Seeking Counsel: An Expert Panel in Mental Health Shares Wisdom

Considering seeking counseling or therapy and wondering how to go about it? IAMAdoptee reached out to three therapists to help you navigate the process of finding someone for you.  This article was originally published as a February 2020 blog post by Katie Bozek, Ph.D., LMFT for the Korean American Adoptee Adoptive Family Network (KAAN). It has been updated and edited for IAMAdoptee by Melanie Chung-Sherman, LCSW and Jaclyn Skalnik, LCSW.

(For the sake of reference and continuity, we will be addressing a licensed clinician/practitioner as a “therapist” throughout this article.) 

Finding a therapist can be a daunting task if you are not familiar with the process. The most empowering aspect of finding a “good fit” is when you are an informed consumer. Often when a client first calls I hear, “This is the first time I have done this. I am not sure what to expect or what to ask.” 

This is meant to be an informational guide to what to expect when looking for a therapist. While there are some specifics for adoptees, it can also be used by anyone else seeking mental health services. 

What to do before calling a therapist: 

Call your insurance company and check on your benefits. You may have a deductible, or a co-pay, or coinsurance that kicks in after you meet your deductible. Not every insurance provider covers mental health services. It is important to speak to your insurance provider (or visit their website) to inquire about mental health coverage. 

Deductible: amount that you have to pay out of pocket before there are any “discounts”.

Co-pay: amount that you pay at each session. Typically a flat rate set by the insurance company.  

Coinsurance: certain percentage you pay of the session cost based on your plan. Typically applies after you have met your deductible. 

Limits of coverage: some plans only allow a certain number of sessions per calendar year OR require pre-authorization for certain procedures such as psychological evaluations/testing, psychiatric hospitalization, or outpatient mental health sessions. 

Remember this is a contract between you and your insurance provider. It will be your responsibility to maintain insurance coverage and payment. If you are utilizing insurance there will not be complete confidentiality. Therapists may be required to share your diagnosis, dates of service, clinical documents, assessments, and rationale to receive reimbursement for on-going services. 

If you do not have insurance, the therapist may have an out-of-pocket cash fee or sliding scale available. You can always ask. Please remember that therapists are providing a specialized service and deserve to make a living wage too. The cost of services are typically standard for their area and level of expertise. 

What should I look for in a therapist?

There are different mental health providers within the mental health field. Most therapists are working towards the same goal (helping their clients function in a healthy and productive way); however, they have different ways of approaching this goal. 

It is important to see a licensed therapist because it means there are certain guidelines and requirements that the therapist has had to achieve in order to become licensed. These provide safety measures to protect the public from anyone claiming that they are able to provide therapeutic intervention and services. 

If you needed surgery to correct a displaced knee, would you prefer a licensed medical doctor who spent years specializing in orthopedics or a non-licensed individual who took a few training sessions? The same is true for licensed therapists competently diagnosing, treating, and providing interventions within the field of mental health. 

There are differences between licensure, certification, and accreditation. 

Licensure is a formal recognition by a governmental and regulatory body that an individual has met the criteria to legally practice their specific field in their state or area. Typically, in order for an individual to become licensed they must complete a degree from an accredited school, pass exam boards, complete hundreds of hours of field/internship rotation, and receive direct supervision by a Board-approved supervisor as well as complete on-going Board-approved continued education throughout their licensure. This also ensures that a licensed practitioner is held to both ethical and legal accountability related to their scope of practice (i.e. a licensed mental health provider is not trained, nor licensed to provide services that a medical doctor or attorney should provide) as well as ensuring public health and provision of competent services. 

Accreditation is obtained through third party, non-governmental professional bodies such as professional organizations that an individual has met predetermined standards of practice defined by that organization (i.e. NASW, APA, ACA, AMA, etc). Typically, accreditation is granted through an individual’s professional association as additional recognition of competence within their specific specialty. 

Certification is written assurance obtained through a third party, non-governmental organization indicating that an individual has adhered to the overall standardized process and delivery of intervention required by that program (i.e. EMDR, CPR, Theraplay, DBT, TF-CBT). This may or may not require licensure, examinations, or additional supervised hours. Not all certifications are evidenced-based interventions or modalities. 

