Therapy 101: A Beginner’s Guide
It’s the New Year, which means you and many others have set some New Year’s resolutions for 2023. Perhaps this is the year you have decided to tackle your mental health and take a swing at the growing trend and sometimes daunting task of starting Therapy. First, congrats on taking the first step towards prioritizing your mental health; or perhaps you are receiving this not-so-subtle hint from your child, significant other or friend who is hoping you consider taking this step. Either way, I hope this guide can help support you in reaching this goal as successfully as possible. It has been quite remarkable how the discourse around mental health and therapy has shifted over the last few years, going from something that was stigmatized, only for people with ‘serious problems’, to a space that anyone and everyone can benefit from.
You may have wanted to start therapy for a while but struggle with where to start. My hope is that this information will be able to help inform you about the logistics of therapy and give you some ideas to be thoughtful of when searching for the right therapist for you. This process can be overwhelming, especially after just a simple google search leaves you sifting through hundreds of therapist profiles (that honestly all sound and look alike). I am aware there have been several new tech industry ventures into the world of mental health, and while their goal may be to make therapy more accessible and affordable, from a therapist’s perspective I worry about the quality of care they are able to maintain.
So, if you are seeking to find a therapist the old-fashioned way, let’s get into it…
HOW DO YOU PLAN TO PAY FOR THERAPY?
This is an important first step, not only because finances can be a major barrier to people seeking support but also because it can help guide you on where to start your search. I have broken down several different possible paths that are available. So let’s start with the first question and one that can be the most frustrating to deal with: the world of insurance.
INSURANCE
It is no secret that healthcare in the United States can be a headache to navigate. I wish that using insurance for Mental Health was easier, but it can be quite complicated. So I will attempt to simplify things:
HMO plans:
If you plan on using your insurance to pay for therapy and your health plan is an HMO plan, access to therapists may be narrower than those planning on using a PPO plan or paying out-of-pocket. The reason is that HMO plans require you to see clinicians that are ‘In-Network’. If you plan to go this route, the best place to start is by looking into your specific plan and seeing which clinicians are paneled in your network.
Without getting into the weeds on why many therapists choose to be out-of-network providers, know that those that are paneled with a specific insurance often have limited availability and so you should plan on reaching out to as many as you can and ask to be put on their waitlist.
PPO Plans:
If you have a PPO plan, you can follow the same guidelines as those with HMO plans. The caveat to PPO plans is that you have the option to seek services out-of-network. While it is not a direct coverage from Insurance, you have the opportunity of being able to pay for services out-of-pocket and request a Superbill from your therapist. A Superbill is a fancy word for a receipt. You can then submit this Superbill to your insurance and depending on your plan’s deductible and reimbursement rate, you get your receipt fully or partially refunded.
The first step is to see if this is an option for you. Contact your insurance company to see how they handle reimbursement and to check what your deductible for out-of-network services is. A Deductible is the minimum amount you must pay out-of-pocket before your insurance will begin to kick in and start to cover some of your medical charges. If you plan to go this route, it is your responsibility to submit your Superbills to your insurance. You should do so about once a month so that you can hopefully max-out your deductible and begin to get compensated by your insurance as soon as possible.
Out-of-Pocket/Cash Pay:
If your insurance does not cover services or for whatever reason you choose to pay out-of-pocket, things become a bit simpler and accessible. To see a clinician in Los Angeles, you can expect to pay anywhere from $150 to $250 per a 50 minute session. Different states, cities and towns will have different rates depending on your area’s market value. Most therapists will encourage you to be seen once a week on a regular basis, at least for the first year or first few months. So factor that into your budget and start to make those calculations about how much you can afford to spend a month on therapy. Remember, like any self-care, therapy is an investment and takes time to allow the process to unfold.
Once you establish what your budget can be for paying out-of-pocket for therapy, you have a few options. If you can afford a therapist’s ‘full fee’, then that leaves you with the most options. However, if you find yourself not able to afford the average full fee you still have some options open to you. The first is you can reach out to therapist to ask if they have any Sliding Scale spots open on their case load. Sliding scale rates differ from clinician to clinician and are spots that some therapist reserve for clients who are not able to afford their full fee. I would recommend casting your net wide and getting on several potential therapist’s waiting lists as these spots can be hard to come by.
