I've Been Thinking about Going to Therapy, Now What?

Mental health problems are common in the United States, affecting more than 50 million people each year. Nearly one in five U.S. adults and one in six children live with a mental health problem (National Institute of Mental Health, 2019; Whitney & Peterson, 2019). However, fewer than half of people with any mental health problem seek treatment. A common barrier to people seeking mental health treatment is limited knowledge about how to connect with a therapist (Gulliver, Griffiths, & Christensen, 2010). In this post, I hope to provide some answers to common questions about the process of seeking therapy.

Should I go to therapy?

If you have been struggling with emotional, social, or behavioral problems – such as distressing and unwanted thoughts, low motivation, or prolonged feelings of stress, sadness, or irritability – then you may have found yourself wondering whether it could be worthwhile for you to go to therapy. The decision of whether or not to go to therapy is often a personal one and may depend on how you weigh the pros and cons at this point in your life. A major benefit of going to therapy is that it is likely to improve your well-being and day-to-day functioning at a faster rate than would be achievable on your own (e.g., Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012). However, there can be some inconveniences to going to therapy. For instance, it typically costs money to meet with a therapist, and weekly or biweekly meetings are usually recommended to see improvements. Notably, most therapists now offer short-term treatments, so the financial and time costs of going to therapy may be time-limited. That said, if improving your mental health is a priority right now, then going to therapy could be a very good option.

 How can I get connected with a therapist?

One way to connect with a therapist is through your health insurance. Call your insurance company (phone number can usually be found on the back of your card) or visit their website to get information about your mental health (sometimes called “behavioral health”) benefits and to get a list of therapists who take your insurance.

Another way to connect with a therapist is to contact your local university. Many universities with graduate programs in social work, marriage and family therapy, or clinical, counseling, or school psychology have training clinics, where you can be seen by a graduate student at a reduced-rate. Feeling wary about having a graduate student therapist? It can feel uncomfortable to put your trust in someone who is still in training. However, some benefits to working with graduate student therapists are that they are likely to be up-to-date on the latest research and trained in evidence-based treatments (i.e., treatments that research has shown to be effective) (Nelson & Steele, 2007). Graduate students are also required to be supervised by a licensed therapist, who is often an expert in the field.

Relatedly, many universities and university-affiliated medical centers are testing cutting-edge mental health treatments and are actively looking for people to participate in their treatment studies. For instance, University of California, Los Angeles (UCLA) students who are struggling with anxiety or depression may be able to receive free treatment through the Screening and Treatment for Anxiety and Depression (STAND) Program by registering at depression.semel.ucla.edu/student/register. Consider contacting local universities or medical centers or visiting their websites to see if you qualify for any treatment studies.

You can also ask your primary care physician for therapy referrals, or search for local therapists online. Organizations, such as the Association of Behavioral and Cognitive Therapies (findcbt.org/FAT), Psychology Today (psychologytoday.com/us/therapists), and the American Psychological Association (locator.apa.org), often include listings for local therapists. However, you will need to determine whether these therapists take your insurance and, if not, then what are their fees. If you have a Preferred Provider Organization plan, it is possible that your insurance company will pay a portion of a therapist’s fee, but that is not a guarantee.

Additionally, you can look into internet-based therapies, self-help books, and apps. Internet-based therapies tend to be more accessible than traditional, face-to-face therapies and may be similarly effective in improving mental health and well-being (Barak, Hen, Boniel-Nissim, & Shapira, 2008). For example, Integrative Behavioral Couples Therapy, an evidence-based treatment for distressed couples, was formatted into an online program, OurRelationship.com, which was proven to enhance relationship satisfaction, relationship confidence, and relationship quality in about two months (Doss et al., 2016). Evidence-based treatments have also been formatted into self-help books, such as the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders Workbook, which features coping skills from a successful evidence-based treatment for anxiety and depression (Barlow et al., 2017). An increasing number of phone apps are also being developed; therapist reviews of these apps can be found on psyberguide.org.

