This is an update of an earlier blog I wrote during the pandemic in 2020.
During the pandemic I wrote the original blog “Seeking Therapy” to provide resources for people struggling through the health crisis. Since that time, I have talked to many people with similar questions that I covered in that blog. This revision is an update to the original blog edited to more simply answer the who, what, when, why, and how of seeking therapy.
ACCESS ANXIETY: HOW TO ACCESS THERAPY
If anything good can come out of a worldwide health crisis, improved access to therapy was one.
- Telehealth options have been permitted by most states and approved for coverage by most insurances, enabling therapists to be more accessible to those in need. Many permissions that were extended during the heath crisis were adopted as permanent practice and technologies that were enhanced to accommodate telehealth and remote work have enhanced.
- Many states have opted in to permanent provisions allowing licensed mental health providers to practice across state lines. This means you can expand your search to participating states if you have not been able to find a therapist in your state. This map shows the participating states as of 3/5/2024 with more states proposing legislation.
https://counselingcompact.org/map/
So there are options for access to therapy, however, finding a therapist can be very intimidating. Big metropolitan areas have many therapists who may specialize in specific treatment methods, treat specific conditions, and work with certain populations. More rural areas may have fewer therapist with openings or with specializations or who take a certain clientele or insurances. The influx of online therapists has introduced additional options, however, how can you know where to start? And how can you tell which therapist is a good fit?
Starting the search for a therapist is much like looking for anyone to do any kind of service, like a good doctor, a good mechanic, a good contractor, and so forth.
- Ask a friend – Word-of-mouth can be a great way to find out about local therapists. Asking friends who are comfortable with sharing their therapy experience for recommendations will usually provide a pretty good starting point. They can give insight to their perspective of a therapist’s personality, methods, and overall things to expect.
- Ask a Professional – Asking another professional how to find a therapist is another great way to find a therapist. Your primary care doctor will most definitely have a list of therapists in your area. This is part of your doctor’s overall wellness resource package! Give them a call and ask.
Also, your school counselor can help you start your search! Whether you are in elementary school, middle school, high school, public school, private school, college, grad school, technology school, trade school…there are counselors and advisers who can connect you with names of therapists! Reach out! Let them know you are looking for a therapist! - Check the Insurance Directory of Network Providers – Some health insurance companies have a directory of providers that are in-network with their insurance. This is true of therapists. Starting with the provider directory will not only give a list of mental health providers but will also assure that the therapist you choose can take your insurance.
- Check the Licensing Website – Every state will have a licensing board or two for therapists. Typically therapists will be one of two educational backgrounds: social work or professional counseling, although they may have a different titles or subspecialties, like Marriage and Family Counseling. Both have to be licensed by their respective licensing boards in order to practice.
A search for “board of social work” or “board of professional counseling” in each state should offer a link to the licensing board. And each web page for the licensing board should have a link for “license search” or “counselor search” and a way to search the therapists that have an active license with that state. A general search for a city can yield a list of ALL licensed therapists in that city who are licensed through that board. - “Google It” – “googling” a therapist in your area is another way to get a list of therapists, though it may require a good deal of time browsing. Likely, the first several recommendations may be from www.psychologytoday.com, or www.goodtherapy.org, or other such professional listing sites. Therapists on these sites have paid membership or advertising fees to be listed there with their bios and pictures. These therapists are some of your choices, but are not all of the licensed therapists in your area. Keep scrolling and you will find other recommendation compilations as well, such as www.healthgrades.com, which will list therapists who have registered for credentialing, meaning they have signed up to be reviewed and considered by insurances companies. Again, this is some but not all of the licensed therapists in an area. But it is a start.
Googling a therapist you are given as a recommendation by some of the other methods can give you more insight about that therapist. Many therapy practices and individual therapists have websites with pictures and bios and a list of things that they generally treat that you can read and review. You can tell a lot by their websites, such as what their philosophy is about mental wellness or what kind of language they use to talk about their work. - Cold Calling – Calling a therapist’s office and asking questions is a great way to directly find out about that therapist and practice. If there is a receptionist answering the phone, they can usually give you a pretty good overview of the therapist and their work. And if there is not, we therapists are usually happy to answer questions you might have about us and about therapy in general.
