A great many people are feeling stressed, anxious, apprehensive, lonely, and depressed in this era of COVID-19. It is totally understandable. The novel coronavirus has created a difficult and challenging period for all of us, both adults and kids, alike– both in the USA and globally.

Worries and anxiety about COVID-19 can seem overwhelming, at times. Social distancing, uncertainty about one’s health and wellbeing, new financial challenges, altered daily routines, social isolation, unique work pressures, and increasing use of alcohol or drugs have amplified the risk of developing mental health problems. Numerous studies confirm that COVID-19 has created a mental health crisis.

For example, researchers from the University of Oxford and NIHR Oxford Health Biomedical Research Centre evaluated the health records of 69 million people in the USA, including 62 thousand people diagnosed with COVID-19. Their research confirmed that nearly 6 percent of adults diagnosed with COVID-19 developed a psychiatric disorder for the first time ever within 90 days, double the incidence for patients who didn’t have COVID-19. The new mental health challenges we are now facing because of COVID-19 are very real.

One way to help cope with the malaise and disquiet that COVID-19 has caused is turning to mental health providers – psychologists, psychiatrists, clinical social workers, marriage and family therapists and mental health counselors– in never seen before numbers. Since COVID-19, a great many people have turned to these healing experts. Calls to my private practice for an appointment have been the most frequent I’ve seen in 40 years! I have a growing waitlist and have been unable to refer the overflow to trusted therapists in my community because none of my colleagues have openings in their practices – everyone is too busy!

Given this very recent trend for a great many people to seek out mental health services in the face of COVID-19, it seems timely to share some ideas on what to look for when seeking a therapist to help you deal with your newfound anxiety, stress, loneliness, social isolation, insomnia, overeating, or depression. This article provides some preliminary recommendations – hopefully helpful! – for the first-time consumer of mental health services. I’ve divided the recommendations into two parts: what to consider before your first appointment. And what to be thinking about once you begin counseling.

What to Consider Before Your First Appointment

Okay. You recognize that you are experiencing some symptomatic distress, perhaps interpersonal problems, or just feeling stressed at work or home. You have reached the point where you think that it would be helpful to seek mental health counseling. How to decide who to contact and who might be helpful for you? Here are five important things to consider if you are at this tipping point in your decision to contact a mental health therapist for help:

• Ask someone you trust for a referral: Can I get a recommendation from a trusted friend, family member or colleague who has seen a mental health provider and found the therapist helpful?

• How much do they charge? The fees that mental health providers charge vary considerably – probably a whole lot more than you might think! They vary based on training of the therapist – for example, psychiatrists and clinical psychologists typically charge more than clinical social workers or mental health counselors, years of experience, licensures and certifications, type of therapy, and location.

• How long have they been practicing? If you can afford it, it is certainly advisable to seek counseling with someone with a whole lot of experience. I am reluctant to recommend to a client on my waitlist a tenderfoot or greenhorn therapist – someone who is a relative rookie, still learning ‘the ropes’ of how to effectively work with different clients and treat various mental health problems. But the fact is that not everyone can locate or afford a highly experienced counselor. If the therapist you are considering is young or doesn’t seem to have many years’ experience, then ask the prospective counselor if she has a clinical supervisor or mentor that works with her on cases.

• How many clients have they treated with similar problems or circumstances to your own? During your initial phone contact, it is certainly advisable to ask the therapist if they have worked with other clients with similar problems or issues to your own. You want a therapist who has familiarity, experience, and comfort with clients like you (for example, single parent with a special needs child; recent graduate of law school who twice failed the bar exam and is intensely anxious about taking it a third time; recently retired professional who is unhappy in his marriage and drinking too much). You also want a therapist who is familiar and competent working with problems like those that led you to seek mental health counseling. For example, if debilitating anxiety has led you to seek therapy, then ask the therapist how much experience they have working with clients like you with unbearable anxiety.

• Do they follow a particular type of therapy? There are literally hundreds of different types of counseling and psychotherapy. There is a growing body of research supporting the efficacy of different types of therapy, and these are the ones that, hopefully, your prospective therapist embraces in her work with clients. It isn’t difficult to conduct a search on the Internet and check out whether the approach that the therapist follows is “evidence-based” and has research supporting its effectiveness. Be aware that different approaches often use different techniques.

The good news is that in 1995 Consumer Reports published a landmark study of psychotherapy effectiveness. The report concluded that psychotherapy worked very well, that longer-term counseling tended to be more effective than shorter-term counseling, and that no particular modality enjoyed a competitive advantage over any other for any disorder. The report also concluded, not surprising, that insurance limits or caps on choice and duration of therapy were associated with less favorable outcomes.

A few of the more popular types of psychotherapy include cognitive-behavior therapy (CBT), dialectical behavior therapy, mindfulness-based therapy, EMDR, psychodynamic therapy, interpersonal therapy, couples and marital therapy, client-centered counseling, existential counseling, and narrative therapy. Also, your therapist may recommend a trial on a psychotropic medication if she thinks that this would be helpful. Medications are prescribed by physicians, so your therapist may refer you to a psychiatrist they consult with or to your primary care physician for the prescription.