If you are in a crisis, you can call the National Suicide Prevention Lifeline at 1-800-273-8255 or contact the Crisis Text Line by texting “HOME” to 741741. In case of an emergency, call 9-1-1 or go to your nearest emergency room.

I contacted a therapist, now what?

As you are choosing your therapist, it can be helpful to ask prospective therapists some questions to see if they might be a good fit.

What is your therapeutic style?

Finding a good therapist can be similar to finding a good sports coach or music teacher: You are looking not only for competence but also for an interpersonal style that fits with yours (Norcross & Wampold, 2011). For example, some people excel with a sports coach who pushes them to their max, whereas others prefer someone who allows them to go at their own pace. Ask potential therapists about their style (To what extent do they consider their clients’ preferences? To what extent do they tell their clients what to do? How do they handle disagreements with clients?), and consider whether their style might work well for you.

What is your approach to therapy?

Therapists tend to have different approaches to therapy based on what they believe causes distress and what they believe to be effective solutions. Common approaches to therapy include: cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), psychodynamic therapy, and humanistic therapy. There have been debates about whether these therapy approaches are equally effective (Lilienfeld, 2014) – with some scientists arguing that certain approaches are more effective than others – but there are several studies showing that each of these approaches can be helpful for treating a variety of mental health problems (APA Presidential Task Force on Evidence-Based Practice, 2006). Some of these therapy approaches may be more or less in line with what you are hoping to get out of therapy, so it is worthwhile to ask prospective therapists about their therapy approach. For instance, someone interested in learning coping skills for better managing their stress might be most pleased with CBT or ACT.

Do you use evidence-based treatments?

Evidence-based treatments are treatments that research has proven to be effective for addressing a particular mental health problem, such as anxiety or depression (Chambless & Hollon, 1998). Evidence-based treatments have been shown to be better than usual care at addressing individuals’ mental health problems (Weisz et al., 2013). Accordingly, you are likely to notice more improvements with a therapist who uses evidence-based treatments than with a therapist who does not.

How will you monitor my progress?

Think about the last goal that you worked toward: Earning a good grade on an exam? Training for a race? Preparing for a musical recital? It was probably helpful to monitor your progress, whether that was tracking the number of questions that you answered correctly on a practice test or the number of miles that you ran or the number of times that you had a flawless practice performance. That’s because monitoring progress can give us a sense of how we are doing and what, if anything, might need to be adjusted to help us meet our goal. The same is true for therapy. Individuals treated by therapists who monitored client symptoms and functioning improved faster than individuals whose progress was not monitored (Bickman, Kelley, Breda, de Andrade, & Riemer, 2011), so it is worthwhile to ask prospective therapists how they might monitor your progress if you were to meet with them.

 Any logistics: How much do you charge? Do you accept insurance? What is your availability? When can I schedule my first appointment? How often do you typically see clients? How long do you typically work with clients?

Going to therapy is an investment. If you want to see sustained improvements in your well-being and day-to-day functioning, it may mean attending and paying for weekly therapy meetings for at least a few months. That said, it is helpful to make sure that attending therapy can be as logistically feasible as possible (e.g., does this therapist only meet with clients during your work hours?) (Gulliver et al., 2010) and that you have an idea of what to expect if you decide to work with this therapist (e.g., are you looking for short-term therapy, and this therapist only offers long-term therapy?) (Haine-Schlagel & Walsh, 2015).

 Once you have found a therapist who seems like a good fit for you, then you will likely have a first meeting where your therapist will ask you many questions about the problems that you have been experiencing and what you are hoping to get out of therapy. After that, therapy will begin, and you should be on your way to improved mental health and well-being.

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References

APA Presidential Task Force on Evidence-Based Practice. (2006). Evidence-based practice in psychology. American Psychologist, 61, 271-285.

