Tips for picking the right therapist or counselor


By: Jennifer McMillen Smith, MSSA, LISW-S, Division of Infectious Disease and medically reviewed by Ann Avery, Infectious Disease Physician at Metrohealth Medical Center

Some days it’s all too much. Maintaining your HIV treatment, school, work, family, love life— you name it. They’re all pulling you in 16 directions.

You know it’s all about staying on your HIV meds and doing what it takes to be healthy and happy. But what if life gets so far out of hand that you don’t even feel like taking your meds?

It happens to the best of us. Therapists and counselors help us make sense of it all: finding the right path, ignoring the wrong paths, and getting to a place where life makes sense again.

Choosing the right therapist can be one of the best decisions you ever make. These tips will help you find one who can do the most good for you.


Get used to the idea of working with a mental health professional

We talk a lot about HIV stigma here at Positive Peers. Well, there’s also a stigma attached to getting mental health treatment — as if it’s a sign of weakness or something.

Sometimes you just need someone to talk to. But your friends, partner, and family are more likely to be mental health amateurs: They mean well but they haven’t been trained on the best ways to clear all the confusion out of your brain. Sometimes, they can try to help but actually make things worse.

For these reasons, you’re better off working with a mental health professional. They have the training and experience to know where you’re coming from and help you find your best way forward.


Four kinds of mental health professionals

These are the four most common types of people you might work with in the mental health field:

  • Counselors. A counselor can do you a world of good. They often help people overcome their addictions and figure out how to succeed in their careers. Some counselors come from tough situations, and they use what they learned to help other people just like them.
  • Therapists. A therapist helps you sort out your mental challenges in a formal treatment plan. Therapists work with all sorts of people, from defiant teenagers to stressed-out corporate CEOs. Therapists may be experts in nutrition and wellness in addition to mental health. They typically have at least a bachelor’s degree and advanced training in their specialty.
  • Psychologists. A psychologist has advanced training in the workings of the human mind. They usually have college degrees ranging from bachelor’s to master’s or even doctorate. Psychologists may do counseling or therapy (or both) to help people make sense of their problems and find ways to overcome them. They can’t prescribe meds, but they can refer you to a doctor who can.
  • Psychiatrists. A psychiatrist is a medical doctor who specializes in mental health. Psychiatrists can prescribe drugs and confer with other doctors about your HIV treatment plan. They can help you find medications to fight off depression, anxiety, bipolar disorder, schizophrenia, and other problems. Some psychiatrists do counseling and therapy, but many focus on prescribing the best medications.


What to look for in a mental health professional

Remember that each person’s job defines how they can help you. A psychiatrist might not do the work of a therapist, and vice versa.

Your therapist or counselor will spend the most time helping you figure things out. So, you’re looking for chemistry — a sense that the two of you click on a level where you can be honest with them.

Some therapists have online reviews of their skills posted. Look for people who have mostly good reviews, but take the bad reviews with a grain of salt. The people who complain the loudest aren’t always the ones providing the best insight.

Try to talk to your therapist on the phone for a few minutes to get a sense of the kind of person they are.

You don’t have to stay with a counselor who isn’t a good fit. Don’t get discouraged if the first therapist you visit isn’t the right one for you. That said, sometimes a mental health professional say some things you don’t want to hear (it’s ok — we’ve all been there!), but that doesn’t mean they’re wrong. Give yourself some time to absorb what they’ve advised before moving on to another therapist.

If you’re in an HIV support group, ask people about their counselors and consider getting a referral to one of the good ones. Just a piece of advice: it might not always be a good idea to get the same counselor or therapist as a close friend or a romantic partner. You want to have a mental health professional that you can be open with without having any conflicts of interest.


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Red flags and warning signs

Most people working in the mental health field are licensed, well-trained, and truly care about the people they are helping. Now and then, however, people in this field stray from their appointed duties. Things to be on the lookout for:

  • The therapist doing most of the talking. Therapy usually involves you talking out your challenges, while the therapist asks a few questions to guide you along. You should be doing most of the talking.
  • Frequent interruptions. Your therapist should give time to explain what’s on your mind without breaking your flow of thought.
  • Inappropriate behavior. Your counselor is not your friend. They are paid to help you but they must keep a professional distance. They should not ask their clients out on dates or try to make any kind of sexual advance.

If a counselor creeps you out for some reason or just rubs you the wrong way, start looking for one you like better.


Find out what your insurance covers

If you have health insurance, you should find out what kinds of treatments are covered. Most kinds of therapy are too expensive to pay for on your own, but some clinics provide free counseling.

A local university or college might have students who can do counseling at low rates or even for free. Nonprofit groups also offer free or low-cost counseling.

Don’t let cost rule all your decisions, however. You may be able to explain your situation to a therapist you like and negotiate a rate you can afford.


Establish goals

Before you dive into therapy, take a few minutes to write down your goals. Make a list of the challenges you’re dealing with, and rank each one in order of importance. That keeps you focused on the most crucial issues and helps avoid distractions.

Talk these goals over with your therapist and make sure you’re both on the same page. We recommend that you don’t lock in your goals, however. Your therapist may help you understand an underlying problem you have to deal with before you work your way down your list.


Building trust

Ultimately, working with a therapist means creating bonds of trust. You should feel comfortable telling your therapist anything. They should encourage you to explore your feelings and figure out what makes you tick.

Don’t let anybody tell you there’s anything wrong with getting counseling. HIV (and life in general) can create stress that’s tough to work out on your own. A good therapist ensures you don’t have to go solo.

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