Finding a therapist who works for you… even if you’ve had a bad experience in the past

Remember that you’re the boss, and use this step-by-step process to stay feeling empowered, informed and in control.

Photo by Priscilla Du Preez on Unsplash

Why write this article?

Skip to “so you want a therapist” below if you want to get right to the search steps, or go directly to the free downloadable PDF version.

Anne* sighed when I asked her about her homework. She hadn’t done it.

During our last career coaching session, we’d realized that a lot of Anne’s resistance around work was deeply related to unresolved trauma from a former abusive relationship. Her homework had been to look for a therapist who specializes in helping people process trauma. As we picked away at why she hadn’t gotten around to it, a torrent of her past, bad experiences came out.

“I’ve had therapists who see my sexual orientation as something to treat,” sighed Anne, a lesbian in a long-term, committed relationship. “I’ve also got an old diagnosis and I feel like when therapists hear it, they stop listening to me and just see that.” The more we talked it through, the more it became clear that for her, therapy was not simply a tool she could use when she needed extra support — but an interaction that had taken her vulnerability and need and offered support that was at best, lacking, and at worst, harmful.

Over the last 2 years(during the pandemic) I’ve referred more clients to therapy than ever before. Many found wonderful, productive, supportive relationships — but Anne was not alone in having had a bad experience. I’ve had clients tell me about tragic cultural incompetence — a misunderstanding and judgment of their religion, background, or race. I’ve had clients tell me that therapists had dismissed their trauma telling them “not to think about it.” One client shared that his therapist seemed to just use their sessions to complain about her life.

The other reason many of my clients were balking in the therapist search was simple overwhelm, something I can relate to. In college, when my depression got so bad I couldn’t ignore it anymore, I pulled myself together and used the tiny amount of energy I had to see the college counselor. I was totally transparent, totally vulnerable, trying to avoid the weird combative relationship I’d had before… They essentially said, “Woah woah woah that’s a bit above my pay grade,” gave me a list of names and booted me out the door.

Of course, my experience isn’t on par with having a trauma dismissed or my identity pathologized, but for a depressed person to be given a series of complex, emotionally taxing tasks… let’s just say, it wasn’t the support I needed in the moment. It took me a few more months to book an appointment with the first name on the list. I was lucky, and that therapist was perfect for me, but the situation could have easily could have gone another way — with me never actually getting help and just getting stuck in the struggle.

There are amazing, thoughtful, intentional, lovely, smart therapists out there, but just like any field, there are good eggs and bad eggs.

Unfortunately, we often find ourselves seeking a therapist at a moment in our lives when we are struggling the most, and don’t have the bandwidth to discern good from bad. We’ll make a quick decision rather than a thoughtful one.

Whether you’re completely overwhelmed, healing from a past bad experience, or simply daunted, I wanted to create something to break down the search.

So you want a therapist:

Here’s a list of bite-sized steps to use to find a therapist who’s a good fit for you. Go through the steps as far as you need to until you have 3–5 practitioners to call and start exploring work with. If you live in a dense city, you might need to go through all these steps. If you live in a more rural area, your options may be more limited. The information here is not exhaustive, just enough to start breaking down the overwhelm.

Note: Here’s a link to a downloadable PDF version of this checklist — I find when I’m overwhelmed, I go analog, so just in case your mind works like mine does, I thought this would be a good resource.

Step 1. If you know and trust any therapists, ask them for a referral to someone they recommend who specializes in your needs

Step 2. If you don’t have therapists in your network, go onto a website like psychology today (like Netflix for therapists!) and find a list of practitioners in your region

Here are some additional resources for finding a therapist, excerpted with permission from “Trauma and Design” by Rachael Dietkus, LCSW

  • Inclusive Therapists offers a safe, simpler way to find a culturally responsive, social justice-oriented therapist
  • National Queer and Trans Therapists of Color Network — a healing justice organization committed to transforming mental health for queer and trans people of color
  • Therapy for Black Girls — an online space dedicated to encouraging mental wellness for Black women and girls
  • Asian Mental Health Project — works to increase dialogue via storytelling and helping to spread support resources with mental health professionals
  • Decolonizing Therapy — a source for radical, affirming resources related to therapy and the growing awareness of work that sits at the intersection of psychology, somatics, spirit work, and activism through therapeutic containment
  • The Loveland Foundation — an effort to bring opportunity and healing to communities of color, especially Black women and girls

