You Need Help: Finding a Therapist for the First Time

Q:

I’m a 25-year-old queer woman who has struggled with anxiety in some form or another for most of my life. I’ve never been diagnosed but I’ve had what I think are panic attacks in the past, but I don’t know if they’re really bad enough to count; I have a friend with social anxiety and my panic attacks don’t sound as bad as his. I’ve wanted to start therapy for a while, but I don’t know what to look for in a therapist, and no one in my family has ever seen a therapist before. Where do I even start?

A:

The first thing that I notice about your letter is that there’s a certain amount of doubting yourself and your experience. You say you’ve experienced anxiety most of your life, and in the next sentence, you make sure to write that you’ve never been diagnosed, and that you don’t know if your panic attacks are “bad enough” to be considered real panic attacks, especially compared to your friend’s. It is of course impossible for me to diagnose you from a short letter, but I do want to point out that whether the anxiety you experience fits into the definition of “diagnosable” or not, it has been bothering you badly enough and for long enough, that you’re writing in about. You don’t need to compare yourself to some objective experience of anxiety, and you also don’t need to have it “as bad” as someone else to be deserving of help and care. And while I understand the impulse to hold space for people who have it “worse” than you, you can also acknowledge and seek help for your own suffering without checking yourself (ESPECIALLY in therapy) or invalidating your experience. (It’s a practice, though, giving yourself the space and consideration you extend to others, and it’s understandable if it doesn’t happen overnight.) So here is your permission to declare your anxiety exactly as bad as you feel it, without the parameters of “bad enough,” from this therapist-in-training, to you.

As the first person in my family who has ever sought the help of a therapist, I relate a lot to your letter. Unfortunately, the process of finding a therapist is kind of like finding a good gynecologist — sometimes it’s hit or miss, and it can be really uncomfortable and awkward when you’re working with someone who isn’t a good fit. The first place I would start would be to ask around your friend group, if you have any friends who go to therapy. Ask them what the experience of therapy is like for them, how it felt in the beginning, how they found their therapist, what they like about the process, and what they don’t like. If you’re in school, you could also look into mental health services on campus and try out short term counseling there, or at least ask for local referrals. If you’re not part of any university, you could also look into community mental health centers, which have the added benefit of being more likely to accept insurance or offer sliding scale therapy options.

When I started therapy, I asked a friend of mine where she went, and she referred me to a clinic where interns were trained, which is also a good way to try to keep therapy costs low, if that’s a concern. I stayed with my first therapist for a couple of months, then stopped when her internship came to an end, and restarted again a few months later with someone new, who I still continue to see three years later. I had a pretty lucky, straight forwards process — the one person I saw in-between my former and current therapist was too expensive for me, but referred me to my current dude, and it ended up being a very comfortable working relationship.

While I hate “consumer” language when it comes to therapy (my supervisor refuses to refer to clients as “clients,” preferring the term “patients” because the root of the word — pathos — implies the suffering that therapy clients seek help with), there is some use in really taking ownership of the fact that this working relationship is about YOU and your needs. Any therapist worth her salt won’t force her own methods on you, choosing instead to gently stay where you are and take things at your pace, especially in the beginning of your work together. It’s important to pay attention to your first impressions and how you feel when meeting therapists to evaluate if you’re a good fit. Maybe jot down how you feel afterwards, without censoring yourself. It’s okay to give someone a couple of tries, but don’t feel like you have to doubt your gut feelings about someone. If you get a bad or uncomfortable vibe from someone, it’s okay to politely decline working with them, and keep looking.

When it comes to the type of therapy you think you would most benefit from, it’s also important to do your research. In my Masters program, we focus on two main schools of therapy – psychodynamic therapy, which originated with Freud’s psychoanalysis, and cognitive behavioral therapy, which was created by Albert Ellis and Aaron Beck. Psychodynamic therapy is known as insight oriented therapy; sessions are more likely to be open ended, and you’ll likely talk about your childhood, your family relationships, and your own relationship history as a means of making sense of what is troubling you now. Cognitive behavioral therapy, by contrast, is more geared toward helping you figure out how to solve problems and feel better now. There are a couple of different school of cognitive behavioral therapy, including ACT (acceptance and commitment therapy), DBT (dialectical behavioral therapy, created by Marsha Linehan in order to work with clients with borderline personality disorder), and REBT (rational emotive behavioral therapy).

