Why Is Finding A Therapist So Hard? Help!

Nearly every mental health expert I’ve spoken to as a wellness writer for Refinery29 has emphasized to me the importance of therapy. It doesn’t matter what I’m reporting on — almost without fail, they’ll slip into our conversation that everyone who has the option to seek therapy should do so. Despite hearing that dozens of times, I’ve never felt like I needed a therapist. If I’ve sometimes felt anxiety or sadness, it’s never felt like enough for me to seek professional help.

The past 15-ish months have changed my perspective. Nearly three in four psychologists who work with patients for anxiety disorders saw an uptick in demand for treatment after the onset of the pandemic, according to a survey from the American Psychological Association. Teletherapy platform Talkspace reported a 65% jump in clients between mid-February and May of last year, mostly due to pandemic-related anxiety, a spokesperson previously told Refinery29. The unprecedented changes of the last year, and the uncertainty caused by COVID-19, drove many people to seek help. “I think everybody could benefit from having someone to talk to, especially anybody with any kind of marginalized identity,” psychologist Alfiee Breland-Noble, PhD, tells me over the phone. “What do you have to lose?”

I’ve begun to think of therapy as not dissimilar from physical check-ups, like bi-annual teeth cleanings or yearly OB/GYN appointments. You don’t have to be in horrific pain to get them, and while you may feel fine without them at first, it’s ultimately best to stay on track.

So the decision to try therapy out was relatively easy. But actually finding a mental health professional was a lot more confusing and convoluted than I had expected — way harder than finding my dentist. I couldn’t figure out what my insurance covered, or which doctors took insurance. Telemedicine was available, but I couldn’t tell if something like text therapy was legit. I had no idea whether or when I’d be hit by some bill I couldn’t afford. And from talking with experts and my friends, I know my experience isn’t unique. Finding a therapist is hard — and only getting harder, as the increased demand is leading to dwindling appointments slots.

So we put together this guide, which aims to walk you through how to actually find a therapist, in a price range that you can afford. (We start by talking about insurance, but offer resources anyone who's uninsured and underinsured too.) We’re not going to lie — it is work. But in the end, the state of your mental health is what’s most important. And like Dr Breland-Noble said, what have you got to lose?

Are you looking for a few check-in sessions, or to establish a long-term care relationship? Do you need a therapist with a background in a particular type of treatment or trauma? If you’re from a marginalized community, are you looking for a culturally competent and/or affirming therapist, or one who is part of the same community as you? Are you open to meeting in person, or would you prefer to stick to virtual sessions? What days and times will work for you? Knowing these details up front can help you tailor your search, so you won’t waste time contacting practitioners who aren’t a good fit.

If you are in a place where you have insurance, including Medicaid, going through your provider may be your most cost-efficient and easiest bet. One of the very first things I did in my search was head to my insurance provider’s website to view their directory of in-network therapists.

And… to be honest, it was kind of disappointing. At first, the list that came up for available therapists in my area had only five names on it. That’s when I learned this pro tip: Call your provider (the phone number should be on the back of your health insurance card). I did, and the person who took the call somehow found a better, longer list of therapists available for me, and gave me advice about how to  navigate the website more effectively. The more names you can get, the better, since I found that some providers are listed as accepting clients, but actually aren’t.

If calling doesn’t help, there are also a handful of online databases that list mental health professionals, and let you filter by insurance, and other details. Psychology Today is one of the largest. There’s also Therapy For Black Girls, the American Psychologist Association’s Psychologist Locater, and Inclusive Therapists.

If you have insurance, but can’t find an in-network professional, ask about your insurance provider’s out-of-network coverage. (I found it easiest to, again, call my provider and have someone walk me through my options.) Many plans’ out-of-network benefits require you to pay for the full cost of your appointments until you meet a set deductible. Then, they’ll begin to cover a percentage of each session. 

So in my case, I found an out-of-network therapist who charged $225 per visit, and my out-of-network deductible is $1,000. I’d have to pay out of pocket for five sessions, but then my benefits would kick in, and I’d be charged $90 per session. (Also keep in mind that some providers require that you pay out of pocket and be reimbursed by your insurance company later.) This strategy can, obviously, be cost-prohibitive — but if you can afford it (and more on that below), it provides you with many more options for care. 

If you don’t have insurance or your mental health benefits are insufficient, there are different kinds of platforms that strive to connect people to therapists that offer truly affordable, out-of-pocket care. Open Path Collective is one fantastic option. The platform connects you to a network of therapists who charge $30 to $60 a session — you’ll just need to pay a one-time fee of $59 to access the service. 

