Choosing a professional to help in your life is one of the most important decisions you can make.  If that person is helpful, life will be better.  If not, it can actually be damaging.  A good fit is crucial.

A good fit is when you have a sense of looking forward to sessions.  You should feel lighter afterwards.  You should have a plan or a bit of homework.  Your thoughts might drift to “I should call him/her” if you are struggling.  You should see improvement, or at least more hope if your situation is more entrenched.

A bad fit is when you find yourself dreading sessions, not telling the truth, being resentful about paying or wondering what you are actually doing in this work.  A bad fit can be damaging in that a person could come to hate therapy, refuse to ever go back, effectively cutting off a huge avenue for growth for years to come.  Even worse, it could leave the therapist’s words ringing in your head, making you feel crazy or more self-conscious.  Talk to your therapist first, before leaving, if possible.  Often, changes can be made.  If not, switch practitioners.  Look for natural helpers (friends, school social workers, EAPs, pastors, etc) to generate many names.  Then, get each person talking on the phone.  You’ll have a gut feel as to how they answer, if it feels right.

Bear in mind that it will take a few sessions to become completely comfortable with so much openness with a new person.  But there truly should be a sense of this being “right” or “ok”.  Your therapist should also be able to articulate the direction they would like to take you in, discuss methods of progress towards your goals.  If not, watch out for “Uh Huh” therapy, as I like to call it … . (Basically, everything you say is met w an “Uh huh… .”) 

For a child/teen, choose someone who can bridge both the kid world and the adult world.  Many therapists are more comfortable in only one or the other.   An ability to be at the kid level with play therapy or an ease of connecting with a teen matters.  Look for toys or fun in an office and attitude as well as invitations from the therapist for you to be a part of this work. 

For couples therapy:  Choose someone who has read and thought about couple interactions and can discuss their learning (ie the theories they like).    A good couples therapist should be able to balance “both” sides and be able to discuss how they interact.  Look for someone who is assisting you two to talk w/ each other, too – not just someone who referees and is the ultimate judge of mental health. 

Finally, look for someone who is training to stay on the cutting edge.  There is a lot of movement right now in the mental health field and a growing split is occurring between the new technologies that are out there vs practitioners who are not learning and improving themselves. 

Are there differences between the various degrees?  Psychiatrists are MDs who prescribe meds that can effect a change in your brain chemistry to help alleviate symptoms.  In some states, PhD or PsyD Psychologists can prescribe as well.  Many psychiatrists don’t tend to have a lot of therapy experience, but are outstanding at understanding the workings of the brain.  Many people have both a therapist and a psychiatrist that should work together on your behalf.  Otherwise, there are minor differences in training and outlook between degrees;  but even more important, in my opinion, is what how long they have been in the field, the enthusiasm of their recommendations from others and their continued training in this complex area.  Gauge your comfort level with their personality and style.  The smartest doctor can have a horrendous bedside manner, as we’ve all experienced! 

What about in vs. out of network on my insurance?  Be aware that while insurance is helpful financially, many experienced practitioners are starting to opt out of accessing insurance reimbursements … mostly because they can.  Their training, expertise and warmth put them in demand and like any field, they would like to be paid for their work.  Insurance panels pay horribly low and are getting lower.  The right practitioner can be cost effective for you because they use each session wisely.  Consider for yourself if this is a life changing issue that will hamper you in life if not dealt with … it might be worth it to put some resources towards it with their right practitioner.  I you must be in-network, consider expanding the location of your search and commuting further.

Remember — effectiveness and comfort are where it’s really at – you need this problem to change and it won’t unless you can relax and be a comfortable partner with a person who knows where to take you.  Don’t settle for less!