Sometimes when we need it the most, therapy can feel out of reach. Tracking down a provider with availability who you like and can also afford is no easy feat.
You could compare finding a therapist to apartment-hunting in a crowded housing market. Demand is high, availability is limited. It requires persistence, flexibility, and the knowledge that you may not be able to check every one of your boxes.
In a poll of mental health and substance abuse workers conducted earlier this year, 90% of workers surveyed expressed concern that new patients won't be able to access care. And more than half of providers who work directly with clients say their waitlist for new clients is longer now than it's ever been before.
And if your finances are tight – say if you're on Medicaid, or you selected an insurance plan with a narrower network of doctors to save on premiums – you may find it's harder to make an appointment with a new therapist compared to other health care providers.
With all that said, Theresa Nguyen, chief research officer at Mental Health America, says it's important to consider your personal fit with a therapist, as well as the cost. "It's such an intimate experience. It's unlike finding any other doctor," she says.
Here's a guide to finding a therapist who can help you – taking both your mental health needs and your budget into account.
Step 1: Figure out what you need help with
There are lots of reasons to consider seeing a therapist. Maybe you feel depressed, or unlike yourself. Maybe you're feeling burnt out or under pressure with family obligations. Nguyen recommends getting specific about what you'd like to get out of the experience right off the bat, so you can seek out a therapist who matches your goals.
"If I am resolving family issues, ... I want to feel warmth and safety with this person. If I am going to therapy to manage a life change that might trigger a depressed episode, I'm going to find somebody who understands what's related to the change that I'm negotiating," Nguyen says.
It's also okay to go into therapy without really knowing precisely what you want out of it, says psychologist Lynn Bufka, a spokesperson for the American Psychological Association. "Sometimes people just feel bad or life's not going how you want it to go," Bufka says, "and it's hard to be more specific." Therapy could be a step forward.
Step 2: Assess your financial resources
Therapy can be expensive – or not, depending on where you go for care or whom you see. Know your coverage options and budget before deciding where to look for a therapist.
Working with insurance:
If you have health insurance, your insurer will typically provide a directory of covered therapists on their website.
However, bear in mind that payment often works differently for mental health providers than medical doctors. Instead of a copay, many therapists will ask for the full payment at the time of your appointment. Then it's up to you to submit your receipts to your health insurer for reimbursement. Nguyen says that's because therapists tend to operate on a smaller scale.
Insurance coverage is typically limited to therapists in your state. Many providers now offer teletherapy which is typically also covered, and can give you access to therapists outside of your immediate area. Some app-based therapy providers, such as Talkspace, also accept insurance, but coverage can vary depending on your state.
Depending on your state's licensure laws and your insurance coverage, you may be covered to see a therapist who lives out-of-state, as long as that provider is licensed in the state where you live. Check with your insurance company.
Self-pay
If you've exhausted your in-network options, you may want to consider paying out-of-pocket. If you can afford it, paying full price may enable you to get seen sooner, or access a therapist with more advanced education or specific certifications.
The full price of a fifty-minute therapy session with a therapist in private practice is usually between $100 and $200 or higher, depending on your location.
App-based therapy providers are on the lower end of out-of-pocket options. The popular app BetterHelp offers memberships from $60-$90 per week, depending on your location. (BetterHelp is a sponsor of NPR.) Some private practices and individual therapists offer a sliding scale based on income or financial means.
Free and low-cost therapy
Some county mental health departments and non-profit organizations like Mental Health America provide free and low-cost therapy for people on Medicaid, people who receive social security for disability, and those without insurance. That's what's called "community mental health, as opposed to traditional outpatient or inpatient treatment," Nguyen explains.
Some health centers that receive funding from the federal government also offer low-cost or free mental health care. Find federally-funded health centers in your zip code using this searchable directory.
If you're receiving free care, Nguyen notes, you still have a say when it comes to choosing a therapist. Ask for information about the different providers available and pick the one that feels like the best fit.
If you are employed, another free option worth exploring is if your workplace offers an EAP, or employee assistance program. EAPs are time-limited, typically five to six sessions. And they're designed to address problems that affect your performance at work — but that can be pretty broad, says Bufka. "If I'm struggling with parenting or work-life balance, that's affecting my job, right? If I've had depression for years, the EAP is unlikely to fix that for me, but they very well may help me find somebody to address that," she says.
Ideally, using the EAP benefit will be completely confidential. Find information about it in your employee onboarding documents or online benefits portal. If you don't see that information, it can still be worth asking your human resources department if there is an EAP available to you.
Step 3: Do some searching – and understand credentials
Now that you know the lay of the land cost-wise, start hunting.
The directory at psychologytoday.com and goodtherapy.org are useful for learning about the therapists in your area and targeting your search. Many share bios, photos or short videos about themselves. You can search by issue, like "depression," "addiction" or "marriage counseling," or by type of therapy. You can also search by age, gender, ethnicity, language, sexuality, and insurance accepted.
Primary care doctors and other health care providers, as well as family and friends may be able to recommend providers, says Bufka.
If you have a sense of what issues or diagnoses you want to address, you can hone your search by researching what type or modality of therapy might be most useful. Some common types include cognitive behavioral therapy or CBT – which focuses on changing patterns of thought and behavior; mindfulness-based cognitive therapy, which incorporates meditation techniques; or psychodynamic therapy, which reaches for the roots of emotional suffering through self-reflection.
