Considerations For Getting Started in Therapy
Many folks might be curious about starting therapy but struggle to know how to select a therapist or even how to consider therapy services. If you do not work in the healthcare field yourself or are new to the idea of investing in therapy, you may be very unfamiliar with how it all works.
This post aims to help people become more familiar with the current landscape of therapy so that you can make informed choices about your care.
Therapy can be life-changing with the right therapist, but it’s also an important investment of your time, energy, and money so it’s wise to be very selective when choosing a therapist.
The decision to start therapy…
Sometimes people start therapy and have a very clear reason for seeking it out and other times, they know something feels off but need some help clarifying their goals and taking meaningful and effective action.
Issues I treat/ My approach…
In my practice, I help people improve the quality of their intimate relationships and their overall emotional well-being. I work equally with individuals and partners, and I enjoy working with folks from all walks of life. My extensive and culturally informed training has allowed me to work effectively with folks across differences. As a white, cisgender therapist, I strive to create a sense of safety, trust, and comfort for my LGBTQIA+ and BIPOC clients. I also work with many interracial and interfaith couples as well as expats.
One my most meaningful professional experiences thus far has been participating as a post graduate student at the Ackerman Institute for the Family here in NYC. Through scholarship, I was able to spend a full postgraduate year studying the art and skill of therapy alongside thoughtful, deeply dedicated, and curious peers. During this time, we shared cases together, consulted as a team, and even participated in the extracurricular Talk Race group, where we unpacked our own intersectional identities more deeply with regard to our intention vs. impact out in the world. I believe these unique and in-depth, long-term training opportunities have allowed me to be the most effective, curious, and informed therapist I can be. I very much consider myself a life-long learner and I deeply value curiosity–both personally and professionally.
I often work with partners who are looking to improve their communication, cultivate a more optimal erotic intimacy, or move through the major shift of transition to parenthood. In these sessions, we dive into how to keep their relationship strong through this major life transition. We unpack communication issues, sex/ affection issues, destructive interactional patterns, outside relationships, repair after arguments, and in general — how to nurture a satisfying relationship over the long-term.
Individuals may be struggling with relational challenges, family of origin issues/ trauma (in the form of abuse or neglect), dating/sex, cultivating satisfying connection, and the stress of navigating major life transitions in general.
Ultimately, I help folks overcome significant barriers and move through individual blocks by providing a personalized approach based on research and my extensive clinical experience.
Therapy can help you to recognize your interpersonal patterns and understand where you might be struggling so that you’re better equipped to handle life’s diverse challenges. The therapist can collaborate with you in a really personalized way to help you to be more effective. It is this tailored approach and the unique therapeutic relationship that you share with your therapist that makes therapy such a special, effective, and worthwhile endeavor.
Whether you are struggling with some form of self-sabotage, or feelings of loneliness or you are having difficulty in your interpersonal relationships— therapy can be a great way to begin addressing the barriers so that you can ultimately enjoy life more fully, cultivate more meaningful relationships, and experience more pleasure, joy, and satisfaction on a regular basis.
Familiarize yourself with the idea that it is a large (but worthwhile) investment of your time, money, and energy.
Therapy is likely not going to feel convenient—in any way—although it might feel like just the thing you really need, it probably won’t be convenient for you.
It’s the kind of thing where you have to make time for it and really put in the effort to see the results. However, therapy with the right therapist can truly be life-changing.
Tip #1: Understand the present landscape of therapy…
Familiarize yourself with the landscape of therapy so you are informed about what’s available to you and what kind of therapist might be the best fit for you. Most therapists are trained fairly well to handle the common reasons people might come in—anxiety, depression, stress, and relationships, etc. But, based on their professional training, they might take VERY different approaches and that approach can make all the difference.
In addition, level of experience will also play a huge role in the quality of your experience. While experience is optimal here, if you are on a very tight financial budget, I recommend pursuing the care at a reputable training clinic in the area. That way, you can have a good quality experience on a very tight budget—since those therapists are carefully monitored and supervised by highly qualified and experienced licensed therapists. Some drawbacks to this option are that there may be a small wait to be seen, and you may have to agree to be filmed for training purposes as well as disclosing financials. I will talk more about this a little later on in the post.
It can be helpful to view therapy as a time-limited investment and not this ongoing expense that never ends. This can help you contextualize the value of the service. Ideally, you will want to pursue therapy with an experienced and licensed clinician who has the skills, knowledge, and experience to help you in an effective and timely manner.
Once you have narrowed down a few choices, take some time to read their bios and website. This will allow you to gain a clear sense of their training and level of experience as well as how many years they have been a therapist. There is nuance to finding the right fit and there are many factors that influence fit. The therapeutic relationship is a very unique one with legal and ethical standards in place. In my practice, I personally provide a four-session diagnostic assessment. While it requires more investment up front on the part of therapist as well as the client, I believe this is the best way to provide the most appropriate value to clients at this beginning stage.