I’m partial to cognitive behavioral therapy myself, because it’s clear and directive – you’ll come in each week with an agenda for treatment, and your therapist will give you exercises and homework to practice outside of session. The whole point of CBT really demystifies therapy and makes the client a part of the process, as opposed to psychodynamic therapy, wherein the therapist is still often treated as the “expert” or authority in the room. Cognitive behavioral therapies also tend to be more short term (10-12 sessions, though they can go on for longer) and more likely to be accepted by insurance companies, as they are more easily measurable (and god knows insurance companies are all about deliverable results).

There are yet more therapies available to you. Some of the types of therapies I’m into also include narrative therapy, where the client is encouraged to understand the story they are creating around their lives, and see themselves as separate from their problems, distancing themselves from the issues at hand and allowing for more agency and creativity in approaching stress and conflict. I find somatic therapy really cool, especially considering how often talk therapy seems to forget that we’re not just talking brains in jars, we have bodies that experience the world in non-verbal ways and receive tons of important information from the world around us. I also highly recommend therapies that encourage mindfulness – focusing on being fully present and embodied in the here and now – such as mindfulness based stress reduction, which have been shown to be effective with anxiety, depression, and even chronic pain.

If this all sounds overwhelming, don’t be alarmed! Most therapists in the U.S. at least practice from an eclectic, integrative perspective, and social workers in particularly receive a generalist education in their Masters programs, though many go on the specialize in a specific modality that resonates most with them. What this means is that you don’t need to know everything there is to know about the different types of therapy for you – you just have to have a sense of what might work for you. After that, you and your therapist can work together to uncover or create a specific approach that is unique to your needs, and they’ll bring the clinical knowledge and training. If you feel like you know what you want to come in with each week, or if you want to spend time exploring how your past led you to where you are today, the free association of psychodynamic therapy could work for you. If, by contrast, you want your therapist to be a little more directive, and you want to do homework assignments in-between sessions, maybe do a little exploring into the cognitive behavioral therapies. If you don’t know at all what might work for you, then that too is a perfect place to start with your therapist. Psychoeducation, or teaching clients the ins and outs of what they expect from therapy, is a big part of the beginning of the process, and most therapists are sensitive to the fact that many people come to therapy without knowing quite what to expect.

It’s also important to remember that when you show up to therapy, you bring all of yourself. That means that all the intersections of your identity – your race, your gender, your sexuality, etc. – are in the room with you. And the same is true of your therapist. While most therapists are encouraged to be conscious of this in the room with the client (and relational cultural feminist therapy specifically centers this in how therapy is practice), the unfortunate truth is that it is sometimes hard for folx of various marginalized identities to find good therapists. There’s no easy way around this, but remember that you deserve the type of care where you can show up with all of yourself. You shouldn’t have to spend the valuable time in therapy that you are paying for educating your therapist on issues of race or sexuality, for example, and you shouldn’t be expected to sit through microaggressions and ignorance as part of your therapeutic work. It can be extremely difficult to speak up and assert yourself to someone who has a lot of fancy-lookin’ letters after their name – but I’m here to let you know that just because someone is super educated, doesn’t mean they know everything, and doesn’t mean that they’re the expert in your life and lived experience. You are.

Finally, remember that your therapist isn’t going to have a magical cure to all your problems (though I can say from experience that it is VERY tempting to pretend I have all the answers to everything in, as evidenced in me writing this column). Therapy is work that you do, with the support and guidance of your therapist. Take a look into what kind of style you might be interested in. Are you cool with sitting and sifting through your past as your therapist helps you develop insight into your patterns? Maybe consider a therapist whose orientation is psychodynamic. Would you rather a therapist who takes a more direct, assertive approach, giving you homework assignments and exercises to practice between sessions? That therapist might lean more towards cognitive behavioral therapy, or any of its offshoots (I’m a fan of ACT). Are you artistic, creative? Art therapy and narrative therapy can be helpful ways to tap into the strengths of that side of yourself. Most therapists blend their approach and will adjust to your needs, but going in with an idea of what might resonate with you could help you narrow down your search.

Most importantly, remember that ideally, therapy is your place to be all about YOU. It’s your place to be safe, vulnerable, and authentic, in order for you learn about yourself. So start your therapy journey with that in mind, because it’s never too early to start practicing how to prioritize yourself and your needs.

