By Lissa Carter, LCMHC
Update, 3/7/22: I’m delighted to announce the addition of Julie King Murphy, JD, NCC, LCMHCA to our practice! Julie is accepting new clients and is seeing people in person and via telehealth. Learn more about Julie here.
I’ve been receiving inquiries from a lot of wonderful people lately, people who are attempting to prioritize their mental health and are struggling to find a counselor to work with. Sometimes I wish that I could work with every single person who reaches out to me. I hate it when my practice is full and I have to turn people away, even though I know there are thousands of wonderful counselors out there, many who might be an even better fit than I would have been. I hate it because I know that, when a person is struggling and suffering, even the tiniest setback can feel insurmountable, and when your vulnerable request for help is answered with a formulaic “I am not accepting new clients right now” the feeling of rejection could be enough to stop you from trying again.
Let me start by stating an unfortunate truth: finding a counselor is not an easy process. It is not a simple process. And ever since the COVID-19 pandemic, finding a counselor who has openings for new clients has been more difficult than ever.
I’m hoping this post can offer, at the very least, some answers to the questions that people looking for a counselor ask most frequently---and the ones they might not know how to ask. I’m hoping it can demystify mental health lingo, empower you to ask for what you need, and offer you a sense of greater agency in both the search for a counselor and, later, within the counseling relationship.
I’ll pose questions in the likely order you would need to ask them, as you engage in the process of finding a counselor for yourself or someone you care about.
Would a counselor help me?
In general, if you are experiencing difficulty in familial, intimate, or work relationships, overwhelm, anxiety, depression, grief, anger, a sense of futility, a sense of helplessness, attacks of panic, self-loathing, seeing or hearing things that others don’t see or hear, role changes (such as becoming a parent, losing a child, divorce, marriage, loss of a parent, dramatic change in career, health, or identity), discomfort in your relationship with substances, food, sex, media, alcohol, and/or other coping mechanisms, confusion about your own behavior patterns, or a sense that accustomed methods of handling emotions and thoughts are no longer working for you, counseling can help.
If you are feeling dissatisfied with your career, education, or finances; or you are struggling in a specific area of life that has more to do with a deficiency of skills than with emotional or mental problems, you might be better served by seeking out an employment, financial, or life coach, or by taking a class that will teach you the necessary skills. If you are being targeted, bullied, profiled, or abused, legal recourse followed by counseling might be the most helpful course of action.
Will counseling take away my symptoms? Or should I seek medication first?
If your anxiety, depression, helplessness, or thoughts/beliefs/feelings are so debilitating that you cannot realistically engage in the process of counseling, you might consider medication as a first course of action. Talk to your primary care physician or psychiatrist (if you have one) about how you are feeling and ask if medication can help. Studies show us that a combination of medication and counseling is more effective, in most cases, than medication alone, so once you are feeling regulated enough, revisit the idea of counseling.
Another caveat here—counseling actually won’t take away your symptoms. A good counseling relationship is more about learning new ways of relating to your thoughts, feelings, relationships, and behaviors. Can counseling change your life and offer you relief? Yes. Will you walk away from counseling and never experience anxiety, depression, or suffering again? No---because these experiences are part of being human. However, a good counseling relationship can help you handle these experiences in a much more compassionate, much less debilitating way.
Okay, I think counseling can help. Where do I start?
There are several important considerations here. I’ll take them one by one.
a. Financial investment.
Do you have insurance? If so, you may want to call your provider and learn what their mental health copay is. Ask if you can see mental health providers that are out of network, and if so, what the increase in your cost would be. Ask if seeing a mental health provider will cause your insurance provider to mark you as having a “pre-existing” health condition that will increase your insurance rates. Ask if your insurance has limits on the number of mental health sessions you can engage in per year, and if you have to meet a deductible before they start paying for mental health. Ask if they cover the issue you will be seeking help with (most insurances—don’t get me started—won’t cover family or couples therapy at all). If you know you want to use your insurance, the first place to start your search for a counselor is through your insurance provider’s database of in-network counselors.
Are you uninsured? Check into free local programs; the VA offers free counseling for veterans and many nonprofits offer free counseling to certain populations. Call 211 or visit https://www.211.org to discover local nonprofits offering counseling in your area. You can also ask if your school or place of work offers counseling; many universities and schools have onsite counseling and increasingly the workplace offers EAP or EAN (Employee Assistance Plan or Network) services with anonymous free counseling. You can also try https://openpathcollective.org , an alliance of counselors that offer low-cost, sliding scale counseling to the un- or under-insured.
