The Right 'Fit': Tips for Finding a Therapist Who Gets You

Hello, hello! I hope your Fall is starting off strong and you are doing any and everything you want to do in order to celebrate the season.

Today, I thought I would write a post to help potential clients find a therapist they actually like and want to work with. We need to solve that age-old problem of "who the heck do I pick if I am scrolling on Psychology Today or Mental Health Match or just googling "therapists for anxiety in _____ area?"

When you're looking at providers or doing consultations with them, I think focusing on four key items is helpful:

• Notice the key words on their website or directory listing.

  • I think looking at their years of practice is smart (new graduates are lovely, but largely untested clinically and will need to cut their teeth for a bit before developing their own clinical style).

  • Checking out what modalities they have listed will give you insight into how much they've invested in their clinical skills thus far. Trainings like IFS, EMDR, Brainspotting, Somatic Experiencing, TEAM-CBT certification, I-CBT, ERP, etc. are expensive and show dedication to a higher craft of healing, in my opinion.

  • If they say they use an eclectic approach, I would shy away from that listing. 'Eclectic' sounds like a clinician is throwing darts at the wall and seeing what sticks, treatment-wise.

  • Another red flag would be an unprofessional picture, like a bad selfie (you know the kind I'm talking about... where it looks like the photos men after 40 on dating apps choose-- See the example meme below!) or one with poor lighting. Now, this doesn't mean they're a bad therapist, but it makes me wonder how invested they are in their business overall.

• Ask the right questions.

  • When you book a consult with a therapist, it's good to come in with a list of questions for them. Don't ask your questions via email, for two reasons. Reason one: you want to hear their tone of voice, and see their body language if you can. You're interviewing them, while they are deciding if they can serve your clinical needs. Reason two: your email may not get answered if there are too many qualifiers in it. Good therapists are busy, and they want to get you booked for a consult or intake, not answer questions via email. I'm sorry if that sounds harsh, but I want you to find the help you need, not linger in an inbox.

  • Good examples of questions include:

    • How do you help clients navigate the change process?

    • What's your favorite coping skill to teach?

    • What type of training do you have in treating XYZ issue?

    • How would you describe your personality in the therapy room?

    • If you have a certain issue that is coming up that is sensitive or important to you, ask about it. Example: "I need help navigating my religious trauma, while I continue attending church. Can you help me with that balance?"

• Prioritize the importance of schedule availability, financial commitment, or personality fit with the clinician.

  • What matters to you? Cost? If so, check to see if the clinician takes your insurance or not, determine if they offer superbills for out of network reimbursement if they are private pay, or ask about a sliding scale availability in the consultation. The worst they can say is no. If they don't have any sliding scale slots and are private pay only, you can certainly see if they would be willing to meet every other week instead of weekly. I wouldn't recommend monthly sessions initially. You won't heal as quickly and may pay more in the long run anyways, due to the stalled treatment pattern.

  • Schedule availability? If you can only meet at evenings or weekends or at 2pm on Wednesday and that's it, you will need to be flexible about cost and clinician personality fit.

  • If you find a therapist you would LOVE to work with, then it may require a bit more of an investment financially and a flexibility with scheduling. Something I remind clients of is that research tells us a quality therapeutic relationship is the main key for healing. So, if you want the most success, this may be the most important piece for you. However, it's okay if you need to prioritize the money aspect or the scheduling piece first!

• Look for signs of good ethics and/or boundaries in your future therapist.

  • Why? Because a therapist with poor boundaries or ethics is ripe for burnout and lackluster or harmful treatment practices. And because you want to learn about healthy boundaries from someone who exhibits them in their own life and business.

  • What are the signs to be looking at?

    • Check what time the clinician emails you back at or returns calls at. If they email you back at 3am, that would be a sign they struggle with time boundaries.

    • Ask them how they handle crises with current clients. If they say, "oh you can call me anytime...", while that may be reassuring to you, it's a sign to me that they can't disconnect and/or they feel an alarming personal responsibility to their clients outside of sessions.

    • Ask around about the therapist with trusted people you know. If someone you know has had a good experience with them, that's a better sign you can trust them.

    • Check their licensing board website and look them up to see if any complaints have been levied against them in the past and what for.

    • See if they say anything about hobbies, creativity, exercise or family/friend time in their 'About Me' section. You want a therapist who preserves their energy outside the therapy room by engaging in healthy fun things outside of their work. They will be more refreshed and ready to help you heal when they are in the room.