It can be anxiety provoking to call people directly and ask questions. Sometimes it helps to write your questions down so they are ready when you call. They might look something like this:
– Do you have openings?
– Do you work with adults/children/seniors?
– Do you take this insurance?
– Do you work with people who have _____ (anxiety, depression, stress, developmental struggles, relationship issues, and so forth)?
Often, people will call my office and will just explain what is going on in their world and we will work through their questions from there. For example, they may call and say, “I think my child may need to see someone. They have been really struggling with the COVID changes and are having a hard time in school. They don’t get to see their friends and they are staying to themselves a lot.” I will pick up right from there and we will talk about everything they need to know to make a decision about therapy.
THE FIRST APPOINTMENT ANXIETIES: WHAT CAN YOU EXPECT IN AN INTAKE
Lets talk about what you can expect in a therapy intake with an example of someone who comes to see me.
I start preparing to see this client before the appointment. They would have been sent intake paperwork to complete, in my office it is online. I look over their intake paperwork, which consists of questions related to their area of concern, family history, and questions related to wellness, like “how would you describe your sleep” and “describe your substance use.” These questions are important for me to be able to have a more complete picture of the needs and struggles this client may be facing.
My first visit with this client is for an hour and a half. Sometimes we may go through it faster, if, for example, I am working with a child or an adult who is overwhelmed by the process and needs to have a shorter time. In these cases, I may need several sessions to do an intake, but the other sessions would be at the regular rate. In the intake, we meet each other, we talk about therapy and I answer any questions they may have about therapy or about me. And we start to uncover their concerns. Here we also talk about how we will start our work together.
After the intake, I take all of the information I have gathered from their registration packet and from our intake and I have to do all of the necessary referencing, researching, and exploring that is required to make at least a preliminary diagnosis and develop the sketch of a treatment plan that we can go over together.
Sometimes I need more information, such as if the person has been to other therapists or psychiatrists or has been in treatment. I may need to request paperwork from those providers, with the person’s consent. I may need to collaborate with another treating psychiatrist or physicians with that person’s consent. I may need to collaborate with behavior therapists or school officials or courts with that person’s consent. We discuss all of these things together.
This is just example and an overview, but it is typical of the experience I have as a practitioner.
STIGMA ANXIETIES: HOW TO ADDRESS PERSONAL STIGMAS RELATED TO SEEKING THERAPY
Access to therapy is only one barrier to people who are thinking about therapy. Other considerations, such as stigma related to being in therapy and negative experiences in therapy in the past can make seeking therapy seem uncomfortable.
— I n t e r n a l D o u b t s
Internal fears or worries are normal when we are trying something new, like sharing our innermost thoughts with a stranger. Internal fears might be:
- “I don’t want to bother anyone.”
- “I should be able to handle my problems on my own.” (That inner voice is sometimes the voice of a critical-person from the past.)
- “My problems aren’t bad enough to see a therapist.”
- “My problems are too bad and a therapist will think I’m crazy.”
- “Maybe I am crazy and going to a therapist will prove it.”
First thing to know is that you are not a burden! What you feel, think, and experience is important and therapists are not bothered to work with you.
Second, you are not weak for coming to talk to a therapist!! On the contrary, it takes strength to open up to a person you do not yet know and tell them your experiences.
Next, there is not a maximum or minimum requirement for struggle! A struggle is a big enough struggle to bring to therapy when it is causing you pain or anxiety or fear or sadness. It doesn’t have to grow. And you don’t have to keep it inside until it does.
Finally , no, you are not crazy! Language matters. The word “crazy” is an old slang term that is loosely defined as everything from “mentally deranged” to “extremely enthusiastic” (Google Dictionary). It is a word that is used to demean ourselves or others. There will be times when we need to change the language that we use, with others and with ourselves.
— T h e E x p e n s e
The cost of therapy is a big consideration for people, and sometimes a barrier. The cost of counseling sessions vary by areas within a state, typically more expensive in areas with higher cost of living and less expensive in areas with lower cost of living.