Coaching: There are “coaches,” or “life coaches,” that may promote similar services and have some “training,” but unless they have a state approved license, they are not considered a professionally trained therapist. There is no regulating body that oversees them and the care that they provide. There is no curriculum or guidelines for becoming a “life coach”. 

  • There are some individuals marketing “attachment/adoption” services who are not licensed, but may be “certified” in a specific training that may not be evidenced-based. Some may also be well-intentioned triad members (adopt parents, adoptees, first family members) providing coaching or “attachment” services, but are not licensed or formally trained in mental health assessment, intervention, and supports (e.g. even though I go to a dentist, does not mean I am a dentist). 

When seeking any professional for specialized services such as medical, dental, mental health, or legal assistance it is important to verify that the individual is operating under a professional body and has obtained licensure to practice within their scope of practice. It is one thing to be “trained” (or have completed some continuing education hours) in a field and another to be a licensed practitioner who is held to a standard of legal and ethical accountability by the general public, governing bodies, and peers. 

The specific letters behind their name denotes their license, and the level that they are licensed.  Some of the different licenses are: 

  • LMFT = Licensed marriage and family therapists
  • LMSW = Licensed master’s level social workers (in some states LMSWs cannot provide direct mental health therapy services)
  • LICSW/LCSW = Licensed clinical social worker (master’s level)
  • LP = Licensed psychologists
  • LPC = Licensed professional counselor

“LL” = limited license. This therapist has met some of the requirements, but has not taken the full licensure test. therapists with an “LL” are required to be supervised by someone who is fully licensed. 

“L” = fully licensed. This therapist has met all of the criteria and requirements, including passing the licensure exam. 

“i” = intern status. This therapist is still under the direct clinical supervision of a fully licensed, Board approved clinical supervisor. 

*Other letters denote specific certifications that the therapist has done beyond their designated license. 

**It is also important to verify a professional’s credentials and licensure on your state’s licensing board. There are some who may have an MSW, MFT, Ph.D., but are not licensed to practice mental health in your area. You can find out by visiting your state’s mental health licensing board websites. 

How do I find a therapist?

Ask around. Ask some friends or your doctor who they would recommend. Below are some other online resources that can help narrow your search. 

You can also check on your insurance company’s website. They will have a list of therapists that are in your network. 

Some resources are: 

https://adoptionsupport.org/member-types/adoption-competent-professionals/?states=ia

http://iamadopted.net/adoption-trauma-therapists-you-need-to-know/

https://www.growbeyondwords.com/adoptee-therapist-directory/

www.aamft.org

www.psychologytoday.org

Understand what you are looking for in therapy. What issues do you want to address? You may not always know, and that is ok. Sometimes just having a working knowledge gives you an idea of what you are looking for when looking for a therapist (e.g. if you are grieving, then you will want to look for someone who has a background in working with grief). 

When you are a person of color, it can be beneficial to work with a therapist of color; however, depending on the area that you reside in finding therapists of color, particularly therapists of color familiar with adoption-specific issues, may be limited. This is the same as an adoptee. It is beneficial in many ways to speak with another adoptee, however, that is not always possible. Having intersectional identity commonalities (e.g. being a person of color, sexual identity, gender identity, gender expression, disability, and/or an adoptee) does not always guarantee that you will connect in a therapeutic way, but can support the process in unique ways. 

This is just as it is in real life: just because you have some things in common, does not mean you will get along. 

For adoptees, it is helpful to find a therapist who understands adoption development through a lifespan lens, grief, loss, trauma, racial/ethnic, and other identity dynamics–and how these impacts a person’s lived experience. 

Adoption is not a monolithic experience, but vastly unique and complex. It is equally helpful to consider what specific sub-specialties that you would want a therapist to have familiarity with. Not every therapist who identifies as adoption-informed is formally trained or knowledgable about every area of adoption. The more specific your identified needs are, the more helpful this may be as well as minimizing potential pitfalls later on. It is important to understand that the more specialized a therapist is, the more wait time it may be to be seen. It is okay to inquire about wait lists, but if you are in immediate need you can request a referral list from a therapist. 

