A step-by-step guide for those who want to improve their mental health.
Written with James Sun, Kristine Ortega, and Maggi Yang
Intro
Wanting to start therapy can be daunting. Society doesn’t socialize us to talk about our feelings easily, and if you’re like me, there’s probably a lot beneath the surface that you don’t interact with. However, getting therapy doesn’t have to be stigmatized or seen as a sign of weakness. I like to think of therapy as going to the gym, but for your emotional and mental state instead of your physical one. The desire to improve and grow is all you need for therapy to be beneficial to you.
I initially wrote/compiled this guide as a private document within my Drive that I’d periodically update and share out to people who asked. Recently, I thought to publish it after enough new people asked if they could share it with their friends as an aid. It contains many questions I wish I knew to ask when I first got started, and I hope it can be useful to you as well if you’re looking to take some first steps into finding a therapist.
Disclaimer: This is intended for people who are looking for non-clinician therapists — I am not in a position to give advice about what to look for in a psychiatrist.
ask yourself what you need
what’s bothering you?
Before you search, you should start by listing the things that are bothering you. This can look like many things — is it a feeling eating away at your sanity? Is it something you feel like you’ve been scared of addressing? Is it a constant annoyance in the back of your mind?
One person’s list might read:
I hate my job. My boss sucks.
My girlfriend says I drink too much.
I’m always anxious.
Other people think they’re better than me.
I’ve been dating this person who I really like, but I don’t know why I don’t want a relationship when it seems like this could be something great.
Another’s might say:
I’m still sad about my breakup from 3 months ago.
I’m hopeless.
I can’t focus at work, and I make mistakes.
Sometimes, I think life isn’t worth living.
This can be a useful reference for your first session or consultation with your therapist, which is often open-ended and involves answering the question, “What brings you here today?”
the emotion wheel — a helpful aid
I am generally in denial of negative feelings that I may have, so I find it difficult to name exactly how I feel. If you are like me, the emotion wheel (a tool my therapist gave me, actually) can be a helpful aid in describing what you may be feeling at any given moment. I find it easier to make neutral statements like “I felt <emotion> when <event, interaction> happened” as a starting point.
screening tools
You don’t need to have a mental health condition to want to see a therapist. However, if you suspect you are undergoing a mental health condition, it can be helpful to take a screening test to gain an idea of what you might be interested in seeking treatment for. Common conditions include anxiety and depression, but there could be a combination or an entirely different condition going on. Here is a link to take a mental health screening test.
getting “better”
Unfortunately, there is not really such a thing as fully curing a mental health condition the way you might get over a viral or bacterial infection. Getting “better” doesn’t always get rid of the underlying problem — sometimes it just means having mechanisms to manage the overwhelming emotions enough to keep trying.
However, it is still helpful to think about what “healthier” looks like, as it can help you assess progress and fit as you begin your therapy sessions. I recommend drafting a series of goal statements, similar to the series of bothering statements. Here are some examples:
- I want to be able to spend time with my friends without feeling sad.
- I want to be able to get out of bed.
- I want to have a way to calm myself when I have a panic attack.
- I want to feel less anxious when I can’t see my romantic partner for a few days.
practical search tips
Psychology Today has a good and broad directory to start with if you want to go through insurance. However, most directories are not curated so you will still need to sift through the results.
You can filter the results by age, insurance, gender, ethnicity, religion, location, and if you know which specific issues you’d like to address, you can add those as well. Most therapists usually list a wide range of issues and their bio is much more telling of their therapy style and focus.
When you cast your net wide this way, you may find some bad eggs, but don’t let this deter you from seeking personal peace and happiness. There are some more personalized out-of-network practices but they may be more expensive, and it will still take a lot of work to find a good fit (see the section below).
As you find potential therapists, it is a good idea to cross-compare in Yelp and other review engines before coming up with your list of therapists to reach out to. I recommend contacting 2–3 therapists whose bios resonate with you to start. However, I ended up having 13 consultations before I found a therapist that was a good fit for me.
