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

• 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

• The initial consultation: somewhere between “test drive” and “first date.”

The analogy to dating is hard to avoid when talking about the therapist search, and with good reason: many of the same principles and pitfalls apply. For instance, the first date tends to go better if you let your guard down and ask a few “sensitive” questions; the more first dates you go on, the better your chances of finding a good match; and so on.

But there are also important differences: for instance, you don’t need your therapist to share your core philosophical beliefs or want the same lifestyle as you. What you need is a therapist who can accurately comprehend and skillfully support your efforts to build your chosen masterpiece—whether by helping you do the introspective and data-mining work to figure out what you want to build in the first place, or by arming you with the tools to execute on your vision, or by helping you identify and remove any psychological obstacles that are getting in your way.

How can you guess from a first encounter whether a therapist is likely to be up to these tasks? While it’ll usually too early to know for certain, here are some telling signs to watch for:

1) Are they making their own effort to get to know you and evaluate the fit? For instance, do they frame their initial impressions as hypotheses, rather than foregone conclusions? Do they encourage you to ask questions about the therapy they do, and help you make your own informed decision about whether it suits your needs? Or do they forge ahead on the assumption that they are obviously the best therapist for you?

2) Do they calibrate their questions and responses over the course of the session based on what they hear you saying (or, perhaps, not saying)? For instance, if their first attempt to describe what you are feeling does not quite hit the mark, do they notice this and try again? If you’re not fully bought in to some aspect of their approach, do they either shift gears or help you express your reservations and work through them? Or do they seem to be following a pre-written script?

3) Do they bring out the best, most honest and courageous within you? Do you find yourself sharing things you hadn’t previously admitted even to yourself? Do you leave the session feeling called to purposeful action and reflection? If there’s a nervous knot in your stomach, is it the kind that forebodes a rocket launch? Or the kind you get when you’re doubling down on the procrastination tactics that have kept you grounded?

Building your therapy

With all these tips comes a crucial caveat: a motivated, optimistically oriented client can derive some benefit from almost any therapist. This has been borne out by research, and it closely jibes with my own experience from both sides of the couch. A standing appointment with a trusted confidant whom you’re paying to scaffold your self-improvement can be an incredibly powerful source of insight, momentum, and accountability, even if you’re generating most of it.

In this light, you might ask: “then why not just eliminate the middle-man?” And indeed, depending on the nature of your struggles and the tools or insights needed to resolve them, you may be better off pouring your energy and creative effort into solving the problem yourself than into finding and working with a therapist—just as you might be better off managing your own investments than finding and working with a portfolio manager. The cost-benefit analysis involved is analogous: would the value added by a well-chosen expert outweigh the costs of finding and employing such a person? In both cases, the answer depends on your particular goals and priorities; and the size of the value-add depends on the thought and effort you put into finding someone good. The strategies I shared above should hopefully guide the thought and effort you put in, assuming you do decide that the value is worth it. For instance, perhaps you’ve already read a hundred self-help books and still haven’t found a solution to your problem; or perhaps you simply don’t have time to read a hundred self-help books, so you’d rather invest the time and energy to find a professional whom you can trust to distill their insights for you. 

As you weigh the decision, just know that competent, insightful, trustworthy therapists are not as rare as they might seem. I’ve met many of them on my personal and professional journey. There are therapists whose masterful weaving together of deep scientific knowledge, emotional attunement, and individualized insight and connection-making I can only hope to equal someday. I would not hesitate to refer a client or loved one to any one of these therapists, both because I know they're good, and because I trust them to know their limitations and make an appropriate referral if they find they're not well-suited. The trick is to find and make the most of your own version of such a therapist, as determined by your own goals, priorities, and circumstances (including your geographic location and financial constraints). This search is yours to build. I can only arm you with some tools and a general vision of the transformative growth that might await you on the other side.