Social media is your friend when exploring therapy for the first time. Check out these awesome therapists/collectives dedicated to doing the work from an intersectional perspective:

@decolonizingtherapy
@the.holistic.psychologist
@thenapministry
@mujeresxpsych
@nedratawwab
@therapyforlatinx
@sexpositive_families
@thefatsextherapist

Christina Tesoro is a New York City-based writer, sex educator, and therapist. In her spare time she loves to read tarot cards, lift heavy objects, and go on long walks with her dog. She is determined to learn how to do a split.

Christina has written 12 articles for us.

19 Comments

  1. (full disclosure i am a white cis femme with health insurance and i’m aware those several layers of privilege really change my circumstances compared to others. i hope this is still helpful info!)

    I see a therapist weekly. I found her through psychologytoday.com, which let me filter my search results based on things related to me. my therapist lists on her profile that she has experience working with queer individuals and families, people who have experienced sexual assault, people who are dealing with gender issues, and general transitional times. I also Googled her to see if anything came up and the titles of papers she had written seemed promising, like they didn’t seem like she would try to force me to be someone else.

    starting to see a new therapist is objectively awful. “Hi, nice to meet you for the first time, here’s my heaviest emotional shit!” it hurts and its sad and embarrassing and just shitty. but it is literally their job to be supportive about it. if your therapist isn’t creating a safe space for you to share everything awful about you, then they might not be the right provider. in my case, it’s every awful thing my anxiety/ptsd says about me or nasty things my abuser said outloud about me that i’m afraid are true. it feels REALLY hard to repeat those things but it really helps my therapist understand me. therapy is great because you get to be the main character in all the stories and you have a built in person who wants to celebrate your triumphs and sit with you when you’re in pain.

    also if you just want more reassurance or info re: therapy, this podcast was really helpful to me https://unladylike.co/episodes/043/sad

    thanks for coming to my tedtalk

  2. Awesome article, Christina. Starting therapy can be such an overwhelming experience, and your advice is so so so solid. (You’re going to be a great therapist!) One other idea for the poster would be to seek out group therapy, as a complement or alternative to individual sessions. It’s been hugely helpful for me, in complement to work I had done with a psychotherapist. Also – tends to be more affordable than 1:1 sessions, which can be nice!

    Therapy has been life-saving for me. (Personally love the psychotherapy side of things – it’s cool to see patterns and structures emerge, and work to live outside them!) Hope the original poster is able to seek it out and find a good fit.

    P.S. Bechdel’s “Are You My Mother?” is a fun queer read relating to therapy and the theory!

  3. Thank you for this article! I’ve been trying to start this year and was recently discouraged when this one person I sought out was not accepting new patients. This was the kick in the butt I needed to resume my search, so thank you 🙏🏿

  4. Just adding to the ‘yes, you are allowed to go to therapy and it can take some searching’ chorus:

    I had a lot of trouble giving myself permission to go to therapy because things ‘weren’t that bad’ and also it is not a thing ppl in my family do (I do have very easy access via insurance and financial stability). After a meh-bad experience with a more randomly assigned therapist, I tried working with someone in a queer poc practice. Voicing my hesitations to the person I ended up working with helped a lot – the first thing we worked on was me having permission to take up my therapist’s time and appointment slots in a qpoc practice (I’m white passing & usually don’t claim poc spaces) and spend money on therapy.

    Two years later, I realize I had varying levels of depression for many, many years so my ‘normal’ was actually not great, and the point I was at when I did go to therapy _was_ ‘that bad’ but I couldn’t see it when I was in it.

    Me using therapy to develop the practices that help me be marginally better more of the time has helped EVERYONE around me – partner, friends, family, coworkers, organizers.

    In case anyone in Ann Arbor MI is looking for intersectional therapy, https://amplifycolectivo.com/ and https://www.integrativeempowerment.com/ are great!

  5. Here to put in a plug for somatic therapy, especially ones based in neurobiology and trauma. I reached a plateau with talk therapy and CBT where it was no longer doing anything to help resolve my deeper issues, and this fact itself was feeding even more into my panic spirals. But then I was lucky enough to find a therapist who uses an approach that helps “reset” the effects of trauma on the nervous system, and it was exactly what I needed.

  6. I’m really glad you wrote this! It can be a hard process. My first therapist was recommended by a friend who was queer but didn’t really grasp queer stuff. I finally got the guts to leave after the THIRD time she asked if my partner was going to have bottom surgery (the language she used to ask was ugh too). It’s so hard to leave someone with whom you’ve discussed such intimate details of your life.

