Let’s say it how it is: it is ridiculously hard to find a decent therapist. As someone who has been a psychotherapy client before and as a therapist myself, trust and believe I fully know and understand that it’s needle and haystack-levels out there. And don’t let you have 1 or more marginalized identities and kinds of oppressions you are dealing with. In their article, ““Sorry, I’m Not Accepting New Patients”: An Audit Study of Access to Mental Health Care,” (Email queeringpsychology.com for access to the full article) Heather Kugelmass discusses how hard it is for Black people to find a therapist. According to the study, a working class Black man would have to call 80 different therapists before 1 therapist calls them back. Who has the time for that seriously? Queer and transgender people of color, especially, also have seriously difficult time finding a competent therapist because many graduate programs do not teach how to provide care to LGBTQAI clients. The better programs will have 2 courses at the very most AND transgender and intersex people are barely an uncomfortable whisper throughout the entire course(s). Not only are people of color, especially LGBQTAI people of color, systemically kept out of counseling and psychology fields, but many actual, real life therapists are scarily unprepared to deal with clients who aren’t White, well-off cisgender heterosexual able-bodied men who are just need temporary assistance going through a difficult life transition like a divorce. So needless to say, Kegelmass’s study did not surprise me. In fact, the study continues to say that “despite health care providers’s explicit endorsement of racial equity, they have a strong pro white implicit (i.e. non conscious) bias […] These stereotypes and other sources of bias, in turn, influence their decision about whether to extend offers of care” (Kegelmass, Heather. (2016). “Sorry I’m Not Accepting New Patients”: An Audit Study of Access to Mental Health Care. Journal of Health and Social Behavior, 57(2), 2. https://doi.org/10.1177/0022146516647098).
Now, let’s take this to the next logical conclusion. We’re grown. If the pro-white biases are keeping many therapists from calling people of color back, what other actions are being influenced by their biases? With all that as background and context, how does somebody even find a therapist worth a damn in the usually little bit of time they have? Especially if you are using insurance, you may have a limited amount of sessions you can have in a certain timeframe so being able to quickly and efficiently shop for therapists is an important skill to have. It is so important to remember that a therapist is providing a service to you and if things don’t feel right, it’s not worth staying. Life is far too short and you have healing work to get done. You and the therapist have to be compatible enough so the both of you can work effectively towards your goals. If there isn’t a good fit between y’all, you will probably become distracted from the work and/or otherwise won’t be able to focus on yourself and your goals. So this isn’t the time to “be nice”. If you don’t feel good chemistry and the fit between you, the client, and a therapist isn’t working for you, it’s time to move on. The purpose of this piece is to help people figure out if a therapist has the right fit/chemistry for them in 1-3 counseling sessions. After you went and called 50-11 therapists, who has the extra energy/spoons to waste dealing with a therapist who can’t really do much for you?
A colleague, Kiya Black, artfully describes the work to find the right therapist as searching for the right pair of jeans: “Finding the right therapist is like finding the perfect pair of jeans. Sometimes you get lucky, and the first pair fits JUST right. Most of the time though, you don’t. The waist don’t fit. The leg too long. The fabric is just – crunchy. And on a bad day? You might think that means something is wrong/flawed with you. Nawh. Nawh. That ain’t it. It’s just NOT the right pair of jeans. You might have to try a different brand. A different size. A different model. But – eventually – you’ll find the PERFECT pair of jeans. Cloth like yes. Ass like WHAT. Cozy like perfect. And that’s how the right therapist will fit too – they’ll make you realize just how wonderful YOU are.” I love this metaphor because it perfectly describes the work it can take for many people, especially marginalized people, to find the right therapist for them. As Ms. Black describes, if you and the therapist don’t have the right fit, it’s probably time to try another therapist. It’s not you. It’s not all jeans (therapists). It’s the fit. And even though it may take a lot of work to find the right therapist for you, it’s so worth it.
Before you even make the phone call and/or walk into an office, the work starts at home and in your head. What do you want? Walk in knowing that. Using Ms Black’s metaphor, when people go shopping, they usually have a general idea of what you are looking for and work from there. Shopping for a therapist works in a similar way. It will save you so much time and effort to be intentional with your hunt. You are a client looking for quality service. You should take some time to think about you are looking for before walking in.
