How to (and not to) choose a therapist

When you set out on your therapeutic journey, it's important that you have the right person accompanying you. Don't overthink it -- but don't ignore the selection process either. Overthinking can result in you never settling into the work of therapy (of course, this, in itself is a therapeutic issue), and just jumping in with a therapist who isn't compatible with you can make your work slower and less rewarding.

Because of the provider shortage, you may feel like you don't have options to choose from, but that might not be so true. Consider the following sources:

1. Insurance provider network lists. I'm sorry to say that many insurance companies will provide lists of providers, many of which are not taking new clients. The good news is that often, you can search their list by your own criteria, including any demographics and specializations you are seeking. Additionally, some plans have staff that will make the calls for you and narrow the list down to a few names that do have openings. Also sorry to say that many providers don't deal directly with insurance companies because they have had difficulty collecting, encountered bureaucratic obstacles, and have become unable to continue offering services at the rates insurance companies pay. (See my blog on why therapy is so expensive: https://www.alexmackenziemft.com/post/why-is-psychotherapy-so-expensive-1)

2. Check with your insurance company about whether your plan allows for out of network coverage, and at what rate. You will want to fully understand deductibles, exclusions, and reimbursement rates.

3. Check sites like:

   1. Psychology Today Therapist Finder: https://www.psychologytoday.com/us/therapists

   2. California Association of Marriage and Family Therapists Directory: https://www.scv-camft.org/directory

4. Check with third party facilitator organizations like Alma, or Betterhelp, which contract with therapists and insurance companies to handle administrative burden and credentialing.

5. Try Universities and Institutes that often have graduate and postgraduate training programs, where therapists in certain types of training are available to see clients at reduced fees.

6. Ask your Primary Care Physician for referrals they trust

7. Search your County Mental Health website for resources

8. Investigate community counseling services.

9. Check your company benefits website and see if you have an Employee Assistance (EAP) benefit. These programs generally offer a limited number of sessions at no cost to you or your family members, and assist with access.

   
   

Once you have sourced a therapist or therapists that might be of interest, Take time to think through what you hope to change.  Call a therapist that matches your preferences (gender, language, race/ethnicity, location, etc), explain briefly what your goal is and ask the therapist how they would help you.  Listen to the answer and see if the approach makes sense to you, and whether you felt cared for by the therapist, and why the therapist believes that would be the right approach.  This allows you to get an initial assessment of the two most important factors that associate with successful outcomes: Potential warmth and therapeutic alliance (Strongest predictor of good outcome), and whether you can understand one another (Flexibility of approach, therapeutic communication).

A clarification about Measurement Based Care (MBC):

You may encounter some hype about Measurement Based Care (MBC) outcomes as you look for a therapist. I am a big proponent of MBC -- an early adopter and enthusiastic user. But there is a big divide between therapists, care organizations, and payors about the appropriate use of the measurements that come out of it. There's a bit of pseudo science out there.

Unfortunately, a big part of the divide between care organizations, payors, and therapists is that some organizations have lost therapists' trust by misleading approaches to how the results would be used. MBC was introduced in a couple contexts I've worked in as first, a clinical tool to help the clinician and patient to optimize their work together. (It works great , providing insight about opportunities to improve the therapeutic alliance..

Quickly, the story changed to MBC being used as a marketing tool to demonstrate superior results for a given healthcare system. (Healthcare organizations SHOULD brag about using MBC as a tool, but should NOT try to win business by comparing their results to other organizations because the measurements are too easy to manipulate by means that are damaging to the patients, and aren't valid comparisons.)

Next, payors began using MVC measurements as a factor in assessing clinician performance and setting compensation, which is nonsense. Using MBC for provider selection or performance evaluation simply isn't valid given that different therapists work with different populations, which respond to treatment differently. The simplest example is that therapists who serve populations who have better access to social determinants of health will probably respond better, making it look like those therapists are better.