The very first appointment is usually an intake appointment. This appointment is longer than a regular appointment and usually includes a lot of background gathering so that the therapist can learn about the client’s history and experiences. These are more expensive than a regular appointment. Typical cost out of pocket for a regular appointment can be anywhere from $80 to $160 or more per session, depending on the area. Intakes may range from $125 to $300. These are just ball park estimations.
This is a lot, I know.
Why is therapy so expensive?
Let’s look for a minute at what goes into rate setting.
One reason for the high cost of the session is related to the level of responsibility and liability that the therapist accepts when they agree to see a person for counseling. A therapist must be able to identify areas of need, develop a collaborative treatment plan, and administer the interventions required to meet the needs of that client. This includes proper diagnosing, understanding of tools and methodology to treat the identified conditions, and ongoing research, resources, and recommendations to help that client reach their goals. It is an incredible responsibility.
Another reason for the cost is that it requires an unbelievable amount of time both in the session hour and outside of that hour.
An intake for services takes over an hour and it requires preparation time before the intake as well as follow up work afterward. A 1 ½ hour intake will generally translate to 7 hours of work. So if I charge $100, for example, for the intake, it comes to $14.29 per hour.
How can I afford therapy?
Fortunately, there are some ways to make therapy attainable to everyone, even if you have limited income.
- Insurance – Most insurance companies, especially since the Affordable Care Act, have included mental health services under their covered services. You can call your insurance company and ask if it covers therapy and if there is a limit to how many visits you can make on the plan. Many times, you and your therapist can negotiate for additional visits based on your need.
Some insurances say they cover therapy visits, but may apply those visits to your deductible. (Insert angry-faced-emoji here!) Personally, I think this is ridiculous and therapy should be treated as “primary care” which is generally covered and apart from deductible. This is definitely a question to ask your insurance! If this is the case, your insurance would be billed but whatever they apply to the deductible would be charged to you out of pocket. - Income Based Options – There are therapy practices, usually non-profits, who offer income based rates, also referred to as “sliding scale.” These practices, and the therapists who work with them, usually get grants or other funding to offset the cost of the services. You would have to apply to be considered which would include providing your financial information such as pay stubs and tax information. This is used to calculate the rate you are charged.
Don’t think that because the therapist is working for a non-profit or a community health facility that they are not as qualified or concerned about you! They have the same requirements for licensure and continued training as all other therapists. If you really struggle to make a living and would like to seek therapy, these programs are available! - Shorter Session Times at Reduced Cost – Sometimes therapists will offer shorter session times to be able to fit your out of pocket budget. This is something we do at my practice. We offer 30 minute, 45 minute, and 60 minute session with pricing for each when a person either does not have insurance to cover the cost or their insurance is applying their visits to their deductible. We will maximize that reduced time! You may have homework! It will take us working as a team! But we would rather someone have access to therapy, even for less time, than to not reach out and to struggle without it.
- Pro-Bono Work – Pro-Bono means “work undertaken without charge” (Google dictionary). Free services. Did you know, in most states, therapists are required to provide some pro-bono work as part of licensure? Yep! There is usually not a time requirement, like a certain number of hours of pro-bono work per year, but they are required to offer some! They may do this in a variety of ways, of course. In our area, many providers collaborate with outreaches, such as youth outreaches, shelters, detention facilities, and so forth, to give their time and expertise to the community. Reach out to some of the organizations and see what might be available and if you qualify.
The last point I want to make about the cost of therapy, however, is this: INVEST IN YOURSELF! THERAPY is worth it! And YOU are worth it!
— A H i s t o r y
Sometime people’s experience with therapy has not been good. They may have been forced to go to therapy as kids. Maybe they were subject to aversive therapy interventions, such as some behavior therapies or therapies that have been banned like conversion therapies. Maybe they have been to non-licensed practitioners who did not really know what they were doing. Maybe they had a therapist who was unethical and broke trust with them. Maybe they didn’t connect with their therapist because of personality differences or cultural differences or religious biases or gender biases that felt like barriers that could not be overcome.
There can be any number of reasons that a person may have had an unpleasant therapy experience and have since stayed away.
