I’ve been thinking about writing this blog post for a long time. Every time someone calls me in their search for a therapist, or a friend asks for some advice on how to find the right therapist for them, I wish I could inform more people of some principles to guide their search. So here it is! Finding the right therapist for you is a process where a few simple tips and a little guidance can go a long way. As a therapist, I care that people access the best care they can within their budget, to fit their personality, and that is most likely to help them. It saddens me when I hear ‘oh I tried couples counselling and it didn’t work’. And I then ask ‘well did you like the counsellor?’ and they answer ‘not really’, I ask ‘did they have a specialization in couples counselling?’ and they say ‘I don’t know’.
This is not their fault of course, it’s that there is a gap in knowing what the norms and standards of care in the profession are. Our world is very specialized and there are too many lingos and norms to possibly to know all of them. The reason the all too common situation above saddens me is because counselling has a much better chance of leading to growth and change when there’s a good fit. Also, it might decrease people’s willingness to try again when they’ve had a less than great experience the first time after usually a long time of building up the courage to try. But armed with these ideas and tips, I hope this will empower you to seek a good fit from the very beginning.
The following is a bit of a detailed read. So here are the main points:
It’s normal and okay to shop around at the beginning, you won’t insult the therapist.
Some concerns are specializations and you should seek therapists who have specialized training and experience to help with these. These include: resolving childhood trauma & PTSD, eating disorders, couples counselling, therapy for children/play therapy.
Call about 3 therapists and ask them questions – you can often get a felt sense of personality fit from that.
There are many modalities of therapy, and you might jive with some better than others.
I understand that when someone is looking for a therapist, typically something is going on that is driving them to seek some relief and the idea of doing a ton of research to find the right therapist for them might feel like yet another obstacle or burden. But don’t despair – ultimately, finding the right fit is worth the effort up front! Besides, most therapists are easy to talk to and understanding, so they usually help the conversation along and are empathic.
Personality, type of therapy they practice, and training is something you can ascertain over the phone with a potential new therapist by asking a few questions and some therapists offer a free first session. Take them up on it! And don’t feel obliged to continue if you don’t feel comfortable with them.
The following information applies to a BC context. I’ve worked in different parts of the world as a therapist, and from province to province and country to country the rules are very different due to different laws and training standards. The questions I recommend asking to a new therapist might still be useful to someone outside BC but the terms and requirements for professional designations are specific to a BC context.
Distinguishing between terms in BC
Psychotherapist, Counsellor, Registered Clinical Counsellor, Psychologist, Psychiatrist, Life Coach – what’s the difference? This is an important one. In BC, only the terms Psychiatrist, Psychologist, Registered Clinical Counsellor (RCC), Registered Social Workers (RSW), and Canadian Certified Counsellor (CCC) are protected terms. Each of these has a regulatory body that reviews the credentials and training of the person applying to use the term, and ensures they adhere to an ethical code. In BC, anyone can call themselves a Counsellor, Psychotherapist, or Life Coach even if they belong to an association. The terms are not protected. I recommend seeking a therapist who has at least Master's level training in Counselling or Social Work to entrust your or your family's psyche and mental health with. The field of Psychology is continually advancing and is complex - a Masters represents more time to assimilate knowledge, training, and supervision with a more senior professional. Ideally, this therapist is also keeping up-to-date with training and best practice as it emerges.
RCC’s and CCC’s have a Master’s of Counselling or equivalent in BC. MSW’s have a Master’s of Social Work. Psychologists have a PhD or PsyD in Clinical or Counselling Psychology, unless they were grandfathered in with a Master’s degree when the laws changed about a decade ago. Psychiatrists have a medical degree and then specialized training in Psychiatry. They are the only ones who can prescribe medications. Their fees are covered by MSP. Unfortunately, they often have long waitlists. Private Psychiatrists have shorter waitlists.
Cheaper alternatives to individual private therapy
It is unfortunate that public mental health provision in Canada is so poorly funded. When I lived and worked in Australia anyone could go to their GP and even if they had mild or moderate levels of mental health afflictions, they could get a referral to see a private Psychologist covered mostly by Medicare. Here in Canada there are community mental health clinics that provide free psychotherapy, but they often have long waitlists – usually 6 months or longer. Universities that have Master’s of Counselling or Clinical Psychology programs usually have student clinics at reduced fees where you can see counsellors in training supervised by someone more advanced in the field. Some private therapists have a sliding scale, which means they offer lesser rates based on income. The Canadian Mental Health Association (CMHA) branch near you can likely point you to the cheaper service options in your community.
Also, you could consider joining group therapy to keep costs down. Often the learning in groups is equally powerful and supportive, and helps generate the feeling that we are not alone in our struggles and that others get us.
How to choose the right therapist for me?
Here is something that many people don’t know about the process of finding a therapist: it’s okay to shop around before you engage a therapist! Many therapists offer a free first session or telephone call in order to allow you to feel them out.
I recommend calling about 3 different therapists and having a conversation on the phone. Here are some examples of questions you can ask. If you dislike the phone (an increasing number of people do these days), you can send an email explaining you don’t like the phone and see if they can answer some of these questions via email (it might just take longer to get back to you) or in person.
