What Kind of Therapist Do I Need for Anxiety? How to Choose & What to Expect

Brian O'Sullivan, M.S., LMFTAnxiety

This article is for informational use only, should not be considered clinical advice, and does not establish a patient-therapist relationship.

The field of psychology can be confusing for the average person. Unless you’ve trained as a therapist, it’s unlikely that you know the difference between all the titles in the field.

So, what kind of therapist do you need for anxiety? There is no specific title for an anxiety therapist. Any licensed therapist can treat anxiety, however, it’s recommended to find a therapist who specializes in anxiety. This is usually made clear on the therapist’s website or directory profile. You can also ask about their experience and training. 

In this article I’ll address the difference between therapists titles and how to understand a therapist’s background in order to find the most suitable help for your anxiety.

Types of therapists

Psychologist – Psychologists hold a doctorate degree and are required to have 2 years of supervised experience to become licensed. Psychologists are trained and qualified to administer psychological tests and diagnose the full spectrum of mental health disorders. Psychologist are also trained in and offer talk therapy.

Therapists / Psychotherapists / Counselors – Therapists, psychotherapists, and counselors hold a masters degree in counseling psychology. Though they have less schooling requirement, they often have the same number of years of supervised experience as a psychologist in order to become licensed. Most of their training is in talk therapy and diagnosis.

The average client will not know the difference between working with a psychologist vs a therapist, psychotherapists, or counselor. What is often more important is the therapist’s training, their specialization, and the goodness of fit between you and the therapist.

Psychiatrists – Psychiatrists hold a doctorate degree in medicine. Though some psychiatrists do offer talk therapy, they usually have very limited training in it. Psychiatrists are best used to obtain consultation on prescription medication and ongoing medication management.

In this article, when I use the term “therapist,” I’m not referring to psychiatrists. I’m referring:

  • Counselors
  • Psychotherapist
  • Marriage and Family Therapist
  • Mental health clinicians
  • Social workers

Which type of therapist is best for anxiety

Generally, talk therapy is the best place to start for anxiety versus medication as talk therapy is less invasive, without the side effects of medication.

Especially if your anxiety is not severe, you’ll likely find relief by attending talk therapy sessions on a regular basis, and may never need medication.

Understanding your therapist’s training, experience, and specialization is far more important than deciding between working with a psychologist, therapist, psychotherapist, or counselor.

General therapists are often broadly trained. They have experience in a wide-range of topics: relationships, trauma, anxiety, depression, life transitions, grief, and addiction. And many of these therapists see a wide-range of clients (adults, couples, teens, children) throughout their entire careers. General therapists are great for people who are experiencing general stress around life transitions.

For people who have a specific issue they want to address, like anxiety, it makes more sense to find a therapist who specializes in it.

A therapist specializing in anxiety spends all day seeing clients dealing with very similar issues as you. They will also have very specialized, up-to-date training on the treatment of anxiety treatment and are aware of the latest research findings on the topic. In short, they spend most of their time understanding the subtilties of anxiety.

If you have been referred for medication or know you’d like medication, you will have to go to a psychiatrists as they’re the only professionals, besides medical doctors, who can prescribe. Psychologists, therapists, and counselors may refer you to psychiatrist for a medication evaluation, but they cannot prescribe, adjust your medication, or advise you on medication.

Finding a therapist who specializes in anxiety

Finding a therapist can be overwhelming. Therapists are notoriously poor at marketing and developing an online presence. So, doing a google search in your area will likely yield results, but you’ll likely only see a very small percentage of therapists that actually offer services in your area.

Google Search

To help with your local Google search, here are some search terms that might be helpful to use:

  • “CBT anxiety therapy in [city]”
  • “Anxiety specialist in [city]”
  • “Exposure therapy in [city]”
  • “Anxiety psychotherapy in [city]”
  • “ACT anxiety therapy in [city]”

I’ll explain more about CBT, ACT, and exposure therapy later in the article.

Therapist Directories

There are a number of online directories that lists therapists. I find them to be a little overwhelming, and almost all therapist mark that they work with anxiety, but only a few actually specialize in it. Most of the directories have strong filtering capabilities to find get closer to your idea therapist:

Finding Online Anxiety Therapists

Before COVID, most therapists were opposed to online therapy. The general antidotal agreement in the field was that in-person is better.

Since COVID, therapists had no choice but to move their services online. And many are seeing the benefits and some are even shutting down their in-person practices altogether.

This is a huge benefit for clients as you have more access to specialists, no matter where you live. However, just because you find an online therapist, doesn’t mean the therapist can legally work with you.

