Jill Gichuhi felt abandoned when her therapist of three years left the practice. Referrals to providers within the same office netted only tenuous connections. Her six-month search, including calls to social workers and psychologists on her health insurer’s list, prompted calls back from counselors without room for new patients, and those who didn’t treat her type of trauma. Or no response at all.
Her desperation ended when she stumbled on a solution few Boston-area residents realize exists: Therapy Matcher, a client-therapist matchmaking service administered by the Massachusetts chapter of the National Association of Social Workers. The individually-tailored referral service, run by social workers who screen a database for likely best-fits, called back two hours later with two promising candidates, including a therapist Gilchuhi saw 10 days later, and who she continues to visit.
“They do all the leg work for you,” said Gilchuhi, a Quincy resident, who is director of the Compass Helpline at NAMI-Mass, the state’s chapter of the National Alliance for Mental Illness. Compass Helpline provides next-step referrals to people with wide-ranging mental health challenges. “We don’t have all the answers,” she said, “but we try to get people to the person who does.”
Ask anyone who’s been in this position: Finding a therapist in the Boston area for a pressing mental health concern, especially for a teen or child, can feel overwhelming. When you need a kind and understanding person who can parachute in to help avert a crisis, if only by listening, sometimes the search feels like a never-ending scavenger hunt while the sun is swiftly sinking.
“We know it’s hard to find a clinician. There’s a supply and demand mismatch,” said Dr. Ken Duckworth, director of behavioral health for Blue Cross Blue Shield of Massachusetts, the state’s largest health insurance provider. “Demand has increased as the stigma has softened.” Although Eastern Massachusetts has an enviable supply of psychologists, social workers, and licensed mental health counselors, there aren’t enough who accept insurance, experts say, at a time when demand for behavioral health care is surging nationwide.
“ ‘I’m so glad you picked up the phone. You’re the 20th therapist I’ve called.’ It’s a familiar message I’m hearing,” said Dan Do, a licensed social worker and therapist who works for a nonprofit consulting company in Lynn.
Last year, 23 percent of Massachusetts residents sought care for mental health or a substance abuse disorder for themselves or a family member, according to the 2018 Massachusetts Health Reform Survey, and 38.7 percent of adults who looked for help in the last 12 months reported their needs unmet. Recommendations released in January from a study by the Blue Cross Blue Shield of Massachusetts Foundation and Manatt Health call for strategic improvements to access, a reduction of wait times, and measures to ensure a continuum of mental health care across all communities and populations, regardless of income bracket and health insurance plan.
But thanks to professional networks, sophisticated matchmaking services, and online therapy through telehealth, the quest can be shortened dramatically. You need to know where to search, who to call, the amount and scope of your insurance benefits, and your ability to pay out-of-pocket. And you need to be open to tapping sleuthing help from teams of people in the know.
When Emily Stephen of Newton tried to find a therapist for her elementary school-age child, she identified the traits she considered essential: experience with children, a focus on anxiety, and cognitive behavioral therapy training. She made lists of potential providers and clinics with ample staff. Then she started phoning.
“I had to expand it to anyone who treated kids. Eventually, I wasn’t even looking for people with the right skill set. I was looking for anyone and hearing, “We have a one-year waiting list.” I must have called at least 20 different practices” for about three months, she said.
Relief came when she contacted William James College’s Interface Referral Service, at the recommendation of a provider. She received a call back within 24 hours, was interviewed for 20 minutes about her child and hopes for a therapist, and received four referrals within 48 hours. She and her child went to two intake interviews, then selected one. “I never would have found her myself,” Stephen said. “And we saw her within a week.”
Here’s advice from experts – who agree on the range of search options, but not always the order in which to try them.
The first, best stop is your primary care provider, including your pediatrician or OB-GYN practitioner. Their offices keep lists of therapists their patients have reported success with, and with whom they have working relationships. Communication between providers is key, especially when chronic medical conditions may be affecting mental well-being.
Seek referrals from friends, family members, and co-workers who like their therapists and who may treat issues like yours. In the end it will boil down to personal chemistry; both clinician and client must sense the relationship will flourish, said Kevin Kozin, a social worker in Lexington, and a lecturer at Boston University School of Social Work. That’s not just a matter of personalities jibing; you need to believe your therapist truly cares, that this is someone you can trust with the unseemly realities of your struggle, and who is strong enough not to shrink or judge. “Don’t give up. That person exists,” but you may have to meet several before you choose, Kozin said.
