In the previous chapter, you caught a glimpse of the different types of talk therapies available. Not every therapy helps with every problem. Your goal is to find both the therapy and the therapist that will help you. This is not easy. Early in your mental health journey, you may not fully understand or be able to express the problems you’re experiencing.
Training, education, and experience can vary widely among therapists. Knowing the basics of mental illness, diagnosis, or any particular therapy is not a given. You hope that if you approach someone who can’t help you, they suggest alternatives. That isn’t necessarily the case.
This chapter is all about finding a therapist who can help you. They need to understand your situation. You may show up with a diagnosis and clearly identified goals. Or, your therapist may need to help you start from scratch, exploring your symptoms to identify goals.
Having identified the problems, hopefully correctly, they need to confirm the most suitable types of therapy. This may not be straightforward. If a type of therapy is appropriate, hopefully they have the training and experience to provide it. If therapy isn’t appropriate or other treatments are better suited, perhaps the therapist can direct you to the right provider.
Finding someone to provide talk therapy can be extremely challenging. In most places, anyone can call themselves a counsellor or therapist. Specific qualifications or expertise aren’t required. However, most train in disciplines such as psychology or social work. The amount and areas of training can vary. You may be surprised to know that some counsellors, therapists, and psychologists have no training whatsoever in mental illness or knowledge of the DSM, etc. (Thankfully, most do.)
Many people rely on recommendations from others they know and trust. But with the wide variety of people, personalities, problems, and treatments, what works for one person won’t necessarily work for you.
If you’re looking for a therapist, start with their background and qualifications. We’ll discuss three aspects of this: training, the role of regulated professionals, and worldview.
If you’re looking for someone to help with diagnosis, look for (or ask them for) evidence that they’ve received appropriate training. It could have been a major part of a university degree. It could also come from courses or workshops in specific areas. Ask them if they follow the DSM, the role diagnosis would play in your treatment, how they approach therapy, etc.
Similarly, if you’re looking to treat a specific problem, ask about their qualifications to treat that problem. Have they received training in relevant therapies? How much training and from where? Ask them why a particular treatment is right for your situation and what the alternatives are. How mainstream is the type of treatment they provide? Can they provide independent, credible evidence that this treatment is appropriate? Run their answers by someone you trust who has some understanding of the area.
Unfortunately, a therapist’s degree by itself may not tell you very much. Someone with a BA, MA, or PhD in Psychology may have done most of their coursework in abnormal psychology, i.e., mental illness, which would be helpful. However, instead, they could have trained primarily in experimental psychology, human factors, psychometry, etc. These won’t provide enough of the relevant training needed to be a good therapist. The same applies to degrees in social work, education, etc.—all vast areas of study.
Of course, someone with excellent credentials may not be able to help you, while someone with a thinner resume might have the right skills and experience obtained through other means. Personal recommendations and reputation play a big role.
If someone says they are a medical doctor, you can assume they completed standard training and have certain qualifications. Legislation regulates who can call themselves a doctor. Other professional titles may also be regulated in this way. What titles are regulated, and the qualifications needed to use each title, vary widely between jurisdictions.
For example, in Canada, each province has different legislation creating a number of regulated health professions. Each profession creates a regulating body, typically called a college, that defines educational requirements, practice standards, and guidelines, as well as disciplinary processes. If someone meets these requirements and agrees to abide by the standards and guidelines (and pays a fee), they can become a member of that specific college. In return, the province provides exclusive use of a professional designation to members of that college.
Legislation only restricts the use of the exact designation. While “Registered Psychologist” may be regulated, if “psychologist” is not, anyone is free to use it. This could be someone who completed a PhD in psychology, someone with an undergrad degree in psychology, or even someone who took one course or read a book on psychology.
A therapist using a regulated professional designation guarantees a level of training. This does not guarantee that they’re an appropriate person to help you of course. Other titles or designations, whether backed by a trade organization or made up out of thin air, provide far fewer guarantees.
This doesn’t mean that someone without a professional designation can’t be very helpful to you. You’ll just have to ask more questions to find out. Remember, different jurisdictions have various regulated professional designations, standards, and rules. Do your research.
Earlier in the book, we described the biopsychosocial model. Those who subscribe to this model understand mental illness is rooted in a mix of biological, psychological, and social factors. The appropriateness of treatments is determined based on scientific evidence. This model, and the set of perspectives and assumptions behind it, is an example of a worldview.
