Over the past month, I have been asked “Linda, how do I find an online therapist in California” several times. I was asked this by a friend, a relative, this relative’s friend, and a few clients who are trying to help their friends find therapists. It really highlighted for me that it can be really confusing and overwhelming to find a therapist, especially for those who are bravely seeking therapy for the first time! 

I love nothing more than helping connect people to the right therapist, because when the fit is right, it is magical! However, the truth is it is hard to figure out how to find one unless you have a helpful therapist friend guiding you. Not everyone has this kind of friend, so I’ve decided to share the process I recommend for finding a therapist that’s right for you so that you can access all the benefits of online therapy.

In a perfect world, insurance would cover all therapy, even if a person didn’t meet criteria for a mental health diagnosis, in recognition that taking care of one’s emotional well-being proactively is good for people on an individual and collective level. The insurance companies would pay therapists well, such that all therapists could afford to take insurance and so that consumers would have a wide variety of affordable therapists to choose from and could be selective in choosing based on fit, rather than who is available and in network with their insurance plan. As we all know, we do not live in this world. Not even close. My advice below recognizes this and aims to arm people with the knowledge to try to navigate this imperfect system, but I want to be clear and unequivocal in stating that this is a problem our government must fix, not individuals. 

OK, let’s get down to brass tacks.

What is the difference between types of therapists?

The term therapist is an umbrella term for mental health providers who provide therapy, which is also known as psychotherapy or talk therapy. However, there are several kinds of therapists to choose from and it can be a bit confusing. What does it all mean?

The types of therapists are psychologists, licensed marriage and family therapists (LMFTs), licensed clinical social workers (LCSWs), licensed professional clinical counselors (LPCCs), and psychiatrists. 

Doctoral level therapists

Licensed psychologists, like me, have their doctoral degrees in psychology, either a PhD (Doctor of Philosophy) or a PsyD (Doctor of Psychology). Doctoral programs tend to be 5-8 years in length, including years of clinical training and not including a year of clinical practice after graduating (called a postdoc). The PhD is the more traditional route and includes a heavy emphasis on research and science, while the PsyD is more clinically focused. However, many PhD programs include a lot of clinical training and many PsyD programs also include research. In general, schools that are accredited by the American Psychological Association tend to be good quality and there are excellent PhD and PsyD psychologists. One thing that separates psychologists from other types of therapists is that they are trained to do psychological testing for court proceedings, learning disabilities, diagnosis, etc.. Psychologists are regulated by the California Board of Psychology.

Psychiatrists have their MD, which is the Doctor of Medicine degree. Like other MDs, they can prescribe medications. These days, psychiatrists primarily focus solely on psychiatric medication to alleviate mental health symptoms. While in the old days, psychiatrists were the main type of therapist, only some of them are practicing therapists. In most states, psychiatrists are the only type of therapist who can prescribe medication, although some states (Idaho, Illinois, Iowa, Louisiana, and New Mexico) allow psychologists with extra pharmacology training to prescribe as well. Psychiatrists in California are regulated by the Medical Board of California. As an aside, Psychiatric Nurse Practitioners also prescribe psychiatric medications, but generally do not do therapy.

Master’s level therapists

Master’s level therapists have their master’s degree, which are generally 2 years in length, plus an additional 2 years of clinical experience. They are similar in that they are all trained to provide therapy for a variety of concerns. However, there are some subtle differences that set them apart. 

Licensed marriage and family therapists (LMFTs) tend to get more training on marriage and family therapy as their title suggests. Licensed clinical social workers (LCSWs) tend to get training on how systems (oppression, healthcare, poverty, etc.) shape mental health, with a focus on connecting people with resources. However, there is a lot of overlap between types of master’s level therapists. There are LCSWs and LPCCs who do family and marital therapy and LMFTs who focus a lot on systems and resources. All master’s level therapists are regulated by the California Board of Behavioral Sciences (BBS). 

In California, master’s level therapists are required to complete their 2 years of clinical practice after they graduate with their degree. During these two years, these therapists are registered with the California BBS as “associate therapists,” meaning they have graduated and are regulated by the state, but are in the process of accruing the 2 years of clinical experience necessary to get a full license. These therapists have the designation associate marriage and family therapist (AMFT), associate clinical social worker (ACSW), or associate professional clinical counselor (APCC). These therapists are required to be supervised by a licensed therapist. 