These may be factors to consider, but are not exclusive: 

  • Domestic, infant adoption
  • Foster adoption
  • International adoption
  • Transracial adoption and racial identity
  • Kinship adoption
  • Embryo adoption
  • Surrogacy
  • Blended families/custodial issues
  • Birth search and/or reunion: domestic/international
  • Return to birth country/place of origin
  • Suicidality and adoption
  • Child Trafficking
  • Rehoming/Dissolution/Disruption
  • LGBTQ+/NGB/NGC 
  • Disabilities
  • Immigration rights and international adoption
  • Genetic Sexual Attraction (GSA) 
  • Adoption legislation and advocacy 
  • Parenting as Adoptees 
  • Abuse and neglect in foster care/adopt family
  • Developmental impacts (FASD, institutionalization, attachment history)
  • Eating disorders
  • Substance use
  • Mood disorders (depression, anxiety, PTSD, somatoform, etc)

Finding a therapist who works toward the integration of diversity, inclusivity, equity and social justice in their clinical work is a plus. Some therapists have additional training and certification in specific areas like substance abuse/compulsive behaviors, complex trauma, and transracial adoption to name a few. These may be listed on their website or other listings such as Psychology Today and/or therapist registries. It is strongly recommended that you ask what they specialize in and what training they have received. 

What questions should I ask?

After doing your research, you should have a list of therapists to call. When making your list of questions be cognizant of how many questions you have and then choose the top 3-5 that are most important to you. 

Some self-reflection questions to ask yourself: 

  • What salient identities are important factors that I need a therapist to understand? (e.g. For some adoptees, it is critical that a therapist be LBGTQ+/NGB/NGC-competent, as well as adoption-informed and a person of color). 
  • What will be the most important identity factors to find in a therapist, if I cannot find all of these identity characteristics? 
  • What important factors do I want to address related to adoption? 
  • What are my current challenges? (i.e. insomnia, restlessness, worry, sadness, racing thoughts)
  • What has/has not helped me in the past? 
  • What has been my experience with mental health professionals? What am I seeking? 
  • What can I afford? When can I attend a session? 
  • Am I comfortable with telehealth? Does my insurance cover this? 
  • What am I hoping to accomplish/address in therapy? 
  • Do I prefer talking through my issues or obtaining direct guidance/problem-solving support at this time? 

Some suggestions to ask therapists: 

  • How long have you been providing mental health services?
  • Are you fully licensed or under supervision? If they are under supervision, it is important to ask if they are required to videotape sessions due to supervision regulations in their area. Who will view our session? 
  • How often do you see clients who have lived-adoption experience? Approximately what has been your caseload percentage of adoptee clientele? 
  • Do you see adoptees, adoptive parents, or birth parents? If so, what are the ages? (There are many therapists who claim to be adoption-informed, but are not formally trained in adoption lifespan issues and may not have substantial clinical experience with adult adoptees and triad members beyond specific developmental stages). 
  • If you identify as disabled, what accessible accomodations do they provide? 
  • What is your experience working with transracial adoption issues? 
  • What training have you attended that is specific to adoption? What types of training were these (about adoption issues, about specific therapeutic approaches to adoption)?
  • What is your theoretical model (approach) to therapy?
  • How do you conceptualize adoption-specific counseling? 
  • How do you correspond with clients? 
  • What is your protocol related to a crisis? 
  • What training/workshops/research have you sought that address diversity, social justice, equity and inclusion work in adoption? 
  • What adoption-specific books/articles/social media outlets do you recommend to clients? (This may also be listed on their website). 
  • Review their intake forms and questions related to adoption. How adoption-inclusive are the forms and intake process? Are there specifics that relate to preferred names, gender-affirming markers/names, sexual identity, assumed dates of birth, social history sensitivity, and identifiers for family members (i.e. first family, adopt family, foster family, step family, etc?). It is important to note that not all therapists will have been trained in comprehensive adoption-fluent intake forms, but these comprehensive pieces help adoptees recognize a more inclusive adoption-competent therapist at the beginning. 

