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How to Choose a Therapist or Counselor

I have heard many stories over the years over the factors that come into play when people seek our a mental health counselor for the first time. For many, this is a deeply personal decision that they spend a great deal of time researching, and for others it is a very quick decision that entails scheduling with the first person to answer the phone. We’ll outline a few areas to consider when looking for a therapist, and help you get started with your first visit. At the end of the day, the best way to assess this is to go and meet with a counselor, and get a good sense of what they’re about, and how they think they can help.


Word of Mouth

Referral sources often get feedback about the experiences that other people have had with local counselors. Asking your family doctor, pediatrician, friends or other trusted source can be a great way to get an honest appraisal of quality clinicians close to home. If you know a therapist in a nearby community, they will also be very likely to know some quality therapists that are nearby. Ask around, and get some ideas about who may be a good “fit” for you.


Area of Specialization

Not all counselors are “specialists”, but they all should be able to give you an appraisal of their comfort level with treating specific issues. If your difficulty falls outside of their experience, they can often suggest someone that has focused more heavily on that area. The term “specialty” in mental health services is often different than the term “specialty” in medicine. Medical specialists often narrow the scope of their practice and pursue board certification in that specialty. Most mental health counselors receive training in a broad range of areas, and continue to work with a wide range of problems throughout their careers. They note “specialties” in therapist directories to indicate that they feel capable and effective with a certain issue or population. The best way to clarify this is to contact the therapist and ask about how well equipped they are to address what you are struggling with.


Scheduling Flexibility

While I frequently encourage people to seek out good therapy rather than convenient therapy, the best kind is therapy that you can realistically show up for on a consistent basis. Skilled clinicians are in high demand, and don’t be too put off if they do not have any openings when you happen to be free. If you are able to find some wiggle room in your schedule, and they can do the same, it’s often a solvable issue. It is worth asking if a therapist that you like expects any openings in the near future. They may have a sense of which spots contain people that are “wrapping up”, and may be able to work out something slightly inconvenient in the short term, until something more comfortable opens up later. If you don’t have any luck, keep looking! Sometimes catching the right counselor at the right time results in serendipity, and they have an opening at just the right time.


Theoretical Orientation

A clinician’s “orientation” refers to the specific type of therapy they use to treat issues (an orientation is based on a specific psychological theory, hence the term “theoretical orientation”). Some orientations are very pragmatic, focusing on modifying behavior or thought patterns as they relate to your day-to-day life. Cognitive Behavior Therapy, or “CBT” generally fits this description, though there are exceptions to the scope of the focus that CBT takes on. If people are looking for something shorter term and “tangible”, CBT or a similar modality might be a good fit. Other orientations focus on longstanding unconscious patterns that have been problematic, and may be a part of a longer-term process in therapy. Psychoanalytic or psychodynamic therapists employ techniques and processes that fit this longer-term focus. All of these approaches have a rich history of helping people improve their lives, but finding a good fit with how you see the world might be beneficial to your outcome. Don’t be hesitant to ask therapists about their orientation, and how they apply that style to your issue.


The “Intake” as an Interview

The very best way to asses the fit between you and a certain therapist is to meet with them for an initial visit. An “intake” session is usually an hour long session in which the clinician gathers background information to help plan a strategy for improving your symptoms. This is most certainly a two-way street, and allows you the chance to ask questions, and assess your comfort level with that person. They should be able to articulate some ways that they think they can be helpful to you, and you should feel some level of comfort in your interaction (though this certainly improves over subsequent visits). If it’s not a good fit, don’t be afraid to try someone else.

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