Which type of therapist should I pick?

The one who is the best fit (more on this below). Truly, the designations above have very little impact on who is going to be the right fit for you. There is simply too much overlap in the categories. There are therapists in each group that provide individual, family, and couples therapy and address systems and resources. Unless you need testing (psychologists) or medication (psychiatrists), there are therapists in each group who can meet your needs. 

How do I find a therapist?

There are several strategies you can use. 

Ask people you know if they have anyone they can recommend. People are often happy to share their recommendations when asked, but don’t necessarily walk around advertising this information unless asked (suggesting that someone needs therapy can be… tricky).   

Ask your healthcare provider (doctor, doula, midwife, psychiatrist, physical therapist, etc.). Often these folks know therapists who specialize in the needs of their patients. 

Use a reputable therapist directory. The two main ones that I recommend are Inclusive Therapists and Therapy Den. Both of them are large and allow you to search by location, insurance, speciality, gender, language, race, and more. Both of them are also committed to social justice, diversity, and  inclusivity and both provide detailed profiles so that you can learn about each therapist. There are numerous smaller directories that are more specific to a location (i.e. Los Angeles Psychological Association directory), type of therapy (i.e. EMDR), or population (i.e. Therapy for Black Girls). Psychology Today is also a huge directory, but they also refuse to use photos of anyone besides young, thin, beautiful White women despite lots of pushback and are based in the Cayman Islands. I mention it solely because if you are striking out with the other directories (more likely if you live rurally), it may be worth a look.

Call your insurance company. This is the least helpful option, but they will be able to tell you who is in network and accepting patients in your area and can help direct you generally to a therapist with a particular experience or demographic. However, they really don’t have much detail about therapists to offer you.

Then what?

Whichever strategy you choose, I would do the following:

1. Find the therapist’s website to learn more about them. A therapist who cares a lot about being the right fit for their clients is going to make the effort to provide information about them, their training, their approach, their specialties to help potential clients determine fit. 

2. Look up the therapist on the California Department of Consumer Affairs website to make sure they have an active license in good standing. 

3. After completing the previous two steps, pick at least 3 therapists who seem like they might be a good fit for you and schedule consultations. Someone recently said to me “interview 6, pick 1” and this seems like good advice, though it may take more or less than 6.

What is the deal with consultations?

Research continuously shows that the relationship between client and therapist, and the degree of fit, is far more important in ensuring a good outcome than any other variable, including which specific type of therapy a therapist practices. 

Good therapists know this and offer free consultations (typically 15-30 minutes long) to allow you both a chance to chat to assess fit before you have to commit to a full therapy session. The therapist should explain confidentiality (and the limits to it), ask you what you are looking for and ask questions to get to know your needs, tell you how they work with clients, and answer any questions you may have. They should also be transparent about fees and their cancellation policy.

I would consider it a red flag if a therapist is not willing to do a consultation. 

It can feel overwhelming to think about telling 3+ therapists about yourself and what you are looking for, but doing so allows you to pick the person you feel most comfortable with and who you feel is best qualified to help you. Doing this legwork ahead reduces the chances you start with someone who isn’t the best fit, and then have to change after you’ve already invested time, money, and energy. 

What should I look for in a consultation? 

The overall point is to ensure you feel comfortable with someone, reasonably confident they can help you, and that how they work with clients is an approach that works for you. 

Consider the following: 

• Was the person professional? 

• Did they take the time to explain the limits of confidentiality and answer all my questions?

• Do I feel comfortable with them? 

• Do they have expertise with the kinds of problems you want help with?

• Do you “click” with them?

• Are they focused, warm, and nonjudgmental?

• Do they have availability at times that work for me? 

• Can I afford their services?

I cannot emphasize enough to trust your gut. If you feel uncomfortable for any reason or get a weird vibe (not the fun kind of weird), even if you aren’t immediately sure why, I would trust that and pick someone else. Therapists are like every other profession under the sun - there are some people who are truly excellent, lots who are good enough, many who are okay, and some who are terrible. Also, some else’s ideal therapist may be your worst nightmare. Trust your gut!

