The Stressed and Busy Person's Guide to Finding a NYC Psychotherapist

Living in NYC can be incredibly stressful. Why do you think people stare at pictures on Instagram all day as an escape? It has long been known as the commercial center of the world, and with that comes jobs and lifestyles that can induce anxiety, depression, and other mental health issues. It's well documented by organizations such as the American Psychological Association (APA). TimeOut Magazine rated New Yorkers as the most stressed out in the world. Stress-inducing factors include commutes on crowded and delayed subways and a high cost of living. Suicide rates are correspondingly high. In addition, the effects of the Covid-19 pandemic have hit residents hard.

If you are suffering from anxiety, depression, OCD, or PTSD and considering seeking professional help you'll have to wade into the morass of therapy directories, a wide range of fees for therapy, and mental health credentials that can be confusing for anyone not in the psychology field. What if you're suffering from feeling like you should be doing something different? How do you navigate all this to find a therapist? What if you're not sure if you need therapy? I hope this guide will help.

Preliminary Steps to Consider

It's normal to feel nervous or intimidated when finding a therapist who's a good fit, but here are some starting points:

• Use your company's human resources department for help. Larger companies often have established help lines for employees who need mental health assistance. Sometimes these are referred to as Employee Assistance Programs (EAP), and many New York City firms have them. These services often include short-term counseling and phone help. If you find that you need more mental health services and help than the EAP can provide, they can refer you to professional therapists for ongoing treatment.

• Search the internet. The internet is rife with therapist directories such as PsychologyToday, TherapyNext, the American Psychological Association and others. These directories have therapists from all areas of Manhattan (Soho, Financial District, NoHo, The East Village, Lenox Hill, Chelsea, etc.) and allow you to search by zip code and specialty. You can read about the treatment approaches of their therapists by browsing profiles and reading bios, which should include their education, credentials, and years in practice. Most therapists have social media accounts where you can find additional information to see if the therapist might be right for you.

• Ask friends and acquaintances for recommendations. Word-of-mouth is often a great source of finding a qualified and helpful therapist. It can be a tricky situation though, to tell friends or family members that you are reaching out for help, but you may find that others have felt the same way. It may actually increase the strength of your relationships by showing vulnerability, and this can lead to a strengthening of familial and friendship bonds

• Insurance company provider directories. Your health insurance company, assuming it offers mental health coverage, will have a provider directory where you can search for a therapist in your area. Many of these directories allow you to narrow your search according to different therapy criteria such as price, location, and treatment approach. Although there have been issues with these directories being out of date, and sometimes a provider who's listed may not still be taking that insurance anymore.

• Colleges and school resources. Because of the mental health crisis in the U.S. over the past few years (2020 onwards) most schools and colleges offer counseling services. If you are a student or have a child who's enrolled it's a good place to start - contact the school's counseling or guidance office and they should be able to give you a list of therapists in your zip code or county.

• Ask your doctor or other health professional. Primary care doctors, family physicians, nurse practitioners, and other health professionals may work with psychotherapists. They can help refer you to an in-network therapist who takes your insurance or who may offer a manageable out-of-pocket fee.

Mental Health Coverage - Insurance Questions and Concerns

If you have health insurance, you should call them and get answers to the following questions:

• Their policy for out-of-network providers vs. in-network providers.
• Your deductible and its start/end period.
• Your copayment, if any.
• If there is a limit to the number of therapy sessions they will cover.
• The maximum benefit amount they will pay for mental health services.
• What types of therapists they work with (e.g., MSW, LMHC, Psychologist, Psychoanalyst, etc.)

Choosing the Right Kind of NYC Therapist

What do you choose: Therapist vs. Psychotherapist? Psychiatrist vs. Psychologist? MSW vs. PsyD vs. PhD vs. MFC? here are many different types of therapists that provide excellent psychotherapy services. Some of the credentials are:

• Master's-level degrees: LPC - Licensed Professional Counselor, MSW, LCSW - Master of Social Work, Licensed Clinical Social Worker, LCPC - Licensed Clinical Professional Counselor, MA, MFT, LMFT - Master's in Family Therapy, Licensed Marriage and Family Therapist. These therapists can diagnose, offer psychotherapy and counseling, and often practice a range of different therapeutic approaches depending on their personal preference and training. They cannot prescribe medications, but may work with a psychiatrist who will provide medication management. Probably the most common mental health professionals and who treat substance abuse, relationship issues, anxiety, depression. Often less expensive than practitioners with doctoral degrees such as PsyD and PhD. The important thing to remember here is that the personality and style and skill of the therapist is more important than the distinction between these credentials.