On search tools like https://beingseen.org, https://www.therapyden.com, https://www.atherapistlikeme.org, and https://www.psychologytoday.com/us, you can search for a therapist that accepts your insurance. You can also filter by licensure type and modality (see below) and check to see that the therapist practices in-person or telehealth, is accepting new clients, and/or has experience with the particular issue you hope to address.
b. Licensure.
Licensed counselors have completed rigorous education, supervision, and testing processes and maintain ongoing continuing education. I cannot overemphasize the importance of making sure that your counselor is licensed. Licensure is separate from education—you can complete a master’s degree in mental health counseling, psychology, or social work without attaining licensure.
That said, there is an alphabet soup of licenses that can make it really difficult to know what to look for. Here’s a quick glossary: For every licensure, there is an associate level (such as LCAS-A, LPCA, LCMHC-A, LCSW-A, and so on) which means that the counselor has passed a counseling exam and is under supervision while they accrue the hours of experience necessary for full licensure. Then there is the full licensure level (LCSW, LCAS, LPC, LCMHC, and so on) and the supervisory licensure level (LCMHCS, CSI, and so on) which means the counselor has undergone additional training to supervise other counselors.
Very generally, you would seek an LMFT (licensed marriage and family therapist) if you are interested in couples or family counseling, an LPC (licensed professional counselor) or LCMHC (licensed clinical mental health counselor) if you are interested in mental health counseling, an LCAS (licensed clinical addictions specialist) if you are interested in substance use counseling, and an LCSW (licensed clinical social worker) if you are interested in mental health counseling with a larger systems/case management approach.
However, you may come across LCMHCs who are highly trained in couples and family work, LCSWs who specialize in somatic and trauma work, LMFTs who specialize in working with adolescents, and so on. We’ll cover trainings and modalities in the next question. However, if you have found a counselor and they are licensed, you can certainly ask them about their training and experience in the specific issues you are seeking help with. For a more comprehensive glossary of mental health titles, go here: https://www.networktherapy.com/directory/credentials.asp
If you know you want to see a therapist with a specific licensure, start your search by googling the licensure board for your state (i.e.; north Carolina licensure board for marriage and family therapists, or California licensure board for clinical addiction specialists). Most licensure boards keep a directory of therapists licensed in your state.
c. Modality
To complicate things further, counselors train in specific modalities after completing their general education. These modalities may target a specific issue, or they may constitute a broad theory/approach to counseling.
You may be drawn to a specific modality because studies show it is the most effective for your particular set of symptoms, such as DBT (dialectical behavior therapy) for the diagnosis of borderline personality disorder; or ERP (exposure and response prevention) for a diagnosis of obsessive-compulsive disorder; or EMDR (eye movement desensitization and reprocessing) for single-incident traumas.
Or you may be drawn to a specific modality because it matches your comfort or interests (Expressive Arts therapy for the creatively inclined, dance or movement therapy for those who prefer to process nonverbally, SE (somatic experiencing) for those who prefer to go inward and connect with the wisdom of the body, narrative therapy for those who enjoy writing and metaphor, etc. )
There are so many modalities that I cannot begin to do them justice here. Browse this list to learn more: https://www.goodtherapy.org/learn-about-therapy/types
If you have worked with a therapist you particularly enjoyed, ask them what modality or theory they practiced.
If you know you want to work with a counselor trained in a specific modality, you can use any of the popular therapist search engine tools like https://beingseen.org, https://www.therapyden.com, https://www.atherapistlikeme.org, or https://www.psychologytoday.com/us and filter your search results by the modality you want. Make sure to follow up by asking the counselor, during your consultation, what training they have completed in that modality.
I found a licensed counselor who works with the modality that interests me. Now what?
First of all, I highly recommend that you start with a short list of 3 to 5 counselors instead of just choosing one. This will empower you to find the best fit instead of pressuring you to stay with the first counselor you call. It will also help keep the ball rolling if you hit a scheduling roadblock or discover that the counselor you hoped to work with has no openings. Let’s be real: the process I am describing is a ton of work at any time, and when your mental health is suffering it can be downright exhausting. You don’t want to lose steam and give up because the one person you picked is nonresponsive or doesn’t feel like a good fit.
Visit the website of the counselors you have picked out (again, use sites like https://beingseen.org,https://www.therapyden.com, https://www.atherapistlikeme.org, https://www.psychologytoday.com/us and https://openpathcollective.org to generate leads) and read some of their blog posts and how they describe their work. Does it feel like a good fit? If not, trust your gut and move on.
If you like what you see, and the counselor is licensed and accepting new clients, schedule a consultation with them. Most counselors offer a free consultation by telephone, telehealth, or in person. Usually you can book this directly on the counselor’s website or by calling them.