Here’s an example of an email you can send:
Subject: Therapy Consult Inquiry
Hi <name>,
I found your profile on Psychology Today and would like to schedule a consult. Are you taking new clients at this time? I am looking for a new therapist and am covered under <insurance plan>. I prefer email or text and you can reach me at <email> or <phone-number>. Thanks for your time and I look forward to hearing from you.
Thanks,
<your name>.
There is always a chance they won’t reply, but don’t get discouraged! Therapists act as their own receptionists and unfortunately aren’t always on top of their inboxes. Don’t start doubting whether it’s worth it to try again — just send a follow-up email or reach out to a different therapist. Some therapists are also in the same network, so if someone you like is not available you can ask them to recommend you to their colleagues.
finding fit
All therapists have different styles and depending on which type you encounter, therapy can either be a horrendous or enlightening experience. I first sought therapy at my university’s student health center, where I had a horrible experience with a man who just repeated back to me what I said and made me feel judged, and it led me to think that therapy was an expensive waste of time and no better than self-help “think pieces” in the ether.
It was really difficult to get over my initial distaste for therapy and try searching again. The second time around, I decided I would be a lot more militant when it came to assessing fit. Generally, therapists will first offer a free intro/consultation call to get to learn about you and what you are going through. This is a good opportunity to ask questions to see if they may be a good fit.
Typical questions they will ask you are:
- What has been your prior experience with therapy?
- What brings you to therapy today?
- Describe what you have been feeling lately.
- (required for legal purposes) Do you have a history or current thoughts of self-harm?
- What are your goals from therapy?
Ultimately, your litmus test should be a gut feeling — your therapist should allow you to feel understood and supported, with a plan of action or feeling that you can improve. Sometimes the aid is something concrete, like an article to read or poem to meditate on. Other times the aid can be a framework for thinking or action that interrupts an anxious thought process on autopilot. Regardless, you should leave each session with more clarity and peace than what you entered with, and you should have positive feelings when thinking about how your therapist made you feel.
As you evaluate fit, it is helpful to create a framework for what effective therapy looks like to you and come prepared with questions to help you understand your therapist’s style. I really encourage you to do a consultation or even a couple of sessions before deciding to stick with one. It is not uncommon to have a great first 2 sessions, do 4–6 sessions, decide that this isn’t a fit for you, and move on to a different therapist. It takes time and patience to find a really strong fit but the investment is worth it.
Here are some factors to consider or form questions around:
problem-solving philosophy
Most therapists have an unspoken philosophy at the core of their practice, and you can generally start to figure this out after hearing the type of advice they give you. Some therapists emphasize acceptance of certain situations, others teach you to let go of attachments. Others teach confrontation or methods of self-soothing. Not all methods of problem-solving will work for you. Even if the end results are the same, the pathway there is different.
- Tip: Try to see if their philosophy and principle for problem-solving resonates with you. One way to evaluate this is by bringing forth a very troubling issue that you’ve been having and asking how you should approach it or the framework they would use to help clients like yourself approach the issue.
- Tip: Many therapists believe in mindfulness or practice Buddhism, Christianity, or other religions. Some of these practices or religions prescribe certain philosophies or perspectives for dealing with the problems that arise in life. If you know that you align or disagree with any of these philosophies, you can screen for this factor or ask directly to understand how their beliefs play into their counseling.
methodology
Another layer to a therapist’s style is the tactics or methodologies they use to help you. Some therapists use cognitive-behavioral therapy (CBT), others are hypnotherapists, mindfulness, or a hybrid of practices.
There are many different types of therapy out there, but I don’t find the labels super helpful. Most therapists I find tend to practice a hybrid of CBT along with other styles. While it’s worthwhile to understand the basics of different practices, be open-minded as you meet new therapists since you may be surprised by what you like. I know people who enjoy hypnotherapy who initially thought it pseudoscientific.
