How to Find a Therapist (And What to Expect When You Do)

If your reading through these posts from the beginning, you probably have a sense of what therapy is, whether or not it works, and what the letters after a therapist's name mean. What you may not have is a clear picture of how to actually find one, and what happens after you do. So, let’s get into those details.

Finding Someone

A lot of us still begin most searches with Google or other search engines, and those are great places to start. You can also look at listing services like Psychology Today, Zocdoc, TherapyDen, GoodTherapy, or Open Path Collective. There seem to be more of these every day, and you’ll often find the same therapists across multiple sites. There are also directories connected to insurance companies or employee assistance programs, which can help narrow options based on cost.

There are also sites that specialize in specific symptoms or diagnoses (like NOCD for OCD, Talkiatry for psychiatry, or Beacon for trauma) or focus on particular populations (such as Inclusive Therapists, Therapy for Black Girls, Latinx Therapy, and the National Queer and Trans Therapists of Color Network). They are going to provide possibly pages upon pages of therapist profiles, but there are usually some filters to help narrow the search.

Your primary care physician can also be a useful resource. They may know local providers, have a sense of who's good, and can make a warm referral if that feels easier than cold-calling a stranger.

Also, word of mouth is underrated. Ask your friends and family if they have any recommendations. Word gets around about really positive, and negative, experiences. You don't need to share details about why you want therapy, and don’t need to know the details of someone else’s therapy to ask for recommendations.

The Consultation

It is somewhat standard now for most therapists to offer a free consultation, usually up to 15 minutes by phone. This is an artifact of the insurance industry - anything more than 15 minutes has to be billed. I recommend taking this offer. It's not a commitment to work with a therapist, and it gives you a chance to hear how someone speaks and whether you can imagine talking to them about hard things. You don't need to call with prepared questions. You can simply describe what's going on and let them respond. The main thing here is to pay attention to how you feel during the call, not just what is said. Do you feel like they listened? Do you feel comfortable? Those are good signs.

It's okay to talk to more than one therapist before deciding. Some people feel guilty about this, as if they're leading someone on. You're not. Therapists expect it.

Starting Out

The first few sessions are usually when we get to know each other. You'll cover some of your history, and provide some context for what is going on now. It may feel more like an extended intake than therapy. That's normal. Things tend to go deeper over time as trust develops and the relationship finds its footing.

You don't need to know what you want to work on before you start. If you do know, that’s great. Sometimes the issue emerges during those first few sessions. What helps is showing up and being honest. Saying what's actually on your mind. Especially if something isn't feeling useful or you're not sure you're in the right place.

How to Know if It's Working

This is a great question. It is hard to answer.

Progress in therapy is rarely linear. It doesn’t follow a simple trajectory. Some sessions feel clarifying. Others feel like you're going in circles. Some might make you feel worse before you feel better. These are all part of the process.

A reasonable question to ask yourself after a few months is whether anything has shifted; if you feel, see, or think about anything differently. Therapy isn’t about being “fixed” or “cured.” A good question to ask is: are you responding to things in ways that feel slightly more like who you want to be? Change in therapy tends to be incremental and only obvious in retrospect.

This raises the question, then, of how to tell that it’s not working or that something's off. There are a few different ways therapy can go wrong.

One is an ethical or professional failure on the therapist's part. These are boundary violations, inappropriate behavior, illegal behavior, or any conduct that makes you feel unsafe. If that's happening, stop and find someone else.

A second is what you might call clinically problematic behavior. This is less overt, but still not okay. It can look like a therapist who is consistently not listening, who feels checked out or disengaged, who is overly controlling or rigid in their approach, or who responds defensively or dismissively when you bring up concerns. You don’t have to tolerate this just because it’s less obvious.

The third is a matter of fit. Sometimes the issue isn’t that anyone is doing anything wrong, but that the relationship isn’t quite clicking. Differences in style, pace, personality, or communication can make it hard to feel understood or comfortable enough to do the work.

It’s also worth being careful here. Therapy can feel difficult, and even upsetting at times. Talking about painful or avoided parts of your life can leave you feeling worse in the short term, and that can be part of the process. The question is less whether you ever feel bad after a session, and more whether there’s a sense of being understood, of the work going somewhere, or of things shifting over time. Consistently leaving sessions feeling worse without a sense of why, or without any larger movement, is something to pay attention to and bring up with your therapist.

The relationship between you and your therapist is the main part of therapy; if that isn’t working, therapy itself probably isn’t working. Therapy, without a good relationship, won’t work regardless of how credentialed or evidence-based the approach.

If something isn't working, say so in the room. That conversation is itself part of the process. If you've had that conversation and things don't improve, it's okay to find someone else. Leaving a bad fit doesn't mean therapy isn't for you.

One More Thing

Starting therapy takes courage. It is hard to look at our lives directly. It is hard to acknowledge that our lives and well-being are worth the effort. Most people who reach out aren't certain it's the right move. That uncertainty usually just means you're being honest with yourself about something unfamiliar.

That's a reasonable place to start.

Mike O'Rourke is a Licensed Clinical Social Worker Candidate in Montana, available for in-person and telehealth therapy. Book a session or consultation.