    • If they let you know that they are full up front, take that as a sign that they have good boundaries. They aren't seeing 40+ clients per week. That's a good thing, for you. Ask them how they navigate the idea of a waiting list or if they want you to just check back in a month or so to see if a slot has opened up. Remember, good therapists don't always have immediate openings, unless they are building a caseload, which is totally fine. A full caseload today may shift to 2-3 openings tomorrow.

There we have it, some of my thoughts on how to navigate the therapist search as a client! Let me know what else you'd like to know or discuss about this process. I know it's hard. Don't get discouraged. You will find the right one for you!

Take exquisite care of yourselves,

Megan

10 Things I Hate About... Our Profession: Ethics and Ethos in the Therapy Room

Dear Mental Health Treatment Community (Therapists, Counselors, Social Workers, Psychologists, Psychiatrists, Psychiatric APRNs, etc.):

Welcome to my soapbox. Today, I wanted to take the time to explore the 10 things I hate about our profession. This is a rant about all the crap that mental health treatment providers do that just, frankly, sucks, and shouldn’t be happening, but isn’t strictly unethical, just unappealing and disheartening to hear about again and again from clients in my therapy room, and from providers themselves.

Yeah, that’s right. I’m talking to you all. Listen up, we all have some explaining to do, and if this post makes you uncomfortable, so be it. (It makes me slightly uncomfortable writing it, so I know it’s something that needs to be said.) I’m not perfect at all of these either, but I do try to recognize them (or be open to feedback from colleagues and trusted people) in my practice, so I can continuously improve. Without further ado, here are the 10 things we need to shift in our profession:

1. Return freakin’ calls and emails from potential clients. Yes, even if you’re full. Yes, even if the client isn’t a good fit for your practice. Yes, even if you’re tired and the email seemed dumb, etc. People are desperate for help, and if their first ten attempts at reaching out to someone fall flat or garner no response, they lose steam and stop trying to get help. If we, as therapists, want a healthier society, then we need to support people’s efforts to create change in their lives by reciprocating their energy when they reach out.

2.  Geez, tell clients their diagnoses, and show them their treatment plan, if they ask to see it. I’m always shocked when providers tell me that they don’t tell clients their diagnosis for fear of “it upsetting them.” Are we not in the business of helping upset people reset emotionally? Can we not handle pushback, criticism or genuine feedback from the very people who we are treating… in an area in which they are admittedly an expert—their own experiences, thoughts, body sensations, and perceptions? This is their health record, not yours, and they deserve to know what your clinical impressions of their symptoms are, and what direction their treatment is headed in.

3. Cease claiming to offer a 'safe space for individuals to delve into their emotions' on your listings and websites. It's cliché, insincere, and devalues the true essence of our work in therapy sessions. If you're not fostering a secure environment for individuals in therapy, then it's best to step away, and figure out what is not working. If you are indeed establishing an unsafe or harmful treatment setting, then it's time to exit the profession. Seriously.

4. Stop pretending therapeutic harm is rare. It's real, it happens, and clients are suffering because we, as a profession, bury our heads in the sand, and don't gatekeep effectively.

   Therapeutic harm is a significant concern that cannot be downplayed or dismissed as an uncommon issue easily resolved by authorities. It is akin to soul murder, where individuals in need of support end up being harmed by those they trust. Recognizing the prevalence and impact of therapeutic harm is crucial, as many vulnerable clients may struggle to report such incidents, particularly in systems that are not easily navigable. (I mean, have you ever met a client, outside of the helping professions, that even knew about the fact that you can look up providers by their names online in order to make a report to their licensing board? I haven't met such a client with that kind of savvy.)

   To address therapeutic harm effectively, it is essential to take the experiences of affected clients seriously, offer them support, and guide them towards appropriate resources if they choose to take action. Prioritizing belief in their narratives, validating their encounters, and ensuring access to necessary assistance are key steps in demonstrating genuine support for those impacted by therapeutic harm.

5. Identify biases and gaps in your knowledge and seek to remedy those you can (with biases, you are required to rectify this issue ethically, so get on it, as soon as you become aware of one), and refer out when you can’t fill the knowledge gap. There are tons of therapists out here, and someone out there is an expert in the thing you’re not. They will be a better fit for the client who needs that kind of help.

