Almost everyone has experienced some kind of disruption to their life during the COVID-19 pandemic, whether it’s isolation, job loss, working or learning from home, or illness or death among family and friends.

Those challenges have led to a surge in demand for counseling services. While Washington state struggles to provide enough access to mental health care for its residents, pathways do exist for those seeking therapy and treatment.

Some people think “my life is so screwed up. I don’t think there’s anyone who can help me or any place I can go,” Seattle counselor and psychologist Carolyn Scott Brown said. But “there are organizations out there that are really committed to helping people realize that change is possible and there is help available.”

Though the search may seem daunting, therapists throughout the state shared their tips for finding a provider who makes individuals feel comfortable and fits their needs.

“There are as many kinds of therapists as there are people,” said Allora Tvedt, a relational psychodynamic therapist in Seattle.

The Mental Health Project is a Seattle Times initiative focused on covering mental and behavioral health issues. It is funded by Ballmer Group, a national organization focused on economic mobility for children and families. The Seattle Times maintains editorial control over work produced by this team.
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Basic terminology

Start your mental health care search by knowing who you’re looking for. “Therapist” and “counselor” are interchangeable terms, said Lesli Desai, a clinical social worker who provides individual, couple, and family therapy in Seattle.

Acronyms behind a mental health professional’s name generally indicate they have received a degree, completed training, passed a test, uphold ethical and licensing requirements, and are in good standing with the state of Washington. Some examples of acronyms are LICSW, which stands for licensed independent clinical social worker, and LMFT, which means licensed marriage and family therapist.

Providers with an A in their title, such as LIACSW, are associates. “Oftentimes they’re incredibly knowledgeable and very good at what they’re doing. They just haven’t finished the process yet,” Desai said. Sometimes that means their rates are lower. However, being provisionally licensed can mean associates can’t accept insurance.

Access to mental health care

The Seattle Times’ Mental Health Project has been exploring issues of access to mental health care. A series of stories published in December took a deeper look at why it’s so hard to get help when you need it.

Why it’s so hard to find a therapist, and stories from readers

Naomi Ishisaka: Finding care shouldn’t be this hard

Guide: What to know when looking for therapy

How Washington’s approach to mental health has changed

Mapping mental health: Washington’s capacity for care

Guide: Tips for when you can’t find a therapist

Life coaches are usually working from personal experiences and often don’t have the same clinical training as licensed counselors or responsibility to a regulatory board.

Typically, in Washington, if you want a treatment plan that includes medication management and therapy, you’ll need to look for both a counselor and a psychiatrist. Psychologists treat emotional and mental needs, and address patterns of behavior; psychiatrists are medical doctors who are authorized to prescribe medication as a form of treatment.

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Where to look

Your primary care provider can provide referrals and recommendations as a starting point. Several online databases also exist: PsychologyToday.com contains a nationwide directory of therapists. You can sort by distance, insurance providers and gender among other categories. Other directories include TherapyDen.com, OpenPathCollective.org and GoodTherapy.org and, locally, SeattleCounseling.org.

Some directories maintain lists of providers who specialize in serving people of color and LGBTQ+ people. Those include MultiCulturalCounselors.org, AyanaTherapy.com, InnoPsych.com, GLMA.org and IngersollGenderCenter.org. Seattle therapist Canh Tran keeps a list of queer, trans, Black, indigenous therapists and therapists of color on his website.

Insurance carriers are also supposed to maintain an updated list of providers they cover and call for clients who are having trouble finding counselors, said Geralyn Peterson, a licensed mental health counselor in Puyallup. However, sometimes these lists are outdated.

Insurance companies can also give out-of-network exemptions in certain cases, Desai said. Make sure to get a call reference number in case there is a problem with billing or your claim gets denied.

Houses of worship and friends and family can also provide trusted referrals, Brown said.

For example, “If you know someone else of color who has worked with a program or a social worker or psychologist, and it’s made a big difference in their life, that can help a lot,” she said.

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Where to find diverse mental health resources in Seattle

People with lower incomes and those who are on Medicaid might find mental health resources through community-based care systems such as Sound Health in King County, Compass Health in Snohomish, Skagit, Island, San Juan and Whatcom counties, Valley Cities in Kent and Frontier Behavioral Health in Spokane.

Reaching out

Once you have identified a few therapists you’re interested in seeing, you can usually find their contact information and preferred method of contact from the directories or on their website.

When sending an email, keep your reason for seeking therapy concise, Peterson said. Include the dates and times you’re available, your insurance provider if you have one, and, briefly, any information important to you.

For example, you might mention that you are dealing with stress and anxiety related to life changes, including a breakup with a long-term partner. You may also add that you smoke marijuana or cigarettes daily and don’t want to stop, or that you have a strong belief in a certain religion or faith, or that you have a military background.

Questions to ask

Most therapists offer free consultation calls that range somewhere 15 and 30 minutes. The calls are an opportunity to ask questions, to share a little bit more about what you’re looking for, to find out what kind of therapy the provider uses and to hear their voice — whether you find it soothing or grating, Desai said.

The most important question prospective clients can ask clinicians is what a typical session looks like. Some therapists use mindfulness and meditation; some assign homework and reading. Others practice skills in sessions; some focus on identifying trauma in the body.

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Therapists also vary their degree of direction and guidance, with some leading in conversation while others sit back, listen and validate experiences, Peterson said. Most can pick and choose, and merge practices based on what the individual client needs. As a patient, you may want to ask yourself whether you are looking to vent, seeking to understand yourself better, or hoping for solutions-focused suggestions for change.

Another way to approach this question is by asking what modalities — or trainings that inform their work — a therapist uses. Two of the most popular modalities are CBT, or cognitive behavioral therapy, and DBT, dialectical behavioral therapy, Tvedt said. The forms of therapy are similar, but CBT focuses on using logic to treat specific goals while DBT focuses on managing emotions and how a patient interacts with themselves and others.

During your consultation call, you’ll also want to ask about the counselor’s scheduling availability and how often they prefer to meet with clients. If you only have time once per month, a weekly cadence of sessions might not work.

Mental health resources from The Seattle Times

Confirm during your call whether the provider accepts your insurance and if there is a co-pay amount. You can also ask about telehealth options, and check with your insurance company about whether online therapy is covered.

If you’re concerned about the cost, you can also ask about sliding scale options. Many therapists keep sessions open for clients who need to pay less than the standard rate. These determinations are made at the provider’s discretion.

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Every counselor should be able to largely set aside their own belief system and work with a client’s world view, Peterson said. However, for people of color, people of faith, women, LGBTQ+ people and other marginalized groups, this call is an opportunity to ensure the therapist can understand and work with your life experiences and needs. An example question may include: “What cultural competency training have you received?”

Following up

If you have trouble finding a therapist with availability, persistence is key, Desai said.

“Keep calling, keep leaving messages, keep trying new people and new numbers,” Desai said.

Create a list of therapists you might want to work with and follow up with them about every six weeks. Availability can change very quickly when a client moves or takes a break, Peterson said. “I can have no openings and then the next week, three of my clients decide they’re done and all of a sudden I have three openings.”

It’s also OK to tell a therapist something isn’t working, Peterson said, or move on and try someone else.

“You can say, ‘You’re not giving me ideas, and I really came in here for some ideas,’ ” Peterson said. “Or you can say, ‘You keep giving me ideas and I just really need to vent.'”

We’d like to hear from you.

The Mental Health Project team is listening. We’d like to know what questions you have about mental health and which stories you’d suggest we cover.

Get in touch with us at mentalhealth@seattletimes.com.