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  • Writer's pictureSofiya Kostareva

Why Is Finding A Therapist So Hard?

In the summer of 2016, I made a decisive career change. Disenchanted with the field of economic development, I enrolled in graduate school to become a therapist. I was prepared to dive deep and grow crucial skills to help others navigate complex and unimaginable situation. But truthfully, I also yearned for the linen-pants wearing, coffee-mug-holding, modern-art-on-wall-hanging idea of it all.

A white blanket lays on the edge of an orange couch, a wooden side table with books and a sculpture sits next to it
Photo Credit @stephanieharvey from Unsplash

Today, I have the privilege of supporting incredible clients, listening to their powerful stories, and witnessing their growth. Connecting with people I wouldn't otherwise come in contact with is enriching and life giving. In addition to client work, a significant portion of my time is spent helping people who aren't my clients navigate the overwhelming logistics of accessing care. While it feels aligned with my ethics to pass along referrals and answer questions, it seems clear the lack of information and support for reliably and successfully finding a therapist is not an isolated issue, but a systemic failure within our medical field and government.

In their Wired article titled "Why Therapy Is Broken" author Eleanor Cummins discusses the conundrum of seeking and engaging in therapy: in the western world it is held on a pedestal as a pre-requisite to living a fulfilling life, but how could someone with no background filter through the myriad of options successfully?

From limited availability to the intricacies of the therapeutic relationship, each obstacle makes finding a therapist feels like an unintentional part-time job. In this blog post, I explore the reasons behind this dilemma, empowering you with insights to navigate the elusive quest for support.

Barriers Impacting Access To Care

Factor 1: Limited Availability

Across the US, there is a shortage of mental health professionals with the demand for services steadily increasing but the supply not keeping pace. Reasons for this include high barriers to entry (costs for attending school, complex licensing requirements that vary by state) and disparity of pay and lower insurance rates as compared to other medical professions. Complicating things further is a high rate of burnout due to the demanding nature of the field.

Factor 2: Affordability

Limited availability then cascades into challenges with affordability. Providers facing lower salaries and highly demanding environments often opt for private practice, where they can set their rates and schedules while retaining the power to manage their caseloads. To combat low insurance rates, providers are forced to take on a lot of clients, juggle a mix of insurance and private pay clients, or opt out of insurance altogether and increase their fees. This leaves clients in a space of choosing between navigating the complexities of insurance or budgeting for a higher cost (and potentially better fitting) service.

Factor 3: The Therapeutic Relationship

The final barrier is picking the"right therapist". There are hundreds of standalone approaches to therapy, some wildly differing from each other. However, despite scant empirical data demonstrating unilateral efficacy of therapy, we do know it works... some of the time. Research shows the greatest predicting factor for positive outcomes is therapeutic alliance or the actual connection between client and therapist. A bit reductionist, but also hope inducing, because it means rather than sifting through hundreds of approaches you can be empowered to listen to your gut on whether someone feels "right".

Tips To Combat Mental Health Barriers

I believe access to mental health care is a human right, just like housing and water. That is why I created the How to Find a Therapist Guide, to help you traverse the four key factors to accessing care. Moreover, I believe it's important for this type of resource to be accessible, and that's why I've chosen to make it free to the public. The hope is you share it freely with your community, so we are all more empowered to make informed choices.

Tip One: Know Who To See

There are so many types of mental health providers, it's important to be clear on WHO you're seeking and WHY. (e.g. Are you hoping to start medication? Be clear on who can prescribe and evaluate you). Use the chart below to help clarify provider types.

A flow chart with white boxes describes how to identify the correct mental health provider

Tip Two: Identify Non-Negotiables

Four key factors will impact your search: type of provider, their approach, format of sessions and fees/affordability. Know if you are flexible in any of these areas (e.g. you don't care if it's in person or online, but perhaps you're firm on budget). All four are ideal, but may take longer to find. Identifying your non-negotiables will ensure a fit that is sustainable.

Tip Two: Trust Your Gut

When you do find yourself in front of a provider, they're going through their questionnaire and you're evaluating if you want to move forward, ask yourself these two questions: "Would I want to spend an entire hour with this person?" and "Would I want this person knowing intimate and vulnerable information about me?". What's your immediate reaction? We may not always get a firm yes. Mostly, we want to be make sure we listen to the hard no's.

For more tips toward a successful therapy search, sign up to receive your free digital guide.

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