Several years ago, before I became a therapist myself, it became clear that my oldest, then 14, needed therapy. I didn’t know where to start. I called every provider within a 30-minute radius on my insurance company’s website, hoping to defray some of the costs. A few called me back only to say they were full or no longer accepting insurance.
Desperate and frustrated, I made another few dozen calls. It seemed nearly impossible to find a therapist who worked with kids and had immediate availability. Finally, I got a call back from Tanya Hull, clinical director of Family Therapeutics in Fairfax. She offered my child an appointment that week with a resident (a pre-licensed therapist working under supervision) at a reduced rate that I could afford. Over the years, my kids have seen three wonderful therapists on Hull’s team.
That was before the pandemic dealt another blow to the nation’s mental health, putting therapists in even greater demand. The share of U.S. adults reporting moderate to severe anxiety rose from 6% in 2019 to 18% in 2022, according to the CDC, and those with symptoms of depression increased from 7% to 21%.
Worsening mental health among teens is also concerning. The latest CDC data finds 21% of teens reporting anxiety symptoms and 17% showing signs of depression.
The good news is that there are more access points than ever to mental health care—thanks, in part, to the advent of telemedicine and therapy apps. But finding a good therapist can still feel overwhelming. A quick search on Psychology Today turns up more than 1,000 therapists practicing in Arlington, Falls Church and McLean, and those are just the in-person providers. Adding virtual therapists increases your options several times over.
I should note that the term “therapist,” in this case, refers to an outpatient mental health professional you might see once a week or so to treat depression, anxiety or another mental health condition. (We’ll get to the different credentials later on.) Therapists don’t prescribe medication. For that, you’ll need a physician (typically a psychiatrist) or psychiatric nurse practitioner.
So, where to start? If you’re thinking you could benefit from therapy, Zack Goldman, a licensed clinical social worker and founder of Solid Ground Psychotherapy in Clarendon, says friends and family can be a great resource. “If you know a therapist or have a friend who sees a therapist they like, ask them for recommendations,” he advises. “Then at least you’re getting the information from someone you know and connect with [who’s had a positive experience].”
Primary care physicians and other medical doctors can also provide referrals. Insurance company websites (my own experience notwithstanding) and therapy practice websites are also worthy starting points. Psychology Today is a popular resource that allows you to filter therapist profiles by ZIP code, specialty, rate and other helpful parameters.
Once you’ve got a preliminary list of providers, then what? Below is some guidance on how to evaluate a potential therapist, what to expect in therapy, and how to fire a therapist when it’s just not working out. The insights are based on my own experience as a practicing therapist, as well as advice from colleagues and from individuals who have sought therapy themselves.
Qualifications (Do They Know What They’re Doing?)
One of the first things you may notice are the different letters next to a provider’s name that indicate their licensure status. In Virginia, most therapists will be a Licensed Clinical Social Worker (LCSW), a Licensed Professional Counselor (LPC), a Licensed Marriage and Family Therapist (LMFT), a Doctor of Philosophy in psychology (PhD) or a Doctor of Psychology (PsyD).
What do these credentials tell you? Frankly, not a lot. While it’s important that your therapist is professionally qualified and legally permitted to provide counseling, the specific license indicates more about how they got their degree than their specialty or level of experience. In order to be licensed in Virginia, LCSWs, LPCs and LMFTs have earned a master’s degree from an accredited program, passed a national exam, and accumulated at least 3,000 hours of supervised training. A PhD or PsyD has similar requirements and has earned a doctoral degree.
In short, all of these professionals can likely help you, so don’t fixate too much on the acronyms.
Debbie Beach, an individual and couples therapist in Falls Church (and a LCSW), agrees: “How the therapist sits with you, how they listen to you, how they are attuned to you, their ability to connect with you is much more important than the license they have,” she says.
Most therapists pursue additional training and certification in specific areas of interest, such as couples and family therapy, addiction counseling or trauma-informed therapy. Those specialties tend to be more relevant to how they can support clients. “Look at someone’s website, look at what trainings they’ve taken,” Beach recommends. “Additional training means they care about that area and they know enough about it to be able to apply those concepts to your work together.”
One field where licensure does matter is neuropsychological testing. PhDs and PsyDs are generally the only therapists who can administer assessments for ADHD, autism, learning disorders and other cognitive or developmental conditions. These tests are often required for accommodations in school, such as 504 plans and IEPs (individualized education programs), or in the workplace.
