Finding a Therapist

A psychotherapist is someone you are going to trust to help you with your psychological and emotional well-being, and therefore, you want to feel confident that you are choosing a qualified psychotherapist who best fits your needs and interests. The following may help you in selecting the right therapist for you:

• Finding a Cognitive Behavioral Therapist
  • Questions for a Potential CBT Therapist
• Types of Psychotherapists
  • Clinical/Counseling Psychologists
    • Counseling vs. Clinical
    • Phd vs PsyD
  • Social Worker (LCSW)
  • Marriage and Family Therapist (LMFT)
  • Psychiatric/Mental Health Nurse
  • Psychiatrist
• Therapist's Qualifications
  • ​​Amount of experience
  • Quality of experience​
  • Range of experience
  • Therapeutic relationship
  • Cultural competence

FINDING A COGNITIVE BEHAVIORAL THERAPIST

If you are suffering from anxiety or stress, it is important to know that decades of scientific research and clinical trials have shown again and again that for many people cognitive behavioral therapy (CBT) is an effective treatment for anxiety and stress and that these benefits tend to be long lasting. 

Many therapists describe themselves as using CBT but some may only be using certain strategies in the context of a more traditional "talk therapy." A structured CBT approach, with specific strategies tailored to a specific treatment conceptualization and with relevant readings and monitoring forms, has been found to be both efficient and effective in the treatment of anxiety disorders, but that does not mean that is best for everyone. What's important is that you understand what your therapist is offering to be sure it is a good fit for you.

Some therapists may use CBT in general but may not have training in the cognitive behavioral treatment of specific anxiety disorders. For example, for Obsessive Compulsive Disorder and Panic Disorder there are specific treatment strategies and explanations that are unique to these particular disorders and are powerfully effective components of treatment.

Therefore, for these particular disorders, it may be more important to find a therapist with specialized training and experience in anxiety disorders who can also provide you with the materials and strategies that can help facilitate treatment. Do not be afraid to ask a therapist questions that will help you determine whether the therapist has the skills and expertise you are looking for. 

Questions for a Potential CBT Therapist

• "What training and supervision did you have in the cognitive behavioral treatment of anxiety disorders?"

• "How much of your practice involves anxiety and stress disorders?"

• "What are your treatment strategies for someone with the types of issues I am struggling with?"
  • For Obsessive Compulsive Disorder, ask about Exposure and Response Prevention.
  • For Panic Disorder ask about "interoceptive" exposure.
  • For Generalized Anxiety Disorder ask about more than relaxation strategies such as mindfulness, scheduling worry time, or the cognitive behavioral treatment for insomnia.
  • For Social Anxiety Disorder, ask about behavioral experiments and social skills training.
  • For all types of anxiety, ask if they incorporate mindfulness or acceptance based strategies.
• "Are you willing to leave the therapy room for the purposes of behavior therapy?"
  • To help with exposure to situations that cause anxiety, going outside of the therapy room may be necessary
• "Do you typically have readings or strategies to practice in between sessions?"
  • The goal in CBT is for you to become the expert on anxiety and its treatment. This can take time and practice. Between-session readings and practices not only can facilitate treatment but also may reduce the number of therapy sessions needed.  
• "How do you feel about medications?"
  • Though medications are not for everyone, they have been shown to be effective in the treatment of anxiety disorders and thus should at least be considered for discussion

Once you have described the problems you are struggling with, you could ask: 

• "What is your conceptualization of the problems I am struggling with?"

• "What are your treatment recommendations?"

• "How long before I can expect to start feeling better?"

• "How long do you expect treatment to last?"

If you do find a therapist who is experienced in the cognitive behavioral treatment of anxiety disorders, it is now up to you to decide how comfortable you feel with the therapist and whether you feel the therapist is able to communicate clearly about anxiety and fit the treatment to your particular needs. You will probably have a sense of this within the first one or two sessions of therapy.

This is your therapy, and you are in charge of getting the most out of it!   

TYPES OF PSYCHOTHERAPISTS

Degree and License

The professional qualifications of a mental health provider are based on two factors: educational degree and license. The educational degree is typically a Masters or a Doctorate degree, while a license means that the therapist has met both national and state requirements to practice in that particular field of study.

An educational degree in a field of psychology usually means that a therapist has been exposed to multiple theories and techniques related to psychotherapy and therefore may be able to compare and contrast psychotherapy approaches to make informed decisions about their own work. Although a graduate degree in the field may not be necessary to be helpful to others, it does at least ensure that a therapist has received a basic level of knowledge about mental health and psychotherapy. 

A license may also not be necessary to be helpful to others, as can be seen in the popularity and effectiveness of life coaches, but a license does ensure that a therapist has a certain level of education and experience to comply with the standards of their profession.