Depending on their background, some people seek out counsellors or therapists whose worldview includes spiritual or religious components. This would include clergy or new age practitioners.
Different worldviews strongly influence the treatments therapists provide and the advice they give. Beware of anyone who doesn’t know the limits of what they can provide. They should recommend you see someone else when needed. A responsible priest won’t hesitate to direct a suicidal person to their doctor or emergency psychiatric resources rather than performing an exorcism. Psychiatrists and psychologists frequently refer patients to one another, recognizing the limits of what each brings to the table.
Ideally, any provider you see will help you find the right treatment for you, no matter who may deliver it.
Some people who work as counsellors or therapists have a very limited worldview. At the extreme, you’ll find people who don’t believe that mental illness is real or biologically based, just different ways of seeing the world. We should embrace these differences, not treat them.
Others believe that mental illness is real, but that all cases are due to one cause, e.g., vitamin deficiencies, childhood trauma, sexual abuse, or gender identity. This can go the other way too. Some people feel that medications are always the right choice for mental health issues, never therapy.1
By now, you probably have a few ideas about what you’re looking for. Maybe you’ve read about the regulated professions in your area and narrowed down the type of therapist you’d like to see. You may clearly understand what problem you want addressed or even what type of therapy you’re interested in. The more you know about what you need, the easier it will be. Now what? Time to go therapist shopping? Maybe…
Not to put the brakes on rampant consumerism, but you are looking for someone to improve your health. Like any other intervention, make decisions about therapy with your treatment goals, timeframes, and other alternatives top of mind. Consult your living treatment plan, not only when finding a therapist but also periodically to track your progress.
In an ideal world, you’d be able to see whoever can best meet your needs. But there are practical realities as well. One of the biggest is cost. Some people can afford to pay for therapy out of pocket, but most cannot. Most insurance plans either don’t cover therapy or limit the number of sessions they support. Therapy for a substantial problem will generally involve many sessions. With typical rates of $150 per hour and up, it adds up quickly.
The following sections outline resources that may be available to reduce or eliminate the cost. What each offers can vary. Even if you have access to affordable therapy, make sure it suits your needs. Free therapy that doesn’t help isn’t worth the price.
At the very least, be conscious of the costs when considering your options. There are other practical considerations, such as location and distance. Are there other concerns such as accessibility to worry about? And, of course, is the person you want to see available? Some therapists may have a full practice or have restrictions on who they take as clients.
If you’re working through insurance, an HMO, or your company’s EAP, they may have a list of people you can see. Otherwise, where do you begin?
Word of mouth is always a good starting point. Does your doctor or another health professional have anyone they recommend for your situation? Do people in your life who are open about mental health have any recommendations? Always keep in mind their needs may be very different from yours. Even if a friend’s fabulous therapist is utterly wrong for you, they may be able to suggest who you should contact.
Most therapists who take private clients also have websites with information about their training, background, types of therapies they use, and problems they see most frequently. If you’re interested in seeing someone from one of the regulated health professions in your area, check the website for that professional college. They may have a directory of members or a referral service that helps match your needs with one of their members.
If you’ve identified a few names, get in touch with them. Many offer a free or low-cost brief consultation, whether via telephone or in person. You can use this conversation to see if they might be a good match. Think about the questions you’d like to ask them ahead of time.
Finally, even if you start working with someone, you’re under no obligation to keep working with them. Finding a therapist who can help you involves not only their skills and training but a comfortable personal connection. Don’t feel you need to stay with someone if the fit is just not there.
When it comes to covering the costs of therapy, health insurance plans are one common way to do it. Many people have plans, whether purchased on their own or provided via a government program or their employer.
If you do have health benefits, read your plan brochure carefully. Find out precisely what is and is not covered, as well as any restrictions or constraints. Plans often pay for a fixed number of sessions per year and may cover only part of the rate charged by the therapist. They may place restrictions on who you can see. For example, your plan may only cover $50 per session for up to six therapy sessions a year with a Registered Psychologist.
Many companies offer workers therapy through an EAP. Typically, the therapy consists of shorter-term practical advice from counsellors via telephone or face-to-face sessions. You’re restricted as to who you see or speak with under this arrangement, though the entire cost is usually covered.
As with psychology coverage in extended health plans, they may limit how many sessions you can use. Unlike extended health plans, there is a bit more flexibility and the possibility of exceptions. After all, companies pay for EAPs to keep their employees at work. If an extra hour or two in therapy will help do that, it’s worth it to them.