A final note on licensure: Legally, a therapist must be licensed in the state where the client is physically located at the time of the therapy appointment. If you live in Arlington and work in the District, for example, you can see a therapist in their D.C. office on your lunch hour, even if that person is not licensed in Virginia. However, if you’re not feeling well one day and want to do a virtual session from home, your therapist will have to be licensed in Virginia as well. Fortunately, many therapists in the D.C. area are licensed in Virginia, Maryland and the District.
If you travel frequently for work or attend college out of state, knowing where your therapist is licensed to practice is especially important. Many psychologists now belong to PSYPACT, an interstate telepsychology compact that allows them to hold virtual sessions in 42 participating states. Similar interstate agreements are in the works for social workers and counselors but haven’t yet taken effect.
Specialties and Modalities
The next set of letters you’ll see on many therapists’ websites and online profiles are the modalities, or types of therapy, they practice.
Cognitive Behavioral Therapy (CBT) is one example. “A lot of people struggle with rigidity. Cognitive behavioral therapists might look at a person’s thoughts, emotions and beliefs, and try to work to promote flexibility in them,” explains Anthony LoPresti, a psychologist in Rosslyn. For instance, he says, “A client may hold beliefs such as ‘I’m not good enough’ or ‘I’m a failure.’ A CBT therapist might challenge that a bit and ask, ‘Can you talk to me about times where you felt like you were going to fail at something, and you proved yourself wrong?’” CBT is a great starting place for depression and anxiety.
Another common modality, which LoPresti practices, is psychodynamic therapy. “I try to understand somebody’s current struggles through patterns that have happened in their lives,” he explains. “I try to help them understand why these patterns exist, when they were developed and what needs they meet. I take the radical approach that everybody, even in their worst behavior, is trying to meet some type of need.”
I used a psychodynamic approach with a former client who wanted to reduce symptoms of anxiety. As we explored his past, we identified a pattern of experiences where he felt powerless. He began to recognize his anxiety as a defense mechanism to protect him from situations that were out of his control. Over time, he was able to notice this pattern as it was happening and change his reaction to the situation. His anxiety lessened considerably.
Having a basic awareness of different treatment modalities can be helpful, but don’t get overwhelmed by the science. “I personally think it’s more important to look at the population a therapist works with and the experience they have, versus the theory they practice,” says SC Nealy, founder of the LGBT+ Counseling Collaborative in Cherrydale. “Not a lot of people would go into their surgeon’s office and say, ‘You have to use this particular method in my surgery.’ If you are seeking out somebody for their expertise, you do have to come in with a little bit of trust.”
Modalities aside, some therapists— Nealy included—specialize in particular populations, such as the LGBTQ community, children, neurodivergent clients (for example, people with autism, ADHD or dyslexia) or various cultures. Having a therapist who understands your background and experience can help in establishing a foundation of trust.
According to Nealy’s colleague, Roland Scheppske, clients may find it helpful to choose a therapist with a similar lived experience or world view. Doing so offers a “baseline of understanding…even if they’re coming in because work is stressful and it has nothing to do with, say, their queerness or their race or anything of the sort. There is still this lived experience of shared marginalization.”
If a therapist doesn’t specify their background, just ask. I’ve had prospective clients ask about my political views, religious beliefs and whether I identify as LGBTQ. It’s okay to ask personal questions about the therapist’s background and beliefs if those factors are important to you. It’s up to the therapist to decide whether they feel comfortable answering.
Virtual vs. In-Person Sessions
Before the pandemic, only about 20% of therapy sessions were virtual. Today, the percentage is considerably higher. One 2023 analysis of U.S. Department of Veteran Affairs data found that more than half of the roughly 277 million outpatient visits made by 9 million veterans between 2019 and 2023 were online. Much of this rise is due to convenience. We’ve become more comfortable with video conferencing and many of us find it easier to fit a virtual session into our busy days.
“Obviously it’s very convenient to be able to just open a Zoom meeting, have therapy, and then move on to the next thing,” says Emily, 29, a Clarendon resident who has scheduled appointments both in-person and online.
The good news is that virtual therapy is widely considered to be effective across a wide range of mental health issues. A recent American Psychological Association review of 24 research studies found that telehealth patients improved at similar rates to in-person clients.