• Doctoral-level degrees: Psychologists typically have PsyD/- Doctor of Psychology or PhD - Doctor of Philosophy degrees. PsyDs are typically more clinically focused, taking 4-6 years to complete, whereas a PhD involves more rigorous and specialized research and often takes 5-8 years. Can be more expensive than master's-level therapists. Often specialize in psychological testing and evaluation rather than psychotherapy

• MD - Psychiatrist: Psychiatrists are medical doctors who have further training in psychiatry. Typically prescribes psychopharmeceutical medications to patients who are referred by "talk therapists" or they work in hospitals and institutions with more severely mentally ill patients. Can be expensive.

• LP - Licensed Psychoanalyst: They have specialized intensive training beyond that of a typical psychotherapist or counselor. Mental health counselors (MA), marriage and family therapists (MFT), social workers (MSW), clinical psychologists (PsyD, PhD), and psychiatrists (MD) often deepen their skills by enrolling in a six-year psychoanalytic training program. Research has found that psychoanalytic therapy can result in longer lasting change than other forms of psychotherapy.

What type of therapy should you seek?

It's a good idea to read up a little on different types of therapy. There are many, and often their methods and principles overlap. For example, dialectical behavior therapy (DBT) is touted to be uniquely effective, yet many of its principles (e.g., analyzing behaviors and learning healthier ways of responding) are well known and common to other forms of therapy. Here's a short summary of different types of therapy:

• Cognitive-behavioral therapy (CBT): Cognitive-behavioral therapy is a type of short-term therapy that helps the patient to understand how their thoughts, beliefs, and attitudes affect their feelings and behaviors. It attempts to make the patient aware of unhelpful thought patterns they have that result in unhappy feelings and maladaptive behaviors. While CBT has been shown to be helpful, it has been criticized as only "treating the symptom" and not the root causes of the patient's unhappiness that may be outside of the patient's conscious awareness. CBT is popular particularly because of its short-term nature and quick-acting (but sometimes shallow) techniques.

• Dialectical-behavioral therapy (DBT): DBT is a talk therapy based on CBT but is adapted for people who have intense feelings that interfere with their ability to function well. It focuses on four main concepts for the patient to internalize: mindfulness to improve their ability to be present in the current moment; distress tolerance to help the person sit with negative emotions rather than immediately acting out; emotional regulation strategies to help the patient to better understand their feelings; and interpersonal effectiveness techniques that bolster the patient's social interactions and improve self-esteem and relationships. DBT was originally designed to treat patients with suicidal behaviors and borderline personality disorder, but it has since been used for the treatment of depression, bipolar disorder, substance use disorders, eating disorders, and impulse control disorders.

• Psychodynamic psychotherapy: Psychodynamic therapy focuses on the roots of emotional suffering. Its main principles are self-reflection and self-examination, and the use of the relationship between therapist and patient as means to gain insight into problematic patterns in the patient’s relationships and their life in general. It has been shown to be a highly effective form of therapy and to result in lasting positive changes in the patient's life unlike some other therapy approaches. It can be used to treat a range of disorders including narcissistic personality disorder (NPD), post-traumatic stress disorder (PTSD), and bipolar disorder, and substance-related and addictive disorders as described in the DSM V Diagnostic and Statistical Manual of Mental Disorders.

• Psychoanalysis: Psychoanalysis has progressed a long way from its founding principles laid out by Freud. I practice a modern form of psychoanalysis which combines the foundations of those written about by Heinz Kohut, the founder of Self Psychology, and modern theorists such as Atwood, Stolorow, Fink, Ogden, and others. Intersubjective Self Psychology (ISP), developed by George Hagman, Harry Paul, and Peter Zimmermann of NPAP, integrates Kohut's views with the principles of intersubjectivity, where the relationship between analyst and patient is co-created by both participants. Modern psychoanalysis views treatement as a two-person relationship, unlike classical approaches. In ISP Kohut's three selfobject transferences, idealization, mirroring, and twinship are considered crucial development-enhancing modes of relatedness between therapist and patient that result in the strengthening of the patient's self and functioning and a consequent reduction in symptoms.

