Finding a mental health professional can be a daunting task. Entrusting a therapist or psychiatrist with your care is a vulnerable and important process, and you may find yourself asking – how do I know if they are the right fit for me?
While there are many evaluative tools that have been developed over the years to measure the competency of mental health professionals, “no available measure of psychotherapy competence has achieved gold-standard status,” concluded Joel Yager, MD, a former professor of psychiatry at the University of Colorado Anschutz School Medicine and staff psychiatrist at the CU Outpatient Psychiatry Clinic, who published an article posthumously in the American Journal of Psychotherapy earlier this year on the topic.
Yager investigated different assessments of quality and competency standards in psychotherapy practices and looked at evaluative tools such as the Barlow and Brown systematic review, along with clinical observations and narrative reviews.
He found that to “assess therapist competence, employers and patients must still largely rely on an assortment of certifications, personal references, and patients’ accounts.” Ultimately, while there are data-backed evaluative measures that can be helpful in choosing a mental health care provider, personal experience may still be the most important factor in determining who a patient works with.
That idea also rings true for Julie Wolfe, MD, assistant professor of psychiatry and medical director of the student/resident and faculty/staff mental health clinics at CU Anschutz. She counts Yager as one of her biggest mentors.
What makes a ‘good’ therapist?
Mental health professionals consist of two large groups that can often overlap: people who prescribe medication and people who provide therapy.
Among others, prescribers can be psychiatrists, advanced practice providers, nurse practitioners, physician assistants, and primary care physicians, all of whom may also provide therapy. On the therapy side are psychologists, social workers, licensed professional counselors, licensed marriage and family therapists, and psychiatric nurse practitioners.
“Even within that therapy realm, there's different kinds of therapy that people can specialize in. You can see how it can get very overwhelming very quickly to try to think about who the right fit for you is,” Wolfe says.
Three of the most important qualities that a mental health professional can possess in order to provide a safe experience for their clients, Wolfe says, are empathy, confidentiality, and reliability. An empathetic therapist willing to listen and attempt to understand what their patient is experiencing is paramount in addressing the reasons a person may seek therapy and helping them heal. Feeling connected to the person providing your care can lead to more honest conversations and a more positive experience, Wolfe says.
During residency, Wolfe recalls Yager, her supervisor and mentor, sharing the same observations.
“When I first started training and therapy, I was very focused on knowledge about key figures in the history of psychiatry and different disciplines. And (Yager) said, ‘Look, people just want to know that you care. People want to know that you're listening to them,’” Wolfe recalls.
Professional boundaries and respecting patient privacy are other key qualities to look for in a therapist. “People need to feel safe in their appointments and their treatment, and confidentiality is a big piece of that safety,” Wolfe says.
Measurable outcomes, while they can be important indicators of the effectiveness of therapy, are much harder to capture. There are rating scales that can track symptoms and record improvements, but with so many external factors impacting mental health, they don’t always provide an accurate measure of how effective a therapist is.
“Patients may not see an obvious change immediately,” Wolfe says. “That doesn't mean that you're not doing good work, and that doesn't mean that treatment is not effective. Things might take longer than you expected or wanted or look differently than what you initially thought.”
How to find your therapist
Wolfe recommends beginning a therapist search with logistical needs. Mental health care can be expensive, so she encourages patients to consider insurance coverage, out-of-pocket costs, and other financial concerns as one of the criteria used to initially find a therapist.
Scheduling is another important piece that can affect the search. Setting a consistent, regular time for therapy can be very beneficial, and finding a therapist who is able to work with your schedule is valuable.
The final, crucial logistical matter is what type of therapy will be most beneficial.
“Are you focused on skills-based therapy? Do you like a more insight-oriented dynamic? Are there specific areas that you want to cover, like addiction or trauma?” Wolfe says. “There are professionals sub-specializing in all different skills and topics.”
Finding a dynamic that feels comfortable, helpful, and fitting is a top priority.
Insurance sites can list out-of-date information and sometimes suggest doctors who are no longer in practice. Some websites allow providers to create their own pages with current information that allow the user to filter by location and specialty.
Some primary care offices offer integrated services and may be able to refer a patient to therapists connected with their clinics.
Even with a growing collection of online resources, Wolfe believes that word of mouth is among one of the most powerful tools in finding a therapist.
“You might be surprised how many people are in their own mental health treatment,” she says. “People that make a strong connection with their therapist are often willing to share that information, and it can be very helpful to hear about other people's experiences with their own treatment.”
Wolfe emphasizes that therapy is a deeply personal experience, and that if a person isn’t feeling comfortable or safe, they have the right to speak up or end a relationship with a mental health provider. Expressing needs and fears can lead to a clearer emotional understanding with a provider, Wolfe says. She encourages patients against feeling guilty about bringing up the conversation about needing to go in a different direction.
Because of the subjectivity of therapy, Wolfe — and Yager in his writings — says that there is no single, standardized way to measure a mental health professional’s competency or quality.
“We are all made up of our own unique experiences and circumstances, so therapy works very differently for two people who may be going through something that looks like same on the surface,” Wolfe says. “It’s so important for a therapist to have flexibility to work with people that are comprised of different experiences and the nuances that make them who they are.”
