Finding A Counselor: Tips and Advice

From Anne Slonim Rafal, PhD, LCSW; anne@annerafal.com; www.annerafal.com

During this stressful time of social distancing due to the pandemic, you might want to consider seeing a counselor or to urge a family member to do so. Many people are deciding to pursue therapy for the first time to address the major life changes that have come with Covid-19. We are all facing new challenges including:

  • Health worries
  • The uncertain end point of social isolation
  • New shared space with family members working from home
  • Worry about long distance relatives
  • Keeping your kids occupied and emotionally safe

You may also want help with managing family conflict, or dealing with increased grief, or anger, along with depression and anxiety. 

It takes courage to pursue counseling or therapy at any time and especially now, when the pulls on our lives and priorities are even more challenged. Needing support from a therapist is only a few phone calls away, and the steps below de-mystify the process. Keep in mind that you will need to engage with the therapist through “telehealth” (also called “virtually” or “remotely” or “online”), which will involve using some simple technology, as described below.

What is telehealth therapy like?

Telehealth is the physically safest therapy available. Telehealth is done at your computer, iPad or other tablet, or sometimes over the telephone. Once you find a therapist (the process will be described below), the therapist will likely send you link to a platform, such as doxy.me. You will click on the link to enter the session. Other platforms, such as Zoom, use a password. These are all simple methods to navigate. Sometimes the internet connection will be weaker than others, so both you and the therapist need to be aware of this. Generally, you will see the therapist on your screen and see a small image of yourself as well.

We still consider your privacy to be very important, and your therapist will have a special HIPAA Online Therapy Consent Form for you to complete.

How will I know how to choose a therapist that is right for me or my family member?

Many providers are “generalists” and can provide treatment for a wide variety of concerns or conditions. Some providers are “specialists” who focus on specific types of concerns or conditions (e.g., eating disorders, substance abuse, trauma, OCD). Others are generalists with some specialty interests and experience. If you have a very specific condition or concern, or a chronic condition that requires a provider with special knowledge, you may want to seek someone with expertise treating that condition.

Help from the right therapist can promote new insights, identify personal or family “blind spots,” and assist with self-actualization and self-growth to improve relationships and reduce emotional suffering. Depending on the situation, therapy may include individuals, partners, or whole families.

Do you have any personal preferences for characteristics of your provider? Factors such as age, gender, religion, and cultural background of the provider may be important to your level of comfort during your regular sessions. Since you may be establishing a long-term relationship with a provider, consider whether any of these factors are important to you when you narrow down your choices.

Will you need medication or monitoring of medication that has already been prescribed for you? 

Only doctors, physician assistants, and nurse practitioners can prescribe medication.

  • A psychiatrist is a medical doctor (MD or DO) who specializes in diagnosing mental health conditions and managing mental health medications.
  • A psychiatric or mental health nurse practitioner can also diagnose and treat mental health concerns with medication, under the supervision of a licensed psychiatrist.

Some primary care physicians (PCPs), physician assistants (PAs), and nurse practitioners (NPs) may be willing to monitor and/or prescribe mental health medications, but you may wish to meet with someone who specializes in mental health care.

In some cases, medication can play an important role in your treatment, and it is often recommended that medications be prescribed and monitored by a provider who specializes in mental health treatment (e.g., psychiatrist). There are many cases when a mental health condition is treated with medication and therapy, in which case you may need to see both a psychiatrist and a therapist.

Credentials, education, and training

When you begin to look for a counselor, it may be overwhelming to find that there are many kinds of professionals who may offer the help you need. Therapists fall into several categories of providers that are all qualified to provide mental health care. Licensed Psychologists have a doctorate (PhD or PsyD) in clinical or counseling psychology. Licensed Professional Counselors (LPCs), Licensed Marriage and Family Therapists (LMFTs), and Licensed Clinical Social Workers (LCSWs) have a master’s degree (MA, MS, MSW) and some also have a doctorate (PhD, PsyD, EdD).

Paying for Counseling

Cost may or may not be a primary concern. The full fee for a 50-minute counseling session will cost at a minimum between $150-$200; more for a psychiatrist. You may want to request shorter sessions or more frequent sessions during this stressful time.

If you have insurance, check your “in-network “and “out of network” costs. Your insurance plan may have a list of network providers, typically found online.

If you plan to use insurance, keep in mind the following:

  • Only licensed therapists can receive insurance.
  • Find out if your insurance plan has mental health benefits.
  • Determine your deductible and co-pay after the deductible is met.
  • Examine the insurance list of approved providers. Keep in mind that this list does not mean that all the therapists listed are currently accepting your insurance.

If you do not have any insurance, or if you have a form of Medicaid as your insurance, your best options may be to find an agency.  In Virginia, some agencies that have sliding scales are Northern Virginia Family Services, George Mason Counseling Center, and the Women’s Center.

Getting Started

In addition to or instead of working through your insurance plan, there are some other ways to find the right counselor.

  • Ask your friends and neighbors if they know any counselors they trust.
  • Search online using your zip code or city, insurance, and/or issue you are dealing with. Most counselors in your area will be listed on psychologytoday.com or www.goodtherapy.com

Identify two or three counselors and read their online profiles. If you choose to call them, be prepared to ask how they work with clients and if they have specific training they use. Afterwards you can read about their approach and decide if it sounds right for you.

Making a Decision

When you first meet a counselor remotely, how will you know that this person is a good fit for you?

  • Does the therapist seem grounded and able to offer you new coping skills and insights?
  • Does the therapist have background and training in the issues that are of concern to you?
  • Do you feel comfortable in this person’s presence?
  • Do you feel this is a non-judgmental person who will accept your values and lifestyle?
  • Does the therapist address confidentiality and other ethical concerns?
  • Does the therapist explain how they work to address your issues?

If you are looking for a therapist, you are taking steps to help yourself. Congratulations— you are already on the path!