What to Think About Once You Start Counseling

Okay, so you have your first or second appointment with your therapist! Here are four things to think about to ensure that the counseling experience will be helpful:

• Trust level: Do you feel like you can ‘open up’ to this person? Trust is critical to success in counseling, irrespective of the type of approach that your therapist uses. My own experience as a therapist, supported by considerable research, confirms that the client must experience a sense of hope, confidence, and a positive expectation for change if success is to occur. You should be able to tell, in the first few meetings, whether you feel like you can be totally honest with your therapist. Do you feel like you can open-up and reveal all your personal ‘crap’ – even the most embarrassing or shameful things that you’d hesitate to even share with a close friend? Do you feel like your therapist is non-judgmental? Do you feel like your therapist ‘fully accepts’ who you are, even after you’ve shared all your ‘dirty laundry’? A highly experienced, exceedingly credentialed, and very reputable therapist won’t necessarily be helpful if you don’t trust her!

• Is there a customized plan to work on your specific issues and concerns? Most therapists follow a fairly routinized approach in counseling. This is like the standardized and predictable approach that primary care physicians – pediatricians and internal medicine physicians, follow when they examine and prescribe treatment during medical exams. However, particularly effective therapists (and primary care physicians!) customize their treatment approach – if only slightly, for each individual client. This customization is based on many factors, such as the client’s unique demographics, gender, age, sexual orientation, ethnicity/race, beliefs and value system, and the details surrounding the specific presenting problem(s) that brought you to counseling.

I like to believe that no two treatment plans should look exactly alike. Similar, sure. But not exactly alike. Ask your therapist to see the treatment plan that they’ve devised for you. The plan, of course, is an evolving document. Even the initial treatment plan should be specific enough that it looks like it was created distinctively for you.

• Is the therapist willing to provide an estimate of how long counseling will continue? This is an easy and unambiguous question to ask your therapist in the first few sessions. You can frame the question as one of my former clients did with me. She allowed me to use her very eloquent wording of the question that she asked me: “If I prove to be an ideal client, how long do you anticipate that therapy will take? I know that you can’t give me an exact number of sessions, but I’d appreciate a ballpark estimate.”

• Are you making progress? This is a more difficult question, whether you are in the first few sessions of counseling or further along on your journey toward resolving symptoms or interpersonal problems, healing trauma or old wounds, or feeling better adjusted and more vibrant and self-actualized. But it’s perhaps the most important question to ponder for any client (and therapist!) in treatment! Experts who research psychotherapy efficacy suggest that, at a molar level, there are four possible counseling outcomes: recovered; improved or improving; no appreciable change; and deteriorated or getting worse. At a more granular level, client progress can be assessed in multiple ways: the therapist certainly has an opinion on whether the client is making progress – and if the client is, then is the improvement on pace with, slower than, or faster than, what was expected? And why? Ask the therapist about the progress or lack thereof that they perceive you are making.

All clients also have opinions on whether therapy is helping. There are many brief self-report measures that can provide useful and rather accurate information on how much improvement, if any, the client is making, and in which specific areas. Many of these brief self-report measures have software programs for scoring and plotting client progress and profiles to visualize client progress. Ask your therapist if they use these self-report scales. If they don’t, then ask them how they measure progress and improvement.

Concluding Comments

COVID-19 has created a mental health crisis in the USA and globally. A great many people are turning to mental health therapists to deal with symptomatic distress, interpersonal problems, or work and home problems. This brief article offers some preliminary ideas on what to consider before your first appointment with your therapist, and also what to consider after you’ve begun counseling. Two caveats: First, a great many mental health practitioners are now using Zoom and work with their patients virtually. This is the reality of healthcare in the era of COVID-19. The reader may need to forgo expecting to meet in the calm serenity of a therapist’s office. Today, virtual counseling – often called tele-mental health, is the most popular approach to working with clients. Second, as mentioned in the beginning of this article, most mental health practitioners are uber-busy these days! The reader will need to be patient and not discouraged in their search for a local, reputable, and qualified therapist. Help is available, it’s just not always readily available!

The author: Steven I. Pfeiffer, PhD, ABPP

Steven Pfeiffer is a popular speaker, consultant, and recognized authority on the mental health challenges unique to the gifted. Dr. Pfeiffer is Professor Emeritus at Florida State University, where he served as Director of Clinical Training. Previously, he was a Professor at Duke University and served as Executive Director of Duke University’s gifted program, Duke TIP, and before that, Executive Director of the Devereux Institute of Clinical Training and Research in Villanova, PA. He served in the US Navy Medical Service Corps as a Clinical Psychologist. He is author of over 200 monographs, book chapters, and journal articles, and twelve books, including the APA Handbook of Giftedness and Talent (2018, APA Books), and The Handbook of Giftedness in Children (2018; Springer). His book, Essentials of Gifted Assessment (2015, Wiley), is considered the gold standard resource on gifted assessment. An active consultant, advisor, and therapist, he has worked with over 2,000 children, youth, parents, and families in the USA and globally.