Another option you have is to look for Associate therapists that take on clients at a reduced rate. Associate therapists are therapists that have finished their graduate degrees and are working on gaining the hours of experience required for licensure. All of these therapists are legally obligated to be supervised by a licensed clinician who oversees their cases with consultation. You can find Associates either working under licensed therapists in Private Practice or you can find them working at community mental health clinics in your area.
Which brings me to the last option. If you are needing low-fee services, you can find therapists who are both Associates or trainees (meaning therapists who are still attending graduate school), working at clinics that do their best to offer quality services while considering your full financial situation. For example, I spent two years providing services at The Maple Counseling Center, where clients were able to meet with a financial team to determine what a fair rate would be based on their income and expenses. There are several clinics around LA and in most cities so a simple search should help! Here are a few that are in different parts of Los Angeles:
· The Maple Counseling Center (Mid-City) https://www.maple4counseling.org/
· Airport Marina Counseling (South Bay) https://www.amcshelps.com/
· Southern California Counseling Center (Mid-City) https://www.sccc-la.org/
· Miracle Mile Community Practice (Beverly Grove) https://www.mmcpla.org/contact
· The Saturday Center (West LA) https://saturdaycenter.org/affordable-therapy/
· The Wright Institute (West LA) https://wila.org/
· Open Path an online portal that allows you access to low-fee clinicians https://openpathcollective.org/
These services can be in high demand and can at times have extended waitlists, so reach out sooner rather than later. A staff member will be able to give you more information on their specific intake process.
HOW DO YOU WANT TO RECEIVE THERAPY?
Another important aspect to take into consideration is how would you like to see your therapist: in person or via telehealth? Since the Covid-19 pandemic, many therapists have begun to offer telehealth services either exclusively or have a practice that is a hybrid of both in-person and virtual sessions. Some people feel adamant that they need to be in a room with a breathing tangible person, while some enjoy the freedom of being able to jump onto session from the comfort of their home in the midst of their day. As someone who currently works with clients in both settings, here is what I will say:
You cannot replace the experience of in-person sessions. I find that my clients who I see in person come into session less distracted as they have made the investment of getting in their car, driving to the office, parking, and entering a space that is designed to be separate from the rest of their busy lives. As a clinician it is nice to see the whole person, body language and all. You also have a bit more of transition in and out of the process: from your therapist collecting you from the waiting room to the moment you sit on the couch, to ending the session in a way that is not as abrupt as exiting out of a screen.
On the other hand, Telehealth has surprised me in its ability to maintain a level of intimacy that I did not expect when I first started meeting with clients at the beginning of the pandemic. Clients are usually in their homes, which can be a positive or a negative depending on their set up. The abrupt switch from wearing your work hat to suddenly being in therapy can be hard to manage. A pro of telehealth is that clients can work with clinicians from all parts of their city or state that they may not have access to if meeting in person were the only option. A lot of people, especially in Los Angeles, revel in the fact that you do not have to commute to an office and park, which can add a significant amount of time to the appointment. It has been amazing for me to work with clients from different parts of Los Angeles and California that I would not otherwise be able to work with. So, accessibility and freedom are a definite plus.
WHO DO YOU WANT TO SEE?
Now that we have discussed the financial and logistical aspects of therapy, we can now start to think about who you want as your therapist. Therapy is a deeply personal experience and thus the person you choose to work with must be someone you feel like you can build a relationship with. Who your therapist is matters. Often people seeking therapy will feel a sense of urgency to get started and will grab for the first therapist that has availability. This may be out of necessity due to a pending crisis or things needing immediate attention. But it also happens because this process can be hard enough and let's be honest, when we have procrastinated on something we usually want to get it over with before our window of productivity closes.
What’s important to remember is that you want to see someone that is the right fit for you. Not every therapist is the best fit for every client. Clinicians vary on trainings and experience, populations they serve, themes and diagnoses they treat, and the styles and approaches they use. I know this can all sound overwhelming, but overall it is a blip in the process and once you find the right setup, it will all be worth it! Here are a few questions to think about that might help you figure out who you would like to be sitting in front of you as you attempt to do this really difficult thing.
