How to Find the Right Therapist

I regularly speak with people looking to start therapy. Most have been postponing their search for months — or even years. Sometimes the delay is related to ambivalence about therapy, but more often than not it’s because the process of finding the right person is so damn frustrating. Many mental health professionals don’t return calls if they’re not in the market for new patients. Confusing insurance plans and high fees force too many people to put a price on their health and well-being.

After twelve years of helping people from all walks of life navigate this process, I have some thoughts about how to improve your chances of finding a good therapy match. These are crucial questions you should be asking yourself — and your potential therapist — before making this important commitment. While I can’t help with finances or insurance plans, this is the kind of stuff every prospective therapy patient should know — things I wish someone would’ve told me when I started looking for my first therapist.

What Do You Want to Work On?

Sometimes it’s pretty straightforward to decide which issue or difficult feeling you’d like to focus on. Maybe you’ve been in therapy before and already have a good sense of areas where you need a little help. Sometimes it’s not so obvious. There might be a lot of contenders, but try to identify your most pressing problem. If that just leads to greater confusion, try another approach. If you’ve ever had trouble sleeping, what challenging feelings or worries might keep you awake? If nothing comes to mind, think about any uncomfortable feedback you’ve received over the past month. Have these same criticisms ever come up before?

Where Should You Look?

Google search and platforms like Psychology Today are your friends. Type in your top problem and search for therapists who specialize in that issue. Platform search filters allow you to add other important criteria like gender, age, sexual orientation, and insurance accepted.

Just because someone is paying for an advertisement to land them on the top pages of a Google search doesn’t necessarily make them a poor choice, but try wading in a few pages deeper. Therapists are some of the last professionals who work independently or in small groups. They don’t have huge advertising budgets to compete with big companies. Google ranks sites by the amount of money they are being paid by advertisers and the popularity and usefulness of the site. Expertise doesn’t enter into the equation.

When I was starting out, I was like a lot of therapists, casting a wide net, trying to be all things to all people. Often you’ll find therapists highlighting their “focus” on everything from soup to nuts. There’s nothing wrong with that, but if you have a specific problem, you want someone who lives and breathes that issue. Don’t worry — no matter what the problem, there’s a specialist out there to help.

It might be tempting to find a therapist based on Yelp or Google reviews, but these sites present a very skewed picture. Professional organizations that regulate our field prohibit therapists from soliciting their patients for reviews. These requests open the door to putting a potentially vulnerable person in a position where they believe they must comply with their therapist’s wishes and supply public praise for their treatment — or risk the therapist’s resentment. Furthermore, many satisfied therapy patients don’t want to violate their own privacy by publishing reviews of what is sometimes considered a very private relationship.

Finding a therapist through your insurance plan’s listing of providers is likely to be a bit of a crap shoot. These lists are not well managed and you’ll receive few responses. Therapists who actively advertise are more likely to have openings.

How to Make Sense of Those Pesky Letters at the End of Therapist’s Names

It’s really important to decode these little buggers because the number of years a therapist has spent in education, training, and practice in large part determines the quality of therapy you will be receiving.

M.D. = Psychiatrist: Typically 6–7 years of education and training after college. Psychiatrists are medical doctors specialized in psychiatry, a branch of medicine focused on the study and treatment of mental disorders. Although some psychiatrists provide therapy, most are focused on managing psychological disorders with medication.

Ph.D. and Psy.D. = Psychologist: Doctoral Level of Education and Training: After receiving a Master’s Degree, typically 3–4 years of education and training in psychological research, testing, and clinical work (i.e. providing therapy).

Master’s Degree Therapists: Typically 2–3 years of education and training in a specific area of focus that is designated by their title. MFT = Marriage and Family Therapist; LCSW = Licensed Clinical Social Worker; LPCC = Licensed Professional Clinical Counselor

Therapists with a Master’s Degree often refer to themselves as psychotherapists, a term generally applied to anyone who provides psychological treatment. It is not an accreditation.

Psychoanalyst: This term generally refers to a therapist who has undergone an approved program in Freudian psychoanalysis. After receiving a Master’s or Doctoral degree, the therapist goes on to train in this specific orientation.

What Type of Therapy Are You Looking For?