Step 3: THE FIRST PASS
Look at each person’s information, and compare them, just like anything else you might buy, and ask yourself some questions:

  • Do they take your insurance (if you’ll be using insurance)?
  • Do they specialize in the issues you feel you need support in?
  • Do they work with your age group?
  • Are they taking clients? (If it’s not listed, you can usually get this information through email or calling the office)

Step 4. The SECOND PASS
If you’re still overwhelmed by options, ask yourself these questions and sort the list accordingly.

  • Do you have a gender preference?
  • Do you have an educational preference? Do you want a psychiatrist? A PsyD? An LCSW? Obreak down what these terms mean a bit below. **
  • How long has the person been practicing? Do you have a preference?
  • Who do they work with? (What communities is this person comfortable and confident working with, and do they align with your needs and values?)
  • Do you like their style? What kind of person would be the best guide and partner for you? You can usually figure out some elements of a practitioner’s style by looking at the practice they work within, training or certificates they hold, and the way they write (blog) or speak about their work.
  • What treatment approaches attract you? There are MANY different kinds, I describe some below. ***

**Here’s a breakdown of different levels of education your practitioner might have:

LCSW licensed clinical social worker

LPC, LMHC, LCMHC, or LCPC licensed clinical professional counselor — master’s level education in counseling specifically

PsyD — Doctorate of Psychology (PHD level)

MD/Psychiatrist — can prescribe medication, has medical training

***There are MANY options out there, and there’s no reason for you to be familiar with EVERY methodology each practitioner offers, but the techniques a practitioner uses can tell you a lot about how they approach their work. Here are a few with some VERY brief summaries to help you begin to discern.

CBT — Cognitive Behavior Therapy — a research-backed technique that focuses on identifying and correcting or modifying unhelpful ways of thinking and behaving

MBCT — Mindfulness-Based Cognitive Therapy — helpful for those looking to reduce stress, manage pain, and bring intentional response to their lives.

ACT — Acceptance and Commitment Therapy — helps clients identify character traits and behaviors to overcome to reduce avoidant coping styles

DBT — Dialectical Behavior Therapy — a form of CBT combined with distress tolerance and mindfulness often used in the treatment of Borderline Personality Disorder

Psychoanalytic — an in-depth therapy technique based on helping the client to make the unconscious conscious so they can make choices about how they think and act

IFS — Internal Family Systems — a compassion-based technique that helps the client to identify and address multiple sub-personalities that try to control and protect the person and are in conflict with the core self — focus is on healing parts and restoring mental balance

Somatic — a practice that bridges the mind-body dichotomy, often effective for treating trauma with physical symptoms

Hypnotherapy — an adjunct form of therapy used to treat anxiety, phobias, bad habits

NLP — Neuro-Linguistic Programing — a debated technique that incorporates language and sensory-based interventions and behavior-modification techniques intended to help improve a client’s self-awareness, confidence, and social skills.

Attachment-based — a process-oriented form of counseling based on developing or rebuilding trust, centers on expressing emotions

EMDR — Eye Movement Desensitization and Reprocessing — psychotherapy that stimulates your brain (through hand tapping, audio stimulation, etc) to access and process traumatic memories

Narrative Therapy — helps clients construct meaning in their lives through storytelling

Step 5. MAKE SOME CALLS
Once you have a shortlist of 3–5 folks who appeal to you, give them a call (or email). Treat this like a job interview for them — you’re looking for someone you can trust with your vulnerability, someone who will make you feel safe and taken care of. Does the person on the other end of the phone, zoom call, or room make you feel that way?

Step 6. Pick a practitioner, set up your sessions.

Extra: This is a space where you are showing up with your heart on your sleeve, it’s ok to protect yourself in that space by walking away if someone makes it feel unsafe — on purpose or by accident. So don’t throw away the list of names!