DOES THE GENDER OF YOUR THERAPIST MATTER TO YOU?
Often, we imagine that females will want to talk to females, males will want to talk to males, and non-binary and trans folks with fellow non-binary and trans folks. But I would encourage you to think about what it would be like to sit with someone of a different gender. It is not uncommon for men to have a difficult time being vulnerable in front of other men, but does this mean they should not seek out a male therapist?
My answer would be twofold: if a difficulty in being vulnerable in front of a specific gender would feel overwhelming and get in the way of you opening up, then perhaps choosing a therapist whose gender identity feels less anxiety provoking would be the best call.
However, if your discomfort is a factor that might be a helpful part of your process I would encourage you to try. For example, if you are a woman who is coming to therapy because you have difficulty building relationships with men, perhaps you could benefit from having an experience with a male therapist. It can be an enriching experience to have the feelings that impact you outside of therapy be brought into the relationship with your therapist. It can give you the the opportunity to really understand and explore the why’s of what makes things uncomfortable or difficult.
WOULD YOU LIKE TO SEE SOMEONE WHO MAY HAVE HAD A SIMILAR LIFE EXPERIENCE AS YOU?
This can be particularly important for people who identify as LGBTQ+, BIPOC individuals or people from specific cultural backgrounds who feel that they want someone who, quite frankly, gets it. They don’t want to have to explain or educate a therapist about aspects of their lives such as culture, religion, family/relational expectations and dynamics, and a host of other components that a therapist of a different life experience may not understand.
It should be noted that even a therapist who may have a similar identity as you will still need to get to understand how your identities impact you personally. For example, a gay male client seeing a gay male therapist may expect that their therapist has a similar relationship to their sexuality that they do, when in fact we all have different experiences that impact us and mold our relationships. So basically, just because we may look or identify in a similar way to our clients, therapists will always want to know and understand how that part of your identity impacts you.
WHAT THEMES OR SPECIALTIES DO YOU WANT YOUR THERAPIST TO HAVE?
When seeking therapy, we usually have ideas about why we are seeking help. Whether it be feeling anxious or depressed, struggling with a life transition or relationships, or symptoms that are impacting your quality of life. It’s important to think about what your presenting issues are so that you can seek someone who may have the experience, training and passion that best fits your needs. All therapists have a foundation of training and education, but beyond that foundation therapists grow their own specialties or niches by taking trainings and gaining experience that inform who and what we treat.
For instance, over the years I have found myself working primarily with young men aged 18-35 who struggle with anxiety, depression, relational issues, boundary setting and conflict avoidance. Which means if I get a call from a young woman struggling with an active eating disorder, I may not be the best therapist for them and will attempt to connect them to clinicians who would be a better fit. When looking for a therapist think about what themes, trainings and experience you want them to have. Do you need someone who has experience treating substance abuse or eating disorders? Do you need someone who has training in OCD or Panic attacks? Someone who has experience with certain Traumatic events or specific diagnosis? Think about your needs and look for therapist that match your needs as best as possible.
Pro tip: Plan to reach out to at least three to five therapists that you feel may fit what you are looking for. This is not only to improve your chances of finding someone with availability, but also important to make sure you find a therapist that you resonate with.
WHAT KIND OF THERAPY DO YOU WANT?
Now I will admit I am a bit biased here, but it’s important to think about what approach you feel will suit you best. There are several ‘modalities’ and schools of thought when it comes to psychotherapy. I will attempt to explain some of the broad strokes to give you a sense of what might work best for you.
