How to Pick an Outpatient Therapist

1. Demographics – Who Are You Going to Mesh With the Most? A foundational study in therapeutic outcomes states that the most robust determinant of successful therapy is a strong “therapeutic alliance.” Therapeutic alliance essentially means how well connected you feel to your therapist, broken down into personal bond, agreement on goals, and agreement on the type of therapy used. So the very first thing you need to look for in a therapist is finding someone you will trust. Whether that is someone who has similar perspectives, personality, cultural background, or any other personal traits in a therapist that will make you feel safe and connected to them.

2. Licensure Type Researchers love acronyms, which can make it easy to feel overwhelmed looking at the “alphabet soup” following practitioners’ names. Here is a list of the most common licensure types in outpatient therapy:

a. Therapy:

• LPC-MHSP – Licensed Professional Counselor – Mental Health Service Provider: This is a person who has a master’s degree in counseling that focuses on diagnosis and individual therapy, as opposed to couples or family therapy.
• LMFT – Licensed Marriage and Family Therapist: This is someone with a master’s degree in counseling that focuses on couples and family therapy.
• LCSW – Licensed Clinical Social Worker: This is a person who has a master’s degree in social work that focuses on providing therapeutic services as well as case management and advocacy.
• Psychologist, PsyD, or PhD: This is someone with a doctorate in psychology. Oftentimes these practitioners focus on higher acuity cases or clinical research.

b. Medication Management:

• Psychiatrist: This is someone with an M.D. or a medical doctorate in psychiatry. They will often prescribe medication and sometimes offer therapeutic services as well.
• Psychiatric Nurse Practitioner: This is someone with a master’s in nursing with a specialty in psychiatry. They can assess, diagnose, and treat mental health concerns with medication management.

3. Payment Oftentimes, finances are the largest barrier to finding a therapist. However, there are still affordable options:

• Self-Pay/Out of Pocket: This is when you pay a flat rate for therapy without using insurance at all. Often, this is the most expensive option, but essentially every therapist has a self-pay option, so you will have access to the most options in choosing a therapist.
• Sliding Scale: This is another self-pay option where insurance is not involved. Instead of paying a therapist’s full rate, they will calculate a lower rate based on your income. Therapists usually have a limited number of sliding scale spots available, but I have seen rates as low as $20 or free therapy sessions.
• Insurance: This is usually the most cost-effective option. However, many outpatient therapists do not accept more than one or two insurance types—if any at all. This is the best price, but you will have a limited number of therapists to choose from. If you are having trouble finding a therapist covered under your insurance, I suggest reaching out to your insurance company to provide you with a list of local practitioners.
• Interns: Another option to find an affordable rate is working with an intern therapist. An intern therapist is a master’s student who is completing the mandatory hours needed to graduate from their master’s degree. Most programs have students complete the majority of their in-classroom work before working with clients directly. Intern rates could be anywhere between pro bono to $80 a session.

4. Specialties/Modalities Regardless of licensure type, therapists will specialize in a few different types of modalities or types of therapy. It is your therapist’s job to figure out what modality is best for you, but if you would like to do some research ahead of time, here are some common modalities used in outpatient therapy:

• Online or In-Person: Most therapists will offer both in-person or telehealth services. There is no consensus on whether one is better than the other overall; it is more dependent on what type of therapy is being done and the client’s preferences and abilities.
• CBT – Cognitive Behavioral Therapy: This is one of the most common modalities used. It boils down to the idea that your thoughts, behavior, and emotions all affect each other. If you change how you think in a situation, it will affect how you feel and act in that situation (and vice versa). This modality is used in a lot of different settings and is often paired with other modalities. It is most commonly used with anxiety, depression, OCD, disordered eating, substance use, and people experiencing change.
• DBT – Dialectical Behavioral Therapy: This modality focuses on effective emotion management and impulse control, often using skill-building techniques. It is most commonly used for personality disorders, depression, bipolar disorder, eating disorders, and substance use disorders.
• Person-Centered: Also called client-centered or Rogerian therapy, this was created in the 1940s and 1950s by Carl Rogers, who stated that all individuals have the inherent capacity for self-understanding and personal growth given the right conditions. This modality is often paired with other modalities and is most used for depression, anxiety, low self-esteem, and relationship issues.
• Solution-Focused: This type of therapy focuses on the here-and-now and future-oriented goals. Clients spend less time on the problems that brought them into therapy and more on their strengths and goals for the future. Usually, this modality takes less time. It is often used when clients have a limited number of sessions they can attend or if the client has very specific goals they want to meet. Often times it is used with behavioral issues, crisis interventions, career counseling, and personal development.
• Sand Tray/Play Therapy: Play therapy is traditionally used with children, although not exclusively. Sand tray is a type of play therapy that has shown positive impacts on both adults and children and gives people the opportunity to process non-verbally. These modalities work well with children, family therapy, trauma, and personal development.
•  Specialized Modalities:
  • EMDR/Brain spotting: Very well-supported intensive therapy for complex trauma.
  • Gottman Method: Extensively researched method for couples therapy.
  • ERP – Exposure and Response Prevention: Directive therapeutic modality for OCD, phobias, eating disorders, and anxiety disorders.

5. Summary Choosing a therapist can be very overwhelming, but at the end of the day, the number one thing you need to focus on is connecting with your therapist. It is okay to “shop around” for a therapist that you trust. Choosing the correct modality for your treatment goals sits primarily on the shoulders of your therapist. If you feel like you need help finding a therapist, please reach out to us at Works Counseling, and our Client Care Coordinator can get you matched with a therapist that suits your needs.