Remember that EAPs are there to support your continued functioning in the workplace. The type of therapy or support you’ll receive is somewhat more limited and practical in nature than if you were paying out of pocket.
If you are off work for a considerable time, usually 90 days or more, you may be receiving long-term disability (LTD) benefits. If a mental health concern is part of the reason you’re unable to work, you may be able to have therapy covered by insurance.
To make this happen, you need to convince your case manager at your LTD provider (insurance company) that therapy would help you return to work sooner. Often, they arrange for you to see a psychologist for a few initial sessions. The psychologist then proposes they cover an extra number of therapy sessions. While the psychologist is often independent, they effectively work for the insurance company. They will report on your progress, identify obstacles preventing you from returning to work, etc.
It may help to ask your family doctor (or psychiatrist, if you have one) to write to the insurance company asking them to fund a psychologist. When you’re off work for health reasons, your insurance company is usually in contact with your doctors already. These recommendations can carry some weight with insurance companies, so are worth pursuing.
On occasion, the cost of therapy is based on a sliding scale. It is adjusted based on your financial situation. Not many therapists are in a position to be able to do this—they need to eat and pay bills, too!
Therapists who charge on a sliding scale may do so within their regular practice. Or, they may volunteer part-time at a clinic where everyone pays either a deeply-discounted or pay-what-you-can rate. If you have trouble locating someone in your area, ask your doctor. They generally know who can provide subsidized counselling or therapy.
You may have a mental health clinic or other organization in your area that provides some counselling or psychotherapy at no charge. These are generally government funded. Depending on their organizational structure and mandate, they may limit the amount of support they can provide and the types of issues they focus on. You may or may not need a referral from a family doctor to access these clinics.
These days, doctors are generally moving away from small, independent practices. In some areas, family doctors are grouped into team-based practices, either in a single clinic space or linking the services of several clinics in the area. Often with some government funding, they can offer services that are not viable in independent medical practices. Access to mental health workers is one such service. These groups go by different names, such as primary care networks or family health teams. Ask your family doctor if they have access to any mental health resources connected to their practice.
There are also psychiatrists who do an extensive amount of psychotherapy in their practices. As health insurance plans may cover psychotherapy provided by doctors, this can be very attractive. The downside is that very few psychiatrists provide an extensive amount, and waiting lists are almost always exceptionally long.
If you can’t afford (or can’t find) an individual therapist to provide the type of therapy you need to meet your specific goals, there may be alternatives.
One option is a more affordable therapist in another location. Many offer therapy via Skype or FaceTime. Online brokers are emerging that connect patients with appropriate therapists. Of course, everything we discussed earlier about checking into a therapist’s qualifications, background, and type of therapy offered still applies.
If you’re looking to learn new skills and techniques (rather than seeking practical advice or a depth therapy), you’ll have more options. As we noted, these types of therapies aren’t closely tied to your personal situation.
We’ve already mentioned groups and courses teaching skills such as mindfulness or CBT. You may be able to find no-cost or low-cost options in your area. While not ideal, there are online skills courses, too.
Books can also help you learn skills and techniques. Of particular help are workbooks that provide step-by-step instruction, along with exercises at each step. Many excellent workbooks have been created by leaders in the field who have taught a therapy for many years. You can find some recommendations on our website; see Appendix A.
There are also many mental health smartphone apps, though of highly variable quality. Some help teach you a technique and are set up like a book or workbook, though often contain only a small subset of what you’d find elsewhere. Others help you practice a technique once you’ve learned it. Mood tracker apps allow you to monitor your symptoms and may remind you to practice or guide you through some techniques.
Interpreting a therapist’s training or credentials is difficult. Some are members of regulated professional colleges.
Keep in mind constraints such as cost, location, and insurance coverage, but make sure the therapy they offer will meet your needs.
Group benefits may include employee assistance plans, which can provide some therapy. Extended health benefits may pay for other therapists.
Some clinics offer fees on a sliding scale based on income. Other more affordable options are therapy groups, courses, workbooks, or apps.
Providers may understand the value of many treatments, yet only offer a few. This is very common. A psychiatrist might agree that medications and psychotherapy would be helpful but only offer medication management. They would recommend that patients see someone else for psychotherapy.↩
Now Available! A MSP-supported live course for BC residents based on the book. [Mar/2023]
While you can read it for free online, there are conditions on sharing it with others (see below). You can also still purchase copies in paperback or e-book (PDF, Kindle, Kobo, etc.).
Now Available! A MSP-supported live course for BC residents based on the book.