- Tip: You can directly ask your therapist if they have any specializations, and they can explain their credentials or the type of therapy they most practice. If it sounds unclear you can ask them for an example of what a typical session might look like.
communication style
Do you need someone to call you out when you’re deluding or contradicting yourself, or would that make you shut down and not want to be vulnerable anymore? Do you want a cheerleader or someone who gives the hard truths? Would you prefer someone tell you the answer you’re searching for, or ask you questions to lead you to find the answer yourself? Do you prefer a therapist who talks more or listens more?
These factors may not seem important at first, but in moments of stress, communication style can play a critical role in whether you feel challenged to reach for a goal or defeated and too disheartened to continue.
- Tip: Ask your therapist how they support their clients when they get emotional during sessions, or how they challenge their clients when talking about difficult topics or trying to change a fixed thinking pattern or belief.
- Tip: Ask your therapist what are common issues their clients get seen for and how they describe their approach, and see if any resonate with you. For example, therapists that deal with deep trauma frequently are good at reframing or reconstructing narratives which can be very messy and painful work — different communication styles could either mean lots of probing questions to dissect what truly happened, or lots of space so that the client can retell the story at their own pace. You can see how a difference in communication style here might be seen as helpful to one person but frustrating to another.
practical matters
Therapy can be expensive and inconvenient, but it’s up to you to decide what you spend. In the Bay, therapists can charge upwards of $500 an hour with little ability to see if they are actually helpful or not. On the other hand, many companies offer a mental health benefit where you can get connected with free counselors via Modern Health or the Lyra network.
I personally prefer my therapist over the ones at Modern Health (I’ve had 5 sessions with one of their counselors through my company’s benefits), but I think I speak out of confirmation bias due to all the work I had put into finding her. Other people I know have commented similar things about the larger platforms… but I’m also a proponent of taking whatever resources you can get, especially if it’s free therapy.
It is also important to consider if you want in-person or telehealth therapy sessions. I find that video conference therapy sessions work best for me, but others want to do exercises or experiments that must take place in a therapist’s office.
- Tip: It is perfectly reasonable to ask about the cost during the consultation — after all, you will be paying this individual to listen to you and help you with your problems. If a therapist is too expensive, just keep searching. Many of my friends (in other geos) have insurance plans that cover 80% of the cost, leaving each session to be about $15–50 each. I chose a therapist who does not take insurance but charged $130/hour which I thought was reasonable for the Bay. If private practice is truly too expensive, you can express your financial need to the therapist you are interested in (sometimes they offer lower rates) or research if there are counseling students who charge lower fees.
last remarks
Again, congratulations on making the decision to find a therapist. Therapy is hard and the search is harder, but I have seen so many people’s lives improve as a result of the effort that they’ve put in.
My therapist has been with me through breakups, job changes, family emergencies, fights, accidents, and even a pandemic — and it’s amazing for us to look back on the amount of growth and progress I’ve made in both my ongoing anxiety and depression. There were once days where I could not see any meaning in continuing to live, or days where I’ve been able to do nothing more than hold myself in a ball under the covers, and therapy was key to giving me the strength to continue past those dark moments. I still have bad days every now and then, but I can definitely say I am doing better. Now, I see my therapist on demand instead of on the twice-weekly cadence I had once needed.
I also credit therapy for a lot of the good things in my life. When it came to the decision to leave my old job in the Big 4, my therapist helped me define my decision-making values and separate them from the guilt I felt about leaving my projects or the fear I had about failing in a startup environment. My therapist also helped me process and accept my growing feelings toward a friend and encouraged me to face my fear of commitment, which eventually led to the start of an awesome relationship.
Lastly, I was able to share some of my learnings with my family who has since come around to not only accept therapy as an aid but also recommend it to my sister when they learned that she struggled with a depression worse than mine. It was such a breakthrough to see that after years of intense stigma (in Asian culture, it’s seen as a failure of the entire family if anyone struggles with or shows signs of mental illness), my parents learned to speak of it with pride and eventually embraced its effectiveness in helping me.
It takes time to show the results, but I’m a huge proponent of the benefits of therapy and I really hope that this document helps you and your loved ones feel less stigmatized and more empowered when it comes to promoting your mental health and wellbeing.