Be prepared for therapists to inquire and/or discuss the following to determine if they are able to meet your specific needs: 

  • Limits of confidentiality and mandatory reporting laws related to abuse and neglect
  • What brings you to therapy? 
  • What are your goals? What do you hope to address? 
  • Tell me about your current mental health status and symptoms. How long have you experienced these symptoms? 
  • Have you attended counseling before? What was your experience? 
  • Have you ever been hospitalized due to mental health? If so, when? 
  • Are you currently taking any psychopharmacological medications? If so, for how long? What kind? Dosage? 
  • Have you thought about hurting yourself or others currently? In the past? 
  • What has helped you currently? In the past? 
  • Tell me more about your current relationship dynamics (i.e. family systems, partner/spouse, friends, colleagues, community, etc) 

These questions should be a starting point and give the adoptee a place to begin to understand the therapist as a whole, not just for their specific adoption knowledge.

There will be several forms that you will need to fill out prior to your first session. These forms are typically required by a therapist’s licensing body, state/federal regulations, organization policies, and general information about the scope of their services. The therapist is not trying to be difficult, but ensures that you have both legal and ethical informed consents to treatment prior. They also have a legal obligation to disclose this information to prospective clients. Documents that may be required before your first therapy session: 

  • Contract to Services (signed agreement between therapist and client for services)
  • PHI (Personal Health Information)
  • HIPAA Consent and Release (Health, Information, Portability and Accountability Act)
  • Intake form and questionnaire 
  • Consent to Treat Minors (may include Release by each custodial caregiver/parent)
  • Fee Agreement/Method of Payment
  • Release of Information (if requested by therapist and client agrees to share case content)
  • Copy of driver’s license and/or health insurance card 

The two areas that can be deal breakers are insurance and availability. 

  • Verify that they take your insurance (if you have insurance). If you do not have insurance, you can ask about a sliding scale (fees based on your income or what you can afford), or what their out-of-pocket costs are. 
  • Ask about their hours and location. This is especially important if your job does not have a lot of flexibility and you have limited hours. Therapists also have families and lives outside of the office (surprise, I know!), so do not expect that they will be available after your work hours all the time. After school and evening hours tend to fill up fast, so be prepared to be flexible in your schedule as well (as much as you can be!). 

Your Rights Entering Therapy

Clients have a right to know several factors before, during and after therapy sessions end. These rights may vary from state-to-state and will also be determined based on an indvidual’s license and professional Code of Ethics (Standards of Practice). These are a few to consider: 

  • You have a right to know how your therapist’s credentials and licensure. There should be a copy of their licensure listed on their state Board of Examiners as well as in their office. 
  • You have a right to know the fees for service before your first session. 
  • You have a right to understand what services will be rendered and how your records will be stored. 
  • You have a right to be treated with competence, dignity, and respect at all times.  
  • You have a right to review your clinical file at any time. 
  • You have a right to ask about your diagnosis and inquire about the reasoning for that diagnosis. 
  • You have a right to privacy and confidentiality. 
  • You have a right to not be abused by a therapist. 
  • You have a right to terminate services at any time (this may be required in writing). 

**Covid-19 Considerations**

In light of the current pandemic, we want to recognize the increased need for accessible mental health supports. For many adoptees the collective global trauma involving unpredictability and loss of control can be increasingly upsetting during this time. Depending on the area you are seeking mental services, most therapists are providing telehealth sessions. There are a few things to keep in mind during this time: 

  • Many U.S. states have relaxed licensing regulations by allowing out-of-state licensed therapists to practice telehealth services (online mental health delivery) during a governmental emergency declaration of disaster. 
  • This is meant to provide temporary mental health provision during the pandemic, but it may not ensure long-term care with the same therapist (as some therapists may be restricted to work in that area at the end of the emergency order). 
  • There may be more delays in getting a session scheduled due to the transition to online services coupled with the elevated need for mental health services in general. This may be more challenging in different areas. 
  • Not all insurance companies will cover telehealth services. It is important to check with your provider. 

Final thoughts

Therapy is not intended to tell you what to do, nor determine if your decisions are right or wrong. It does not provide immediate relief from a lifetime of experiences, but provides deeper insight into how those experiences may intersect with daily life. Therapy should help guide you in understanding the context of your thoughts, feelings, behaviors and how these impact your overall functioning within the world you navigate. 