If this is the case for you, I encourage you to reach out, continue looking, stay open to the possibility of a connection with another therapist. DON’T GIVE UP ON YOU!!
Feel empowered to seek a therapist who will listen and will commit.
Overcoming a negative experience in a professional setting can be tough, but it is possible.
Some personal disclosure, I have major anxiety about seeing the dentists. My anxiety can be so high that I have had trauma triggers during dental appointments that have been temporarily crippling. One appointment I had for a cleaning, I was a mess for hours afterward.
A natural reflex during this level of anxiety is to avoid it. Leave. Don’t go back. I have done that in the past. BUT…I need to go to dentists. Its important. And if I have to go to the dentist, I’d like to have a good relationship with a dentist! And to be fair, the dentists often had no idea that I was triggered or that I might be triggered.
So I to make a plan to get what I need. First, I need to find a dentist I feel comfortable talking to about my triggers and asking to partner with me to have a plan if triggering occurs. Second, I need to communicate any discomfort so they can make adjustments.
I started by asking friends, family, and finally the amazing pediatric dentist my kids saw for recommendations. Then, I called and talked with the office staff. I shared about my anxieties and that I need a dentist and hygienist with a patient and calm demeanor. Finally, I scheduled a consultation so I could meet them in person. My next dental experiences were much better and the new practice I chose has worked with me through anxiety.
Some things that you might consider as you open up to the possibility of seeking therapy again:
- Therapists are as different as people are different. Watch for times when you might assume what they are like before investigating.
- Talk to them, let them know your concerns about past history. See how they respond. If you feel that you can trust them and they are considerate of you as an individual, try a few sessions.
- Therapists do sometimes make you uncomfortable. They may challenge you and confront you. They may not tell you what you want to hear. They may not do the therapeutic intervention the way you want them to. The therapist may have to do things, such as make reports, when there is a danger of harm or exploitation. This may happen. But all of this should be with full disclosure and with a spirit of compassion, empathy, non-bias, and full commitment to your wellness and healing. Even though these things may be hard to walk through, they can be just what is needed to bring trust and healing during very difficult times.
RECOGNIZING AN EMERGENCY
Though I openly encourage people to seek therapy whenever they feel they need it, even if there is not a current crisis, I strongly urge people to seek therapy when there is one. I’d like to close this blog with information about how to identify a mental health emergency.
- Unusual and uncharacteristic behavior for the person, such as not speaking or rapid speech, refusing to eat, not caring for themselves, paranoia, not sleeping for days at a time, engaging in risky behavior such as excessive substance use, reckless driving, aggression. These can indicate a mental health situation and at the very least the person should see their medical professional.
- Threatening to harm themself or others is a mental health emergency that should not be ignored. If it is safe, this person can be taken for evaluation at their doctor’s office, a nearby hospital, a or community mental health facility. If they are not safe to transport, it may be necessary to call 911.
**Here I want to say that many states and localities have CIT (Crisis Intervention Team) programs in which officers are trained to respond to a mental health emergency in a non-lethal manner. This is a program that is collaborated through NAMI (National Alliance on Mental Illness) and you can find more information on this here https://www.nami.org/Advocacy/Crisis-Intervention/Crisis-Intervention-Team-(CIT)-Programs. If you suspect that the person is having a mental health emergency and the level of danger is high to warrant a 911 call, please indicate it as a Mental Health Emergency and request CIT trained officers. If safe, stay with the person or nearby to facilitate their safety. - Suicidal thoughts or comments are a mental health emergency and the first step is this: BELIEVE THEM!
It is better to be responsive to suicidal thoughts and comments and find out that it really was not an emergency than to not be responsive and learn that it really was.
Reach out to a doctor, a teacher, a therapist, a trusted adult who can connect them with help.
Call the National Suicide Prevention Hotline at 1-800-273-8255 or https://suicidepreventionlifeline.org/.
Maybe the person has not said that they are suicidal.
Maybe they have just withdrawn, are not engaging in activities that they used to.
Maybe they comment that things would be better if they were not here.
Maybe it is you.
Maybe you feel this way.
Pay attention!
Tell someone!
Reach out!
YOU ARE IMPORTANT!
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