You can also search for non-profits and other organizations that have created mental health funds or free therapy resources for certain communities. The National Queer And Trans Therapists Of Color Network has a Mental Health Fund that eligible people can apply for, that is meant to help queer and trans people of color pay for mental health support. The AAKOMA Project (which was founded by Dr. Breland-Noble) also aims to provide free therapy sessions to Black teens and young adults.

Even with my out-of-network coverage, that $225 therapist I mentioned before was too expensive for me. If I’d really been dead-set on them — or if I didn’t have insurance or I was underinsured — I could have asked if they offered a sliding scale. This means they adjust their session cost, typically based on the client’s income. Most therapists that offer this option will say so on their website, but it never hurts to ask; the deductions can be significant, and can go a long way in making therapy more affordable.

Dr. Breland-Noble also says to look for therapists that advertise “self-pay,” which means they’ll let you pay without going through insurance (even if you have it). They tend to be more willing to discuss a sliding scale rate. “Those are the words you’re looking for,” she says. “If you see a provider that takes self-pay, sometimes what you can do is share your situation with them and many providers — depending on their own circumstances — will be willing to work with you.”

This is a good idea at any point in your journey to finding mental health care: Ask a trusted friend, family member, coworker, and/or your primary care doctor to refer you to a therapist. After learning that I was looking for a therapist, for instance, one of my coworkers let me know of a therapist group they liked in New York City. I’m still on my parents’ insurance, so that provider ended up being out-of-network and too expensive for me — but it’s always good to have the vetted options.

Reaching out to friends for referrals can be especially helpful with those who have marginalized identities — if you’re LGBTQ+ and someone you know recommends a LGBTQ+-friendly therapist, that’s one less step you have to take to access affirming care.

You can also ask therapists for referrals. If one professional ends up being too expensive for you or unavailable on a certain day, they may know someone or work with someone who can take you on. Since I found that some databases weren’t always up-to-date, this may help you find someone who’s accepting new patients but isn’t listed as such, or is newer to practicing.

During the pandemic — with more people needing mental health care and it being impossible to visit with therapists in person — virtual services became more popular. Talkspace, a platform that hosts audio and video therapy sessions, but that also allows you to privately message your therapist throughout the day is one of the most well-known. But services such as Betterhelp have similar approaches.

The upside to these options is that you don’t need insurance to access them. They’re not cheap: a Talkspace membership costs $65 a week. But the service emphasizes that it allows you to text your therapist whenever you need a check-in, five days a week, which justifies the cost.

But some therapists say that text-based services in particular are not a long-term solution for mental health care. “It seems like a great solution — in theory, it sounds great — but I don’t think [text-based services] have proven its efficacy,” Jessica Macnair, LPC, tells Refinery29. The American Psychological Association also notes that clients who have more serious mental illnesses, such as PTSD or substance abuse issues, likely need more treatment than virtual platforms like these can provide. So if you’re just looking for quick check-ins or need support while you’re searching for a longer term therapist, trying something like this out may be useful — but proceed carefully.

Prior to my own personal therapy journey I didn’t realize that this was an option, but one way to access affordable mental health care is through a local training clinic at a hospital or a university. These facilities may let you work with a student who is being trained to be a therapist or a psychologist for a low fee. These students aren’t licensed yet, but are typically supervised by licensed practitioners. 

If there’s a training program near you, you should be able to find it online. For example, I did a quick Google search of “therapist training clinic near me” and found that Yeshiva University in New York City offers a sliding scale of $5 to $40 for psychotherapy sessions. Contacting the National Alliance on Mental Illness HelpLine or MentalHealth.gov are good options for finding student therapists, too. Some programs like this take insurance, but many additionally provide self-pay care at much lower-than-typical fees. 

Another option: Some local hospitals or community centers also provide free or low-cost support groups, sometimes led by professionals and sometimes peer-based, which can be great, accessible alternatives to traditional one-on-one therapy. Finding these resources may take some Google sleuthing, though. Mentalhealth.gov has a good list of organizations that have chapters across the country, like Active Minds and Youth M.O.V.E. National. 

If you’re in urgent need of mental health care or help, there are crisis numbers you can call such as Crisis Call Center, National Eating Disorders Association Helpline, Trans Lifeline, and the National Suicide Prevention Lifeline. Although not a long-term solution for care, they are always there for you if you need them.

In all honesty, I’m still sorting through the in-network options from my insurance provider. Setting aside the time to sift through the list, calling the therapists, and setting up consultations has felt overwhelming, and there have been plenty of times where I just wanted to give up, save myself some money, and move on. But I know that caring for my mental health is one of the most important things that I can do for myself right now, especially after a year as hard as this one. I wish it were easier — but for now, I’m considering my efforts to be an investment in my future wellbeing, one that I’m sure will pay off.