This helps me to gain clarity over what’s happening and what’s bringing you and/or you and your partner(s) in and it also serves to help you assess whether I’m the right fit in a meaningful and in-depth way.
From there, once we’ve reviewed the findings together and determined a possible course of treatment, I am honest in letting you know if I’m not the best therapist for you and will provide other thoughtful referrals in this case. If it turns out we agree to proceed together, we’ll sort out a schedule based on defined treatment goals. Either way, you will have a more clear sense of the current barriers and the work involved to cultivate more satisfaction and lasting results.
While it’s tempting to think you can assess fit over the phone, it’s not the best approach. It’s simply not possible to gain a meaningful sense of therapeutic fit in a brief conversation that is focused on logistics of care: i.e.- scheduling, fees, and availability. In my experience, you have to schedule sessions to really see if it’s the best fit. That way, you can get a sense of the therapist’s style and approach to the work. You can also get a better sense of if you can see yourself building trust with this person. Therapy is an important investment so you will want to be thoughtful.
Looking at fees…
Let’s briefly touch on fees. In general, experienced and highly trained therapists who are fully licensed and have been practicing independently (not requiring supervision) for at least 6/7 years, will not take insurance and will most likely have higher fees. In NYC, that is generally over $275 per session. However, if you have health insurance with out of network benefits, many insurances will likely reimburse you for a large percentage of the fee.
So for example, if the therapist charges $300 per session and your insurance covers 50% of the fee, you would receive $150 of the fee back in the form of a check from your insurance company. Sometimes, your plan may cover even more! I have seen some plans cover up to 80% of the fee, so it’s definitely worth checking out. Many therapists also provide a sliding scale fee structure, so it can be helpful to ask about this during your initial call.
Do some research and find out what your particular insurance plan covers. I recommend doing this as soon as you have decided to seek treatment. That way, your initial calls to therapists are more productive.
You can say to your insurance company that you’d like to see ____ provider because they specialize in _____ *insert specific issues that you are struggling with; “they have a unique background and training in this area so I feel they will be more effective than another provider.” You can also mention that you are looking to go to a provider who is experienced.
Therapy can be extremely helpful if you are looking to improve your relationship to self and others. If you’ve always found your family to be a source of stress/ frustration and there have been troubling experiences in your family of origin while you were growing up, you may find a licensed marriage and family therapist is a nice choice since they will be well-versed in family and relationship dynamics and how to improve them.
Licensed MFTs will be familiar with how to best approach these issues and help you function at your best in all relationships—work, friendships, intimate partners, and of course, relationship to self.
Tip #2 Sort through the different types of trained professionals…
Some terms to help you sort through the options:
Licensed Marriage and Family Therapist – LMFTs are trained to provide high quality therapy and work with individuals, couples, and whole families, so they have a breadth and depth approach to the work. MFTs take a contextual approach to the work so they will be able to take a look at many factors that might be influencing your presenting concerns. Rather than place you into a diagnostic toolbox, they will take a holistic approach to your care.
Psychiatrists – are medical doctors who are able to prescribe medication. Sometimes, they also provide therapy, however, you will want to look into their approach and therapeutic training to learn more about how they provide psychotherapy. In some cases, a person might have a psychiatrist as well as a therapist whom they see weekly.
Social worker – many social workers pursue a clinical career where they have completed supervised therapy (clinical) hours and clinical supervision so they can provide therapy. Not all social workers pursue this path however. You will want to look for a social worker who has the letters “LCSWR.” This ensures they have the proper clinical experience/ clinical training.
Psychologist – these providers have completed a PhD or a PsyD and might conduct research, provide therapy, or provide a combination of the two. Again, you will want to learn about their expertise and training to familiarize yourself with their approach to treatment. There is a wide variety of specializations/ modalities within clinical psychology so you may want to visit their website to learn more about their particular approach and the common issues they treat.
Tip #3 Understand the difference in the options…
Here’s a very quick overview: you can receive these services through an outpatient clinic, a hospital, a stand alone clinic, or in a private practice setting. You can also pursue the services through one of those large online companies that advertise on google where they claim to set you up with the ‘best match for you.’ However, you will want to proceed with caution as these are large, high volume operations. I would be curious to understand how they maintain high quality standards of care and what systems are set up and in place to ensure a quality experience. Remember, if it seems too good to be true–it probably is.
If privacy is most important to you—yep, you guessed it!— A private practice setting is likely the best fit for you.
With so many choices, it would make sense that you might feel overwhelmed. However, I’m going to offer you some inside tips on how to find the best care for you to help make your search easier.
First, understand the landscape. What do I mean by that? Well, when managed care (insurance companies) took over the management of psychotherapy services in the 1980’s, many things changed.
Managed care now determines the price of the therapy services, how long they deem care should go on for, and can even influence clinical decisions based on the diagnosis and what they deem is the best path or course of action. In short, the insurance companies have a lot of control over the matters related to your mental health care and what services they choose to cover. This is one of the reasons why many providers opt to not be in-network with insurance companies—They would essentially be working for the insurance company instead of for themselves and their client(s).