Barak, A., Hen, L., Boniel-Nissim, M., & Shapira, N. (2008). A comprehensive review and a meta-analysis of the effectiveness of internet-based psychotherapeutic interventions. Journal of Technology in Human Services, 26(2-4), 109-160. doi:http://dx.doi.org/10.1080/15228830802094429

Barlow, D. H., Farchione, T. J., Bullis, J. R., Gallagher, M. W., Murray-Latin, H., Sauer-Zavala, S., . . . Cassiello-Robbins, C. (2017). The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders: A randomized clinical trial. JAMA Psychiatry, 74(9), 875-884. doi:http://dx.doi.org/10.1001/jamapsychiatry.2017.2164

Bickman, L., Kelley, S. D., Breda, C., de Andrade, A. R., & Riemer, M. (2011). Effects of routine feedback to clinicians on mental health outcomes of youths: Results of a randomized trial. Psychiatric Services, 62(12), 1423-1429. doi:http://dx.doi.org/10.1176/appi.ps.002052011

Chambless, D. L., & Hollon, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66(1), 7-18. doi:http://dx.doi.org/10.1037/0022-006X.66.1.7

Doss, B. D., Cicila, L. N., Georgia, E. J., Roddy, M. K., Nowlan, K. M., Benson, L. A., & Christensen, A. (2016). A randomized controlled trial of the web-based OurRelationship program: Effects on relationship and individual functioning. Journal of Consulting and Clinical Psychology, 84(4), 285-296. doi:http://dx.doi.org/10.1037/ccp0000063

Gulliver, A., Griffiths, K. M., & Christensen, H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: A systematic review. BMC Psychiatry, 10, 9. doi:http://dx.doi.org/10.1186/1471-244X-10-113

Haine-Schlagel, R., & Walsh, N. E. (2015). A review of parent participation engagement in child and family mental health treatment. Clinical Child and Family Psychology Review, 18(2), 133-150. doi:http://dx.doi.org/10.1007/s10567-015-0182-x

Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427-440. doi:http://dx.doi.org/10.1007/s10608-012-9476-1

Lilienfeld, S. O. (2014). The dodo bird verdict: Status in 2014. The Behavior Therapist, 37(4), 91-95. Retrieved from https://search.proquest.com/docview/1564155391?accountid=14512

National Institute of Mental Health (2019). Mental illness. Retrieved from https://www.nimh.nih.gov/health/statistics/mental-illness.shtml

Norcross, J. C., & Wampold, B. E. (2011). Evidence-based therapy relationships: Research conclusions and clinical practices. Psychotherapy, 48(1), 98-102. doi:http://dx.doi.org/10.1037/a0022161

Nelson, T. D., & Steele, R. G. (2007). Predictors of practitioner self-reported use of evidence-based practices: Practitioner training, clinical setting, and attitudes toward research. Administration and Policy in Mental Health and Mental Health Services Research, 34(4), 319-330. doi:http://dx.doi.org/10.1007/s10488-006-0111-x

Weisz, J. R., Kuppens, S., Eckshtain, D., Ugueto, A. M., Hawley, K. M., & Jensen-Doss, A. (2013). Performance of evidence-based youth psychotherapies compared with usual clinical care: A multilevel meta-analysis. JAMA Psychiatry, 70(7), 750-761. doi:http://dx.doi.org/10.1001/jamapsychiatry.2013.1176

Whitney, D. G., & Peterson, M. D. (2019). US national and state-level prevalence of mental health disorders and disparities of mental health care use in children. JAMA Pediatrics, 173(4), 389-391. doi:10.1001/jamapediatrics.2018.5399

About the author: Alayna Park, M.A., C.Phil., is an advanced graduate student in the first-ranked Clinical Psychology Doctoral Program at UCLA. She has authored more than a dozen scientific articles and given more than 50 presentations on how to make information about mental health more accessible and how to improve the quality and effectiveness of mental health treatments. Her research has been recognized with awards from UCLA, the Association of Behavioral and Cognitive Therapies (ABCT), the American Psychological Association (APA), the Society for a Science of Clinical Psychology (SSCP), the Society for Implementation Research Collaboration (SIRC), and the Delaware Project. In her clinical practice, Ms. Park uses treatments that research has shown to be effective, drawing primarily from Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT), and tailors therapy based on her clients’ goals. She believes that therapy should focus not only on improving individuals' mental health but also on helping them lead more rich, full, and meaningful lives.