CBT, ACT, DBT, EMDR… again with the letters! Don’t be alarmed if your head is spinning. These days you’ll find Cognitive-Behavioral Therapy prescribed for just about everything under the sun. No doubt it’s effective, but there are plenty of other evidence-based treatments that are just as useful and might better suit your needs. Most therapists integrate several approaches depending on the problem being addressed, but they usually have one or two go-to orientations. Therapists go to school to learn about these approaches so you don’t have to. The best way to tackle this question is to ask your potential therapist how their orientation goes about helping people with problems like yours. Don’t be shy — you can even ask for examples.

Another way to determine if a therapist’s orientation is suited to your needs is to think about how you’d like to feel when you’re with them. Do you like people who are more interactive or do you need space to reflect and not feel crowded? Do you want a therapist to provide you with concrete feedback about things that have helped other people in your position? If you’ve been in therapy before, what helped? What didn’t help? Keep in mind that any effective treatment is bound to trigger uncomfortable feelings and frustrations. That doesn’t necessarily mean that you’re out of alignment with your therapist’s approach.

Another good question to ask yourself is how long you expect to be in treatment. Are you looking for open-ended therapy with goals that will be defined over time or do you want to dig in for two months on a single issue and then move on? There are many brief treatments that are great at addressing specific problems like phobias or everyday types of stress and low mood. If you’re dealing with problems that have taken a lifetime to accumulate — the type of problems that seriously impact your mind space and ability to function — then you need to be realistic about the amount of time it will take to experience true transformation.

Weekly meetings are still the norm though this can vary with the types and severity of problems you’re working on. Be sure to ask what the therapist recommends with regard to the frequency of meetings. It’s crucial to meet regularly to get good traction on addressing the problems at hand. If you can’t commit to a weekly time slot, ask how flexible the therapist is with scheduling.

Finances

Several years ago laws were passed saying that insurance companies must provide the same access to mental health help as they do to medical services. This has been a blessing and a curse for everyone involved. On the one hand, people who never had access to therapy can now find help. However, powerful insurance companies have made the hurdles of being a provider quite high with bargain basement compensation to boot. More and more therapists are saying “no more” making it harder than ever to find the right person.

This needn’t be a roadblock. Most insurance plans provide reimbursement for services outside their network. That means you pay your therapist upfront and then get paid back by your insurer. Any therapist worth their salt will be able to walk you through this process and have the proper paperwork on hand for you to share with your insurer.

If you find a therapist’s fee unaffordable, ask if they have a sliding scale. You might also work out a plan to meet every other week if it makes sense given the severity of your symptoms and the goals you’ve set for treatment.

A Few More Things to Remember

You’re likely in a rush to get to work once you’ve started actively looking for a therapist, but it’s a good idea to interview at least four people. This is an important investment in money and time — it’s also one of your best shots at improving your quality of life.

Don’t be afraid to trust your gut. There are many intangibles to relationships that can’t be captured on a checklist. Check in with yourself after the initial call. Overall, how did the call make you feel? Did you want to move closer to the person or do you feel like you’d like to withdraw? Were you feeling hopeful? Listened to? Did you feel neutral or nothing at all?

Therapists don’t agree to work with everyone who reaches out. This can be especially hard if you’ve experienced a lot of rejection and abandonment. Try your best not to take it personally if things don’t work out. During the initial call — and in the first few sessions — the therapist is trying to determine if you are a good fit for their skills and current caseload. Most therapists are total softies and would love to help everyone who reaches out. From our side, it can be very difficult — but sometimes necessary — to give the tough-love feedback, “I don’t think I’m the right person to help you.”

Referrals from friends, family, and physicians are a common path to finding a new therapist. That’s fine, but remember that you are looking for the best fit for you. Just because a referral is convenient, don’t throw all of the above advice out the window. Vet these professionals in the same way you would with someone you found online.

The Inside Scoop on How Mindfulness Meditation Really Works

This post is a passage from my upcoming book, Daddy.

Our minds think and feel constantly — even when we’re asleep. The internal racket can be deafening to the point that we come to mistake each of our passing thoughts and emotions for our essential selves.

If an alien landed on my rooftop and asked me for a sample of what it’s like to live inside a human mind, I would tell it to take a sixteen-hour flight to Sydney with a seatmate who won’t stop talking. That’s what it’s like to just sit and think, sometimes. Then, I’d tell the alien to imagine that a sadistic flight attendant (let’s call him Todd) allows us to change seats, but only at random and not at a time of our choosing. While we might relish sitting next to Betty White for a few hours, what happens when we’re led down the aisle to be seated beside Donald Trump? In ``Song of Myself,” Walt Whitman famously wrote, “I contain multitudes.” No doubt, we each contain multitudes, and wrangling this motley crew of fellow passengers into some sort of productive working relationship is essential if we are ever to find happiness in life.