6. Get really good at apologizing. I apologize regularly in session. I want clients to understand that I know I’m not perfect, and witness what a genuine acknowledgement of remorse and repair looks like. This doesn’t mean I get it right every time, but I want to get it right most of the time.

7. Assess for neurodivergence prior to slapping a big label like Bipolar Disorder or Borderline Personality Disorder on there. This doesn’t mean you need to operate outside your scope, so put down your damn pitchforks, psychologists. Nobody out here is suggesting that I, an LCSW, should be doing a ton of testing that I’m not trained in. What I am saying is this: Be curious about the possibility of neurodivergence first as an explanation (either full or partial) for the symptoms a client is experiencing. "As per the survey taken by the National Depressive and Manic-Depressive Association (DMDA), 69 percent of patients with bipolar disorder are misdiagnosed initially and more than one-third remained misdiagnosed for 10 years or more (1). Similarly, a survey done in Europe on 1000 people with bipolar disorder found a mean time of 5.7 years from the initial misdiagnosis to the correct diagnosis (2,) while another study reported that on average patients remain misdiagnosed for 7.5 years.(3) And quit assuming because a client annoys you that they have a personality disorder. Your annoyance probably has more to do with counter-transference, your nervous system dysregulation, and your own lack of differentiation of self, than your client's personality. Plus, when we think about ourselves in the room first (a.k.a., figuring out what is being stirred in us), we become better clinicians, who are better able to regulate our clients and teach them new ways of getting their needs met. It's strengths-based to 'check yourself before you wreck yourself' (clinically).

8. Adopt the golden rule when working with other providers. Think to yourself, "Is this the way I want to be treated by another professional in my field?" It is okay to disagree with other providers. It's okay to see a case differently. It is even okay to correct another provider's behavior, if you believe it to be unethical. Here's the key though: you can speak to that person privately first. Get clarification. Make sure you have a clear understanding of the situation prior to judgement. After all, isn't that what you'd want in return, if your places were reversed?

9. Get consultation when you really need it. And pay for it. Your colleagues’ time and expertise isn’t free. Sure, if you’re at lunch with someone and want to explore a simple clinical question with your friend, that’s fine. I don't mind when my friends or office mates wanna bat around ideas. However, if you want clinical consultation on a complicated case, lots of information about business or marketing techniques, or you're asking about a treatment modality that is specialized, like EMDR, Brainspotting, IFS, etc., pay an expert. Get some expert clinical consultation that is good, and good consultation usually isn’t free.

10. This one is specific to people in middle management, upper management and the C-suites at agencies, group practices and non-profits. If you haven’t seen a client in 5+ years, haven’t attended a therapy specific training in the last three years, and/or receive six-figure bonuses while your clinicians on the ground have to receive food stamps to make ends meet, then you don’t get to play dumb when your burnout rates are high, when clinicians are leaving in droves, or act like you would know exactly what to do clinically in a difficult, multi-layered case. When young clinicians come to me asking if what their COO or upper manager is asking for is ethical, and it's not, I am appalled. And guess what? Those COOs and managers get to do what they want. They've earned their stripes and they don't get replaced at agencies. They, like fat on a soup, rise to the top of the boiling pot. Don’t assume years in the field equals clinical expertise or knowledge on how to build a thriving, supportive agency environment.

There it is, folks! The spicy list of the 10 things I hate about our profession. Again, I want to reiterate, I've done many of these things before in my own practice. I've made mistakes, but as the great Maya Angelou said, "Do the best you can until you know better. Then when you know better, do better." Here’s the thing: we have to be able to have these types of conversations in order to move forward collectively towards a future where mental health treatment is accessible, safe, effective and collaborative. And this future is possible. If we all pitch in.

What do you think? Did I miss anything on this list? Are any of the points particularly powerful or thought-provoking for you? Let me know in the comments below!

Take exquisite care of yourselves,

Megan

Citations

1. Lish JD, Dime-Meenan S, Whybrow PC, et al. The National Depressive and Manic-Depressive Association (DMDA) survey of bipolar members. J Affect Disord. 1994;31:281–94.

2. Morselli PL, Elgie R. GAMIAN Europe. GAMIANEurope/ BEAM survey I—global analysis of a patient questionnaire circulated to 3450 members of 12 European advocacy groups operating in the field of mood disorders. Bipolar Disord. 2003;5:265–78.

