Finding a (Good) Therapist: Confidence, Fitness, and Stigma


When it comes to talking about mental health challenges, very little attention is given to the process of accessing mental health care when you need it. The assumption is often that if you have good health insurance it will be easy – but that turns out to be wrong.

The system is difficult to navigate, with lists of practitioners often out of reach and outdated.

“[Practitioner] the lists are massively filled with wrong numbers,” says Wesley Boyd, professor of psychiatry and medical ethics at Baylor College of Medicine and lecturer in global health and social medicine at Harvard Medical School, who writes on the issues of social justice, human rights and access.

“They are filled with full practices and these are even practices that do not even accept insurance. So if the lists don’t work, for people like you and me and everyone [else] …they actually work quite well for insurance companies when it comes to making a profit,” he says.

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Boyd explains that a shortage of providers and increased demand in the wake of COVID, combined with an onerous amount of reimbursement paperwork, has also meant that many mental health practitioners no longer take out insurance because they can keep practices full with patients paying over $150 per session.

Boyd says which treatments will be covered by insurance and the importance of finding the right match are key.

“Some of the studies that say the most important and beneficial factor for therapy is the quality of the relationship between patient and therapist, and I agree with that,” he says.

“When it comes specifically to accessing mental health care, those who can afford it have a substantial advantage over those who cannot. And it’s absolutely heartbreaking,” says psychiatrist and medical ethicist Wesley Boyd. Photo courtesy of Wesley Boyd.

Jonathan Bastian explains to Boyd why many suffer in silence, struggle to find help, and are ashamed to speak up. Of all the challenges, Boyd says, stigma is the biggest barrier to accessing mental treatment. Despite laws guaranteeing parity, mental health and physical health are scrutinized differently by insurance companies.

“There is still so much stigma that I’m not sure what we need to do to overcome it,” he says. “But we definitely have to. I think seeing a lot of celebrities come out and talk about their own mental health issues is a great start. I think having conversations like this is another way to go.

Boyd draws on recent research and studies on the mental health treatment disparity by insurance companies and shares his own experience trying to help others navigate the system.

“There is no easy way out,” he says. “I’ve helped friends, I’ve helped family, and that’s not easy, to put it mildly — and I’m very well connected in the mental health community.”

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