Again, make sure you schedule at least 3-5 consultations so you don’t feel pressured to go with a counselor who might not be a good fit. Shop around. The highest predictor of success in mental health counseling is a good therapeutic relationship, so you really want to pick someone you feel comfortable with, not just the person with the most years of experience or the best-sounding degree or the most polished website.
What should I ask the counselor during the consultation?
The most important advice I have here is this: Remember that you are interviewing them. Sometimes an odd power dynamic arises in therapy where the client can feel as though the counselor is the expert and has all the power. Try to remember that this is a job interview, and you get to decide if you want to hire this counselor.
Don’t be afraid to ask questions about cost, frequency, and scheduling. Trust your sense of whether this person is warm, compassionate, and nonjudgmental enough that you would feel safe talking about vulnerable feelings and experiences. If you have had bad experiences in counseling before, bring that situation up as a hypothetical and ask how the counselor would handle it. For example, “if a client came to you and shared that they were feeling angry enough to hurt a family member, how would you handle it?” or, “if a client shared a difference of opinion or a critique with you in session, how would you handle it?” Ask about the counselor’s experience with the issue that you are struggling with, and ask about their training in the modalities that interest you.
Make sure to assess whether the counselor has openings that fit your schedule, accepts your insurance, and meets in person/via telehealth (whatever your preference might be). Don’t be afraid to ask about their safety protocols for COVID, or whether their office is ADA-accessible.
The most important thing is that you feel comfortable with the counselor you choose. We can’t do good work with people we do not feel comfortable with. I would even go so far as to say that you should feel the counselor genuinely cares about you as a person and is interested and curious about what you have to say. Whatever their level of expertise, it is only as good as their ability to communicate and share it with you.
What if I find more than one counselor I like?
There are many incredible counselors out there! One question that can help you discern whom to work with if you’ve found more than one viable candidate is “what voice is missing in my life?”
Here’s what I mean by this. Some of us are surrounded by critical, argumentative people. In that case, it could be helpful to choose a counselor who offers lots of compassionate support. Some of us are surrounded by unconditionally loving friends who automatically take our side. In that case, it could be helpful to choose a counselor who is more direct and confrontational. Some of us need a directive voice in our lives, a voice that offers scaffolding and objectives to help us reach our goals. Others have too much of that already and need a voice that urges self-compassion instead of perfectionism. What voice is missing in your life? Hint: it’ll probably belong to the counselor that makes you feel a little bit anxious/nervous/excited because you can sense this relationship may lead to actual change.
How will I know when to leave counseling?
There are a few red flags that indicate you should leave counseling. These include:
The counselor breaks confidentiality by talking to people you have not authorized them to talk to (this does not include their legal responsibility to report in certain situations, all of which should be covered in the initial paperwork you sign)
The counselor makes sexual advances toward you or violates your physical boundaries without consent
You do not feel safe enough with the counselor to open up (perhaps the counselor has been inattentive or disrespectful, or has acted angry, blaming, or rude without attempting to repair the relationship)
The counselor does not respect the terms of your contract (cancels sessions without warning, changes the price and/or terms of counseling indiscriminately, is unresponsive when you attempt to communicate, does not listen to your feedback)
You have been showing up regularly, practicing any exercises the counselor offers, and participating fully in each session, but you are not experiencing any change or any progress toward your goals. When you bring this up with your counselor, they dismiss you, act defensive, or refuse to make any changes.
Note the difference between feeling uncomfortable/challenged and feeling unsafe. Good counseling takes us onto new ground and out of our comfort zone. It can be tempting to leave counseling when it gets uncomfortable, so ask yourself this question: “Is this discomfort in service to becoming who I want to be as a human being? Are the uncomfortable feelings I am experiencing right now in the interest of helping me achieve my goals?” If the answer is yes, push through. If the answer is no, it might be time to find a new counselor.
If you have found a great counselor and have addressed most of your goals in counseling, you may find that although you are feeling better you do not want to leave the counseling relationship because it is helpful or enjoyable to have this time to talk through the challenges of life in a supportive environment.
If you find that most of your sessions feel conversational, and counseling poses a financial burden, it’s worth evaluating whether you wish to continue in counseling or if you may be ready to leave. Please note that there is nothing wrong with continuing in counseling for as long as you wish, but it is always your choice to leave when you are ready. Don’t be afraid to talk it through with your counselor if you think you are ready to leave.
I hope that this post is helpful, although it is by no means comprehensive!
One of my most cherished hopes for my vocation is that mental health can become easier, simpler, and less expensive to access. In the meantime, please reach out for any support or help you need in navigating the process.
You are worth the time and effort it takes to find the right counselor. You matter, and you do not have to suffer alone.
If you have questions or suggestions, please feel free to comment below or email me directly at innerlightasheville@gmail.com.