"Being in therapy is great," comedian Caroline Rhea once joked. "I spend an hour just talking about myself. It's kinda like being the guy on a date."
It's not a bad analogy — the dating one — when you're setting out to find a therapist. You want someone with whom you can spend an hour week after week; someone with whom you can be vulnerable; someone you trust and respect.
But a therapist plays a unique role in your life — helping you identify and tackle points of distress in a way that family and friends and partners are unable to do. Sometimes at upward of $150 an hour.
So the search is sticky. And it's usually embarked upon during an already stressful time.
"It's a very vulnerable thing to be in therapy," says Lynn Bufka, head of the department of practice, research and policy at the American Psychological Association. "As with any health care provider — whether it's a physician or nurse or therapist — you're interested in finding someone who's competent. But the question of fit becomes even more critical with a therapist, because you're going to see that person quite regularly and you want to have a comfortable relationship."
Start the search. "Asking a friend is a reasonable place to start," says Bufka. "Many people find success with that. You can also ask your health care provider."
An Internet search for umbrella organizations can also lead the way: The American Psychiatric Association, the American Psychological Association, the National Association of Social Workers, for example.
"We all have national professional associations. and they all have state chapters," says Mark Hamilton, executive director of the American Mental Health Counselors Association. "With electronic directories, you can often call up a picture of the person and see their credentials and see what area they specialize in."
Check credentials. "Ensure the person is licensed within psychology, which implies they've met at least the minimum education and experience standards to practice within the profession," says Bufka. "It also gives the patient some protection, because the duty of a licensing board is to protect the public."
It's also fine, Bufka says, to ask for a bit of background. Where did you go to school? When did you get your degree? How long have you been practicing? Do you have an area or areas of specialization? Do you work with clients in similar circumstances to mine?
Do some self-reflection: Ask yourself where the root of your stress appears to lie: Within yourself? Your child? Your spouse? Are you struggling with an addiction? Are you entertaining harmful thoughts?
And don't worry if you can't pinpoint an exact starting point for your feelings of malaise. A good therapist will help get you there.
"The goals of therapy will be determined mutually between the therapist and patient," says Bufka. "Therapy can help you make significant changes in areas of your life that might be contributing to your distress. It can help you see how all the pieces fit together and when one problem developed in relation to another."
Schedule an initial meeting: Plan to spend a chunk of time on the phone or in the office with a handful of therapist candidates before committing to one person. Find out how each handles payment, whether and what kind of insurance is accepted and how much experience they have with your particular stressors.
"You could say, 'I think I have OCD. Have you treated this kind of problem?'" Bufka says. "They might say they really want to do a good evaluation to make sure that's truly your situation. But they also might say they have a lot of experience treating anxiety and OCD is a kind of anxiety and here are some ideas how we would proceed.'"
Some people want to know how long it will take to start seeing changes, says Bufka.
"That's a reasonable question," she says. "Your problems are unlikely to change overnight, but change can be a variety of things: symptom reduction, improvement in mood, improvement in function, better ability to get to work, improved relationships. Therapy outcomes can also mean an increased self-understanding and not repeating prior patterns."
Trust your gut: "It's very important to keep in mind you are the person seeking the service and you're in charge of deciding whether it's the right fit or not," says Bufka. "You're not going to go to someone you don't think is going to help you."
That said, remember that you're not looking for a pal — or a date.
"You don't have to necessarily like the therapist," Bufka says. "It's important to feel the therapist respects you and understands you and has the expertise to help you with what you're seeking help for.
"Sometimes a therapist is going to challenge you and push you, and it's not going to feel warm and fuzzy," she continues. "They should push you in a way that feels respectful and at a pace you're comfortable with, but that doesn't mean therapy will be without difficulty."
What the terms mean
"The term 'therapist' is a very general term that can be applied to a variety of different professions serving a variety of different needs," says Mark Hamilton, executive director of the American Mental Health Counselors Association. A primer on a few of the main types of mental health professionals:
Psychiatrists: Specialize in diagnosing and treating mental or psychiatric illnesses and are licensed to prescribe medication.
Psychologists: Hold doctoral degrees in psychology. Not licensed to prescribe medication, but can refer patients to a psychiatrist.
Licensed clinical social workers: Specialists who hold at least a master's degree in social work and have met state licensing requirements for minimum working hours (likely 3,000). Often help patients with psychological, social functioning and relationship problems.
Licensed mental health counselors: Required to hold at least a master's degree in counseling and 3,000 hours of experience. Able to diagnose and treat mental and emotional disorders.