Of all the approaches I’ve learned about (and utilized on myself and my patients), I have found mindfulness meditation to be the single most impactful and accessible.

Personally, I have found that mindfulness meditation is an invaluable tool to help calm the mind and find greater equanimity with the diverse planeload of passengers we each carry inside. Familiar to most as a component of the vast and complex system of Buddhist and Hindu spiritual philosophy, mindfulness meditation has gained popularity in the West in recent decades as a stand-alone, non-secular approach to stress reduction. First popularized by the research of Jon Kabat-Zinn, Ph.D., I had long avoided looking too deeply into mindfulness meditation because I felt it was unscientific and had negative associations with New Age charlatans and middle-aged men with ponytails. However, a few years ago, something finally clicked after I took some time to carefully examine the overwhelming empirical support for the benefits of meditation from study after study coming out of major universities. I finally had to ask myself a very rational question about something that appeared highly irrational: “If even a fraction of what researchers are claiming is true, then why aren’t you giving this a fair chance?”

Managing Mental Time Travel and Other Distractions

The most popular way to practice mindfulness meditation is to find a quiet spot where you won’t be interrupted. Then, sit in a comfortable, upright position, with your eyes closed. Next, turn your attention to the process of the exchange of air as it passes in and out of your nostrils. Don’t take deep “gulps” or try to control your breath in a forced manner. Just breathe naturally through your nose, not your mouth. When you notice that your mind has drifted off, gently guide your attention back to your breath in a non-judgmental fashion. Simply set a timer and try it for about ten minutes a day. That’s it: just sit down and shut up.

This approach is often referred to as “anchored” meditation because we are using our breath as an anchor point for our attention. Inevitably, the first thing people notice when they attempt this type of meditation is just how often their focus wanders away from their anchor point. Even under the best of circumstances, you will notice that your mind will replay events from the past or delve into future concerns. This mental “time travel” is typically layered with complicated feelings, judgments, and associations that our minds find highly stimulating. Consequently, when you sit down to meditate, you should fully expect your attention to be drawn to the voice of that talkative seatmate from your flight to Sydney. If you’re anything like me, he’ll probably start guffawing with Donald Trump from across the aisle. This does not mean it is a failed meditation: this is what meditation is. Over time, you will learn to observe your thoughts as they flit across your awareness rather than identifying with every single one.

The Goal of Mindfulness Meditation May Not Be What You Think

Unfortunately, those new to meditation are prone to regularly assessing their efforts, feeling frustrated they are not “better” at doing something that, on its face, seems so straightforward. Many people make the mistake of trying to measure the relative success or failure of a single meditation based on how long they were able to keep their minds focused on their breath and how relaxed they feel after finishing.

In my work coaching patients through the ins and outs of developing a mindfulness practice, I’ve found these judgments can often be traced to a pop-culture misconception that achieving a Zen state (an empty mind, free of worldly concerns, absent of thought and feeling) is the goal of meditation. While these sentiments may be valid in some regards, it’s important for beginners to approach this process with humility, and not to get ahead of themselves by imagining themselves to be on par with a Tibetan monk who has been practicing since childhood and has renounced all worldly obligations and belongings.

Because mindfulness meditation and most self-care strategies appear quite simple and straightforward (it doesn’t help that people who are meditating look like they are napping in an upright position), most novices approach these practices with unexamined hubris. Although we all sometimes wish for an off switch to the parade of thoughts and feelings that constantly vie for our attention, I’m sorry to tell you that there is simply no such thing: there are no grand tricks to be shared because the system cannot be gamed. What we do possess, however, are powerful self-care practices (meditation, exercise, healthy diet, psychotherapy, cultivating core strengths and positive psychological traits) that enhance overall health and well-being. Rather than an on/off switch, these practices can be thought of as analogous to a dimmer switch that adjusts our internal settings by incremental degrees over an extended period of time.

Building the Muscle of Present Focus

In many respects, the practice of meditation should be thought of as an activity like physical exercise. When we work out, we build our strength by engaging our muscles in repetitive movements against a force (weight + gravity). In meditation, the strength of our non-judgmental, present awareness (not an “empty” mind) is the muscle we are trying to build. The persistent, non-judgmental redirection of our wandering mind back to the breath might be thought of as the equivalent of doing a rep at the gym, building up the muscle of non-critical, present focus.

