All of us probably know someone (or have *been* someone) who thought about (or even openly talked about) how we “need therapy” and “should probably see a therapist.” Despite knowing this, many times we avoid, delay, or just never follow up on getting ourselves the care we know we need. There are lots of reasons people don’t seek help and those reasons can be really complex (and, often, things we need to address as a culture) but sometimes we don’t follow up simply because we aren’t sure exactly how one goes about getting a therapist. In this post, we’ll run down a step by step list for how to get a therapist:

1. Crunch the numbers

First things first, before we talk about starting therapy, let’s talk about how to figure payment. Basically, there are four categories of payer-types, and these types of payments will impact how you get in contact with a therapist: 1. Insured and covered for Mental Health treatment, 2. Not covered by insurance, but able to pay out of pocket, 3. Able to pay a reduced rate, or 4. Not able to afford any payment for treatment.

Thankfully, therapy is available for people in every category, although in the opinion of this clinician who has also been a client in each of these payment categories at different points in my life, often the quality of care is relative to what you pay. Free counseling can be AMAZING- but often isn’t, due to programs with rotating pre-pre-licensure therapists or inconsistent scheduling. If you can afford to pay any amount, you may find better results by seeking a therapist or clinic with a sliding scale that fits your budget (Open Path is a good resource for locating therapists with sliding scales starting at $30 per session)

WHAT IS SLIDING SCALE PAYMENT FOR THERAPY?

“Sliding Scale Fees” are fees that are reduced for low-income individuals. Usually, this is done via a conversation with the therapist or office manager about what you are able to afford, and what the therapist is able to accept. Most therapists have to limit the number of sessions they’ll do sliding scale per week, so the waiting list to see a therapist at sliding scale might be longer than for those who can pay market rate.

HOW MUCH SHOULD THERAPY COST?

There’s no hard and fast rule for how much therapy should cost, since rates vary according to a therapist’s training, experience, the specific issues they have specialized in, and by geographic region. You can expect most full-price rates for therapy to be around $120-$150 per 50-minute session in an urban area, and $80-$120 in less urban areas.

HOW DO I KNOW WHAT I CAN AFFORD TO PAY?

If you ask for sliding scale rates, you can expect to be asked, “what can you afford to pay per session?” There’s no fixed percentage, like there is for calculating what you can afford for a mortgage or car payment, but the number you land on should be a number that has a cost to your lifestyle without putting you at risk for defaulting on loans or stressing about whether you’ll be able to pay rent. The price you pay for therapy should cut into your budget for non-essentials: i.e. what you’d usually spend on things like entertainment, dining out, travel, or alcohol.

Do I need a referral?

Maybe. If you are trying to use your insurance to pay for Mental Health Therapy, you might need to start with a referral from a primary care doctor. Read your policy to find out. If you are paying out of pocket (full price or sliding scale) you don’t need a doctor’s referral or even a diagnosis/assessment in order to start seeing a therapist.

2. Get Recommendations and do Research.

Once you’ve figured out what you can afford to pay, you can begin gathering names. I think one of the best ways to get a therapist is through speaking with people who know you. Friends, teachers, your doctor, and other health care professionals (chiropractors, physical therapists, massage therapists, etc) are great resources- and even hair stylists can be a surprisingly good resource for connecting with good professionals in a number of areas.

HINT: If you struggle to talk about your mental health with friends and family, asking for a therapist referral can actually be a great segue to enter that conversation.

I’VE HEARD ABOUT THERAPIST ORIENTATION, DO I NEED TO KNOW WHAT I WANT?

Most of us learned in Psych 101 about the history of psychology and a little bit about psychoanalysis, behavioral therapy, and potentially other therapeutic orientations. Unless you feel very drawn to one therapeutic orientation, it’s okay to not think much about this when choosing a therapist. A number of studies have found that therapeutic orientation doesn’t significantly influence the outcome of therapy- what does impact outcome significantly is the quality of the relationship that you form with the therapist.

FINDING A THERAPIST ON THE INTERNET:

The internet can be a good resource for locating a therapist- but it can also be like finding a needle in a haystack-of-slick-websites. It’s easy to get LOTS of names, but not necessarily easier to find your therapist. Good websites to use to find a therapist are: the paid Psychology Today listings, Open Path, The Walnut List, and the alumni listings of graduate programs you’ve heard good things about, or organizations that advocate for persons struggling with the issues you struggle with.

If you’ll be paying with insurance- start with your insurance’s website- their listings of in-network providers should be a good starting point.

If you’d like, you can do some homework at this point checking references and checking online for reviews of the therapist on your list- but it should be noted that part of good therapy can agitate clients sometimes- one or two negative reviews online could say more about those reviewer’s conflict styles true reflections of a therapist’s skill. (there’s also quite a bit of research on negative review bias- check out this write up on the topic from The New York Times.) Additionally skewing online reviews for therapists: professional ethics prevent therapists from ever soliciting (positive or negative) reviews from clients.

3. REACH OUT.

Once you have some names, it’s time to reach out. Try not to get set on one therapist  based on recommendations or what you’ve found online, as good therapists will often be booked solid. If the therapist is full and you are not in crisis, you can ask for a spot on a waiting list.

How to contact a therapist:

Historically, a phonecall to the office was the “right” way to make initial contact with a new therapist- but now it’s generally very okay, if an email address is listed, to make initial contact and schedule the first session via email.

Sample text for an initial email contacting a therapist to set up a first appointment:

“I got your name through ______ and I’d like more information on scheduling an appointment for therapy. Are you currently accepting new clients? If so, I’d love to set up a meeting. I’m generally available on _______. I can be reached at _______. Thanks”

“Hi ____, My name is _______, I’m reaching out hoping to schedule a consult to see if we might be a good fit for working together on my ______. I don’t know if you have sliding scale rates, but I’m currently (student/single mom/financially struggling/etc) and am trying to find therapy for under $__ per session. Please let me know if you are available for a meeting”

4. MAKE A LIST

Starting therapy can be anxiety-provoking. Meeting new people is always a little scary, and people often feel especially vulnerable in the first few sessions. The therapist knows it’s scary and- trust me- thinks you are a strong and brave person just for reaching out and showing up.

If it helps, it is okay to come in with a list of questions or concerns. Your list can be a really good place to start. It’s also ok to show up without anything to talk about! Therapists often have a structure they follow for the first session or two- so know that you are NOT responsible for filling the space.

5. DO A FEW CONSULTS & TRUST YOUR GUT

When we are in crisis, it’s especially tempting to just jump in to work with the first therapist who sits with us- and that’s not necessarily a bad thing if it gets us stabilized to the point where we can make an informed choice to continue with the therapist or seek a better fit.

Since we know that the quality of the relationship between the therapist and the client is the best predictor of therapy having a good outcome*, it’s worth the time to meet with several potential therapists and see which “clicks” for you. Trust your gut on this one- it’s easy to overthink it, but after meeting with a few, ask yourself which therapist you WANT to see again, and which therapist you can imagine yourself opening up to.

6. Choose and Dive In

Therapy is an investment, and once you’ve chosen a therapist you’ve made the first step towards the many rewards of time invested in caring for yourself via therapy.

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