Also, before choosing a platform like Better Help or Talkspace, please educate yourself on the privacy concerns with both that members of Congress are investigating. 

What about insurance?

If a therapist is in-network, that means they are approved as a provider with your insurance plan. This means you will only pay your copay, after satisfying whatever deductible you have. 

Unfortunately, because insurance companies pay so little, many/most therapists in private practice are out-of-network (also called private pay or cash pay). This means they are not an approved provider on any insurance panels. 

Because so few therapists accept insurance, the ones who do tend to have long wait lists. The therapists who accept insurance also may have to see a ton of clients just to make ends meet, which increases their risk for burnout.

However, your insurance may still cover a portion of the expense of therapy with an out-of-network therapist. You will need to call your insurance carrier and ask them if they cover out of network providers, as this varies widely by plan, even different plans by the same insurance carrier. If they do cover out-of-network providers, they will typically reimburse you a percentage of the cost, after meeting your deductible. Be sure you ask them if they cover telehealth, what your deductible is, and how much they will reimburse. Generally, you will pay the out-of-network therapist and then they will provide you with a monthly invoice called a superbill that includes all of the information the insurance company will require (including the diagnosis). You will submit this superbill to your insurance company and they will reimburse you for the portion they cover. Be aware that insurance companies require a diagnosis for services to be covered and that couples and family therapy are not covered unless it’s specifically related to helping an individual with their mental health diagnosis. For more information, on this, check out my FAQ section.

Be aware that if the insurance company says they cover 50% of the cost after your deductible is met, this may mean 50% of what Medicare says the rate for therapy should be, which is likely less than what a therapist may charge. A therapist sets their fees based on the cost of living and doing business where they are located, their level of expertise/experience, and other factors. For example, let’s say a therapist charges $250 per session. It will be important to ask if the insurance company will pay 50% of that $250, or 50% of what Medicare pays for therapy. When in doubt, you can ask the therapist you are considering what “code” they use for therapy, which determines what insurance companies will pay. Most therapists use 90834-95, which is the code for the standard 50 minute therapy session via telehealth. 

How else can I pay for therapy? 

If you have a health savings account (HSA) or flexible savings account (FSA), you can use the funds to pay for therapy, as therapy is a qualified medical expense. 

There are also organizations that help pay for therapy for underprivileged groups, like the Loveland Foundation.

Lastly, many therapists are well aware of the access problems that insurance companies create, and offer limited sliding scale spots to help make therapy more accessible.

Final thoughts

I hope this helps you find the best therapist for you! And remember, if it doesn’t work out, it’s okay. You can either bring this up with a therapist if you’re not feeling things are quite right (a good therapist will welcome this conversation) and see if you can course correct. Or, you can just switch. If the first person you try isn’t the right fit, it doesn’t mean that therapy won’t work for you or that therapists aren’t good, it just means that person isn’t right for you.

Get Support With Online Therapy in California

Well Woman Psychology can give you get the support you deserve as you navigate life’s challenges and pursue personal development. Whether you are seeking support for trauma, sexual concerns, reproductive health, body image, or relationships, Well Woman Psychology can help. Starting therapy can be intimidating, but your bravery will be rewarded with building skills to help you live your best life, support, and compassion through online therapy in California with these steps.

1. Reach out for a consultation at Well Woman Psychology

2. Meet with an online psychologist in California.

3. Start receiving the support you deserve.

About the Author, an Online Psychologist in California:

Dr. Linda Baggett is a Licensed Psychologist at Well Woman Psychology, serving clients online in California, Illinois, New York, and Washington. She received her PhD in Counseling Psychology from the University of Memphis. Based in Manhattan Beach, she specializes in supporting women be the best version of themselves. She has expertise in relationship issues, sexuality, pregnancy loss and miscarriage, birth trauma and postpartum issues, infertility, trauma and PTSD, EMDR, and body image and size-based oppression.

Disclaimer:

This blog is for educational and informational purposes only, is not a substitute for individual medical or mental health advice, and does not constitute a client-therapist relationship.