The primary purpose of a licensing board is to protect you, the consumer, from possible exploitation and harm by overseeing the competence of its therapists. Qualified education, supervised experience, passing standardized exams on psychotherapy and law and ethics, and continuing education are the standards met by a licensed practitioner.

The educational degree does not necessarily have to match the license. For example, it is possible to have a doctorate (PhD/PsyD) but be licensed to practice at a master's level (LMFT/LCSW). In addition, having a license to practice psychology does not necessarily mean that the psychologist’s doctoral training was in clinical psychology. Those with PhDs in cognitive, social, organizational, and developmental psychology can feasibly sit for the exam and become licensed as long as they have met the other requirements for licensure.

Therefore, it is in your best interest to look at both the degree and license along with training and experience to fully understand a therapist's competencies.  

CLINICAL/COUNSELING PSYCHOLOGIST (PhD/PsyD): 

Clinical and counseling psychologists have academic doctorates (PhD or PsyD) and, to officially use the term “psychologist,” must have a license to practice in the state. Clinical and counseling psychologists have expertise in psychological testing and in the assessment, diagnosis, treatment, and prevention of psychological disorders.

Academic training is usually 5-7 years and includes clinical experiences ending with a full time position at a pre-doctoral internship. In California, about one year pre-doctoral and one year post-doctoral experience and a passing score on a national examination are required for licensure. Licensure as a psychologist is denoted by the letters PSY followed by a series of numbers.  

PhD and PsyD programs can vary widely in terms of admission requirements and quality of education and training.    

Counseling vs. Clinical 

There does not seem to be much of a difference between clinical and counseling psychology programs, though clinical programs have traditionally included more training in the areas of more severe psychological disorders and counseling programs have focused more on delivering services in university settings.

Traditionally, clinical psychologists have focused more on psychological or neurological assessments whereas counseling psychologists focused more on vocational assessments.

Both clinical and counseling psychologists can be seen in academia, community clinics, private practice, and college counseling centers, but in medical settings, it is more common to see clinical psychologists.

PhD vs. PsyD 

Many PhD programs are based on a scientist-practitioner model that emphasizes the balance between clinical and research training whereas PsyD programs focus more on clinical training. The PhD scientist-practitioner model emphasizes the importance of developing practitioners who can also evaluate or produce research on the causes and treatments of psychological disorders.

SOCIAL WORKER (LCSW)

A licensed clinical social worker (LCSW) holds a master’s degree in social work (2-3 years of academic training), has completed about 2 years of supervised post-degree clinical experience, and has passed a written examination.

LCSWs have training in mental health and social welfare systems and are qualified to provide psychotherapy. For more information on California's requirements for social workers, click here.

MARRIAGE AND FAMILY THERAPIST (LMFT) 

Psychiatrists, psychologists, social workers, and psychiatric nurses are the four nationally recognized mental health providers, but some states also provide licenses to practice psychotherapy to masters level counselors.

In the state of California, a Marriage and Family Therapist holds a master’s degree in a relevant field, has about 2 years of supervised post-degree clinical experience, and has passed the California licensing exam. While their training is in marriage and family therapy, they may also be qualified to treat individuals dependent on their training.  

Click here for more information regarding MFTs and LCSWs in California.

PSYCHIATRIC/MENTAL HEALTH NURSE

To be listed in the state of California as a psychiatric/mental health nurse, a California Registered Nurse must hold a master’s degree in psychiatric/mental health nursing and either two years of supervised clinical experience or credentialing by the American Nurses Association as a Clinical Specialist in Psychiatric/Mental Health Nursing.

A psychiatric/mental health nurse often focuses on the treatment of psychiatric disorders and is qualified to provide psychotherapy. Those with special training in psychopharmacology hold an advanced nurse practitioner license that allows them to prescribe medication under a physician's supervision.

PSYCHIATRIST (MD)

Psychiatrists are physicians with medical degrees (MD) who specialize in the diagnosis, treatment, and prevention of psychological disorders. It would be important to find a psychiatrist who has had post-graduate residency training in psychiatry (usually 3-4 years) and has passed a national examination to become board certified by the American Board of Psychiatry and Neurology.

In the state of California, only psychiatrists and other licensed physicians are approved to independently prescribe medications, electroconvulsive therapy, or other medical procedures.

Regarding psychotherapy, not all psychiatrists have had extensive training in psychotherapy, and therefore, it would be important to inquire about training and experience in psychotherapy if you are considering engaging in psychotherapy with a psychiatrist. 