Some questions to think about before starting to schedule appointments:
What kind of therapeutic relationship/dynamic are you looking for? Do you want them to be your equal who provides a service to you? Do you want them to be a teacher and you the student (peep the change in power dynamics here)? Do you want a therapist whose style is more about collaboration or do you want a therapist whose style is more them feeding you information?
What part(s) of your life do you want to focus on and/or what are you willing to talk about in therapy?
What is making you want to start/restart therapy? What are some of your goals for therapy? What do you want to get out of this? How will you know when you have achieved these goals?
What values do you want to grow and foster in yourself? Look for those values in the therapist
First of all, congratulations for coming to the intake. That’s huge. The work continues at your intake appointment. Even if you end up doing the intake with someone who is not going to be your therapist, there are still things you can learn about the agency, hospital, private practice, etc. from the intake session. And that information is important. You need to figure out if this is a space where you want to receive therapy (and if the workers can create a safe space here for you). How does the person doing your intake treat you? Do they make you feel welcome and/or comfortable potentially receiving mental health services here? What kind of questions are you asked during the intake? Do the questions make you feel included? If the questions and the whole process makes you feel like they’ve barely worked with people of color, disabled people, LGBQTAI people, etc., that’s worth noticing and keeping in mind. All of this is information that will help you make your final decision later.
Counseling Session #1
Every therapist is different, but there are certain things that you should be able to expect from a first therapy session. Like the start of any relationship, there is a get to know you phase between therapist and client. Both you and the therapist are trying to see if this will be a good fit for the work you need to do. The therapist should take this time during the 1st session to explain who they are and what they are bringing to the table, i.e. their name, credentials, experience, and theoretical orientation.
It always bothered me how many people see a therapist, but don’t know their credentials or what qualifies them to be working with you. Are they a mental health counselor, social worker, psychologist, etc.? What kinds of experience and training do they have that qualifies them to be working with you? Just like you wouldn’t go to an eye & ear Dr to remove your wisdom teeth, it’s important to pay attention to a therapist’s specialties and their experience with working with people like you and/or your specific issues.
Also what is their theoretical orientation? And does that match what you want in a therapist? A therapist’s theoretical orientation determines how a therapist sees themselves, how they see you the client, how they see your psychotherapeutic relationship, the tools and strategies they will use, and the parts of your life they want to focus on. Usually on therapists’ websites, they list their theoretical orientations in their descriptions or by their contact information. Take a little time and google their theoretical orientation. Google the tools/strategies they use in their work and see if any of that appeals to you and what you wanna do. If you still aren’t sure by the first session, ask the therapist to describe their theoretical orientation in more detail so that it makes sense to you. They should be able to break this down no problem. If they struggle to explain this to you or don’t want to explain it, that’s something else to keep in mind. You really should be able to walk out of the office able to describe, in your own words, who the therapist is, how they are qualified to help you, and the perspective they work from.
Another IMPORTANT thing that a therapist should have a conversation with you about in the 1st session is confidentiality. You might have filled out and signed a confidentiality agreement during the intake, but just reading and signing a document isn’t enough. When you, the client, leave the 1st or 2nd session, you should be able to answer the question: What is the therapist’s POV on the limits of confidentiality in therapy? Usually, with a few exceptions, whatever clients talk about in session is confidential and most of the time is legally protected client private health information (aka between you and the therapist). The exceptions are usually for 1)sharing info to coordinate the best care with other providers in the client’s healthcare team (which the client gives permission for), 2)speaking with parents and other people cleared by clients, 3)reporting child abuse/neglect, 4)calling emergency services in case a client is a danger to themselves/others, and 5)reporting when a client is at risk of harming someone else (duty to warn others at risk). The therapist should explain their usual limits of confidentiality, what makes the limits important, and why it’s important for therapists to discuss with clients ASAP (in the 1st 2 sessions aka informed consent). Confidentiality and the limits of confidentiality are part of the therapist’s role of protecting the client and the wider community. Did the therapist fully explain confidentiality to you and invite you to ask any questions? If not, see if they bring it up during the 2nd session (and if they don’t, bring it up yourself).
“So What Brings You to Therapy Today?”