It’s important for those new to meditation to understand that you may or may not feel more relaxed during or immediately following a sitting — but that’s not really the point. Remember that you might feel nauseous, sore, and worn out after a particularly intense workout. Then, after some time exercising in this way, you’ll suddenly realize you can lift a couch all by yourself. What the practice of mindfulness meditation facilitates is a growing power to non-judgmentally observe each present moment without reflexively involving ourselves in the types of mental time travel to which we have become accustomed. Therefore, “mindfulness” refers to being as attentive as we can possibly be to each passing moment as they arise throughout our day-to-day life — not just during the times when we are “officially” meditating.

Mental Fusion With Reactive Thoughts Make Us Act in Bizarre Ways

Most people scarcely recognize that they live much of their lives in a state of autopilot. While our bodies are moving through the present moment, our minds are constantly engrossed in a form of mental time travel, only partially attentive to what is happening around us. When we’re on autopilot, we exist largely in a reactive state, our responses grounded in the well-defined, self-limiting schemas reflected in the select neural pathways of the brain. On autopilot, our awareness can be said to be psychologically fused with our reactive thoughts and emotions. People vary greatly in the degree to which they are fused with their thoughts and emotions, with our capacity to observe these passing phenomena fluctuating over the course of a day (or a lifetime) depending on the nature of the events and the demands at hand. Those at the extreme end of this continuum have no objective distance between their thoughts, feelings, and awareness. There is little sense of being a detached observer of one’s inner experience. Like breathing, these reactive thoughts and emotions are viewed as an automatic part of the self — they occur without warning and require no mental effort. From someone fused with their reactive thoughts, you will often hear statements like, “This is just who I am” or “I’d have no idea about how to go about things differently.”

For those suffering from PTSD, Complex Trauma, and BPD, the sense of fusion with reactive thoughts and emotions is pervasive — much the same can be said of phobias, severe anxiety, and depressive disorders. Psychological material related to traumatic events becomes the locus of all automatic responses. In the midst of my own dissociative states and traumatic responses, I treated my every feeling and thought as a fact. To understand just how problematic this approach can be, let’s return to the example of our talkative seatmate on our flight to Sydney.

Let’s say we hit some mild turbulence, and he starts freaking out, racing up and down the aisle screaming, “We’re all going to die!” Then, he starts demanding that you put on a parachute and jump out of the airplane. How would you react? If you are fused with your thoughts and feelings, it’s very likely you’d start looking for an emergency exit to pry open and anxiously wait to be suited up. Clinically, this is the definition of “psychosis.” While we all sometimes have thoughts and feelings that might otherwise be known as “batshit,” fortunately, few of us take action on these thoughts because we recognize them as dangerous extremes. Nevertheless, these types of thoughts and feelings tend to persist, causing great mental anguish and leaving us puzzled over how to calm these irrational parts of ourselves. If you take the Cognitive-Behavioral Therapy approach to manage these experiences, you would, in essence, ask your irrational seatmate to suddenly — some might say magically — become rational. You’d ask that he somehow break through his panic and logically consider the evidence that you are safe based on mathematical calculations involving atmospheric disturbances and g-force stresses on aluminum welds. Perhaps as a follow-up, you would tell him to write down the alternative scenarios where the plane won’t go down, and then ask him to distract himself with the in-flight magazine. Or maybe you’d try the “power of positive thinking” approach and tell him to “believe really hard that the plane is not going to crash.”

I don’t know if you’ve ever tried to reason with someone who is being swept under by powerful emotions, but you’re not likely to get very far if you start off by trying to deny their reality. Often, the frightened person will respond defensively and double down on their convictions. Although the CBT approach is not off target, you would first need to understand this passenger’s motivations, misguided though they may be. For example, would it change your approach to know that your seatmate has survived a plane crash? That he’d been trapped in the wreckage for days, watching his fellow passengers die one by one? Maybe he had the chance to parachute out of the plane and bring back help, but refused because he was too afraid? Would it help to understand that amid powerful emotions, our physiology is in a state of fight, flight, fawn, or freeze? There is adrenaline and other powerful hormones being released into the body, and blood being siphoned away from the prefrontal cortex (the seat of executive functioning) and into our limbs.

