How to Vet a Therapist

“For many people, it’s difficult to share personal information with somebody who they don’t think can fundamentally understand their viewpoint,” explains clinical psychologist Cindy Graham, founder of Brighter Hope Wellness Center.

In the United States in 2019, only 4% of psychologists were Asian, 7% were Hispanic, and 3% were Black. This is significantly less diverse than the U.S. population.

“So finding someone who is the same race, ethnicity, sexual orientation, or even religion can be difficult,” Graham says. “When someone is ‘on the outside,’ people worry that they won’t understand and incorporate their culture into their treatment.”

During a recent Healthline Media Town Hall event, Academy Award nominee, Golden Globe winner, star of the award-winning film “Hidden Figures” and Fox’s hit drama “Empire,” Taraji P. Henson describes what therapy has been for her and what it can be for others as well.

Certain mental health conditions can also make it difficult to trust a therapist.

“People with obsessive-compulsive disorder, post-traumatic stress disorder, or anxiety are often afraid of being judged,” says Melissa Sornik, a licensed clinical social worker who works with special populations of gifted children. “Or, they might be afraid of learning that there’s something terribly wrong with them.”

And, depending on your past experiences, trust might be downright scary.

“If you’re someone who has been emotionally or traumatically injured in your life, or if your core relationships were very fragile and you were never able to have solid attachments, you’re going to struggle to attach in therapy as well,” says Cheryl Knepper, a licensed professional counselor who’s the senior vice president of clinical operations at Caron Treatment Centers.

While all therapists can provide mental health support, different types offer a specific set of services.

Licensed professional counselor

These counselors typically approach therapy with a more practical approach. Their goal is to help clients work through and solve their behavioral or mental health problems.

Social worker

The goal of a social worker is to help clients succeed in their community and home environment. They can connect people with local resources and services, such as community programs or trainings, as well as work with their family members or school staff.

Psychologist

A psychologist works with clients who have more severe symptoms of conditions or more complex issues, like trauma. They often take a research-based, scientific approach to their treatment and can also perform psychological testing and diagnosis.

If you need to be prescribed medications, you’ll often go to a psychiatrist. Psychiatrists are medical doctors that often specialize in the clinical or prescription side of therapy and treatment.

Q: Why won’t you just tell me what I should do to change things?

A: “In order to truly remedy a problem, the client has to identify it and find solutions that will work for them,” Sornik explains. “Therapy is really about empowering them to work on the problem themselves.”

“It’s the problem-solving part itself that needs support,” Sornik adds. “If we do it for them, then change really hasn’t happened. We help them develop the skills, the resilience, and the tenacity they need to solve problems on their own.”

Q: Are you going to tell my parents/school admin/job what I say?

A: This is a tricky one. You’re entitled to confidentiality with your therapist, but there are a few exceptions.

“The rules vary by state, but in general, if there is abuse or neglect, then we must report it,” explains Graham. “If a child is threatening self-harm or to harm someone else, then we must tell their parents. If it’s an adult, we will call emergency services.”

Where it gets complicated is that parents have access to their children’s medical records. And courts and insurance companies can also access medical records. So can your employer if your work mandates therapy.

“So it comes down to if a therapist takes very detailed notes. The best thing to do is to have a conversation with the therapist about the limits of confidentiality,” Graham advises.

Q: What are your methods and techniques?

A: There are several types of therapy, methods, and techniques available. Some therapists may specialize in one type of therapy or know several techniques.

Some options include:

• Psychoanalysis and psychodynamic therapy: A therapist will help you search for meaning and motivation behind your behaviors so you can change them.
• Behavioral therapy: Cognitive behavior therapy (CBT) and dialectal behavior therapy (DBT) are common types of therapy that help you learn skills to better manage your behaviors and thoughts.
• Eye movement desensitization and reprocessing therapy (EMDR): This trauma-based therapy can help you replace negative emotional reactions with positive ones.
• Exposure therapy: An experienced, licensed therapist can use this therapy to carefully reintroduce what’s causing you distress, help you manage your symptoms, and change your response.
• Interpersonal therapy: You’ll work on improving your interpersonal skills by looking at the relationships you have with other people.