Most (if not all) states say that just because therapy happens online, the therapy is considered happening in the state the client currently is located. So, if you’re located in California, your therapist needs a California license to legally see you for session.

Here are some ways to find an online therapist specializing in anxiety (just consider what state their license is in and where you’re located):

  • Google Search Suggestions:
    • “[State you live in] anxiety specialist”
    • “[State you live in] anxiety therapist”
    • “[State you live in] anxiety psychologist”
  • Use Google to find articles and blog posts written by therapists around anxiety topics you’re dealing with
  • Search podcasts for guest appearances by anxiety therapists
  • Search YouTube to find videos created by anxiety therapists

Ensuring the therapist is qualified

Once you find a therapist that stands out, here are some other things to look for.

Their license number

Each state has a licensing board that governs therapists. Most laws require therapists post their license on their website and any other advertisement. Any good therapist will make their license number easy to find on their website.

Do a Google search for the state their licensed in and the type of license (e.g., Marriage and Family Therapist, Social Worker, Psychologist, etc.). Also, add something like “verify license” to the search query. The search will look like:

“[state] [license type] verify license”

In the results you should see the state’s licensing board. Click on the result, which should bring you to the license verification webpage. If not, you should be able to navigate to it by searching the menu. Then type in the full name of the therapist or their license number.

What are you looking for?

First, you want to make sure the license is valid. A valid license tells you the therapist has completed the required training and continuing education requirements to maintain their license.

Their website and profile’s focus

A therapist’s website or directory profile should be focused on anxiety disorders. If you’re not certain within a couple of minutes of scanning their website that the therapist has a specialty in anxiety or a specialty in anything, more than likely they are a generalist.

Their therapy modality

Typically, the best way to treat anxiety is by using Cognitive Behavioral Therapy (CBT), Acceptance Commitment Therapy (ACT), Dialectic Behavioral Therapy (DBT), and Exposure and Response Prevent Therapy.

If you don’t see the therapist has training in any of these, they likely are not trained properly to treat anxiety.

Some therapist will use Psychodynamic therapy to treat anxiety, which is exploring your childhood and upbringing and how it impacts your present day life. However, from my experience, treating anxiety by first trying to understand why it’s there is like trying to break up a physical fist fight by first trying to understand why they started fighting. It’s probably best to first break up the fight. Anxiety is the same.

Types of therapy for anxiety

There are various approaches therapists are trained in to help clients. These approaches are called modalities.

In general, you can separate modalities into two different categories: insight oriented vs behavioral / skills based.

Insight orientated modalities explore how your past shaped who you are today. It’s very much concerned with the origins of the challenges you are dealing with, and by understanding these origins, we can find resolution.

Behavioral and skills based therapies focus on practical, present day solutions. These type of modalities take the stance that by focusing on our present day behavior, we can

A good anxiety therapist is going to be familiar with many different modalities, and will draw from different modalities to meet your specific needs.

With that being said, I think a good anxiety therapist should at least be familiar, comfortable, and regularly use these modalities:

Cognitive Behavioral Therapy (CBT) – CBT address how our thoughts, feelings, and behaviors all impact one another. Your clinician will work with you to understand these three components and you will work together to experiment with new behavior that will change other parts of the triangle. Sessions typically around 45 to 60 minutes in length and talk with one another.

Acceptance Commitment Therapy (ACT) – ACT is also a type of CBT and like DBT has a mindfulness component to it. ACT’s main goal is to help clients identify values and figure out ways to align behaviors with those values.

ACT also works under the assumption that a large part of our anxiety is created by trying to reduce our anxiety. ACT is about learning to accept intense emotions. Not to necessarily complacent, but to give up the struggle of trying to avoid and escape anxiety.

ACT also works under the assumption that clients aren’t broken and therefore something to be fixed.

Dialectical Behavioral Therapy (DBT) – DBT is a type of CBT. It also works with our thoughts, behaviors and emotions, but with other skills and approaches.

Mindfulness is a big component of DBT, which is exactly what I described in this article: being an observer of your thoughts rather than a participant. This is a skill we all have, DBT’s goal is to further strengthen this mental muscle.  DBT’s approach is that be becoming more aware, we become less reactionary to our environment, our thoughts, and our emotions. And ultimately, we gain more control.

Another key component is acceptance of self. Which is also contradictory. How do we accept ourselves, while also maintaining the desire to change ourselves? DBT aims to address this conflict.

DBT, just like CBT is collaborative between the therapist and client, and session are typically 45 to 60 minutes in length.

Exposure Response Prevention (ERP) – ERP is about exposing ourselves to the very things that cause us anxiety.

