It’s so easy for someone to tell you to “reach out! ask for help!” but it’s so much more complicated than that.
There are lots of reasons to go to therapy. It’s not about “needing” therapy, it’s about deciding to make changes and improve your life. Therapy is a tool that can be beneficial to a lot of people, no trauma or mental health diagnosis required.
Some people decide go to therapy because they’re living through a difficult situation. Other times people find a difficult experience from the past is holding them back. Maybe they want to learn a specific skill, like maintaining boundaries, being more assertive, or managing their anger. Maybe they need to learn to cope with a tough situation or find the courage to get out of it. Maybe they just need a safe space to talk. Maybe they approach therapy without any specific goal. Those are all great reasons to see a therapist.
Common reasons to see a therapist
- Feeling overwhelmed and hopeless
- Dealing with major life changes
- Difficulty concentrating on work or racing thoughts
- Feeling disturbed by emotions like guilt, anger, and sadness
When you need to talk to someone right now
If you’re in a mental health crisis, the steps are actually pretty simple:
- Call a crisis hotline (here’s what to expect)
- Go to the emergency room (bring something to do/keep you calm while you wait)
If you’re not ready for either of those steps, you can check out these free resources for talking to a trained professional. They’ll connect you with someone to talk to right away.
Finding someone to talk to
Lots of people talk about ‘going to therapy’ or ‘getting professional help’ like it’s one thing. But that can mean so many different things!
Sure, some people do go lay on a couch and talk to a psychiatrist, but there are many other versions of getting help, too. There’s no type that’s ‘best’, what matters is choosing the type that feels right to you.
If you have access to a social worker through your medical network, health insurance, or Employee Assistance Program (EAP), they can be a great resource. Many of them offer counseling services. They may be all you need and if they’re not they can provide referrals and ideas for what type of help is available.
Ways to see your therapist
Therapy doesn’t mean you have to be able to go to an office, sit in a waiting room, and then talk to someone for an hour. Which is great, because lots of us just can’t make that work in our lives right now.
There are lots of apps that will connect you with a counselor for video chats, phone calls, text, and email. Each app is different. Some schedule it all, others allow you to connect with someone whenever you want. Some apps pair you with a specific person, others connect you with a team or whoever is available. They also offer professionals with different levels of training. This can be confusing (so many apps! so many options!) but it also means you can find one that works for you.
You don’t need to use an app to find a counselor who will do remote sessions or offer support between meetings. Many directories of counselors will include this in their search criteria.
Types of therapists and counselors
Like with any professional, the degrees and awards don’t always make a huge difference in the actual care you receive. A counselor with very little experience may be just as helpful to you as someone with lots of books and awards to their name. It depends on the dynamic between the two of you.
Additional years of training may or may not make a meaningful difference in your experience with a therapist.
It’s quite common for people to see more than one type of therapist as part of their treatment, like going to a psychiatrist who manages their medication, a counselor for individual therapy, and a social worker who runs a CBT group.
There are so many types of licensing, here’s a list of what all the credentials mean.
A Licensed Professional Counselor (LPC) & Licensed Mental Health Counselor (LMHC) both have at least a masters degree and post-graduate supervised experience with clients.
Most social workers have a masters degree (MSW) or doctorate in social work. Licensing requirements differ between states, so while most states require a masters degree, others allow people to become licensed with an associates or bachelors degree (BSW). Social workers are trained in counseling and many other aspects of supportive care, not just mental health.
If your caregiving situation is causing you distress — especially if you are struggling with practical aspects of care — a social worker may be the best person for you to talk to. Their training in economic, social, and home situations can help you address the situation itself, rather than just your response or ability to cope with it.
A psychologist has their doctorate and is licensed to administer particular diagnostic tests.
A psychiatrist has completed medical school with a focus on treating mental illness. They can prescribe psychiatric medication.
Faith and therapy
Many therapists offer faith based treatment, incorporating faith into everything they do. Many faith leaders are trained to provide various levels of counseling and therapy. If faith is a core part of your life, your faith community is a great place to start the search for a therapist.
Most therapists are respectful and sensitive to the needs of people of any, all, or no faith. You may want to keep this in mind when looking at therapy directories as well as when you first talk to someone.
Types of therapy
There are lots of different reasons to go to therapy, so there are lots of different kinds of therapy. There are also lots of different ways to help people and theories about the best way to help people cope with different types of issues.
The type of therapy you want might change as your life changes. It’s totally okay to switch therapists because your goals have changed — or maybe you’ve just changed your mind.
Maybe right now your life is so challenging that you just need a space that’s warm and validating and makes sense. Maybe you want someone who can help you confront the difficult, unsavory truths about yourself so you can grow as a person. Do you want someone who can gently nudge you or do you want the straight up truth?
Some types of therapy are designed to address a specific challenge in a short time frame. Others are designed to go on as needed, or indefinitely. By talking to potential therapists about your situation, you can get an idea of what type of therapy you’d most benefit from.
There are a lot of theoretical orientations. Lots of us have an idea that therapy is all about reexamining your childhood and the unconscious, but things like solution oriented therapy don’t involve that.
