Finding a therapist in your 20s can feel daunting, but there are countless tools at your disposal to help you find the support and connection you need most to navigate the challenges of adulthood. Not only is it possible to find a solid therapeutic match with a caring, committed clinician, but you can also do it in a way that is accessible and affordable.
Why Finding the Right Therapist Is So Important for Young Adults
Mental health clinicians sometimes refer to turning 18 and the 7+ year period that follows it “the cliff,” especially for those diagnosed with any kind of mental illness, since they are almost always going out into world after high school or college with a limited skill set in which to navigate the developmental period that the American Psychological Association describes as “emerging adulthood.”1,2 This challenging time can also lead to failure to launch, Peter Pan syndrome, or a quarter life crisis, among other mental health concerns. For those in this age group who are in college, there are a unique set of stressors that can easily lead to burnout, anxiety, and depression.
Statistically speaking, emerging adulthood is also the period of time in which three-quarters of any mental illness (AMI) and/or serious mental illness (SMI) emerge for the first time in a person’s life, so beginning psychotherapy with a competent and caring psychotherapist during these years is crucial.
In 2017, the National Institute of Mental Health found that young adults aged 18-25 years had the highest prevalence of AMI (25.8%) and of SMI (7.5%) compared to adults aged 26-49 years.3 Furthermore, in addition to being at the most risk for developing a mental illness, another more recent study done in 2019 found that of the over 600,000 people surveyed across the US, young adults in their twenties were going through more sustained periods of depression, at rates much higher than almost a decade ago,4 but were also the least likely to get mental health care.1
It is also widely thought that suicide is now the second leading cause of death in Americans ages 10-34.5 What’s more, even if young adults don’t actually go through with a suicide attempt, the National Institute of Mental Health again reported that as of 2019, serious suicidal thoughts were the highest in emerging adults, ages 18-25, than in any other age group.6 In light of these alarming statistics, it’s crucial to find a psychotherapist in your twenties if you are experiencing any mental health issues or thoughts of self harm.
Where to Find Possible Therapists
First, ask around: Family, friends, work colleagues, or even your doctor if they know of someone. Sometimes, word of mouth can be a strong reference as to the skill and style of a therapist. Searching an online therapist directory or calling your health insurance company for a list of psychotherapists can also help. Additionally, if you are a member of a support group like AA or Al-Anon, other members of these groups may also recommend a psychotherapist that you could work with.
Deciding What’s Important to You
Figure out what’s important to you in a psychotherapist. Is it their education, or credential? Do they need to be religious or of the same religion as you? Is their gender or sexual orientation important to you? Do they need to be fully covered by your insurance? Whatever it may be, making this list is essential to your search for the right fit.
Therapy Modalities
Once you’ve decided what’s important to you in a psychotherapist, the next thing to consider is which modality the psychotherapist works from and if it is the right one for you. Generally speaking, psychotherapists work psycho-dynamically, behaviorally, or a combination of the two.
Behavioral psychotherapy is best described as psychotherapy that addresses and works with dysfunctional emotions and behaviors through goal-orientated and task-based work.7 The primary focus of behavioral treatment is to reduce and/or eliminate unwanted behaviors through action.8 Generally speaking, behavioral psychotherapy is almost always shorter-term.
Psychodynamic psychotherapy on the other hand, recognizes that the relationships and circumstances of early life continue to affect us as young adults and that once we gain insight into the reasons for our negative thoughts and feelings, positive changes in your thoughts and feelings can be made. Psychodynamic psychotherapy usually takes much longer than behavioral therapies, and is not always ideal for someone struggling with a compulsive or addictive behavior.
Sometimes, people even start with behavioral psychotherapy to stop their compulsive and/or addictive behaviors and then move on to psychodynamic psychotherapy to address the thoughts and feelings behind the compulsions and addictions.9
Lastly, some therapists combine behavioral approaches with psychodynamic approaches and are therefore called “eclectic” in their approach to treating your issues.