The premise of ERP is that it challenges the avoidance strategy. Avoidance is a common, maladaptive coping strategy used by people dealing with anxiety.

Logically avoidance makes sense: “This certain situation causes me anxiety, so I will avoid it.” What happens, however, is anxiety becomes increasingly higher the more the person avoids. Avoidance also tends to spread into other areas. In short, avoidance works in the short-term, but it usually causes us more trouble in the long-term.

ERP’s goal is to break this cycle.

ERP is commonly understood as a technique used to habituate our brains to triggers. However, I think a better way to understand it is that it teaches clients that they can in fact lean into the anxiety and face it.

The relationship

Just because a therapist has all the right training and decades of experience in working with anxiety, doesn’t necessarily mean they’re the right therapist for you.

Research has shown over and over again, that one of the most important factors in the success of therapy is the bond and alliance between the therapist and the client.

It’s critical that you understand your therapist and that you feel your therapist really understands you. Connection and trust are the foundation for therapy. Without it, session will likely lead nowhere.

Though there’s no way to know if you have a connection without first meeting with the therapist. There are some ways to get an idea before:

  • What kind of reaction do you have browsing the therapist’s website?
  • Does the therapist have any articles online? Do they resonate with you when reading through them?
  • Does the therapist have any videos? This is a great way to get a small sample of the therapist’s demeanor and style.

If you don’t have a good feeling in the first two sessions, it’s probably best to try a different therapist.

And a good therapist will be able to understand if you want to try another therapist. If they don’t understand, that’s probably even more validation that they’re not the right therapist for you.

Your first session

The first session should start by the therapist explaining confidentiality and times where they’d need to make a mandated report. The therapist should also make it clear to you what fees are involved with therapy.

After that, the session should be focused completely on you. The therapist should make it a priority to understand what issues are bringing you to therapy and help you to define and clarify what success in therapy would look like for you.

In general, by the end of session, you should have a feeling like there is some sort of a plan and path forward. Also, I think it’s important that you generally have a good feeling by the end of session. Not that you’re anxiety is gone by the end of first session, but instead of little more ease and hope on finding the relief you’re after.

Warning signs

  • Limits to confidentiality is not reviewed in the first session
  • They talk more than you
  • Doesn’t ask you many questions
  • Comes across as condescending or arrogant
  • Rigid in approach
  • Constantly late or cancelling appointments
  • Constantly reassuring you everything is going to be ok; colluding with the anxiety
  • Constantly giving you advice on life decisions
  • They talk about their own lives often
  • Constantly wasting time on small talk at the beginning and end of session
  • Unprofessional attire
  • Answers phone calls during sessions
  • More focused on diagnosing you rather than learning your perspective of the issue
  • Seems more focused on getting you back for another session than you actually improving and reaching your goals
  • Offended or defensive when you try to end therapy or are honest that therapy isn’t working

Great questions to ask your anxiety therapist

Do you consult with other anxiety experts on a regular basis?

No matter how much training they’ve had, no matter how many years of experience, a good therapist should be involved with regular consultation.

Why? One of the main reasons we go to therapy is to receive unbiased, objective views on our lives. Though therapists receive years of training on how to stay objective, they are human. In order to remain objective and to make sure they aren’t being biased and to ensure their own issues aren’t interfering with the therapy, they consult.

How long can I expect to be in therapy?

Though a therapist can’t (and should never) guarantee results or a certain outcome in a certain amount of time, they should be able to give you a general idea of how many sessions to expect.

Have you been to therapy yourself?

Many schools require a certain amount of therapy in order to graduate, but not all do. And if your therapist has never been to therapy themselves before, this usually isn’t good sign.

Everyone gets stuck in life. Including therapists. And if there is anyone who shouldn’t be opposed to reaching out for help in times a need, it’s your therapist.

Some of my best training as a therapist has been in my own therapy.

What should I be doing outside of therapy?

Often times people leave therapy sessions feeling stronger and better. However, the goal of therapy shouldn’t be to rely on therapy the rest of your life to feel good.

Therapy should be about making changes, which means taking action outside of session. A good therapist should be nudging and challenging you to take action, and this is a good question to ensure you’ve found this kind of therapist.

References

Ardito, R. B., & Rabellino, D. (2011). Therapeutic alliance and outcome of psychotherapy: historical excursus, measurements, and prospects for research. Frontiers in psychology2, 270. https://doi.org/10.3389/fpsyg.2011.00270

Zur, D. (2019, February 12). How to choose a Therapist, DR. OFER Zur, ph.d. Retrieved April 11, 2021, from https://www.zurinstitute.com/choosing/

This article is for informational use only, should not be considered clinical advice, and does not establish a patient-therapist relationship.