How do you know whether in-person or virtual is best for you? The first consideration may be a practical one. You’ll have access to a broader pool of providers if you’re open to virtual sessions. (There just aren’t as many therapists working in person.) This becomes even more of a factor if you’re looking for someone with a specific ethnic background or specialty.
Also, consider whether your schedule is flexible enough to allow for in-person sessions. Some therapists offer evening or weekend appointments, but those slots are hard to come by.
The next consideration is why you’re coming to therapy. “For people who are doing skills-based work—coping skills, communications skills—virtual is fine,” Nealy says. In-person sessions may be more helpful for those with a history of trauma or interpersonal difficulties. “If you’re working on anything that involves [relationships with] other people, in-person is, in my opinion, always going to be the most impactful,” she advises. “Over 90% of success in therapy has to do with the therapeutic alliance [between client and therapist]. And that is just not something that can be developed in the same way virtually.”
Couples counseling is one such scenario, Beach says, noting that body language and other unspoken dynamics can be harder to pick up on during a virtual session. “I miss the opportunity to see if [when] someone’s crying, is the other person reaching out to comfort them? Is the other person scooting away? Or let’s say somebody’s angry and upset. Are you able to tolerate that while sitting next to each other on the couch? Do you get up and leave?”
In my experience, children also benefit from in-person sessions. So do teens and adults with ADHD or who are otherwise easily distracted. (One therapist told me she can see a client scrolling on Facebook during virtual sessions from the reflection in their glasses.) Concerns about privacy and candor also come into play if there’s a chance others may overhear your conversations during virtual appointments. “I’ve had clients who have had partners or roommates walk by,” says LoPresti.
For some clients, going to in-person therapy feels more intentional and meaningful. “It feels like more of a commitment to yourself when you are really dedicating that time to work on yourself,” Goldman says. “Just getting out of the house for some people is therapeutic in itself.”
Costs and Insurance
Therapy is expensive. According to FAIR Health, an independent nonprofit dedicated to transparency in healthcare costs, a one-hour therapy session in Arlington costs around $250. That tracks with my admittedly less-than-scientific survey of colleagues’ rates. If you’re going weekly, that means an investment of $13,000 per year.
Insurance can help defray some of the expense. While most insurance plans (including Medicare) offer at least some coverage for mental health care, benefits vary widely. Using an in-network provider in the same way you might choose an in-network primary care doctor or specialist is one way to keep costs lower. Start with your insurance company’s website, find a therapist who is in-network, and then pay a copay for each session. The copay is typically in line with the amount you’d pay for any medical specialist.
There are, however, a few potential issues with using an in-network therapist, starting with availability. A recent study by the Kaiser Family Foundation confirms a shortage of mental health care providers in Virginia and nationwide. And thanks to declining reimbursement rates—on average, insurers reimburse less than half the hourly rate—there are even fewer therapists these days who accept insurance.
Another downside is that insurance companies have a great deal of control over treatment for patients using in-network benefits. A 2024 investigation by ProPublica concluded that, “It is often the insurers, not the therapists, that determine who can get treatment, what kind they can get, and for how long.” The nonprofit’s findings turned up dozens of examples in which care was denied to patients in crisis.
As Nealy puts it, for in-network providers, “the client is always the insurance company.”
In addition to health insurance, some employers offer employee assistance programs (EAPs) that provide access to counseling at no cost, but these benefits are not designed for long-term support. You may be limited in your choice of providers, and EAPs usually cap the number of sessions. EAPs are a great resource if you’re seeking temporary support with a specific challenge, such as a life transition, or immediate help in a crisis. If you need more sessions than the EAP allows, some plans give you the option to pay for additional appointments.
If you can’t find an in-network provider or prefer not to use one, you can always pay out of pocket and seek reimbursement yourself. Most therapists will provide what is called a “superbill” to submit to your insurance company, which details your diagnosis, appointment dates and length of sessions.
According to FAIR Health, a typical plan reimburses 70% for therapy on average, bringing the out-of-pocket cost for a $250 session down to $75.
If you decide to go this route, first call your insurer to confirm your out-of-network mental health benefit. This should include the number of sessions eligible for reimbursement, the allowable amount (the percentage of your therapist’s rate the insurer deems reasonable), your coinsurance amount and your deductible.
