BLOG - Why Is It So Hard to Get a Therapist?

by Chay Tanchanco, LMFT

If you're already a member at Foresight, then you've finally made it to the part where you get a therapist. But often people will tell me that they've waited months for someone to contact them, for a therapist's availability to open, or for their insurance to authorize care.

Why does it take so long? And why is it so difficult?

According to GoodTherapy.com, there is a projected shortage of therapists, psychologists, psychiatrists, counselors, and social workers continuing from now into 2025. There is an expanding awareness of mental health in our culture, which is a good thing - though we also need financial stability and priority for providers and clients alike for this to be sustainable. Different areas of our country, especially rural areas, may have isolated or no mental health workers at all.

Here in the Bay Area and in the cities of California, we have some privilege in our access to therapists. There are over 30,000 licensed marriage and family therapists (LMFT), 14,000+ licensed social workers (LCSW), and 15,000+ mental health counselors as of 2019. The population of California is about 40 million and about 1 in 5 adults in the U.S. are living with a diagnose-able mental health condition, so let's say that about 8 million people in California need some sort of mental health support. In theory, if everyone was spread out individually for all of these mental health workers, each one would have about 133 clients per year. With groups and varying timelines of care, this would be (in theory) possible.

But how do we find our therapists? For most of us, especially now, we can't afford to pay out of pocket - we have to get coverage through our insurance.

Each insurance company has its own design of packages and often they are difficult to navigate. Understanding your own coverage can be the first and most frustrating barrier. And even when your insurance gives you a list of providers, it may be unclear if the ones on the list are a good fit for you--in many cases, it's just a list of names and phone numbers or email addresses, and even then it may not even be updated for whether the therapists on that list have availability.

Being persistent in looking for a therapist can be extremely difficult, especially when you're experiencing intense emotions and feeling drained of energy. If someone in your life can help keep you accountable and supported until you find a professional, schedule regular contact with them.

Tip #1: Use PsychologyToday.com to search the names of therapists that are listed in your insurance OR to search for therapists according to their expertise or insurance coverage. Many therapists will have a profile on the site. It is helpful to see a picture and a more personal explanation of their philosophy of care.

And where are they? There can be a saturation of therapists in certain areas, mainly where people are able to pay out of pocket, not necessarily where there is just a larger population. Even though demand in a certain area can be high, therapists may not be able to afford to live there or simply are not willing to live there. Of course, with COVID-19 and the Internet, there has been much more availability for telehealth than ever before. This may alleviate the pressure of physical location, though you should still identify local crisis services and immediate support for safety.

Tip #2: Therapists are only able to work within their state, unless they have multiple state licenses. Keep this in mind if you are going to move out of state or leave for an extended amount of time. Pre-COVID, the rules in certain states were much stricter about even temporary living or vacations, but now they are much more flexible. Talk to your therapist about any travel or moving as we are required to confirm your location.

Getting the right fit is essential. No two therapists are exactly the same, and even the "best" therapist in one person's experience is not the best therapist for everyone. Our service is a personal one, built on trust and connection with you and your needs. It can be frustrating to go through insurance, then call office after office, and finally get to your appointment with your new therapist only to discover that you don't quite "click" or feel understood.

If you followed Tip #1, you may be able to see their philosophy of care as well as their specialties on their page or website. These can be diagnoses such as anxiety, depression, or ADHD, and they can also be a general focus such as trauma, family stress, relationships, parenting, etc.

Tip #3: Ask your therapist or the office scheduler for specialties or preferences. It's okay to ask for a gender preference, cultural/ethnic background, or area of expertise. Especially for BIPOC and LGBTQ+, it is essential to feel safe in the therapeutic environment in order to experience growth and relief.

See our previous post: How to Identify a Trauma-Informed Therapist for further tips

These tips won't take away all of the frustration; hopefully, they alleviate some of the pressure and isolation you may feel. Accessible mental health care should be a priority in our society. At Foresight, we are working toward making that a reality for every person.