In addition to the different therapeutic approaches there are also various treatment modalities including group therapy, individual (one-on-one) therapy, family therapy, and couples therapy. When you are choosing a therapist you should mention your preference during the initial consultation or session.

Other Considerations When Seeking Therapy

• Do you want in-person or online therapy? Up until the Covid pandemic online therapy was rather rare but it has exploded since then. Many people like its convenience. No travel time or associated costs, no missing appointments because of traffic or train delays. However, viewing a therapist on a screen is not the same as having real human, in-person interaction. Some patients prefer the process of traveling to their therapist's office and talking in person. It's wise to be wary of firms that provide mass therapy via smartphone (HelloAlma, BetterHelp) and there are some reports of substandard care from such organizations.

• Are you seeking therapy for a particular issue? Many therapist directories let you search for therapists who treat your specific issue. As an example, if you are having trouble with family issues consider searching for a "marriage and family therapist" (LMFC), or if you're experiencing longstanding mental health difficulties such as chronic depression consider a psychoanalyst.

• Personal preferences are important: Your identity, race, gender, religious affiliation, age, and self-perception may influence you to find a therapist who specializes in what's important to you or even shares your personal characteristics. For example, if you are LGBTQ you may prefer a therapist who works specifically with LGBTQ issues.

• Is cost important to you? If you don't have the money or health insurance to pay for the often high cost of NYC therapists there are mental health, psychoanalytic, and psychotherapeutic institutes and organizations that offer low-fee therapy. NPAP.org, MITPP.org, NIP, and other organizations are examples. You can also search for therapists who offer a sliding-scale fee. It's wise to get a free 15-minute consultation with a therapist so you don't have to spend more money than you need.

• Do you need a therapist in your neighborhood? There are many Manhattan therapists in neighborhoods like the Upper West Side, Gramercy Park, and Midtown. The Bronx has a lighter concentration of therapists. You may have to travel if you want an in-person therapist.

When you start your search for a new therapist make sure to write down at least a few names of therapists who you may think will be a fit. If a therapist is fully booked and cannot take you on as a patient ask them for the name a colleague they recommend. It's important that you get a good initial feeling about them. It should not in any way feel like an unwelcoming process. If this occurs, find another therapist.

Scheduling Initial Consultations

When you have contacted a few therapists and asked about their availability, treatment approach, specialty, and populations they work with you can compare your notes for each one. Schedule an initial consultation, which is often fifteen minutes and free. This will enable you to assess which therapist is the best fit for you.

During the consultation or first sessions, you might ask the potential therapist these questions:

• Does the therapist accept your health insurance provider? There's a broad range of health insurance plans and companies. Aetna, United Healthcare, Oxford, Medicare, HealthFirst are some. Benefits vary. Some mental health providers do not take health insurance. This is partly because therapists are so in demand that they don't want the administrative burden of filing insurance claims. However, some therapists can be "out-of-network" providers, which means you may be able to get some reimbursement from your health insurance company if they offer out-of-network benefits for mental health services. Money issues are important. Call your insurance company to find this out. Also, ask your therapist if they offer a sliding-scale fee structure.

• What’s their theoretical approach? Each therapist usually has a particular theoretical approach, such as CBT, DBT, psychodynamic, mindfulness based. Ask about their approach to treatment in your first appointment, then ask friend or colleagues if they recommend such an approach. You can decide on whether you might like a classical approach or a more modern one.

• Personal preferences are important: Your identity, race, gender, religious affiliation, age, and self-perception may influence you to find a therapist who specializes in what's important to you or even shares your personal characteristics. For example, if you are LGBTQ you may prefer a therapist who works specifically with LGBTQ issues.

• Do they have a license? You can look up a therapist's license number and expiration date on the New York State Office of the Professions Website. Health insurance providers generally only reimburse for licensed therapists. Similar to finding a doctor, you wouldn't want one who isn't licensed!

• What level of education have they completed? Social workers, licensed mental health counselors, and family therapists have master's degrees while clinical psychologists have doctoral degrees (PsyD, PhD). It doesn't necessarily mean one type is better than the other. There are bad therapists with doctoral degrees and good therapists with master's degrees. Psychiatrists are medical doctors who specialize in medication for mental health issues and can write prescriptions.

• What’s their specialty? Like most cities, NYC has a broad range of therapists who have different specialties in addition to treating general mental health issues. These include anxiety, depression, OCD, ADHD, addiction and substance abuse disorders, narcissistic personality disorders, anger management, and others. The beauty of it is that there are many therapists and you should be able o find one who specializes in the issue you have.