If you’re not sure what type of therapy you’re interested in, you can narrow the field by deciding what types you don’t want to try right now.
There are lots of types of therapy, but they generally fall into four broad categories: psychoanalysis, behavior therapy, cognitive therapy, and humanistic therapy.
For more information on different types of therapy, check out Pyschology Today and Good Therapy.
Psychoanalysis and psychodynamic therapy
With this general approach, you seek to change behaviors, thoughts, and feelings by first uncovering and understanding the unconscious motivations behind them.
When people imagine therapy, this is often the style of therapy they think of. You and your therapist will dive deep into your past and your inner workings.
One type of psychotherapy is eye movement desensitization and reprocessing (EMDR), which aims to help you move past traumatic events by reducing the intensity of the negative emotions the memories evoke.
Psychodynamic therapy can be helpful to people who suspect their actions and behavior has unconscious motivation and you’d like to understand the source of your unresolved emotions.
Behavior therapy doesn’t focus on why you do something, it aims to simply change behaviors that cause people distress. This may take the form of desensitizing someone to phobias by safe, repeated exposure to the source of their anxiety.
cognitive therapy focuses on helping people change their thoughts, which in turn will change how they feel and behave.
Cognitive behavioral therapy (CBT)
If you want to change the way you think without the typical woo woo therapy stuff, CBT might be the best fit for you.
If you’re struggling with the emotions of caregiving and the major life changes that come with it, acceptance and commitment therapy (ACT) can help you accept the emotions you’re experiencing, come to terms with the situation you’re in, and move forward with adapting.
Types of CBT include dialectical behavioral therapy (DBT), mindfulness-based cognitive therapy (MBCT) and cognitive processing therapy (CPT).
Humanistic therapy and existential therapy empowers people to make choices that allows them to draw out their potential. Rather than focusing on the symptoms that brought you to therapy, you focus on your needs, what you find meaningful, and your ability to determine what your life will be like.
With client centered therapy, the therapist empowers you to be the authority on your own experiences. Your therapist is your equal, there to support you on your journey without telling you what to do.
Gestalt therapy focuses on where you are in your life right now, removing the lens of our past and how that warps our interpretation of events. Past and current struggles are brought into therapy sessions by reenacting them with your therapist, along with a wide range of body work, art, and other therapeutic tools.
Many therapists practice integrative or holistic therapy, which incorporates elements from different therapeutic approaches based on what’s most appropriate for the situation.
If you’re interested in therapy to help address family dynamics, a family-oriented systems therapist might be what you’re looking for. The family is viewed as an emotional unit and the role of the community is included in devising ways to transform behavior.
People who are caring for a spouse often seek couples therapy to help them navigate the major changes an illness can have on their marriage. A Licensed Marriage and Family Therapist (LMFT) is the best person to guide you through this. Most people in couples therapy go with a specific goal or issue in mind and the therapist treats the relationship, not the individuals. While understanding the dynamics of your relationship are helpful, the ultimate goal is to adjust your behavior to improve your life together.
If you have a specific issue you’d like to address, without delving into your past and analyzing yourself, solution focused brief therapy is probably the best fit for you. The first step is identifying the goal of your therapy and you’ll work with your therapist to look at what you’re currently doing to manage the problem and uncover new solutions to improve your life. Therapy aims to help you learn to see what is within your power to do, rather than the limitations you face, so you can more easily find solutions in the future.
Finding a therapist
Once you have an idea of what kind of therapist you want to see, what type of approach suits you, and how you want to communicate with them, you’re ready to actually find a therapist.
If you have insurance that covers therapy, they’ll have a directory of in-network providers. Always confirm that they’re still in-network, as these things can change.
Psychology Today and ZocDoc also maintain directories of therapists. If you’re in a big city there can be a lot of providers to choose from, so there are all sorts of filtering options. If you go to a local support group, they can be a helpful source for referrals. Local community centers and libraries may be able to provide you with a list of therapists. Some health systems have programs that will match you to a therapist, doing the vetting for you.
Other US therapy directories:
- Therapy for Black Girls
- National Queer & Trans Therapist of Color Network
- Lighthouse LGBTQ+ health & wellness
You don’t really need to know exactly what you’re looking for. It’s pretty common to decide that a certain type of therapy isn’t the best fit, to switch between types of therapists, or to decide you don’t ‘click’ with a particular therapist.
Finding the ‘right’ therapist is a really personal thing. There are plenty of therapists who are great, but maybe not great for you and your goals. You want to find someone you’ll be comfortable being vulnerable with and accepting guidance from.
Once you have a list of potential therapists, take a look at their profiles to get a feel for who they are. Most therapists are happy to talk to you to help you decide if it’s a good fit. They can explain their approach, situations they have particular expertise in, and answer any questions you have. It can be helpful to chat with a few therapists before you decide to make an appointment.
Don’t forget to ask about their availability. Maybe you only have one day a week that you can meet and they already have clients at that time. Most people find it hard to go from therapy sessions right into something social or go back to work, so keep that in mind when picking a time slot. Not all therapists require you to commit to a specific time, so find someone who can offer the flexibility you need.
