Can't find a therapist? Here's what you need to know
You're looking for a therapist and it's been rough. If the many therapists you contacted responded to you at all, it's only been to let you know they're full. If they have a waiting list, it's months long. This would be tough enough to deal with if you were looking for a plumber; it's exponentially harder when it's your own mental health at stake. You might be desperate for help with crippling anxiety or even thoughts of suicide. You might have a personal history of abandonment, neglect, or rejection that makes therapists' responses - or lacks thereof - particularly painful for you. You've got a lot of challenging steps to navigate on your road to recovery; getting help in the first place shouldn't be one of them.
I'm sorry to be one of the many therapists turning you away. Since I can't help by being your therapist, I'd at least like to offer some insider advice about what's causing the problem and how to increase your chances of hearing back. With that said, I recognize that what I'm about to say might trigger anger. I'm willing to take the chance of upsetting some people for the sake of helping those who might benefit from this information.
In case it isn't already painfully clear, right now, demand for therapists far exceeds supply. Perhaps in an ideal world, services would be provided on a first-come, first-serve basis; but when a therapist receives multiple inquiries per day, there's no clear order of priority. Or perhaps in an ideal world, services would be provided based on severity of need, but this can rarely be assessed from brief messages alone; besides, therapists must manage their own burnout, and consider the impact on their wellbeing, as well as the legal risks and obligations, of prioritizing only the most desperate people. Given that this is the real world and not the ideal world, I'm going to share…
What actually determines how therapists prioritize prospective clients - and what you can do about it:
Money.
Go ahead and hate me for saying this. When you're done being mad, come back and read it, because it might be useful to know.
Imagine you've got multiple job offers. Job A pays 50% more per hour than Job B. All else being equal, which do you choose?
Now imagine you're a therapist. You have your regular fees, and maybe a sliding scale. Then you have contracts with various insurance companies, each reimbursing at different rates, ranging from 50% of your regular fee to 95%. While it would be nice from a humanitarian perspective if those numbers didn't influence your decision making, in reality they determine whether you see 30 clients a week, or 20; afford a vacation once a year, or twice; raise your child in a crime-ridden neighborhood, or near a good school; spend your evenings on hobbies, or on paperwork; burn out in 10 years, or 20.
While it would be a violation of contract for me to tell you what rates any given insurance company offers, I can tell you this: the less a company pays, the more inquiries I receive from patients with that insurance, and the more I hear they've had trouble finding a therapist.
What you can do:
Tell therapists upfront your insurance type or budget.
Make sure you're familiar with your mental health benefits. Do you have a copay, coinsurance, and/or deductible? If you've contacted several therapists with no luck, you might have an insurance plan that doesn't offer therapists good incentives for prioritizing their patients.
Tell your insurance company about the troubles you're having.
Suggest that they pay therapists better in this highly competitive market.
Ask them to vet therapist availability and find someone for you, rather than leaving you to figure out who's actually taking new clients.
Suggest that they contract with pre-licensed interns, who will accept the lower pay rates or otherwise help the company broaden their net.
Ask your insurance company to form a Single Case Agreement with a therapist who would normally be out of network for you, so that you can use your in-network benefits with them, on the grounds that the company has failed to help you find an appropriate fit in network.
File a complaint with the State of Oregon's Division of Financial Regulation. Here, you can express that your insurance provider is not doing their job of providing adequate coverage for mental health, as evidenced by your difficulty finding a provider in network accepting new patients.
Use your out-of-network benefits.
If you have the power to do so, consider changing insurance providers.
Or see a sliding scale-based intern at a training clinic.
Finally, see the extra tips below.
Client-therapist fit.
The relationship between therapist and client is the #1 factor in determining how effective therapy will be. Like anyone, therapists want our work to feel effective, meaningful and enjoyable. While any licensed clinician must meet certain criteria, we all have different skills and specialties. Overall, we prioritize those we think we will be most likely to effectively help and mutually enjoy working with.
What you can do:
Make your outreach messages warm, personal and specific. What makes you think that you and this therapist will be a good match?
Availability.
It's frustrating to learn a new client you've spent time corresponding with expects you to see them at a certain time you hadn't previously discussed. All the more so when that expectation is an evening or weekend appointment, just like everyone else wants.
What you can do:
State your availability in your first message. List your ideal times, but also give the broadest range you could accommodate.
Putting it all together:
A therapist has room for one new client, and six new inquiries to respond to in their 20-minute email window. Here's what they might see and think. A: (blank) -Please don't make me do all the work. B: "I need help for anxiety and depression." -Most people do. What else can you tell me? C: "Are you taking new patients?" -Is there a polite way of telling you that while I have room for one person, I don't yet know if that's you? D: "I got your name from my EAP. It says I get 8 sessions." -Your EAP pays far below market rates while expecting me to do extra paperwork all for a client that won't stick around long. I get that you're probably suffering in some way or else you wouldn't be reaching out, but I need a better incentive to prioritize you. E: "I need help for [Very Specific Condition Therapist Never Said Anything About Treating.]" -Did you read my profile? F: "Hi! I found your profile on Therapy Den and I really like what you have to say about attachment theory. I have a history of abandonment and it's causing some anxiety in my new relationship that I would really like to work through. I have Mondays off, and could also potentially make a lunchtime appointment work on a different day if that is all that's available. I have Acme Insurance Co. I'd like to start ASAP, but I can wait up to a month if need be. Please let me know if we can schedule a consultation. Thank you!" -Seems like a potential match. I'm going to take a look at my Mondays, then take the time to write a thoughtful response.
We have limits to our time and energy just like anyone else. Give yourself the best chance at success. Be like Person F.
Finally, three more tips:
Broaden your search: If you're in Portland like I am, then chances are, you're searching for a therapist in the Portland area. But with everything being online these days, you have the option of seeing a therapist via Telehealth as long as the therapist is licensed in the state of Oregon. They could live in Bend, Salem, Eugene, or for that matter, Baltimore; if they're licensed in the state where you reside, you can see them.
Use other agencies & directories: one that I know of is Western Psychological & Counseling Services, where I used to work. For some reason, their business model doesn't include putting therapist profiles on typical search engines. Try their website, and search for other companies - again, anywhere in the state - that may provide therapy without going through the usual therapist directories.
Use other community resources: There may be other options particular to needs you have or communities you belong to. For instance, if you're queer, you might find a therapist or support group through BraveSpace or Q Center.