PSYCHODYNAMIC THERAPY
This is the traditional/classic form of therapy (and the one I am biased too). It is probably the form of therapy you think about when you think of a tv/movie scene where the therapist asks, ‘and how do you feel about that?’. The main thing to know about psychodynamic therapy is that you should expect to talk about your childhood and your experience within your family. If this is something that turns you off, then it may not be the right fit for you. Psychodynamic therapists attempt to understand your history to make sense of how it may be impacting your present thoughts and feelings unconsciously. This kind of therapy is often long term and does not assign homework. Styles vary, but if you are someone who wants your therapist to tell you what to do, this may not be the best fit. I will argue that psychodynamic therapy is one of the most beneficial forms of talk therapy as it can help clients go past just behavior change and really shift how they think and feel under the surface.
BEHAVIORAL THERAPY
This kind of therapy is much more structured than psychodynamic therapy. A Cognitive Behavioral therapist or Dialectal Behavior therapist will discuss your goals for therapy and work to educate you on the different aspects of treatment. CBT clients often tackle symptoms in a direct way and are given worksheets and homework assignments to tackle symptoms outside of session. Behavioral therapy can be helpful for people who struggle with OCD, harsh and critical self-talk, problematic behaviors, and a host of other symptoms. This is often a short-term model of therapy. It is the form of therapy that has the most scientific ‘evidence’, but it can be argued that while it is great at tackling symptoms, a criticism is that is misses going deeper into the source of why these symptoms are presenting in the first place. I would argue it’s great to build skills and obtain tools to cope with distressing thoughts and feelings, but if you are looking to go below the surface this may not be the best fit for you. Though gaining the skills and tools from behavioral therapy can be a very important and helpful step to improving your day to day life.
SOMATIC THERAPY
This form of therapy takes into consideration the body. There has been much research on how our bodies are impacted by our emotions. A somatic therapist will work with you to not only become aware of your body and its relationship to your mental state, but give you tools to help release tension and strengthen your mind-body connection. Mindfulness and grounding are a big aspect of somatic work, while also learning about how your nervous system is being activated by triggers that that need to be addressed. If you are interested in this form of therapy, I recommend taking a look at the bestselling book The Body Keeps the Score by Bessel van der Kolk, which discusses the breakthrough research about how trauma impacts the brain and body.
TRAUMA-BASED THERAPY
There are several forms of therapy that are designed to treat people who have experienced Trauma. There is TRM, EMDR, Brain spotting, T-CBT, Seeking Safety, and many others. What is important to know is that if you have experienced trauma: whether physical, sexual, or emotional you may want to consider seeking a trauma-informed therapist and discussing how they may work with your personal experience. This is not to say that other forms of therapy do not address trauma as well, and there are many therapists who are well versed in several different forms of therapy and can adjust to their clients needs.
COUPLES THERAPY
There are different approaches to couples therapy as well. There is Emotionally Focused Therapy which is based mainly on the foundations of Attachment theory. EFT works to help couples learn their specific ‘Dance’ and identify each partners needs to connect. Gottman Therapy is another school of couples therapy which is a research-based approach that focuses on helping partners communicate and decrease blocks to connecting.
GROUP THERAPY
A majorly overlooked form of therapy is Groups. There are different kinds of groups, but I will spend this time to discuss Process Groups. Process groups are a good option for people who would like to learn more about themselves and how they are impacted/impact others. Group therapy is often cheaper than individual sessions and is an underrated (in my opinion) form of therapy. Groups help participants learn to build intimacy and embrace closeness, practice healthy boundaries and conflict resolution, share their thoughts and feelings in a safe space, identify maladaptive patterns and build authentic connections with others. Group members are expected to give and receive honest feedback in a way that your therapist most likely can’t or won’t.
HOW DO YOU REACH OUT TO A THERAPIST?
You should now have an idea of what you are looking for from a therapist, and this should help narrow your search. There are several different resources that can help you find therapists. Psychology Today is one of the main platforms’ therapists use and you can start by seeing if you can find those that match what you are seeking (yes, it can feel a bit like a swiping through a dating app). Other sites besides Psychology Today are: Alma, TherapyDen, (more to come)
Another option available is to ask someone you know and trust who is already in therapy. Part of a therapist’s job is to have a network of fellow clinicians that they can refer to when needed. Tell this person I am looking for X,Y, Z and ask if they may be able to get you a list of referrals to start from their therapist. Your primary care doctor, your psychiatrist, your college resource center, your friends, siblings or any therapist you may know personally can be a great place to start.
