By Helene Stein, Ph.D.

Reprinted from The Boston Globe 2/21/2002

Over the past year, many of you have asked me how to select a therapist. It's not always an intuitively straightforward process. Just when you think you've gotten a good suggestion, you discover the person can't take your insurance or has no time. Volumes have been written about what makes a successful therapy relationship. Researchers have devoted their entire careers to comparing one model with another to tease out which factors are the most relevant to the success of the therapy. I will attempt to focus on what's feasible and practical.

Just as in any other situation in which you are seeking a professional's services, be an informed consumer.

If your situation isn't an emergency, try to learn a little bit about the training that various therapists receive. Don't be afraid to ask questions. It's confusing. There are professional organizations for psychologists, social workers, marriage and family counselors, and psychiatrists. All of these organizations should have information about their professional training, and the sorts of treatments they are licensed to dispense, readily available to the general public.

If you are in an emergency, don't delay getting help. Rely on the knowledge of other trusted professionals such as your physician, your local hospital, your school, your clergy. You can always make new choices, if necessary, once the emergency has passed.

The next step is to get the names of therapists who are conveniently located for you. You may not always find someone to your liking in your town, but there may be other qualified therapists a town or two away or close to where you work. Your health insurance may determine the pool of
therapists from which you must choose. Since mental health services are managed differently from other health benefits, you will need to select a therapist based on the requirements of your plan.

Furthermore, not all mental health problems will be reimbursed. Ask your plan what kinds of problems they cover. For example, will they cover couples therapy if that's what you think you need? If you use your insurance, your therapist must communicate with the insurance company and comply with its requirements. As a result, some confidential information must be shared.

If there is a closed panel of providers, the therapist you select will come from your insurance company's network. Other plans will allow you to go out of network if you pay a deductible and larger co-payment. Are any of the names of therapists in your area familiar to you, to your family doctor, or others you trust? Local professional groups also may have referral lists of therapists who are taking on new clients, if insurance isn't an issue.

The next step is the most difficult and the most important. Therapy is not easy. You are going to speak with a stranger about your most intimate difficulties. You will answer questions and explore issues you may never have discussed with anyone. You want to feel reasonably comfortable with a potential therapist from the beginning, understanding that you're likely to feel more comfortable as the relationship develops. Many therapists are willing to engage in an initial extended telephone conversation. Others will require an office visit. Either way, each of you will learn about the other. Therapists are accustomed to this process and should not take offense if it's not a good fit.

Be honest and state up front that you are speaking with a number of people, and that you have not yet made a selection. The therapist will want to know what precipitated your seeking help at this time, what treatment (if any) you have already tried, how long the problem has troubled you, and some personal and family history. Since the relationship is still tentative, the therapist will not want you to discuss the problem in depth.

You should ask about the therapist's training and licensure, experience with issues similar to yours, how he or she typically treats such a problem, and how the therapist manages the business aspects of the practice, such as fees or missed sessions. Are you comfortable with the answers? What's it like to be with this person? This is a snapshot. It is an opportunity for each of you to get a glimpse of what it's like to work together. The therapist may tell you that it isn't a good fit and suggest a colleague who might be better. Both of you must agree that the relationship can work.

As always, never suspend good sense. If something doesn't feel right or goes against your better judgment, it's probably wrong for you. Speak to another therapist. On the other hand, therapy will only be helpful if you invest in finding solutions. It won't necessarily be a quick fix, especially if it's an old problem. Be certain that your expectations are realistic. No one can wave a wand or prescribe a magic pill. Medication can relieve symptoms, and therapy can facilitate change. No one can give
you a prescription for what to do with your life. That's your responsibility, and that's the heart of treatment.

Helene W. Stein, Ph.D. is a licensed psychologist in private practice in the Boston, MA area. She consults to businesses and other professional groups.