    Recently I ran into her while holding my 3 month old baby, and she asked when I was due with the next baby. This is like the holy grail of rude, tactless things you can ask someone- do not assume someone is pregnant! Ever! But to compound it by assuming someone is pregnant while holding a very new baby? WTF. Fortunately sleep deprivation causes me to not hold back either so I pointed out that I was a few months postpartum and carrying a lot of belly fat and ALSO pointed out that you should never assume this, regardless of the roundness of someone’s abdomen. She responded by saying my baby (in the 50th percentile for size by the way) looked very big so she thought she must be older than 3 months.

    Y’all. Some people just have no tact and that’s fine but I do think if you’re a therapist you should have just a smidge of it.

  7. I’m so glad this article is here! Such an important topic. When I was trying to find a therapist, regardless to whether or not they were listed as “LGBTQ friendly” (or variations) online, I made a point of mentioning that I’m gay and would be discussing relationships/etc, and basically, do they feel comfortable with that. Better to voice it over the phone and hear their reaction than waste everyone’s time and do it in person, IMO.

  8. Great advice.

    I have 2 questions related to this:

    1. I’m worried that it’s considered rude to ask friends for therapist recommendations. Sharing the same therapist seems like a bad idea?

    2. How do you find a therapist who can address various intersecting issues (ie. homophobia, ableism, trauma, disabilities, etc)? I’ve always found that therapists only really specialize in 1 thing and I’m always disappointed. Do people see multiple therapists for different issues (if they can afford to?)

    • Hey!

      To answer your questions

      1. I think whether or not it’s rude to ask a friend for a therapist recommendation depends on your friendship, to be honest. I’ve offered up my therapist to friends, and discussed what I think some of his strengths and weakness are with regard to our work together, and I would be comfortable with a friend of mine seeing him, but I also know that I would never ask my therapist about my friend’s treatment bc it goes against my own sense of boundaries (and isn’t what I use therapy for). It ALSO depends on the therapist’s policy on taking referrals from current clients — some therapists are comfortable with that, others may find it a conflict of interest. Your friend’s therapist, though, might know of a couple of colleagues they could refer you to.

      2. THIS is a really hard thing to do. Your best bet might be to go with an LMSW or LCSW, because (theoretically, at least) social workers are educated in systems of oppression and cultural context as well as clinical psychotherapy, as opposed to a therapist with a psychology or mental health counseling degree. UNFORTUNATELY, my experience of social work school leads me to take that with a grain of salt as well, though, because I’ve witnessed some truly staggering examples of white fragility and ignorance in my social work program. If you can, I would seek out a therapist who is also of a marginalized identity in some way or, at the very least, ask a lot of pointed questions about the things that bother you, pay close attention to their answers and attitudes (spoken and unspoken), and above all, trust your gut.

    • I think it’s ok to ask friends for therapist recommendations.

      I’ve done it. And I’ve recommended therapists too. It didn’t seem any weirder than asking my friends about dentists or doctors. I admittedly move in social circles where therapy is considered pretty normal.

      I don’t think I’ve ever asked a friend directly about their therapist – just that I’m looking for a therapist who’s good with X and do they know of anyone?

  9. I’ve dealt with various levels of depression for most of my life and have seen more than a dozen therapists. Most of them practiced psychodynamic therapy. After a couple years of this I’d get frustrated with rehashing my story but doing so always revealed new layers. I’ve gotten deeper into the causes of my depression and have revealed undiagnosed illnesses. I’ve done both individual and group DBT for the past few years. It’s been helpful to have the tools DBT provides but it’s taken time to really incorporate them. It’s important that the therapist(s) facilitating the DBT group (or any group therapy) be informed and responsive to the well-being of the whole group. I had a deeply traumatic experience in a DBT program with a narcissistic white female patient who said horribly offensive and invasive things to me about my experience as a blacktina. They went unchecked and when I confronted the administration, I was gaslighted. So if it’s possible and important to you, check out reviews of the therapist/clinic. If it’s in a hospital, maybe contact the patient advocate to get a feel. Try to have very frank conversations with the therapist regarding your concerns. In that same DBT clinic I was assigned a cis white male therapist when I’d previously been treated by female therapists of color. But he and I had a very honest conversation about race and my experiences. Luckily, he was someone who had been doing the work to be aware of his privilege and things were okay with him. At the same time, as my illnesses progressed, I actually found it harder to work with female POC therapist. I did a lot of comparing myself to them and came up on the losing side. So now I have a white cis female social worker who is very conscious and has and sensitive to my needs. She’s great and is less stressful for my brain than a WOC would be.

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