Licensing, Certifications, and Education
Once you’ve decided which modality may work best for you, the next thing to know is who can actually provide therapy. All licensed psychotherapists, whether they be mental health counselors, marriage and family therapists, clinical social workers, psychologists or psychiatrists have to first have a graduate degree in their field to become licensed, and in some cases, certified. Many people find that the fit and style of the therapist matters more than from which discipline in which the provider was trained.
All psychiatrists are qualified to practice psychopharmacology (the practice of prescribing medication for mental disorders, sometimes called “medication management”) after the completion of medical school, boards, and residency. In the present time, most people just see a psychiatrist for their medication management and go to a different psychotherapist for their therapy. Some psychiatrists offer psychotherapy in addition to psychopharmacology, but not always.
Cost & Insurance
The next step is to understand a psychotherapist’s fees, and also, whether or not they’re covered by your insurance plan (in-network) or not (out of network). Generally speaking, many psychotherapists only work out of network with health insurance plans; meaning, you will pay their full free up front, per session, but will then be provided a bill from them at the end of the session that you then submit to your insurance company for partial reimbursement.
If you need a specialist, either for a compulsive or addictive behavior; want to combine psycho-pharmacology (medication management) with psychotherapy; have a high-deductible insurance plan; or, you don’t want your insurance company to know anything about your mental health, then working with an out-of-network psychotherapist may be your best option.10
On the other hand, if budget is a serious issue for you, you do not have a high deductible insurance plan, and do not need a specialist, then working with a psychotherapist who is in-network with your insurance plan may be the way to go. Before you begin searching for an in-network psychotherapist, it’s important to call your health insurance company first to ask them what their in-network mental health coverage will be, including what your copay per session will be. Also ask them if there is a limit to how many sessions they will cover, and what (if any) mental health diagnoses or mental health treatments (like hypno-therapy, for example) will not be covered by your plan.
Once you have decided what you can afford to pay and whether or not you want to use your health insurance to cover the cost of your therapy, the next issue to consider is fit, and this is where a psychotherapist’s website or profile plays a very important role in your selection process.
How to Review a Therapist’s Profile or Website
When first viewing a psychotherapist’s website or online profile, think about what they’ve written and ask yourself: Is the language they’re using accessible to me and do I like what I’m reading? If so, contact them for a consultation. If you don’t like what you’re reading, keep on searching, because this might mean that the psychotherapist you’re looking at has an approach to therapy that may not be a good fit for you.
Next, consider their photograph: Do you get a strong sense of their personality and who they are as a psychotherapist? Do they seem authentic? If so, consider contacting them. If you aren’t getting a sense of their personality, if you have a negative reaction to their photograph, or there’s something about their physical appearance that doesn’t resonate with you, eliminate them from your search and move on. It just may not be a good fit.
What to Ask a Therapist During Your First Call
Now that you have a list of psychotherapists you want to contact, it’s time to also make a list of the questions you want to ask them in the initial phone consultation. Do you want to know more about their education and credentials? Experience? Ethnicity, sexual and/or gender orientation? Write it all down.
When you actually have the phone consultation, first confirm the psychotherapist’s insurance coverage and/or rates before asking them your list of questions. Then, ask away, and pay attention to how they answer your questions and how the conversation between the two of you feels. Is it collaborative? Respectful? Does the psychotherapist sound open, and also knowledgeable? If so, then you may have an initial good match and a first appointment can be booked.
On the other hand, if you don’t like their responses to your questions, or if there’s any kind of impatience, interrupting, or a “hard sell” on their skill set in the conversation, it may be best to ask more follow up questions like “can you clarify more for me your approach?” or “I’m not sure I’m following your answers to my questions, let me ask them again” to confirm that what you’re feeling is accurate. If in any way you feel judged by the psychotherapist in the initial phone consultation, then stop the conversation, thank them for their time, end the call and keep on searching.
