How to Choose a Psychotherapist

What to consider when choosing a therapist and what questions to ask

Choosing a psychotherapist is not easy!  There are many different kinds of psychotherapists — with different types of degrees, and various laws on licensing requirements. It is even more complicated when in a new country as there is more and different information.   For example, standards and practices are different in Costa Rica than in the U.S.  I will discuss some factors to consider when searching for a psychotherapist in general (with the U.S. as our point of reference) and will give you a sample list of questions to ask.

Connection is critical  

Psychotherapy is a collaborative effort between an individual and a therapist. It provides a supportive environment to talk openly and confidentially about concerns and feelings.  Confidentiality and trust are extremely important.  While there are many different therapeutic approaches, the single most important factor, in addition to therapist competence, is the the “click” or sense of connection between the individual and therapist.  Choose the therapist with whom you feel comfortable, not just the person with the most impressive sounding qualifications.

Types of therapists

(U.S. based information.  Type of training varies greatly from country to country.)

Therapists come in many different “shapes and sizes” — meaning that there are many different titles, degrees, theoretical orientations, and specialties.   While more years of training generally indicate greater level of preparation, just because one has a higher degree than another, it doesn’t necessarily mean that they are a better therapist.  After their degree and license, some may have gone on and obtained additional specialized training.  Like any other profession, there is a range of level of competence, ethical behavior, professionalism, giftedness, etc.

Psychologists have a doctorate degree (Ph.D. or Psy.D), meaning on average, 7 years of formal education beyond the 4-year undergraduate university degree, with all the 7 years focused on psychology.  In addition, they need to have passed a licensing exam and other requirements in order to be licensed to practice in a particular state.  To maintain their license, they need to earn ongoing continuing education specific to the field of psychology.  Psychologists tend to focus on the “why” and “how”.  Psychologists use talk therapy and do not prescribe medicine.

Psychiatrists have a Medical Degree (MD), meaning on average, 8 years of formal education beyond the 4-year undergraduate university degree, with at least 3 of the 8 years focused on psychiatry.  In addition, they need to have passed a licensing exam and other requirements to be licensed, and then also pass psychiatry Board exams.  To maintain their license, they need to earn ongoing continuing education.  Psychiatrists tend to focus on medication.

Some social workers can be licensed to practice psychotherapy.  These social workers have a masters’ degree (MSW), meaning on average, 2-3 years of formal education beyond the 4-year undergraduate university degree.  In addition, they need to have passed a licensing exam and other requirements, earning them the title to Licensed Clinical Social Workers (LCSW).

Licensed Marriage and Family Therapists (LMFTs) and Licensed Professional Counselors (LPCs or LCPCs) both complete two year master’s programs beyond the 4-year undergraduate university degree, and complete licensing exams.  LMFT’s tend to focus on relationships among family members. (These licenses vary state by state)

There are many unlicensed professionals offering services.  Many people may find their services useful, but unlicensed professionals may have not received formal training in psychotherapy, and are not required to follow the same professional standards (ethical, legal, clinical) as licensed professionals.  Examples are: coach, clergy, peer support, among others.

Most therapists work with many conditions. However, there are some conditions, circumstances and populations that many do not work with, for a variety of different reasons (preference, training, etc). Some say that they work with everything and everyone, but I suggest that it is very difficult to be experienced and prepared in everything.  There are some areas that are best served with specialized training and experience, for example, children, adolescents, specific language and cultural groups, LGBTQ, infertility, trauma, addictions, eating disorders, couples therapy, family therapy, among others.


(U.S. based information.  Type of training varies greatly country to country.)

Psychologists are highly trained professionals with expertise in the areas of human behavior, mental health assessment, diagnosis and treatment, and behavior change.  Psychologists with doctoral degrees (either a PhD, PsyD or EdD) receive one of the highest levels of education of all health care professionals, spending an average of seven years in education and training after they receive their undergraduate degrees.

Practicing psychologists have the professional training and clinical skills to help people learn to cope more effectively with life issues and mental health problems. After years of graduate school and supervised training, they become licensed by their states to provide a number of services, including evaluations and psychotherapy. Psychologists help by using a variety of techniques based on the best available research and consider someone’s unique values, characteristics, goals and circumstances. (American Psychological Association)

Questions to ask

(first and last questions are intentionally the same)

Ask yourself: How did I feel with that person? (it may be just a gut feeling)

What is your degree?

Where and when did you earn your degree?

Where did you do your clinical internship and how long was it?

Where are you licensed and since when?

What are your specialties?

Who don’t you work with?

Do you speak my language fluently and what kind of experience do you have working with my culture?

What is your type and level of experience with my age group and problem area?

What do you charge?

Where are you located and what days & hours do you work?

Are you available to meet free of charge first to “get a feel” for the connection and answer some questions?

Ask yourself: How did I feel with that person? (it may be just a gut feeling)

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