Finding the right therapist
Looking for a therapist asks a lot of someone who is anxious. You have to compare profiles that often sound alike, call strangers, leave voicemails, describe the problem to people you have never met, and then decide, on the strength of a fifteen-minute phone call, whom to trust with it. Many people put it off for months — or forever — exactly for that reason.
It helps to know that you do not have to get this right the first time. You need someone with the right skills for what you are dealing with, whom you can afford, and whom you can work with. You can find out most of that in a first conversation, and if it turns out not to be a fit, you can change.
If you need help before you find someone, the crisis numbers at the bottom of this page are available around the clock.
Start with what you are dealing with
For some problems, the specific treatment matters a great deal. OCD is usually treated with exposure and response prevention, which has the strongest evidence, or with inference-based CBT, a newer specialized approach. General supportive talk therapy on its own is not a substitute. Panic disorder often responds to CBT that addresses the feared physical sensations, the catastrophic readings of them, and the avoidance that builds up around them. Chronic insomnia has its own protocol, CBT-I. For these, ask whether a therapist is trained in the specific treatment, not just whether they work with the problem.
For other concerns, several approaches can help, and the working relationship between you and the therapist is an important part of what makes treatment effective. Across many kinds of therapy, the quality of the working relationship is one of the more consistent predictors of how well it goes.
If you are not sure what to call what you are dealing with, that is fine. The anxiety resources page is a reasonable place to start, and a good therapist will help you work it out.
What the letters mean
In California, several kinds of professional provide therapy, both licensed and pre-licensure, and all of them can be well trained for anxiety.
LMFT, LCSW, LPCC. Licensed marriage and family therapists, licensed clinical social workers, and licensed professional clinical counselors. All three hold master's degrees, completed years of supervised clinical work after graduating, passed state-required exams, and are licensed by the California Board of Behavioral Sciences. All three treat individuals, whatever the name suggests.
The difference is mostly in the training's emphasis. Marriage and family therapy programs center on relationships and family systems, and on how problems play out between people as well as within them. Social work programs train clinicians to see a person in their wider context, including work, money, housing, and community, and many social workers come from hospital or agency settings. Counseling programs focus on mental health counseling across the lifespan, with roots in career and developmental counseling. In practice, these differences matter less than what an individual clinician has trained in since.
Psychologists (PhD or PsyD). Doctoral-level clinicians licensed by the California Board of Psychology. Some also do formal psychological testing.
Associates (AMFT, ACSW, APCC). Pre-licensure clinicians who have finished their master's degree and are registered with the Board of Behavioral Sciences while they complete supervised hours toward licensure. They are not yet licensed, but they practice legally under the supervision of a licensed professional, and you can ask who that is. Psychology has a similar pre-licensure status, the registered psychological associate.
Psychiatrists and psychiatric nurse practitioners. Medical providers who can prescribe medication. Some also do therapy, but most focus on medication. See psychiatry for more.
The letters tell you about training and licensing. They do not tell you who is better at treating anxiety. Specific training and experience with your concern matter more than which license someone holds.
Titles such as coach or wellness practitioner are not licenses, and the people using them are not regulated as therapists. You can look up any California license or registration on the state's license search.
Cost and insurance
Therapy fees in Los Angeles vary widely. The fees page shows what therapists listed here charge.
If you want to use insurance, check two things with your insurer before you start: whether the therapist is in network, and, if not, whether your plan has out-of-network benefits. Many private-practice therapists are not in network but can give you a superbill, an itemized receipt you submit to your insurer for partial reimbursement. A superbill does not guarantee reimbursement, so ask your insurer about your deductible, the reimbursement rate, and whether the therapist's license and services qualify under your plan.
If you are uninsured or choosing not to use insurance, you generally have the right to a good faith estimate of expected charges, and you can ask for one before scheduling. Ask about sliding-scale fees. Some therapists reserve a few lower-fee spots, and associates often charge less than fully licensed clinicians.
If cost is the main barrier, the Los Angeles County Department of Mental Health help line, (800) 854-7771, can direct you to lower-cost and Medi-Cal services.
In person or online
Online therapy works well for many anxiety concerns, and it widens your options considerably in a city where a cross-town drive can take an hour. Some people prefer being in the room, and some treatments, such as exposure work tied to a particular place, can be easier in person. Either is a reasonable choice.
For online sessions, the therapist generally needs to be licensed in the state where you are while the session happens. For most readers, that means California.
Making contact
Contact three or four therapists at once rather than one at a time. Some will have waitlists, some will not be the right fit, and some will take a few days to reply. Waiting on each in turn can stretch the search into months.
A short message is enough. Something like:
> Hi, my name is [your name]. I'm looking for help with [a few words is fine]. I'd like to know whether you have openings and whether you offer a brief consultation call. I'm usually available [days and times].
You do not need to explain everything in the first message, and you do not need to have the right words for what is going on.
The first call
Many therapists, though not all, offer a short consultation call before the first session. If one is offered, use it. You are not committing to anything. It is a chance to learn more than you can from a profile.
Questions worth asking:
- How would you treat what I am dealing with? What would the first few weeks look like?
- What training do you have in that treatment, and how often do you use it?
- How will we know whether it is working?
- Roughly how long do you expect treatment to take?
- What do you charge, do you take my insurance or provide superbills, and what is your cancellation policy?
- When do you have openings, and how often would we meet?
If you have OCD, panic, insomnia, or another concern with a specialized treatment, ask for a concrete description of how they would work with it. Listing a condition on a profile is not the same as having training in its treatment.
You are listening for a clear answer to the first question. "It depends" is fine if it is followed by what it depends on. Pay attention, too, to how the call feels. Did they listen? Did they explain things in a way you could follow?
The first few sessions
Unless something feels clearly wrong, give it a few sessions before deciding. Early sessions are partly assessment, and a good fit can take a little time to show.
Good signs: you feel heard, you understand what the plan is and why, you can say when something is not working, and you leave sessions with something to do or think about.
Worth noticing: they talk about themselves a lot, they seem not to remember what you told them, after several sessions you have no clear sense of what you are working on, or they dismiss your concerns or pressure you. Any breach of professional boundaries is a reason to leave, and can be reported to the licensing board.
One distinction matters for anxiety in particular. Good anxiety treatment is often uncomfortable, because it involves approaching things you have been avoiding. Discomfort with the work is not the same as a poor fit with the therapist. If you are unsure which you are feeling, say so in session. How a therapist responds to that is useful information in itself.
Changing therapists
Changing therapists is normal, and therapists expect it. You do not owe anyone a long explanation, though a short one ("I don't think this is the right fit for me") can be useful, and a good therapist may suggest someone better suited. Leaving one therapist is not a failure at therapy.
Using this directory
You can search the directory by concern, neighborhood, therapy type, age group, and whether sessions are in person or online. Each listed therapist's California license or registration number is checked against the state board's records. Everything else on a profile is provided by the therapist, and Anxiety L.A. has not assessed anyone's clinical quality. How this works explains more.
Other places to look
Your insurer's provider directory lists in-network therapists. Your primary care doctor can also refer you.
For some concerns, specialty organizations keep their own directories: the International OCD Foundation for OCD, Postpartum Support International for pregnancy and postpartum concerns, and the Society of Behavioral Sleep Medicine for insomnia.