How to Pick a Counselor

This topic is a common question I get and an important one to know about. I'll have a friend or family member will come up to me and say, “I think I need to see a counselor, how do I pick one?” We'll discuss different things that are important to look for in a counselor, how to understand all those letters behind the names, and some decisions to make regarding payment.

Where do I start?

I recommend three main approaches.  

First, word of mouth.  Ask friends or family members if they know of someone they like.  Most people have a friend or family member that is a counselor, so asking them is also a good way to get a good recommendation.

Second, internet search.  Most private practice counselors have either a website or at least a section on a website or directory.  Good websites will hopefully give you a good idea of their specialties and help you pick someone that works with what you'd like to address. On the site you should check out their specialties, payment options, and if they’re accepting new clients.

Third, counselor directories.  Psychology Today is one of the largest(if not the largest) directories out there. You can search for therapists and narrow your search down with filter criteria like insurance, gender, issues, and what population they see.  There are also companies like Alma and Headway that help counselors get credentialed with insurance and you can find a counselor that’s in network with your insurance.

What about all those letters behind their name?

Another thing to consider is what license type to look for. You’ll often see things like LPC, LPC-A, LMSW, LCSW, LMFT, and a whole lot more. One potential red flag is when someone calls themselves something that sounds like they’ll be providing therapy or counseling, but they don’t have any credentials, licenses, and/or education. While I’m certain there are people out there without a formal education and/or license that provide great services, it’s something to consider when looking for professional help. Without a license, there’s also no licensing board with a strict set of rules and ethical guidelines any good counselor needs to follow. By going to someone with a license, you are going to someone that went to school, graduated (usually with a master's degree), and passed the licensing exam that ensures they can be held accountable if they do something unethical. Any licensed mental health professional providing counseling services should be able to provide you with licensing information and, if not, you can always look it up online.

First, we'll look at the LPC. LPC stands for licensed professional counselor and you'll see three versions of this: LPC-A, LPC, and LPC-S. LPC-A is what's called a temporary or provisional license. Someone obtains an LPC-A when they finish their master’s with the necessary classes, do a practicum, and pass the licensing exam. They then have to obtain a certain amount of hours under the supervision of an LPC supervisor, or an LPC-S. This process usually takes a couple of years. Once they complete their hours of supervision, they can become an LPC, which is considered a full unrestricted license. The main difference between the two is an LPC will have more experience than an LPC-A and can provide counseling without needing supervision.

Now we look at an LMSW (Licensed Master Social Worker) and LCSW (Licensed Clinical Social Worker). These are similar in some ways to the LPC. Since I am not as familiar with this kind of license, you can find some of the differences in these licenses here.

So what’s the difference between an LPC, Social Worker, and a psychologist? An LPC finishes a program that is mainly focused on the courses necessary to provide counseling and therapy on the individual and group levels. My program focused a lot on the theory behind the practice, which was invaluable for me. My professional belief is a counselor needs to know why they are doing something, not just learning a certain modality or technique and doing it. A social work program often focuses more on administrative duties and case management, and social programs are often geared toward helping underserved populations. Social work programs offer different tracks depending on if the person wants to work on the micro or macro level. In speaking with my social worker friends, they often say they went that route because they like to work more on the macro level. Social work programs do offer a clinical track for those who are interested in counseling. Psychologists are those with a doctorate degree. While you will find psychologists who provide counseling, you’ll also find them in teaching or research roles.

How will I pay for this?

Let's talk about payment. You have two main routes: paying cash or going through insurance, and both have their pros and cons. The main pro to using insurance is it’s often less expensive but not always. Make sure to check your coverage and see what you’ll be paying for mental health care. The cons are you are limited to a counselor that takes your insurance and insurance often gets to dictate at least part of your counseling journey. This means they may put a limit on how many sessions and what types of therapy they will approve.

Paying in cash is often more expensive, but you get to dictate your whole counseling journey, how many sessions you want, frequency, and who you want to see. Paying cash is also more private. With insurance, your insurance company can request progress notes in an audit. You can always look for a place or counselor that operates on a sliding scale, but the demand for free or reduced-cost counseling far outweighs the supply and you are often put on a waitlist and, at times, a lengthy one.

Deal Breakers

Along with payment, there are a couple of deal breakers I address at the very beginning of a consultation. If one or more of these occur, I offer to help refer out to another counselor that might be a better fit. When and how do you want/need to meet? Some counselors offer weekend and evening hours so if you can’t meet during the day, make sure to find someone that has availability that fits yours. See if the counselor does in-person, telehealth, or both. If you prefer in-person, make sure to find a counselor near you with that availability. Keep in mind that if you are doing telehealth, you can see any counselor licensed in Texas, not just one nearby.

What to look for in a good counselor

We’ll now discuss what to look for in a good counselor. Counselors will usually have their licenses, experience, and specialties listed. Look for one that deals with the main topic you are interested in. For example, I specialize in sex/porn addiction, trauma, depression, and anxiety. I see it as a bit of a red flag if someone says they see all ages and all concerns. You need to have a good fit with your counselor. You want to feel like you can speak openly and freely to your counselor without fear of judgment or that they don’t understand you. You want to feel confident that your counselor understands what you’re going through and know how to help you navigate toward your specific goals.

Now that you’ve picked your counselor, fit is one of the most important things in a therapeutic relationship. If you are having an issue with a counselor, give them a shot and talk to them about it. In my experience with talking to clients about past counselors they didn’t like, there often seemed to be something that could’ve been addressed and remedied. I can’t tell you how many times I've heard people say: “Oh, I didn’t like my last counselor, (give the reason) and then just didn’t see them anymore.” I rarely hear: “There was an issue and just like I don’t want people to so quickly write me off, I discussed it with my counselor and if appropriate, their supervisor.” Like any profession, there are some bad counselors out there. If you feel like you’ve given them a fair shot and the fit still isn’t there, it may be time to find a new counselor. If your counselor has done something unethical, please, please, please, report them to their licensing board. Counselors should make information about their license readily available and you can often find it in the informed consent, their profile and bio, and/or the license itself on the wall or a shelf. A good counselor should explain the process to you, encourage you to ask questions, and treat you with respect. While I believe being transparent with my clients is important, I also think being transparent with your counselor is equally important.

Another thing to look for is this: does your counselor tell you what to do and give you advice, or do they help you become your own good advice giver? I believe every good therapy ends and you finish the therapeutic relationship saying: “Thank you, I now feel like I have the skills to be able to live my life how I want to without needing to speak with a counselor on a regular basis.”

So in recap, decide how you want to pay, and find someone with the experience, license, and specialization you are looking for. After meeting with them the first time, decide if you feel comfortable speaking with them and, if not, bring your concern up with them and move appropriately forward from there.