Once you have a list of 3-5 therapists, reach out either over phone or email. You can introduce yourself, let them know how you found them and that you would like to set up a consultation. Remember, not every therapist is going to reach back out or be the vibe that you are looking for. You should plan to schedule at least three consults before committing to anyone. These days most therapist should have a website; you can reach out via their contact form or if you are someone who enjoys leaving a voice message give them a call.
Most therapists will return your call as soon as possible, but it can be anywhere from 24 hours to a week depending on the practice.
WHAT SHOULD YOU EXPECT DURING A CONSULTATION WITH A THERAPIST?
Consultations are a very normal and important aspect of finding a therapist. The first thing to know is (like a job interview) you should plan to be assessing whether this therapist is right for you, just as much as the therapist will be assessing if they are a good fit for you. These calls can be anywhere from 15-50 minutes depending on how the therapist sets up their intake process.
Here are a few things you should expect to talk about:
· What is your presenting issue/why are you seeking therapy?
· Your prior experience with therapy, if any? What worked and what did not work in the past?
· What you’re looking to gain from therapy?
· Any Questions you have for them: How they work? What population/themes they work with? Their professional background and experience?
You can also expect that the therapist will want to assess things to make sure that they are the right place for you to receive care. These questions are quite routine, and yet very personal to some. Just know that if a therapist asks, they are not trying to ‘catch you’. If they decide that they are not the right fit for you know they are doing with your best interest at heart and not as a rejection. It’s important for therapists to make sure they have the experience and training to support you.
Some of the questions often asked are:
· Are you or have you ever experienced Suicidal Ideation/thoughts of harming or killing yourself?
· Are you or have you ever experienced homicidal ideation/ thoughts of wanting to harm or kill others?
· What is your historical and current relationship to substances/drugs and alcohol?
· what is your historical and current relationship to food/eating/your body? Are you or have you ever struggled with an eating disorder?
At some point on the call you should expect to have an opportunity to flip the script and ask them questions. While a therapist may choose not to disclose personal information, you can ask them about how they work, what populations they work with, how long they have been practicing, if they have sliding scale appointments, do they practice in person and/or telehealth and where they are located. You can also ask any other questions you may have about their practice.
If both of you decide that you would like to take the next step you can discuss setting a fee. Sometimes it can be disheartening to have a great consult only to find that the therapist doesn’t take your insurance or their fee is out of your budget. If this is the case, it is totally appropriate to let the therapist know at the top of your call what you are looking for to avoid waisting either parties’ time.
These consults can quite frankly be a weird experience. Here you are speaking to someone you literally just met and you are doing your best to try to tell them things that you may or may not have even shared with the people closest to you. Remember that you do not need to share everything, but do your best to give an honest and accurate snapshot of yourself.
If it is a match and the vibe and fee are a fit, you can set up your initial session. Your new therapist will send you intake paper work that you should complete and return before the first session. This paperwork will go over the office policy, your rights, the limits and expectations within treatment, and any other information they choose to include in their consent form.
And that’s it. The next step is to sit down, take a breath, and enjoy the ride.
WARNING: you might suddenly feel that all the therapy related memes and social media posts are speaking directly to you! :)
TO WRAP UP…
My hope is that the information I have laid out here is helpful to anyone who is considering making the jump into therapy. I also hope that I did not add to anyone’s overwhelm, because while there might seem like a lot of information here; once you take that initial step the process truly can flow seamlessly. For those who have been considering therapy but have a way of putting it at the bottom of their ‘to do’ list, I hope that this can help alleviate some of the heavy lifting by setting up some initial steps you can take to get the process moving. I am a big believer in therapy (to state the obvious) and know that everyone can benefit from a space and relationship that is designed to be a safe place to seek support and gain invaluable understanding about themselves and how they navigate the world. So whether it’s a personal resolution or you are sending this to someone you hope will take the leap, I wish you the best as you embark on this exciting and (hopefully) fulfilling journey.
(Personal plug: If you are a young man or have a young man in your life that you believe could benefit from therapy please do not hesitate to reach out)