If therapy remains unaffordable, there are other options. Consider whether biweekly sessions might make sense, or look for therapists who offer a sliding scale based on income. The Women’s Center in Vienna and D.C. offers free or subsidized mental health counseling based on need.
You might also search for a pre-licensed therapist—someone who has completed their degree and is working toward licensure under supervision. These professionals typically charge less than a licensed provider and will be designated as either a “resident” or a “supervisee.” Some practices have graduate interns available at even lower rates.
As a recent graduate intern and current supervisee who has sent my own children to pre-licensed therapists, I can attest that there are many excellent providers in this category.
Finding a Match
So, you’ve found a few therapists who seem like a good fit. What now? Most mental health professionals offer free 15-minute phone or video chats to give you a chance to get to know them before scheduling an appointment.
Beach recommends having preliminary conversations with three providers. “It takes extra time and energy to research therapists and to have three calls,” she acknowledges, “but have three calls.” Each one is an opportunity to ask logistical questions regarding fees, insurance and availability, to give the therapist a little background on your situation and what you’re looking to accomplish, and to get a sense of how they work and what therapy with them might be like.
“You can kind of have a speed date to see if you’re a good match,” Emily says, speaking from the point of view of a client. She recommends asking a prospective therapist how they feel about self-disclosure. “With my last therapist, I knew absolutely nothing about her. It made it hard for me to know if she was relating at all to what I was saying.”
For North Arlington resident Louise (not her real name), 65, flexibility was paramount. “I don’t want to have to commit to once a week,” she explains. “Their cancellation policy is also important to me. If somebody says they need a week or two weeks’ advance notice, that doesn’t work for me. It’s just not how my life is structured.”
While education, training and years of experience certainly aren’t irrelevant, research has shown that the connection between a client and therapist—the so-called “therapeutic alliance”—is the biggest predictor of success in therapy.
“If you can trust your therapist, if you feel you can be really honest, that’s more important than anything else,” LoPresti says.
“I think there’s a lot of truth to that,” Louise concurs. “My current therapist is somebody I click with on a personal level. I just generally like him.”
Once you’ve met with a few people, take some time to reflect on how you felt about the conversations, Goldman advises. “If it feels like you guys are kind of on the same page with things, I think that that’s going to be the best sign of a good therapeutic relationship.”
When and How to Fire Your Therapist
In the beginning, your therapist will likely ask a lot of questions to determine how best to help you. This can be awkward—you’ve just met this person and you’re being asked a lot of very personal questions—but it’s also a good opportunity to assess how comfortable you feel. Do they put you at ease? Are they empathetic?
After a few sessions, therapy should feel a little more organic. But occasionally, it just doesn’t click. “I went to a therapist who called me the wrong name a couple times,” LoPresti recalls. “It was like he wasn’t paying attention.”
Louise saw a therapist who “didn’t really offer much, didn’t ask questions. I felt like I was the one trying to carry the conversation. I need somebody who’s giving something back and helping make connections.”
If you’ve given it three or four sessions and the dynamic still feels off, consider talking to the therapist about what’s not working. “I want to give people the permission to say directly, ‘This isn’t feeling right,’” Beach says. “A good therapist is going to be able to hear that and talk through it and not get defensive.”
“I tell clients this all the time: ‘Please correct me if I am wrong. Please tell me if I am assuming, if I’m taking this in the wrong direction,’” says Scheppske. “You need to be able to tell me I’m wrong. And if you’re not comfortable doing that, then that’s a failure on my part.”
If you’ve had that conversation and you still aren’t feeling it, it’s okay to send a polite email ending the relationship. “Most of the time, the therapist knows it’s not working,” Goldman says. “It’s not going to be a giant shock to them, and that can help take some of the pressure off. It’s not going to feel like a one-sided breakup.”
The Wellness Equation
In the best cases, a therapist is a valued partner for as short or as long a period as you need. Bryan, 55, has seen the same therapist on and off for nearly 30 years, ever since his late 20s. “It may have been like every five or 10 years…based upon the circumstances of my life,” says the Clarendon resident, “if I felt like I was getting overwhelmed.”
Emily, who has been in therapy on and off since elementary school, views it as part of her overall wellness. A therapist is “someone to bring out the best in you and help you reframe things in a way that can just make life a little bit easier,” she says.