The bottom line is, do you feel heard, understood, and accepted in this consultation? If so, it’s worth making an initial appointment to see the psychotherapist for therapy. If you don’t, they’re not the right therapist for you and you should keep searching. This is also what to consider in your first appointment: Is this person listening to me, and do I feel that this is going to be a safe space in which I can learn and grow about myself?
What to Consider During the First Session
In the first session there are also a few things you may not find out: Your psychotherapist may not voluntarily give you your diagnosis (all psychotherapists who work in-network with insurance companies have to give you a diagnosis for their claim to be reimbursed), and they usually won’t reveal anything about themselves, since therapy is always about you and your process.
Some therapists will ask you a lot of questions about how you were raised or if you’ve seen other therapists in the past, and if so, what that was like for you. Some psychotherapists will just listen and are mainly focused on allowing you to feel comfortable with them and letting you talk about whatever’s on your mind. If a psychotherapist is predominantly behaviorally based, they will usually be focused on your presenting issues and will most likely tell you how they’re going to help you change them and what the therapy is going to look like.
It’s also important to remember that just because a therapist asks a lot of questions in the first few sessions does not mean that they also can’t be quiet and let you speak as the therapy progresses. Conversely, when a therapist is quiet in the beginning it doesn’t mean that they won’t become more interactive and collaborative with you as time progresses. The first few sessions are almost always about engaging with you, learning about your history, and beginning to establish a therapeutic alliance, and every psychotherapist approaches this a little differently.
What you can figure out in the first session is how you feel. Are you able to relax and open up to the psychotherapist in front of you (or for those working virtually, on the screen) as the session goes on, or is your discomfort increasing because you don’t feel a connection or any kind of rapport? If this happens, verbalize how you’re feeling to the psychotherapist and see how they respond – you may find that they need to make some adjustments to how they’re approaching the therapy with you.
Psychotherapy is a collaborative process, and if you need or want more (or less) of something from your psychotherapist, ask for it, and see how they respond. It may change the course of the session and you may decide to keep seeing them, so it’s important to ask for what you need during the therapy itself.
A word about boundaries and safety: A psychotherapist is a model to you of healthy behaviors and boundaries, so if a psychotherapist talks too openly about themselves (this is called self-disclosure) in the first few sessions, or refers back to their own experiences after you share your own, terminate the treatment and find someone new. Self-disclosure from a psychotherapist is almost always frowned upon by mental health professionals, and it also speaks to what could be a potentially serious lack of boundaries on their part, clinically and otherwise.
Furthermore, if a psychotherapist in any way violates your physical or sexual boundaries, report them and then terminate treatment immediately. Psychotherapy, though collaborative, is always about your safety. Your vulnerability must always be protected, first and foremost.
What to Consider After a Few Sessions
During the first few weeks of treatment, it’s normal to feel a little resistance to the process of opening up and trusting the therapeutic process. However, if you are repeatedly feeling judged and misunderstood or that the relationship between you and the psychotherapist is not collaborative or in any way equal, then they may be a bad fit and you may want to find another therapist. Furthermore, if within the first 3-4 sessions your therapist is consistently distracted by their cell phone, laptop, or anything else, or is very late for your session, it may also be time to change to someone new.11
When to Work With Multiple Therapists
Once you’ve settled into treatment with your psychotherapist, you may also need to seek out the help of an additional psychotherapist, especially if you are struggling with any kind of compulsive behaviors with food, substances, sex, spending, gambling, etc. or need to see a Couples therapist for relationship issues. It’s also acceptable to be in 12 Step treatment to address the substance use while working with a psychotherapist simultaneously.
If you are seeing a therapist for individual psychotherapy and want to do couples therapy with your partner for relationship issues, you will need to see a separate Couples therapist to address the relationship disturbances, since neutrality and impartiality in Couples therapy is essential.
For Further Reading
For more information on mental health issues and finding a therapist that’s right for you, check out the following resources:
Finding a Therapist as a Young Adult Infographics