Some therapists specialize in different modalities (or approaches to sessions). It is helpful to consider what you may need. For some, you may be interested in solution-focused, brief therapy that provides more psychoeducation and directives. There are individuals who desire a specific approach such as EMDR, DBT, psychoanalytics, or CBT. For others, you may need long-term processing and time to develop trust and relationship with a therapist. There may be times that you may need a combination of both styles. All of these approaches can be helpful in the healing process. Inquiring with your therapist about their approach to therapy can help you determine if you want to move forward. 

**There are some methods of therapy that are considered illegal and/or unethical in some states. Some of these dangerous and outdated practices include: holding therapy, rebirthing therapy, and conversion therapy. These pseudo-“therapies” have resulted in abuse, including the death of adoptees in the past. Any therapy encouraging intimidation, threats of harm, withholding affection, identity-based shaming, or are punitive in nature are highly questionable and problematic. 

It is strongly recommended that any individual NOT engage in therapy with those still condoning and practicing these approaches.** 

Therapy is a bi-directional relational process between you and your therapist. It will take time to build trust and rapport with a therapist–particularly if there is a history of mistrust or a negative experience with therapy in the past. There will be times that it will be challenging because discussing difficult life experiences is hard, but it is part of the overall process towards healing and recovery. Ultimately, the goal of therapy is to help you understand what you were not consciously aware of prior. 

The most important part in finding a good therapist is finding one that you feel comfortable with. This means someone who is a good “fit” for you in regards to their style and in how you relate to one another. Sometimes you cannot determine this until you have met with your therapist for a few sessions. If you find that you are not connecting after several sessions, you can bring it up with the therapist. It may just be a misunderstanding or a difference in style. This is not commentary on either person, but sometimes we just do not jive well with one another. 

If your gut says you are not a good fit with the therapist, then keep looking!  It is absolutely acceptable to change therapists and try out a few before settling with one who you feel meets your needs.

What is important in a therapeutic relationship is that you are being heard, affirmed, and acknowledged without judgement. 

If you are in immediate and/or imminent risk of harm to self or others, please contact 911 or visit your local emergency room as soon as possible for assistance. 

You can also access 24/7 crisis assistance and support through the National Suicide Prevention Lifeline at: 

1-800-273-8255

https://suicidepreventionlifeline.org/

TTY for Deaf and Hard of Hearing: 1-800-799-4889

Katie Bozek, LMFT, Ph.D, has been in private practice as a licensed marriage and family therapist.  She is currently the Executive Director of Korean American Adoptee Adoptive Family Network (KAAN) where this article was originally posted.  You can find the original version of this article at https://www.wearekaan.org/post/how-to-find-a-therapist

Melanie Chung-Sherman, LCSW-S, LCPAA, PLLC (she, her, hers) is a licensed clinical social worker, licensed child-placing administrator, and TSBSWE-Board approved clinical supervisor through the State of Texas. She is a Certified Theraplay® Practitioner and Trainer. She is the Regional 3 Representative for the NASW-Texas State Board of Directors.

She is a senior psychotherapist with the University of Texas at Dallas’ Student Counseling Center serving the diverse mental health needs of UTD’s student population. Melanie is also the founder and owner of a private practice in North Dallas where she specializes in transracial adoption, complex trauma, and womxn’s health.  She was an adjunct professor of Social Work at Collin College. In addition, she has worked in the field of child welfare, medical social work, and womxn’s issues since 1999. Her passion includes education and training others to lift the voices of marginalized groups, particularly womxn of color and adoptees, combatting mental health stigma, and addressing power-based violence.

For more information, you can contact Melanie at: counsel@mcscounsel.com or https://mcscounsel.com

Jaclyn Skalnik is the founder of Adoption Wellness and is also a transracial, internationally adopted person. Jaclyn earned a Master’s degree in Social Work from the University of Wisconsin. She has assisted adoptive families throughout their adoption process for nearly two decades. She has presented at global conferences on matters concerning adoption and is passionate about counseling adopted persons and adoptive families seeking support. Other professional experiences include international adoption related travel throughout Asia and Latin America, homeland travel with adoptive families, and advocating on behalf of children who deserve permanency in a loving, healthy family.

Jaclyn is a Licensed Clinical Social Worker (LCSW), a trained Hague Accreditation reviewer for the Council on Accreditation, a member of the National Association of Social Workers, a World of Diversity trainer, adoptive family homeland journey social worker and has facilitated international birth-family searches and reunions.