Q: How will we measure progress?

A: “You and your therapist should set goals and expectations for your work together,” says Sornik.

“These could be short-term or long-term goals. They should check in on these goals every few months to see how it’s going,” she adds. “If you’re not progressing, then together you should look at what you’re doing and tweak it.”

Q: How much is this going to cost me?

A: Many therapists offer sliding scale or pro bono services, allowing some clients to pay less or receive free therapy.

If you can’t afford therapy, don’t be afraid to ask a potential therapist about these options.

But be aware that there are typically a limited number of these slots available, so you may have to wait. And, you’ll likely be asked to provide proof that you’re unable to pay the full amount.

What about insurance?

If you have insurance, you may be covered. Most insurance companies will cover the majority of mental health services if you use an in-network therapist.

However, if you don’t think any in-network therapists are the right fit for you, you can ask your insurance company how they handle out-of-network therapy. Many will require you to pay a certain amount yourself (called a deductible), and then they’ll reimburse you for a portion of each session.

Just be aware, copays and deductibles can vary greatly depending on your insurance. Some might have you pay a $20 copay for in-network therapy and $30 for out of network. Others may require you pay 20–30% for out-of-network services.

Q: How experienced are you in treating ___?

A: It’s totally acceptable and necessary, quite frankly, to get clarity on a potential therapist’s experience — especially when it comes to working with your ethnic culture, group, orientation, specific disorder, or disability.

“Ask them if they are credentialed and licensed to treat you,” Knepper recommends. “They should be able to tell you what they can do for you, what they can treat, and what they cannot treat. You can also ask about any special trainings or certifications.”

Hensen is also an advocate of mental health and the founder of her own organization: The Boris Lawrence Henson Foundation. She explains that asking about a prospective therapist’s repertoire goes beyond their own skin color, gender, or orientation, but how well they understand another group’s struggles.

You can learn more about cultural competency in therapy here.

Q: Do you offer a free consultation?

A: Some therapists will provide a 20 or 30-minute phone consultation to answer some basic questions, like the ones here. But most don’t offer free sessions routinely.

Q: What happens during the first session? Do we dive in right away?

A: “During the first session, you’ll fill out some general intake forms if you didn’t do so already,” Graham says. “Then, a therapist should talk about payment and billing, review consent, discuss the limits of confidentiality, and answer any questions.”

“Next, I ask about preferred names and pronouns, get a full background — including family and medical history, and ask about their reasons for coming in. I also like to learn about their strengths and weaknesses, as well as their goals. During all of this, we also work on our rapport and building trust,” Graham explains.

Q: How long will therapy take?

A: “It really depends on your reasons for therapy, the complexity of the situation, and what the appropriate treatment plan will be,” explains Knepper.

“After 3 months, you and your therapist should evaluate where you’re at, and you should do it again at 6 months,” she says.

“You should discuss how much progress you’ve made, and whether you have completed your goals, if you should continue in therapy or get a recommendation for another level of care,” she adds.

Q: Do I have to tell you about my childhood? Why?

A: “Your childhood is very important because your thoughts, feelings, and decisions are affected by the environment you grew up in and the things that you’ve seen,” explains Graham.

“How you handled things and how you saw other adults react to things directly affects how you learned to cope and react to things,” Graham adds.

What should you look out for when vetting or meeting your new potential therapist?

“Make sure they are licensed in your state and check if they’ve ever had their license revoked,” Knepper recommends. “You can find this information from the licensing board in your state.”

When you meet your therapist in person, Knepper suggests to watch out for certain behaviors:

• A lack of boundaries and personal space, like giving you a hug without asking or wanting to meet you outside the office.
• Passing judgment on how you said or did something.
• Changing the fee structure quickly, without notice.
• Ending sessions short.
• Keeping the office lights dim, as if you’re on a date.

If you think you’ve found the right therapist for you, Graham suggests you schedule your first five appointments (if possible).

That’s about the amount of time it will take for you to get to know each other and determine if it’s the right fit.

It’s OK to decide they’re not the right therapist for you, or that you don’t like the style of therapy they provide. But, make sure to reflect on what you didn’t like so you know what to avoid when selecting your next therapist.