forces, medical, law, police). The reality is some fields have consequences for someone receiving mental health counseling. To those of you, please inquire about the fee associated with obtaining services from your potential mental health provider. There are also usually organizations to assist someone with mental health care costs.
Search Psychology Today. Psychology Today has a prominent feature called “Find A Therapist.” One can search zip code, insurance, issues, sexuality, gender, language, age, faith, ethnicities served, and types of therapy provided. Start here: https://www.psychologytoday.com/us.
Ask trusted friends. I’m in a place where I don’t mind telling people that I go to therapy. I believe it participates in breaking the stigma. My own experience in finding a therapist was so up and down. I went through several to discover who I currently see. I would recommend her to the world. She has even made me a better provider.
Meeting Your Therapist
Sitting in front of a mental health provider can be an extremely vulnerable and emotionally overwhelming experience. The lack of knowledge and the rush of emotions can make it difficult to distinguish if this person sitting in front of you is the right fit. Despite many fantastic and qualified providers in the mental health field, not all are a great fit for YOU. That does not mean something is wrong with you or the mental health provider is not great. At its foundational base, therapy is a relationship. Just like we don’t click with every person in society, we don’t always connect with a therapist. The following are some questions to help parse the right fit for you.
Advocate for yourself and ask questions. “But won’t they be offended by that, Maria?” Any mental health professional offended by you doing your due diligence for care, run. My most productive first sessions have been when patients have asked me about my experience and how to approach their problems. Here are some questions to ask:
What are your areas of specialty? (Depression, Grief, Anxiety, PTSD, Eating Disorders, etc.).
What theories do you work from in therapy?
Ask them to explain what these mean for therapy and how they implement them. Make sure they have been TRAINED in these as well. Watching a YouTube video is not considered formal training.
Will you make a referral when you cannot adequately assist me, and do you recognize the limits of your training?
If someone came to me who had bulimia or anorexia, I would refer them to a friend & colleague of mine who specializes in this. If this were not possible, I would heavily consult an expert in the area to help clinically guide me through this case. A willingness to learn and know their clinical limits is crucial for any good therapist.
An experience I had while at a networking event of therapists discussing marketing strategies for private practices highlighted something significant: verify that person’s training. One therapist at this event was an Army Reserve soldier who said he would use his deployment as a marketing tool to appeal to people who had Tricare (yes, this is a thing). However, he had had no training in evidenced-based trauma modalities and had just graduated from school. Private practices are a business and require marketing. Ensure that your provider is trained in what they are marketing.
What are your fees? Do you participate with my insurance?
How often will we meet, and what is your schedule like?
Some treatment protocols require weekly visits. Suppose your therapist can only see you once a month. In that case, it seems that this will not be a successful or realistic fit to help achieve your treatment goals if your treatment goals are to take a deep dive into your history of anxiety/trauma.
After Your First Meeting
After your first meeting, these are some questions to ask yourself about your interaction with the potential therapist:
Do I like this person? Do they seem to like me?
Do I feel comfortable with them?
Are they competent to work with what I need?
Do I feel heard and understood?
Do I think I can trust my therapist’s judgment?
Do our exchanges usually feel helpful?
Does the approach being used feel like a good fit for me?
Only some things are about formal training. While it is essential, it is not the only thing. If someone is well trained but not personable, it doesn’t matter - you have to have BOTH. There is an authentic human connection component to therapy. A therapist has to show their humanity to build therapeutic rapport. In graduate school, I learned that the therapeutic relationship was the most crucial aspect of optimal treatment outcomes. Thus, here are some other elements that are also essential things to consider about your potential therapist:
They are always willing to learn
They can admit when they were wrong
They can separate their own opinions from the therapeutic relationship
They ask about your goals rather than imposing their own
They can self-regulate in session and not make it about them
They are willing to be human
They SET BOUNDARIES
I am deeply disturbed when I hear about a fellow mental health professional not setting appropriate boundaries. If anyone reading this has research to disprove my following line of thinking, please let me know; I would love to discuss this. I am always seeking to learn & grow. When I hear from patients who come to my office, “My last therapist gave me her cell phone number. I called her whenever I needed help.” One of the therapy goals should be developing coping skills and treatment to assist YOU - the patient - to not need the therapist. When discussing the empowerment of patients, it does not include making patients dependent on the therapist. Other violations of boundaries include dual relationships, sexual interactions, and meetings outside of the therapeutic relationship, to name a few. In ethics training, I am always viscerally impacted by what other providers will do.
Seeing a therapist is one of the most vulnerable things you can do. Feeling that you can TRUST them is of the utmost importance. Please let me know if you have any questions or concerns. I would love to help you navigate this challenging process.
With care and bravery,
Maria B. Wiggins, LCSW-S, ADS
Certified EMDR Therapist and EMDR Consultant-in-Training