After you and the therapist introduce yourselves and discuss confidentiality, the final part of a 1st session usually involves talking about why you’re here. Before this point, your therapist has probably been doing most of the talking. It’s important for the therapist to set the tone, set some boundaries, and start to show you the kind of therapeutic space they can create for you. But now, it’s the client’s time, your time, to talk briefly about what made you decide to come to therapy. All the self-reflection you did up to this moment will come in handy because you will be able to explain the reason(s) you want therapy and the kind of relationship/energy you want with your therapist. This will also be a great time for you and the therapist to start thinking about what your goals for therapy might be. Usually this is the last part of a first session so congratulations, you made it.
Some questions to think about before before the 2nd session:
How was this therapist with setting boundaries?
How confident do you feel in their ability to create a safe space for you to do the work of therapy?
How comfortable do you feel coming out to this therapist (as LGBTQAI, as polyamorous, as into BDSM/kink, etc. if that’s related to your reason(s) for therapy)?
Counseling Session #2
Walking Into This Session
Bring questions or anything you need more understanding on. This isn’t the time to be shy. Reminder: you are shopping for a therapist and your insurance company may have placed limits on the number of sessions you get so we gotta take a step back, really look at the board, and strategize here. Ask any questions. Anything that will help you get a better and deeper understanding of this therapist, how they work, and the kinds of things they’d want to do with you to address the reason(s) you want therapy. Speaking of which, has the therapist mentioned your treatment plan yet? Now that the introductions are over, it’s about that time to start talking seriously about your therapy goals and what needs to be done to get you there.
And that’s where a treatment plan of goals (what you want our of therapy in the short term and long term), objectives (the smaller things you need to do to get to your goals), and interventions (what you and the therapist will do to get you closer to your objectives) comes in to help you map out how to make the best use of therapy. A well-written treatment plan (aka service plan, care plan, etc) is the compass to your work in therapy and it is something that you and the therapist should brainstorm together. The treatment plan isn’t going to be a good, realistic fit for you if you don’t have a serious hand in it. It is a collaboration between you and your therapist to work out how to get the most of what you need out of therapy. Pay attention to how open this therapist is to collaborate with you and how they react to areas of your life that they have less experience working with.
Some questions to think about before before the 3rd session:
How did the therapist respond to your questions/concerns?
How open do they seem to learning new things? A therapist should be able to admit when they are not knowledgeable about something and should be willing to put in some work for the sake of the therapeutic relationship.
Counseling Session #3
During The Session
The 3rd session should be about continued discussions about goals, treatment planning, and the next steps to starting this work with your therapist. If you have questions or if there’s anything from last session you want to talk more about, this is a great time to bring it up. Especially at the beginning so the therapist can fit it into the agenda for the session. Take note of how they responded to your questions and/or feedback for your self-reflection time later. What do you think about the treatment plan so far? How would you describe the treatment plan in your own words? The treatment plan should address the reason(s) you decided to come to therapy and give you a sense of what you will be doing in therapy for usually the next 6 months. If you are having a hard time describing the treatment plan, it means that the plan probably isn’t clear enough and needs more work.
3rd Session Reflections
How does the therapist match up with what you are looking for?
How do you feel about the way the therapist makes you feel or the energy in the space while you are in session with them?
How productive do you feel like you are going to be with them? What kind of team do you think the two of you will be?
Where do you think you will be with this therapist in 6 months?
It is so hard to find a good therapist. I see the struggle. I really do. That’s why I wanted to write this to help y’all on this difficult search. Like my colleague Ms. Kiya Black described in her jeans analogy, it’s not your fault for having such a hard time finding the right therapist and you don’t have to keep working with someone who isn’t right for you. Unless you are mandated, you are not locked into this therapist. You are shopping around. You are interviewing. The therapeutic relationship is a professional working relationship that needs chemistry. Y’all need to be able to work well together. Switch therapists if you don’t feel that there’s chemistry and/or if you’re not looking forward to working with this person. This is about your growth and healing. And you need everyone on your team to be A1.
Thanks for reading. The next piece on Sunday 6/9/19 will be a continuation of “The Process of Change” series, covering community accountability: how community accountability is an important part of healing and growth for and by the community when there’s been harm done.