THERAPIST QUALIFICATIONS

Most mental health practitioners would agree that a therapist's qualifications are based on more than just educational background or license. Other important qualifications to determine competence would be:

• Amount of experience 
• Quality of experience 
• Range of experience 
• Therapeutic relationship

AMOUNT OF EXPERIENCE

Reading from a text, taking a workshop, or seeing a few clients with one particular problem can all be great learning experiences but most professionals really begin to develop their skills with repeated, hands-on clinical experience. With each new client a therapist sees, she reevaluates what she has read and learned and reevaluates her treatment approach allowing her to continuously develop and hone her skills.

In most established PhD programs, students begin to see clients by their second year, then they usually spend the next three years working 20 hours a week at approved local institutions (and often also work extra hours at other community organizations for more variety of experience).

Most psychologists then compete for pre-doctoral internships at competitive APA-accredited* institutions across the country where they see clients and receive clinical training full-time for a year. After graduation, psychologists in California must have another 3,000 hours (1-2 years) of supervised clinical experience to obtain state licensure. 

* Definition of APA-accredited: The American Psychological Association (APA) accredits professional training programs in psychology based on whether the programs meet the standards and guidelines set forth by the APA. Accreditation requires the training program to undergo regular reviews to ensure the quality and integrity of a training program. 

QUALITY OF EXPERIENCE

By the time they are licensed, most psychotherapists have likely obtained a wide range of educational and clinical experiences, but I believe that to develop true competence in a particular mental health disorder or in specific treatments requires rigorous training (1-2 years) with qualified professionals (preferably experts) along with continued up-to-date training in the field.

For example, though I have had experience in these areas in the past, I choose not to treat eating disorders, severe mental illness, PTSD, substance abuse, couples, children, or families because I respect that there are professionals who have obtained more quality training than I in these areas.

On the other hand, I have found it invaluable to have learned from experts in the field of anxiety disorders who have been practicing, learning, teaching, and developing for many years, and I continue to do so. I have also been fortunate to have worked in settings with established clinicians who have also come from strong academic and clinical backgrounds.

If you are seeking help for a particular problem or are seeking a particular type of treatment, it may be helpful to know what type of training (where, when, with whom) the therapist obtained and whether they continue to receive up-to-date information on the treatments and disorders for which you are seeking help.

RANGE OF EXPERIENCE  

Is it necessary to see a therapist who has had a wide range of clinical experiences or a wide range of life experiences? Most problems do not occur in a vacuum but are rather part of a complex network of emotions, life experiences, and relationships. Seeing a wide range of clients in a wide range of settings or having experienced a wide range of life events may allow the therapist to see problems with sufficient depth and clarity to put them into perspective.

In addition, many people’s lives are touched by issues that they may not struggle with themselves. For example, clients may be overwhelmed by having to care for a family member with a serious mental or physical illness or they may come from a family where substance abuse was common. A therapist with some experiences in these areas may be better able to provide direction for the struggling client.        

Is it necessary to see a therapist who has research experience and assessment experience?  Every year, there are new medications and treatments that flood that market. In addition, existing therapies are also being constantly reevaluated and improved upon. Therefore, it can be important to have a therapist who has been trained to evaluate research on the effectiveness of psychotherapy techniques and will only utilize those therapies that have been “clinically proven” through scientifically valid research trials. An interest in research shows a therapist’s commitment to providing the most up to date and effective treatments available.  

As for assessment experience, quality therapy begins with quality assessment. Though comprehensive psychological assessments are not a standard part of psychotherapy, experience in assessment can give the therapist a trained eye to quickly identify issues of concern and can also assist in the development of the most effective treatment plans. If further assessments are necessary, clinicians who themselves have had training in assessment may be better able to make the appropriate referrals for more comprehensive assessment.      

GENERAL THERAPIST QUALITIES

In a survey by Consumer Reports, readers indicated that a caring attitude, ability to listen empathically, genuine commitment to client’s welfare, sincerity, warmth, and responsiveness were all important therapist characteristics. These factors are thought to be important for promoting a positive therapeutic relationship which is characterized by feelings of mutual respect, trust, and hope.

The most successful outcome in psychotherapy occurs when there is a good match between the therapist, the client, and the treatment method. For example, research evidence has consistently shown that cognitive-behavioral therapy is the most effective treatment method for obsessive-compulsive disorder, but if you do not feel comfortable with the therapist or do not have trust in her abilities, the treatment method will have limited effectiveness.  

CULTURAL SENSITIVITY

More recently, cultural sensitivity has also been identified as an important factor that promotes the effectiveness of psychotherapy. The American Psychological Association has focused on developing culturally component therapists over the last decade, and training in cultural sensitivity has become an important component of all established training programs. A culturally competent therapist:

• understands each individual has unique value system based on upbringing and culture

• values diversity (in ethnicity, sexual orientation, religions, etc.)

• is aware of her own cultural biases

• can work effectively in different cultural contexts

• does not assign values (better or worse/right or wrong) to cultural differences