1. Explain the main issue(s) you are experiencing and ask – how would you work with something like this?What is the modality of treatment you use and what are the underlying philosophies of healing that underpin them? [note: therapists who really get their method of practicing have thought about these things a lot and should have an easy time explaining them to you.] You can jot down the modality(ies) they list and then google them afterwards to learn more about them. Many therapists are ‘eclectic’ which means they practice more than one modality – if they answer eclectic, I’d press on and ask which modalities encompass this for them. In my opinion if you detect defensiveness to your questions that’s a red flag. It might suggest a defense mechanism or insecurity around their practice, that they should have worked out by now if they are in private practice.
Each modality has a theoretical underpinning that is a philosophical view of how problems are created and how they can be healed. See if what they explain fits with your underlying worldview and intuitively feels like how you wish to go about healing. Some modes of therapy are more practical/rational, others are more geared to processing and evoking emotional experience, some are a combination. Some involve homework and exercises, some are less structured. Sometimes when people say that therapy doesn’t work for them it’s because they tried a style that wasn’t a good fit for them, their preferences, and needs. Or there wasn't a good personality fit.
2. Ask them what their experience is in working with this issue. Do they have expertise in it? In what contexts/settings have they worked with it?
3. Ask them about their credentials and where they did their education?
4. Ask what professional body they are registered with – you can then check with that body if they are a member in good standing (which means they haven’t had any ethical cases decided against them). You can usually look this up on the professional body’s website.
5. Ask about fees and see if this is within your budget. More does not necessarily mean they are a better therapist. Some therapists price in a way that reflects the (erroneous) perception in our culture that worth goes along with price. Not always of course, but don’t let the dollar figure be the only determinant of their suitability for you. Most professional associations recommend a price for their members to charge. For example, the BC Association of Clinical Counsellors recommended rate is $120/hour and the BC Psychological Association recommended rate is $200/hour.
6. You can ask them whether they undergo clinical supervision and what training and conferences they have been to recently. Good therapists keep learning, updating their knowledge and skills, and are humble to keep working on themselves as people as well as therapists (clinical supervision can aide this and it is a standard in the profession to undergo on-going supervision of some sort, it may be peer supervision as well. Supervision helps therapists work through counter-transference issues and helps them to see clearly what’s their 'stuff' and what’s yours).
7. Ask what days & times they have available for scheduling. Part of keeping up with going to therapy will be whether it fits in your life in terms of schedule and location. Be realistic about how far you want to travel from your home or office to get there and whether their openings fit into your schedule.
8. If they don’t have experience in the issue you are seeking help with or there is another reason you feel there isn’t a good match, it is completely okay to ask for a referral - if there is someone specialized they would recommend. Therapists often have large networks of colleagues and knowledge about who specializes in what. There is an ethical principle of duty of care which is to not practice outside one’s scope of expertise.
At the end of the day, it really doesn’t matter which questions you ask, what you are trying to do to get a sense of is personality fit - whether you feel safe and comfortable talking with this person. There is an intuitive sense here to trust. Also, whether their underlying philosophical worldviews fit with yours. Good therapists are open, kind, grounded and can see the big picture that in everyone’s best interests for there to be a good fit. Any therapist that seems pushy, trying to sell you their services, or makes guarantees or promises of being able to cure you should be related to with caution. This usually feels icky so again here, trust your gut.
Now sometimes we might not jive with a therapist because transference is happening, meaning they trigger us or something about them reminds our subconscious about someone/something from our past we layer on top of them. This might not mean that they are not right for us. You can sit with the feelings a bit to see which it is – transference or a simple matter of lack of fit. It's okay to have preferences in terms of gender and age as well. You will be investigating your psyche with this person after all, and you want to feel comfortable doing so or else it will be hard to open up and go deeper.
What about online therapy?
Online therapy is a good option for people who live in remote communities, have mobility restrictions, busy schedules, or other reasons in-person visits might be difficult. There are many therapists these days who offer videoconferencing options. My personal opinion is that it would be best to choose someone within the province where you live – as then you know they are bound to the laws and standards of that province and can be registered with a certifying body in your province who regulates training levels and adherence to an ethical code.
Also good to know
Even if you thought there was a good fit initially, it’s okay to change your mind part way along the therapy process. Sometimes this is actually more about a subtle resistance to the work of therapy, so if it's possible for you, discuss it with your therapist, because at the very least they can give you a referral and they may be able to help you determine if it's more about fear/avoidance or change tact.
Giving your therapist feedback as to how the process is going is really helpful! For example, If you want more practical strategies, more concrete goals to work on, or more or less of anything in therapy, bring that up – nothing about the process is set in stone.
It’s worth it! On my own journey and over and over in others' stories I hear about the freedom gained of self-discovery and learning using consciousness to stop the repetition of patterns inherited through many generations in our families. We all have them, and they are no one person's "fault" as they inherited them as well - but it is within your capacity to stop the buck here.