Getting and Questioning a Therapist (Amateur Edition)
So I (a psychological layperson, though with an unusually high number of psychologists and therapists in my family and friend group) recently learned that you can just write one reasonably short email that includes a request for a free 15-30 minute consult, then copy-paste it to 20 therapists on Psychology Today (filtering, if you desire, for modality, location, insurance and other), then get a bunch of relatively quick responses and thus quite Virtuously assess multiple therapists before deciding on one. It takes shockingly little time to do the setup piece.
Note: I am not done with this process, so remains to be seen how well it works! I’ve had consults with something like 6 therapists, and think I found 1-2 I quite like and maybe 3 I could imagine working well with, but who knows.
If you have a more specific issue or are interested in a more specific treatment, this may or may not make sense, though I suspect it still does.
Here’s my email:
Hello! I'm looking for a therapist in [location] and was hoping to do an initial short consult to see if we might be a good fit. I struggle with [problem] and [problem]. I really benefit from a therapist who [things I want in a therapist]. If you think we could be a good fit, I would love to hear from you via text or email with times that work for you for a call or video chat. Best, [Name]
Then, and this is key (I think, it’s early days yet), I treat these consults as interviews - I’m assessing their vibe, and the fit, but also getting answers to specific questions.
Questions I’ve been asking:
What modalities do you use and do you tend to mix and match or stick to the more "pure" versions
I have some takes on modalities already, but it’s still useful to hear how they talk about them. I actually don’t care what the answer here is, I think it’s reasonable to do bespoke eclecticism or “if we’re doing CBT, we’re Doing CBT, as the evidence points” but I want to know how they think about it.
In practice, though, I haven’t encountered anyone yet who does the latter, they all “bring X and Y into their practice”, so maybe I should ditch this question. (Though a dear friend who’s a therapist is more structured, so I know they exist)
What are your thoughts on "evidence-based" approaches?
Similar to the above, but this gives me a sense of whether they are really engaged with and interested in research and nerding out about psychology, or more draw from their work experience, or something else. At the moment I’m more interested in the former, but I think there are lots of ways to be a good therapist
Also, we only have evidence on the most well scoped approaches, so it’s reasonable to not stick to the most legible interventions, I just want to know how they're thinking about it
Talk about looking for someone who is interested in explicating theories of change and discussing them, see how they react
This is my current hypothesis of what I’m looking for and would work best with, but I’m not super confident in it
Thoughts on medication
This seems hugely important; they’re not psychiatrists, but if I’m interested in medication, I don’t want that to be a tension with my therapist. Also the other way, you don’t want a therapist who will pressure you into medication if you’re not interested.
Also, since I am interested, and don’t currently have a psychiatrist, seems good to have a therapist who can point me to one
What is your clientele like?
This is trying to get at “do you see a lot of people like me” on the theory that having experience with people like me would be useful for helping me
Sometimes I explicitly ask if they have experience with over-cerebral / over-verbal types
What would make someone not a good fit?
A close person in my life who’s a therapist was surprised I asked, since it’s just hard to know ahead of time
Indeed I have not gotten great answers, but I am still attached to the question
They will always bring up fees and insurance, but you can bring this up as well
I suspect you can also sometimes negotiate fees, I did this a bit and it worked but I haven’t committed to anyone yet
Other things I could imagine asking about or trying to get a sense of
How much the therapist is goal or metric oriented - some people work better having concrete goals they’re aiming for
Does the therapist give homework
Is the therapist excited to work with you - one of them told me this, I think I seemed like an interesting brain to pick apart
Just straightforwardly how smart they are
Things I’m looking for
A feeling of comfort, like I would tell this person things about me that are hard to talk about (though of course sometimes this is built over time)
A sense that they “get me” (also built over time)
I was really impressed by one of the therapists who asked about things that could cause therapy work together to be difficult and asked if something about his style might be a dealbreaker, or how we’d handle that - I found that very useful and I think it conveyed a lot about me to him
Other guides to finding therapists:
Podcast on what works in therapy (simplified answer from this podcast - “fit” and “trust” is a better predictor of outcomes than modality, though I think this could imply lots of different things)
Advice I’ve heard: If you’re looking for people experienced with intellectual types, look for your nearest fancy university and cross reference people in their mental health system with people on psychology today
I tried this, as well as looking through lists of recommended people, but in the end went with volume
You may also just want to ask your friends who they see, if you’re comfortable with that, or ask them to ask their therapists for recommendations (this worked very well for me once)