Photo by Quino Al on Unsplash

What therapists have to say…

After speaking to so many clients who had had bad therapeutic experiences, I reached out and asked my friend, Liann Seiter, LCMFT (Licensed Clinical Marriage and Family Therapist) what she would say if she was a fly on the wall.

1. Not all therapy programs are created equal.

As I am networking, interviewing potential therapists for my practice, etc., I’m learning that not all training programs include the rigor and practice that mine did. Some clinicians go through a whole training without being observed in real-time with a client. They may know the theory behind good therapy but are unsure of how to put it into practice.

2. Not all therapists are created equal

At the end of the day, each therapist is just a human also struggling to figure out this complicated thing called life. We come to the therapy room with different life experiences that help us empathize (or not!) with our client’s experiences. Each therapist also comes with their natural strengths and weaknesses. Ideally, a therapist will be able to identify their weak spots and address them.

Also, our nation’s health system is messed up. Insurance companies don’t reimburse therapists well and can be a pain to work with. Therapists who take insurance often have to take on too many clients to pay bills (therapy burnout is real). Many therapists who can (the experienced ones) don’t take insurance. If you didn’t like your therapist and can afford it, you may want to consider paying 100% out of pocket or using insurance that will reimburse you for out-of-network practitioners.

3. Not all therapy models are designed for your needs

I had a friend who finally fired his therapist of *many* years after the therapist said a very hurtful comment. My friend found a new therapist who used a much more practical model (Dialectical Behavioral Therapy) and within weeks he improved in ways he never did with his previous therapist. It’s such a shame he wasted so much time with the wrong therapy model (psychoanalytic). If you’re not making progress, it may be your therapist’s incompetence, but it may also be that their model isn’t right for you.

4. It’s good to tell your therapist when they fuck up or when things aren’t progressing

Weirdly therapy is also a place where you can talk about your negative feelings about therapy and process your negative relationship with your therapist. A good practitioner will be able to hold space for the client and hopefully assist the client in expressing their needs. I always want my clients to speak up when I mess up — either so I can apologize/resolve the issue, not do it again with future clients, and/or help them find the therapist who would fit their needs better. If your therapist said something inappropriate, culturally insensitive, or reacted to something you said in a way that hurt you can tell them.

5. It’s OK to break up with a therapist that isn’t working for you

I’d encourage people to tell their therapist (me included) that they don’t want to continue therapy rather than ghost them. When clients have suddenly fired me I try to follow up to debrief about it. My goal is that we can end things in a transparent and (hopefully) positive way. I want to help them find a practitioner who can meet their needs if I’m not a good fit for them. But, I also know this is a hard thing to do. Canceling a session with a therapist and not telling why is also fine. I promise, they can take it.

6. I am not doing my best therapy during this pandemic.

I don’t know if there is more to say about this. I am trying my best, but I’m also living with this uncertainty, isolation, and fear. It’s hard to support others during this time. I hate zoom by the end of the day. I have been ramping up my self-care, taking fewer clients, and reaching out to colleagues for support, but the truth is I am having a harder time finding the right words, I struggle to know what I should say as a therapist when what my client says hits a little too close to home in my personal life, and I’m just not great an emailing people back/following through between sessions. It sucks. I wish I could be superhuman. I’m not. I know through the many peer consultation groups I attend MANY therapists are struggling. So, on behalf of all therapists, I apologize. We’re doing the best we can, but that’s far from our all-time best.

Final thoughts:

If you leave this article with anything, I hope it’s these two ideas:

  1. You are the boss. You have the right to interview, to choose, to change your mind, to fire, to question technique and to guide the course of your relationship with a therapist in a way that works best for you.
  2. Just because you’ve had one (or two or three) bad experience doesn’t mean that there isn’t a practitioner out there who would be the perfect partner for your growth. Keep looking for your “good egg”.

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Michelle Krasny

Career Coach and avid researcher, exploring what it means to have a kickass career without sacrificing your soul or sanity along the way: michellekrasny.com