Some types of therapy are particularly specialized to certain issues, like EMDR for post-traumatic stress, and Dialectical Behavioral Therapy for borderline personality disorder and self-harm. However, an individual therapist may offer more than one type of therapy.
You might be wondering if the letters behind a therapist's name – like LCSW, PhD, or MFT should matter to your search. Nguyen, who carries the LCSW (licensed clinical social worker) qualification, says social workers' education and experience can be especially valuable for patients struggling with housing, domestic violence, employment and other social issues. "We're comfortable talking about these spaces as we also unpack trauma," she says.
Marriage and family therapists have a lot of training in family dynamics. "I often think they're very good couples therapists, family therapists," Nguyen says.
You may want to look for a psychologist – someone with a PhD in psychology or a PsyD degree – if you need specialized help with certain diagnoses. For instance, some psychologists provide testing for issues like ADHD and autism spectrum disorder.
Want to verify a therapists' licensure? Check out this step-by-step guide.
Step 4: Assess if they're a fit for you, personally and culturally
Nguyen says when she's researching therapists online as a patient, she looks for indications of who providers are as individuals – to get a sense if she'd feel comfortable with them. "There was a time where the assumption was that a therapist was not supposed to disclose who they were. But I think... that's not how a therapeutic relationship should work. I think that many therapists do give a sense of who they are as human beings," she says.
On the other hand, Lynn Bufka says that if a therapist doesn't disclose much – either in their web presence or in conversation with a client – that's a legitimate professional choice – not a red flag. "Psychotherapy sort of started from the premise that as the therapist I am a blank slate. Over the years it's not the blank slate mode of thinking... anymore," but the idea is still to keep the focus on the client's needs.
Most therapists in the United States are white, and like many institutions, the field of psychology carries a legacy of systemic racism. It's no surprise that both therapists and patients of different racial backgrounds report feeling marginalized or misunderstood in the field. In response, some therapists are developing culturally responsive therapeutic models, and forming organizations like Inclusive Therapy and the Asian Mental Health Collective.
While it can be meaningful to work with a therapist from a similar background, Nguyen recommends prioritizing matching goals over race or ethnic group in your search – especially because the demand for therapy is so high right now.
Step 5: Reach out, and persist
It's exciting, Nguyen says, to live in a time when mental health is becoming destigmatized and part of the public conversation. On the flip side, it can be a struggle to find a provider with availability because therapists have been overwhelmed with demand since the pandemic. "COVID acted as a catalyst to get a lot of people into treatment," she says.
If you feel comfortable asking around your social circle, you might get some valuable recommendations. And if you have friends or relatives who work in mental health, consider telling them you're looking. They might be able to reach out to their professional network, or point you to a resource you hadn't considered.
It's an irony of the system that at a time when you need help, dogged effort might be required to find it. And "when we are feeling distressed and overwhelmed, we don't have the energy," says Bufka. It can actually be a great idea to ask for help finding help, she says.
"If you have a trusted friend who's able to make some phone calls for you, even just to find out, you know, this clinician doesn't have any availability, that can be a reasonable way to go. And if you are a friend or family member of somebody who's really struggling, and if that's something that you're willing to offer to do, that may be really, really helpful to someone," she notes.
Step 6: Interview a prospective therapist
There's a limit to how much you can learn about a person online or second-hand. Some therapists offer brief consultations for free, typically about 15 minutes.
Nguyen recommends coming to a consultation or a first appointment with a set of questions. "You'll probably want to know about their past experience and expertise, and their experience dealing with the kinds of issues you're facing. Questions can be open ended, like 'Can you tell me about your experience working with adult ADHD?' " Nguyen says.
"If you have questions about length of therapy, or number of sessions, certainly ask that," Bufka suggests. "Can I expect to see gains after a certain amount of time? What might that look like? Is the kind of therapy that you provide something that's supported by the research?"
Pay attention to their answers almost as if you were on a date. "It's not sometimes their expertise, it's the tone of their voice," Nguyen says. It's the passion you might hear, or how much they listen. "You're kind of getting your own sense of ... do I feel like we could speak at ease, or am I going to be battling this person unconsciously?"
Personal questions are okay too, Nguyen says. While some therapists might balk at being asked to open up, she believes it's important to the therapeutic relationship and can help build trust. Bufka suggests focusing on your needs as a patient, "not on developing a friendship at the same time."
Step 7: Try at least three to five sessions
After a first appointment, if you think you might be able to work with this therapist, Nguyen says to give it three to five sessions to see if the fit is right. Some discomfort is normal, she says. "especially if this is your first time in therapy."
"But early on you can kind of tell, is this a person that I can slowly let into my life? Do I feel like I can be honest with myself and be honest with them?" says Nguyen.
"I think probably the number one thing is do I feel respected in this relationship? Do I trust this person?" Bufka says.
While finding a therapist who you feel you can open up to is a great start, a crucial component of therapy is time, Nguyen says. "You shouldn't assume it's going to be magical," she says. "It's going to take time to heal. And that includes the work we have to put in to find our healer."
Andrea Muraskin writes the NPR Health newsletter and is a freelance writer and audio producer based in Boston.
Copyright 2023 NPR. To see more, visit https://www.npr.org.