Louise agrees: “I look at a therapist as a partner, somebody to help ground me and get me back to center if I’m really getting out of whack emotionally, psychologically.”
Plus, it’s helpful to have an objective listener. “Friends may be afraid of hurting my feelings or being too critical,” she says. “[People close to you] often have their own stake in the outcome. Therapy is another tool in my toolbox to help me navigate life’s challenges.”
Types of Therapy
Below are a few of the more common forms of psychotherapy (known as “modalities”) offered by mental health professionals.
Cognitive Behavioral Therapy (CBT) helps individuals identify and modify negative or irrational thought patterns and behaviors to improve their emotional regulation and overall well-being. It’s a structured, goal-oriented approach focused on the relationship between thoughts, feelings and behaviors. CBT is a great starting place for treating depression and anxiety.
Dialectical Behavior Therapy (DBT) is a type of talk therapy that combines elements of CBT with mindfulness practices. It can be helpful for those experiencing intense emotions and emotional dysregulation that put them at risk of self-harm. DBT may help with borderline personality or bipolar disorder, PTSD, depression, anxiety, substance use and eating disorders.
Exposure and Response Prevention (ERP) therapy is a specialized form of CBT used to treat obsessive-compulsive disorder (OCD). It involves gently exposing individuals to situations or objects they fear (triggers) while teaching them to resist the compulsive behaviors they’ve used in the past. As Rebecca Berman, clinical director of the Anxiety Institute in McLean, explains, “[ERP] works through a process called inhibitory learning, in which the brain learns that it’s possible to feel anxious and still be okay. Over time, ERP helps retrain the brain to realize that feared outcomes are unlikely or, if the fear does occur, we [know we] have the skills to be able to cope.”
Eye Movement Desensitization and Reprocessing (EMDR) is an increasingly popular treatment that has been endorsed by the World Health Organization and the American Psychological Association to treat various forms of trauma, including PTSD. Using bilateral stimulation, EMDR seeks to change the way traumatic memories are stored in the brain, effectively rewiring a person’s reaction to certain triggers. In the most common form of EMDR, the client follows the therapist’s hand or another object with their eyes while focusing on different aspects of a troubling memory, including images, physical sensations and emotions. After treatment, clients have said they feel lighter and that the memories that previously caused extreme distress now appear hazy and distant.
Internal Family Systems (IFS) is a psychotherapy model used to treat depression, anxiety, panic disorders, eating disorders, relationship challenges and other issues. It views the mind as composed of various sub-personalities, or “parts,” each with its own role and purpose, that operate sort of like a family. When the internal “family” is in distress, these parts can negatively affect thoughts, feelings and actions. For example, a defensive part might snap at a spouse when it feels criticized. IFS therapy works with these parts to help them heal and develop more positive ways of relating.
Psychodynamic Therapy is often what people think of when they picture therapy. A psychodynamic therapist helps the client explore their thoughts, feelings and past experiences to identify recurring patterns and unconscious motivations that influence current behavior and relationships. Through the therapy process, clients increase self-awareness and work to develop healthier coping strategies.
Take the Interview
Shopping for a therapist? Most mental health providers offer free 15-minute phone or video chats so you can test the chemistry before scheduling an appointment. Here are five questions to ask:
What is your approach to therapy? This question gets at how they think about the therapeutic process and should give you a sense of how structured or unstructured your sessions might be. For example, do they give homework?
Have you worked with this diagnosis or issue before? What did your clients find most helpful? Most therapists will be comfortable working with common issues like anxiety and depression, but not all will have expertise in more complex areas such as OCD, autism and eating disorders. Ask what experience they have with your particular concerns.
How long do you usually work with people? Some therapists focus on shorter-term approaches while others see clients for years. Whether you’re envisioning a few sessions or long-term support, make sure you’re on the same page.
How will we know if I’m making progress? Many therapists will help you set goals and check in with you every few months. Some are more structured in their approach to goal setting and treatment planning than others.
Am I a good fit for you? If not, do you have recommendations? Just as you’re assessing whether a therapist is a good fit, they should also be evaluating whether they’re the right provider to support you. We want you to succeed in therapy, even if that means referring you to a colleague who is a better match.
Robyn Gearey, LMSW, is a writer and therapist at River Grove Therapy in Alexandria. She can be reached at robyngtherapy@gmail.com.