3. Ghaemi SN, Sachs GS, Chiou AM, et al. Is bipolar disorder still underdiagnosed? Are antidepressants overutilized? J Affect Disord. 1999;52:135–44

Put Your Visor Up: Changing Automatic Negative Thoughts

Hi friends!

I hope you are doing well. I have been remiss in not doing consistent blogging. While I wish I could promise you consistency, that probably isn't the case with me. My creativity is truly limited to when I get an idea for a post that just won't go away.

What are Automatic Negative Thoughts?

Have you ever felt like your vision or perception of events was obscured? What typically creates this sensation for you? For me, I often find that I struggle with negative thinking patterns (sometimes called Automatic Negative Thoughts or ANTs, for short). Take a gander at this article by Harvard University that explains ANTs in greater detail.

Negative thoughts can make a normally clear issue suddenly opaque and difficult to navigate. Whenever you find yourself in a new situation, such as a first date or a job interview, you may think, "This is not going to turn out well. I can already tell based on how nervous I feel." Subsequently, one of two scenarios unfolds: either the situation goes poorly, validating your initial pessimistic belief, or it goes smoothly, which you dismiss as a rare occurrence rather than the likely outcome in similar situations.

I compare Automatic Negative Thoughts to looking at the world through a windshield covered partially by a sun visor flipped down. Have you ever peered through a windshield and forgot you had left the visor down? This alters your perspective, obstructs your view, and can be difficult to immediately detect since it doesn't completely block the entire view. Automatic Negative Thoughts operate in a comparable manner: they distort your viewpoint, hinder a clear understanding of the current situation, and may not be readily apparent to you. During a recent road trip with my spouse, he repeatedly pointed out the sky, prompting me to squint and attempt to peer around the sun visor I had flipped down earlier, rather than flipping it up.. When I realized what was happening, I laughed, shoved that visor out of the way, and snapped two pictures to showcase the significant difference.

Sun visor view of the road ahead

Clear view of road through windshield

Here's what it looked like once I lifted my visor!

Shifting your Negative Thoughts

I am asking you the following question: How is my thinking obscuring or altering my perspective or view of the situation? Is there any alternate view or a way to see things differently? Can I find a way to 'flip up my visor' so I can see clearly?

Once you master the skill of noticing when your visor is down (a.k.a. negative thoughts have entered the chat), you can work on ways to question yourself and shift your visor out of the way. This doesn't mean you move to the positive, opposite statement from the negative, limiting belief you currently are holding dear. Shifts like that are often why people struggle with changing their thinking. They're trying too hard, and the alternative belief doesn't ring true to them or prepare them for the possibility of failure or difficulty.

So, your brain isn't really concerned with making you happy. It's focused on keeping you alive. This can lead to some pretty pessimistic thoughts, however. Basically, your brain is wired to recall risky situations from the past and use that info to help you stay safe in the future. When people try to change their thinking to "something more positive," your brain automatically moves away from that shift, because it won't serve the ultimate goal of 'keep you alive!'

Reflecting on the earlier example discussed in this post regarding preparing for a first date, we can examine the common errors people make when attempting cognitive restructuring or altering their mindset. Many individuals tend to begin by stating a positive opposing belief, such as declaring, "This date will be amazing. We'll probably end up getting married!" Consequently, they may come to realize that their 'positive conviction' lacks impact and appears to ignore their own feelings of anxiety or nervousness before a potentially anxiety-inducing situation. This self-dismissal is comparable to self-gaslighting. To enhance your mindset or 'shift your perspective,' consider transitioning from the assertion, "This won't go well. I'm extremely nervous." to a more balanced affirmation like "I do feel nervous, and I believe I can deal with this sensation, regardless of how this date unfolds."

Here's a formula to help you find a more neutral, helpful statement:

Acceptance (of your feelings/fears) + Confidence (in your ability to cope) - Any Predictions about the Future = Healthier, More Flexible Thought Patterns

The challenge this week is to work on just noticing when your perspective is shielded or changed by the visor (or negative thoughts) in your way. Give yourself permission to ask yourself if you need to flip up the visor or identify a more neutral thought. Ask yourself questions about the view or situation to facilitate your thinking towards more flexibility. A flexible brain can keep us safe and (moderately) happy!

Take exquisite care of yourself,

Megan