When you start your search for a new therapist the choices can be overwhelming. Make sure to write down at least a few names of therapists who you may think will be a fit. If a therapist is fully booked and cannot take you on as a patient ask them for the name a colleague they recommend. It should not in any way feel like an unwelcoming process. If this occurs, find another therapist.

Preparing for Your First Online Therapy Session

It's normal to feel intimidated or even scared before your first session. A few preparation tips can ease your anxiety and make your session easier:

During the consultation or first sessions, you might ask the potential therapist these questions:

• Be in a private space.? If you live alone it's relatively easy to achieve privacy. Set up your webcam to show yourself from your waist to your head. Try to keep the background free of distractions such as bright windows. If you live with others, find a private room, or even large closet if you need to, that will allow you to speak with the therapist without interruptions.

• Pause your devices. Turn off alarms, calendar notifications, TVs, and other sources of distraction and noise. Interruptions hinder the psychotherapeutic process.

• Become comfortable with therapeutic process. Depending on the severity of your mental health issue talk therapy can be uncomfortable at certain moments. After all, if you didn't have difficult feelings and thoughts you wouldn't be coming to therapy. Some people are more comfortable opening up to a therapist than others. You need to go at your own pace and the therapist should not rush this. Certain treatment approaches such as cognitive behavioral therapy (CBT) may require the therapist to be more directive and instructional. Once you get comfortable in sessions a "therapeutic alliance" emerges in which you and your therapist feel comfortable with each other and begin to make strong progress and symptoms start to ease.

Have you found the right therapist?

During and after your first therapy session, notice how you felt and what you thought. Did you feel they were warm and welcoming? Competent? Did they answer all your questions and explain their approach and general treatment plan? Did they cut the session short or go over? Write down these thoughts for each therapist and compare before you choose a therapist to work with. Contact them and schedule an in-person or online appointment. Fill out paperwork in advance to save time. If your therapist expects you to use a significant amount of your session to fill out paperwork this is a bad sign. A good therapist should be empathic and insightful.

Another important point is that therapy takes time. It can be a slow process of self-realization and growth. Don't expect your therapist to have all the answers or give you some magical advice. They aren't magicians. Be as honest as possible in your sessions and say whatever comes to mind. This can be difficult because the therapeutic relationship and treatment process is not the same as interacting with a friend or colleague. As humans we're not used to saying whatever is on our minds in social situations. Sometimes it may take multiple appointments for you to decide if your therapist is right for you, and that 's ok. You can always leave and switch to another therapist, of which there are plenty in New York! Do not worry about the therapist's feelings.

Crucial first step is to reach an understanding with the patient concerning what his or her symptoms are and what symptom relief would consist of. This task is often not easy to accomplish. Sometimes the work needed to answer this question, in itself, brings significant therapeutic benefit.

A patient will only feel themselves to have an authoritative voice in the treatment relationship if he analyst invites it. also, a patient will only be truly candid if the analyst is willing to be equally candid.

No matter how much conviction analyst inpatient together develop about these insights, if the insights are not accompanied by demonstrable symptom relief, their validity must be questioned.

Sometimes you'll feel worse before you feel better.

If you're going to work through difficult feelings and emotions therapy may make you feel temporarily worse. This is okay and it's part of the process of recognizing unconscious or disavowed traumas, negative experiences, and scary emotions. A good psychotherapist will patiently work with you through these difficult revelations and memories. Ultimately it will result in healing, strengthening of your self esteem, and greater happiness.

The therapeutic process can involve repeatedly talking about the same emotions or experiences. This is normal. It is called "working through." Just like learning a new sport, you must put in the work to get better. Some people feel better in weeks, some take months, and some people need years. It all depends on your particular mental health issue and severity. For a broad range of disorders and categorizations you can look at the DSM V Diagnostic and Statistical Manual). Overall though, you should experience a reduction in your symptoms at some point.

Insights are important, but no matter how much conviction the therapist and patient together develop about these insights, if the insights are not accompanied by demonstrable symptom relief, their validity must be questioned.

If you are seeking therapy I encourage you reach out. I am a NYC therapist near you however I serve all of New York State. I offer a free consultation. I can help you feel more calm, sure of yourself in the world, and ultimately happier in your life and relationships.

Some National and NYC-based Mental Health Resources: