The builder's guide to finding a therapist

This is a lightly updated version of a piece I’ve previously published on my personal blog and in Psychology Today.

Preface: Therapy versus coaching versus…

The guidance below focuses on the question of how to find a therapist: i.e., a trained mental health provider who can help you work through the psychological challenges that stand in your way of building—and enjoying—your own best life. Much, though not all, of this guidance would equally apply to finding a psychiatrist, or an executive coach, or any other professional focused on helping you (or your company or your marriage) improve. Each helping profession has its own idiosyncrasies, and there are confusing overlaps between them that would take several posts to even begin to disentangle.

With that said, some of the same fundamental principles apply whether you’re seeking out one or another type of professional, or whether you’re deciding which type to seek out in the first place, if any. The full stack of judgments involved in this sort of decision-making demands an entrepreneurial approach—a builder’s mindset applied to the design of your own self-betterment journey. The guidance below is, in effect, a practical illustration of this broader approach, as instanced specifically in the search for an individual therapist.

Appreciating the challenge

Given the limited openings in my therapy practice, I spend a lot of time playing therapist-client matchmaker to the kinds of people who tend to reach out to me. The process has given me a lot of sympathy for those who get disheartened and either stop looking, or settle for a therapist who isn't great for them. It's hard enough to know what qualities to look for in a therapist when you just have a "standard" problem, like an uncomplicated case of depression or social anxiety. It can seem nearly impossible when your problem is that you're not sure what your problem is, or that your depression is inextricably connected to what makes you great at your job (and every therapist you've seen has just told you to find a different job), or that you're doing "fine" by conventional standards but have a nagging feeling that you could be getting so much more out of life. How can you guess from a particular therapist's profile whether they'll really "get you," whether they'll ask the right questions and attend to the right details to help you untangle the knot of longings and fears and hangups that has kept you from growing?

To some extent this is bound to be a trial-and-error process, of course; but what I can offer are some strategies for increasing the proportion of "hits" to "misses," and for knowing a "hit" when you find one.

There's already lots of good general guidance available for finding and vetting a therapist, so I would start by reading some of this general advice (such as here, here, and here) if you haven't already. Then I would use the suggestions below to help you further tailor this process to fit your particular, non-cookie-cutter needs.

Generating your list of candidates

• Ask your friends.

If you can get a recommendation from someone who has actually worked with a given therapist and can personally vouch for them, this is usually the best place to start. All the better if they’re someone whose judgment you trust, and if they were seeking therapy for roughly similar sorts of issues to yours. Don’t hesitate to ask your friends, colleagues, social media followers, anyone you think might have good suggestions. The days of hiding or feeling ashamed about therapy are long gone, at least among anyone who matters.

• Search some "curated" databases to get a narrower, more high-quality list. 

In addition to searching Psychology Today's Find a Therapist database—which provides the most comprehensive listing of therapists who fit your general search criteria—it can be helpful to search some professional websites that require therapists to jump through certain special hoops to get listed. While this is by no means a guarantee of high quality, it tends to be biased toward therapists who maintain active relationships with their colleagues, seek out ongoing professional training, and generally approach their work in a thoughtful and self-reflective way. The particular database(s) you want to consult will partly depend on the therapeutic approach (see above) and the areas of specialization (e.g., depression, anxiety, OCD, grief, trauma, addiction, marital relationships, etc) that you want your therapist to have. Below are the databases I tend to use, which lean "cognitive-behavioral" because that's the community I'm most familiar with (but I've also listed a couple more psychodynamically-oriented sources that I've gotten from trusted colleagues).

1. Zencare therapist directory (currently available in 45 U.S. states) - I particularly like how this database curates therapist profiles (e.g., many have video blurbs) and allows you to customize your search (by everything from "specialty" and "approach" to "insurances accepted" to available office hours).

2. Association for Cognitive and Behavioral Therapies (ABCT) Find a Therapist directory

3. International Society for Traumatic Stress Studies (ISTSS) Find a Clinician directory

4. International OCD Foundation Resource Directory

5. International Center for Excellence in Emotion-Focused Therapy (ICEEFT) Find a Therapist directory

6. Integrative Behavioral Couple Therapy (IBCT) directory

7. Accelerated Experiential Dynamic Therapy (AEDT) Institute Therapist Directory

In addition to these national and international databases, it may also be worth searching for specialty-based professional organizations within your state.

• Scrutinize providers' profiles for depth and specificity.

When reading a given therapist's online profile or professional website, ask yourself some targeted questions:

1) Does their distinct style, approach, and personality come across?

A generic or otherwise lackluster profile shouldn't be a dealbreaker; many fantastic therapists have lackluster online profiles. But if a profile is written in a more thoughtful and distinctive way, then you might want to bump it up in your queue. 

2) Does their written style resonate?

If you like their written voice, you’re more likely to like them in person. If they provide a video introduction, that’s an even closer approximation.

3) When examining their list of specialties and therapeutic approaches, does it seem like they checked off every box indiscriminately?

This is generally a red flag for me, unless their profile gives a very compelling explanation for why and how they combine so many approaches. I would have the highest trust in a more selective list, particularly if it includes one or two "specialty" approaches (like "acceptance and commitment therapy" or "family systems") that seem to hang together.

If you're not familiar with a given approach, do a quick Google search and read a description of that type of therapy (you can find an extremely brief summary of some major approaches here, and a more comprehensive list here). Pay particular attention to a) whether the approach seems to have some scientific grounding and legitimacy (as described by a relatively "neutral" source, not just by its originators or direct affiliates) and b) whether it sounds potentially well-suited to you and your situation.

Finally, as a general rule-of-thumb, I would lend a bit more credence to a therapist who says they are “integrative” than one who says they are “eclectic,” as the latter usually signals more of a grab-bag than a coherent, independent-minded synthesis of the best elements of multiple approaches. Again, though, this should by no means be a “dealbreaker”—just a tentative heuristic to help speed up your search, all else being equal. 

• Contact multiple therapists, and ask for additional referrals. 

If a provider seems promising, you have much to gain and virtually nothing to lose by reaching out to them. Even if they’re not taking new clients or their fees are outside your price range, for example, they may still be able to recommend others like them in the area. The more information you can provide about yourself and what you’re looking for, even in that initial contact email or phone call, the better they will be able to tailor their referrals. 

Vetting your candidates