Green for Growth

Table of Contents

**Disclaimer: This might not be exhaustive! It is, however, what I send to my own friends/cousins/etc. when the topic comes up.

I can’t either, folks.

I have a Master’s degree in counselling and I can’t tell from a therapist’s website what it will be like to work with them. That’s not JUST because we’re all using flowery language to sell ourselves, though that doesn’t help. It’s also that therapy is so intimately personal. There are as many ways to do therapy as there are therapists. That doesn’t mean that it doesn’t matter who you choose or that you can’t make an educated choice. There are some definite things to think about:

The research says that therapeutic alliance is the most important factor when it comes to the outcomes of therapy (as in, the progress you make as a client). It breaks down basically into the extent to which it feels like you and your therapist are working on the same goals, being emotionally vulnerable, and holding each other in positive regard. This stuff, which seems simple, is associated with ~45x more change than selecting a specific technique (say, working with thought distortions with a CBT therapist). So how do you max out your alliance? It’s a feeling thing. Ask yourself, in relation to possible candidates, ‘how safe do I feel?’, ‘how connected do I feel?’, and ‘how easy will communication with this person be?’

Some of this can be helped by demographic characteristics. Searching out someone who will understand parts of your perspective because they have some shared lived experiences can be a good way to start. Maybe it enables a shorthand between you, so you don’t have to explain at length why that thing your cousin said was awkward or why you can’t book a session next week for the holiday. You might also be subconsciously drawing on similarities between the counsellor and people you’ve been able to trust (or not) in the past. Hey, humans have built-in safety sensors and we can’t turn them off. It’s absolutely legitimate to acknowledge that our history will show up with someone of a certain gender (or stature, or tone of voice, etc.) and that this could hinder therapy or help it.

I’ll be doing a deeper look at access to therapy in the future, but for now we can go as far as saying that there are some considerations here too. Where are they located? Is their space barrier-free (or at least barrier-free for you)? Can you do therapy online? Would you have the privacy and the technology for that? And one of the biggest is cost. Some people have insurance, and then ensuring that your coverage is good for the therapist you choose is important. Some plans only cover certain types of therapists, or cover fees up to a certain maximum. If you’re paying out of pocket then finding someone providing a sliding scale (or even pro bono!) services might be important.

Credentials affect not just the fees charged for therapy, but also some of the training a therapist comes in with. This is broadly true, but therapists are often pursuing training even after their degrees, so it’s hard to know perfectly from what they studied when they were at university last. In NS there are 3 major groups doing the bulk of the therapy. Psychologists, Social Workers, and Counselling Therapists. All (in NS, currently) do Master’s degrees (or even PhD/PsyD degrees) before they can jump into therapy- at least the kind of therapy that insurance companies will pay for and governments will fund. Checking that your therapist fits into one of these groups (there are some psychiatrists doing therapy too, but they’re rare!) is a start. You might also inquire or check their website to see what other sort of professional development work they’ve done. There are myriad certifications therapists can pursue after they graduate and tons of books to read - so go see what they might reference having pursued.

Referral is a great way to find a therapist, and also signals a laudably open dialogue about mental health and mental illness. If you are in a position to discuss this topic with anyone (family, friend, co-worker being the usual groups) you can see if they have had good experiences with a therapist they can recommend. Not everyone might have the sort of situation that provides them access to therapy referrals through their social networks so reaching out to a community group or family doctor could also help.

I’m currently listed on a couple of directories where therapists advertise their services. One of the major pluses of these is that you can filter and search based on specific criteria very easily. For example, if you want a therapist who works with trans clients you can eliminate all those who don’t and then start your search from there. Or if it’s specifically couples work you’re on the hunt for then you’ll be able to whittle the list down more quickly than trying to surf every individual therapist’s website. I have my hesitations about what directories do though; mainly that they purport to show all therapists in your area when it is actually only the ones that pay to list with them that show up. This potentially cuts lots of your options out of your view and can drive up the cost of therapy with those who have to pay onerous fees to advertise if they hope to be visible. This is partially why I only list myself on both Psychology Today (one of the biggest mainstream directories) and the Affordable Therapy Network of Nova Scotia (focused on sliding scale work).

Some therapists will offer a free consultation phone call to see if you might be a good fit to work together. My experience is that more therapists offer these than advertise that they do, so it can pay off to ask them even if you don’t see it mentioned. This gives a chance to get a feel for what it is like talking with them and also to get any outstanding questions asked. Rather than be a bothersome endeavour, I tend to feel like clients who ask for a quick phone call to see how we can work together are being rightly discerning; that they are showing advanced assertiveness skills and knowledge of how to navigate mental health resources. I don’t widely advertise that I will do consultations either, partly because I don’t want to make it seem necessary, but I haven’t ever refused a client who wanted to schedule a consultation phone call.

Ultimately your first task of therapy, choosing a therapist, is about tuning into your feelings enough to figure out who to pick. There is no right answer and, as I said, even people inside the industry struggle to do so. After some research and some thought it comes down to this: who FEELS like the right therapist for me?