Matchmaking services slash time and frustration. Both Therapy Matcher and William James College’s Interface Referral Service are free to consumers – and only recommend people with an available opening. Therapy Matcher connects clients to social workers, who pay a membership fee. William James Interface charges a flat rate to participating towns – 55 statewide, including many but not all in the Boston area. You have to live in one to get help. The service, staffed by psychologists, social workers, and mental health student trainees, has made roughly 20,000 client-therapist matches since 2007, matching clients to psychologists, psychiatrists, social workers, and licensed mental health counselors sorted by gender, specialty, training, insurance accepted, location, and availability.
Be flexible about the meeting time. And be willing to try teletherapy. Teletherapy is- mental health counseling through a secure, face-to-face online connection similar to Skype. National research has shown that it’s as clinically effective as an in-person session, and it’s particularly popular with clients on the autism spectrum who have mental health issues, said Joy Rosen, vice president of behavioral health at Massachusetts General Hospital. “Waiting in a busy waiting room can be very disruptive for parent and child.”
Depending on your plan, most private insurers cover telehealth, which can produce an online therapy session within 24 hours, especially if your need is urgent. More than 50 percent of Blue Cross Blue Shield of Massachusetts customers have this benefit. Currently, all 1.86 million MassHealth (Medicaid) members have telehealth options. At Mass General’s psychiatry department, roughly 4 percent of the 120,000 yearly outpatient visits by adults and children are through telehealth, nixing time-consuming commutes for far-flung clients. Phone sessions are not included.
Your health insurance company can help – especially when you can’t find someone. “Think of the number on the back of your card as a resource to solve problems, not just to process claims,”said Dr. Duckworth of Blue Cross Blue Shield. Member representatives and on-staff behavioral health case managers can explain your benefits and decipher the intimidating contract most of us never fully read, and steer you to in-network providers, including those with room in their practice. Prior authorization is not required for mental health care.
Depending on your plan’s deductible and co-pay for out-of-network providers, tapping non-network clinicians (including an increasing number who don’t accept health insurance, but will give you a form to submit for reimbursement) can widen your options and reduce your wait for an opening, especially if you’re willing to take a morning or midday slot.
“It helps if you’re willing to budge,” said Angela O’Neil, a therapist in Westminster. The wait for after-school and early evening appointments can be six to eight weeks or longer. “The need is so overwhelming. Everyone’s struggling to get clients in.”
Don’t discount your employer: Employee assistance programs can help you find a therapist, often free of charge, who can provide a set number of phone consults to bridge the gap until you find a counselor to carry you forward.
Online directories and professional associations also are valuable, especially for researching clinical specialties, background, insurance accepted, and finding names you may not have seen anywhere else. The most widely used site is Psychology Today’s, but zencare.co and HelpPro.com also serve Greater Boston. Psychology Today verifies contact information and licensing status when providers list and when their licenses expire, but it’s up to the clinician to update their information. “After narrowing down a search based on your particular issues, it’s not a bad idea to reach out to more than one,” said Crispin Roven, vice president of product at Psychology Today. “We learn a great deal from our early interactions.”
Research shows that therapy success hinges on the quality of the relationship, not on the treatment approach. So whether a therapist favors cognitive behavioral therapy, which changes negative thinking patterns, or dialectical behavioral therapy, which focuses on self-calming strategies, that’s not nearly as critical as how comfortable and understood you feel, said Nanci Ginty Butler, a social worker at Riverside Trauma Center in Needham and adjunct professor at Boston University School of Social Work.
Just as useful are lists of providers vetted by professional organizations such as the American Psychological Association, the International OCD Foundation, and the Anxiety and Depression Association of America.
Guidance counselors, school psychologists and social workers, school nurses, and college counseling centers are a front line and often first-available resource for children during school hours or young adults at college. For ongoing outpatient therapy, they can refer to community providers within walking distance or a reasonable bus or car ride away. Practices near college campuses fill up quickly. Get on several wait lists. And make contact before the school year starts, if possible.
In an emergency – defined as a crisis in which someone needs immediate attention, is in danger of hurting themselves or someone else, call 911 or head to a hospital emergency room. In the Boston area, mobile crisis teams are available 24/7, along with emergency service workers at community mental health centers who can talk you through the situation and advise what to do.
Formal or informal counseling, or at least a sympathetic ear, are often available at places of worship. A rabbi, pastor, priest, or parish nurse, or other spiritual leader or outreach worker, can also connect you to someone in your congregation who has been through what you’re experiencing, who has volunteered to listen and lend support.
“It’s a courageous act for people to reach out for therapy,” said Kozin, an adjunct professor at BU School of Social Work. “It’s my strong belief that people should never worry alone. I don’t think we get through anything in life by ourselves.”
For help or more information, search or call:
interface.williamjames.edu, 888-244-6843 M-F, 9 to 5.
For substance abuse help: helplinema.org
For psychiatric services for children: mcpap.org