Self-Protective Reactions Can Spell Self-Sabotage

Considering the full context of our panicked seatmate, you can see that from his perspective, he is acting as a vigilant protector, sounding the alarm against danger. Leading with a dismissal of his powerful feelings, criticizing him, or telling him to white knuckle it until our flight attendant comes along to reassign us to another seat is tantamount to a failure of empathy against ourselves (remember, he is part of us). Besides, what happens if Todd next seats us at the side of Trump, who proceeds to tell us that he’s going to replace that “disappointing loser,” the pilot, and fly the plane himself? This might be enough for some people to assume the crash position, living out what is left of their life in a state of hopelessness (a.k.a the “living dead”).

To add yet another layer of complexity to our action-packed trip, let’s say Todd reappears with a cart full of goodies that includes bourbon, Twinkies, oxycodone, and sex. Maybe then we can settle in for a while, distracting ourselves with our smartphone (Reddit, Pornhub, Candy Crush…) or the 500 channels of free programming embedded in the screen in front of us. Sooner or later, these addictions and distractions will wear thin, and we awaken from our stupor to find our seatmate buckling us into that parachute while Trump bangs his tiny fists on the door of the cockpit, screaming, “You’re fired!”

While experiencing particularly intense thoughts and feelings, our minds and bodies enter a state of panic that tells us, “This experience must end, right this second, no matter what.” That is the moment when many of us unwittingly make decisions that compound and prolong the problem at hand. While most of us can non-judgmentally observe the personalities of many of our seatmates while the flight is smooth, building the “muscle” of non-critical focus allows us to access these observational powers more easily during times of turbulence, providing greater psychological ballast during moments when we are being swamped by thoughts and emotions.

Being practiced in mindfulness doesn’t mean you won’t experience powerful thoughts and emotions; in fact, once the cobwebs of your reflexive responses begin to be cleared away, you’re likely to notice a richer complexity and greater nuance to your inner life. And in the observing space that opens up, you’ll begin to see that all overpowering thoughts and emotions have a sequence. Like a wave on the ocean, they gather force until reaching a crescendo, crashing down on the shore only to melt away on the sand.

It’s Time for a Heart-to-Heart With Your Inner Todd

We don’t just work out to have muscles while we’re at the gym — we do so because we want our bodies to be fit all the time. In much the same way, meditation improves the conditioning of our awareness (some refer to this as “stabilizing” our awareness) and increases our capacity to sit with powerful emotions and self-soothe during times of crisis. If we don’t put the time in to mentally “work out” with mindfulness meditation, how can we expect our overwhelmed seatmates to calm themselves during moments of panic? Practicing mindfulness allows us to step outside our reactive minds and take a clear look at the operating principles of our most problematic fellow passengers. While some might appear to be villains bent on destruction, once unmasked, you will come to recognize the traumatized plane crash survivor, or the terrified, unloved little boy seated next to you. Approaching your panicked seatmate with compassion also opens the space for the physiology to return to a state of equilibrium after the release of hormones triggered by the fight, flight, fawn, and freeze reactions. If you provide yourself with greater emotional space during times of turbulence, you’re more likely to avoid fear-based, reactive decisions like jumping out of a plane in mid-flight before you’re sure it’s actually going down.

These days, when I’m feeling particularly low, I deploy a subtle, but powerful reframing of my emotional environment by recognizing that “I feel depressed,” or “I feel angry,” rather than the global statements “I am depressed,” and “I am angry.” In other words, I am a planeload full of different passengers, not solely the depressed guy in 14A. During the worst years of my crisis, Todd left me sitting with that depressed guy far more often (and far longer) than I could bear. I drank, popped pills, and slept my days away to try to numb myself to the pain. I would deny that there was anyone else on the plane to sit with and imagined most people lived their lives in first class. Whenever I happened to be briefly seated next to one of my positive emotions, I was suspicious of their motives. I’d say to myself, “This isn’t real. Don’t get too comfortable… Todd is going to come along any second and put me back with the depressed guy again.”

While it can feel truly awful to be seated next to our most troublesome seatmates, according to the Buddha, a fundamental source of human suffering is attempting to cling to the things we love while attempting to evade the things we don’t like. This evasion is, however, not actually possible. In fact, facing things that make you uncomfortable — such as change — is the only way to achieve wholeness. After all, the one certainty in life we can rely on is change. Mindfulness meditation helps us to accept with grace the fact that we have little control over what life (the ultimate sadistic flight attendant) hands us. And you know what? Sometimes, Todd does seat you next to Betty White!

Melding memoir, science, and social history to tell the story of PTSD in a new, relatable way, Daddy is out November 2023. Preorders are now available through Raab and Co.