Level of experience is part of what you are paying for…
At the present time, many experienced therapists opt to accept insurance on an out-of-network basis. Meaning that the client pays for the service up front and the therapist provides the client with a receipt so they can submit it to their insurance company for reimbursement.
This allows the therapist to maintain creative control over the therapy and set her own fees without input from the insurance companies. As a therapist who has been operating this way for a number of years, I can say that this allows for the highest quality care in a private practice setting.
An experienced and fully licensed therapists (of any discipline) has spent many years training and perfecting their craft. In addition to the standard education in graduate school, experienced therapists have likely worked in several different clinical settings and have trained for many years (postgraduate) beyond the minimal requirements of licensure.
It can be helpful to spend a little time considering what are you looking to change/ heal from or move through in therapy… Perhaps you are wrestling with a major life transition, self-image issues or your sense of self-belief. Maybe you want to act in more confident, self-assured ways. Or, perhaps you are struggling with intimate relationships, dating, communication with a partner, anxiety/ avoidance, or work relationships—there may be many reasons you are seeking out some help and support.
People seek help at different points across the lifespan. It is completely human to need a little help sometimes so don’t waste your time or energy judging yourself harshly for it.
Looking into low cost options…
If you do not have a job currently or you are on a very tight budget, there are many options for good care. While many experienced therapists who are operating a private practice tend not to take insurance and charge higher fees, there are several very good options that allow you to have quality care at a more budget friendly price. Alma and Open Path Collective are focused on meeting the need for high quality, low cost services and are definitely worth checking out! I would also recommend training clinics in your area. Many times, the therapists have extensive experience already but are seeking additional training. As a clinician who has trained at many of them in NYC, I can personally attest that there is good clinical work happening within those spaces and solid supervision.
While there are issues with access and affordability — that’s a much larger conversation about our healthcare system in general. It’s a systemic problem and therefore requires a systemic solution. Certainly, it’s not an easy or simple one to fix. The reimbursement rates to in-network providers are very low and do not consider where (geographically) a particular therapist practices or even their level of experience when setting reimbursement rates.
It will surely take thoughtful, committed action to bring about meaningful changes to our current healthcare system so that – as a society, we value the important work of therapists. Once we have a system that truly honors and values mental health across the board, the situation — including access to high quality care will look very different.
In the meantime, therapy services vary in quality and are available at different price points depending on a number of factors. University counseling centers and local training institutes are great places to start in order to find quality, budget-friendly therapy. However, you will likely have to agree to be filmed for training purposes and there may or may not be a wait in order to receive care.
You can call up a local college counseling center and ask them if they can share a resource list of low cost options in your area. Most of the time, they will be happy to help and can send over a list. Additionally, you can do a quick google search of psychotherapy training clinics in your city, and give them a call. Many times, they are in-network or they can accommodate a very low fee in some cases (because they do a very high volume of client hours). Most of the time it will be based on your income so you may want to have some documents ready in order to show that you qualify for certain rates. The therapists in training clinics are supervised by fully licensed and experienced therapists. The cost of sessions at these training clinics is often very low because the majority of their revenue is coming from paid trainings that they host for therapists as well as state and city grants. Therefore, the cost of sessions are able to be kept on the lower end.
Key takeaways given our current mental health landscape:
-Go to the most experienced therapist you can afford.
-Feel free to ask the therapist how many years of experience beyond graduate school they have as well as how many years they have been fully licensed in their state. You can also look up how long a therapist has been licensed in a particular state by searching their name on the department of licensed professions website. It will tell you how many years they have had their license.
-Private practice settings will typically offer the most privacy.
-If you are looking for an experienced and fully licensed professional, expect to pay a premium rate for treatment. If you are curious about the benefits of therapy, you can check out my post by the same name here.
-Insurance companies typically reimburse anywhere from 50%-80% of the full fee for out of network providers. So it it worthwhile to call your insurance company and find out your reimbursement rate, deductible, number of sessions covered per year.
You can ask them about the reimbursement percentage for 90791 (initial), 90834 (individual), and 90847 (couple/ family). If they ask for the fee, you can give them $300 per session so you can get an idea of what you’d actually be paying per session. Each geographic area of the country has what insurance calls a “reasonable and customary rate” based on a number of factors. NYC and SF tend to be on the higher end for example since they are more expensive cities.
-Low cost care is accessible at local training clinics, however you may have a short wait to receive the services.
-Local universities can often provide a list of low cost options in the area so if you are on a tight budget or unemployed at the moment, it is worth reaching out to inquire.
I hope you have found this post helpful on your journey. I know it might be a lot to take in initially, but once you get started with the right fit therapist, it will be worthwhile! Feel free to send me an email if you have any questions about this post.
Warmly,
Jennifer