Another thing to consider is pieces of your identity that are outside of your main reason for seeking therapy. Maybe you want to get support navigating the tricky relationship dynamics that come up with your relatives as you care for your elderly mom. Your family might think nothing of the race, faith, gender identity, sexual orientation, and other identities or lifestyle, but some therapists might get distracted or misunderstand things. You want a therapist who’s already equipped to understand where you’re coming from.
It’s not uncommon for a therapist to come out and say that they wouldn’t be the best match for you or that they’re not accepting new patients, in which case they’re usually happy to make a referral. Most therapists are more interested in helping people than filling their schedule.
Your first session
The first time you meet with a new therapist is usually spent going over your goals for therapy and a bit of your history. You don’t have to compress your life story into 50 minutes, but it can be helpful to have an idea of what they should know ahead of time. What’s going on in your life right now? What are the noteworthy events of your life up to now? You can fill in the details later.
You’ll want to go a little early to your first session. You’ll probably have some paperwork to fill out.
Most people recommend sticking with a few sessions with a new therapist before deciding if they’re a good fit for you. It’s normal for the first few sessions to be awkward as you develop rapport and share your backstory. Of course, if you get bad vibes or just don’t like them, it’s fine to move on and find someone you feel comfortable with.
Part of therapy can be digging up unresolved issues from the past, addressing challenging things you’re going through right now, and facing difficult truths. A good therapist can help you feel safe, heard, and supported even when they’re guiding you through some really tough stuff.
Regardless of the type of therapy, your therapist should be listening to you without judgment.
Don’t forget that you can ask your (potential) therapist questions, too! Do they have experience in the issues you’re dealing with? Are they comfortable with key aspects of your identity? What to they anticipate as potential treatment plans for you?
Some people find a therapist they feel comfortable with right away. Most of the time it can take a little trial and error. Don’t let one or two bad experiences turn you off of therapy.
Esther Perel shares her insight for evaluating your first session and knowing when your therapeutic relationship is (or isn’t) a good fit.
What to expect in therapy
It can be weird to have a time and space that’s all about you when that’s absolutely not something you’re used to. The whole point is to talk about yourself and focus on your needs.
Therapy can be a lot of work. It’s not just making time for your sessions and showing up. There’s a lot of thinking about your life and changing how you live involved. Different types of therapy have different requirements for what participation means.
People have compared going to therapy to going to the gym: it’s not usually enjoyable when you’re at the gym, but afterwards you’re glad you went.
The 45-60 minutes of a therapy session can seem really long…or really short. It helps to go into a session knowing what you’d like to talk about.
It’s pretty common to need some time alone to think after therapy, so many people prefer to schedule appointments so they can go home or do something low key afterward. Journaling after therapy seems like a really popular way to process some of the things that came up, as well as just noting down what you talked about, key ideas to remember (and implement!), and what you’d like to discuss in the future.
Cinematic sort of breakthroughs are rare. It’s more about a thousand tiny shifts in your behavior and way of thinking that add up to a huge change over time. Tiny changes are easier to make, anyway.
Your therapist is not some sort of all-knowing being. They’re not always right. It’s okay to push back. In fact, therapy is a great place to safely practice enforcing your boundaries and disagreeing without fighting.
Your therapist isn’t the only one who can take notes on sessions and set goals. You can, too! Doing this is a great way to make the most of each session.
Remember, if you feel like things aren’t a going how you’d like them with your therapist, it’s totally okay to talk to them about it. It’s a safe space to address things without judgement. Most therapists are happy to get your feedback, adjust as necessary, or make a referral.
Paying for therapy
If you work for an employer who offers benefits, your health insurance coverage might cover therapy. It’s also common for your Employee Assistance Program (EAP) to provide counseling and other services.
It’s not uncommon for therapists to offer sliding scale fees. The Psychology Today directory lets you search for this. Some therapists will take on pro bono patients, so it’s worth asking if this is an option if you can’t afford to pay.
The NAMI helpline and Substance Abuse hotline can help you locate free and low-cost options near you if you’re in the US. They both know about tons of programs, it’s not just substance abuse related.
Graduate schools and teaching colleges often offer low-cost therapy. All services are done under the supervision of a licensed practitioner and trainees have already gotten a ton of training by the time they’re working with patients.
There are many support groups and group therapy programs. These are usually less expensive than individual therapy and sometimes are even free. To find out what’s offered near you,
- search online
- talk to a social worker
- ask at your local library
- ask at your local hospital or medical center
- ask your friends
How long does therapy last?
How long you go to therapy is really variable. If you’re going to therapy with a specific goal in mind, maybe you’ll stop once you’ve achieved that goal.
Some types of therapy are designed to go on for specific lengths of time, like CBT programs. Others can go on indefinitely.
It’s totally okay to go to therapy for a while, take a break, and go back later. Maybe a new issue comes up. Maybe you find yourself facing a new challenge. Maybe you just feel like things are a little stagnant and need help moving forward.