The last time I wrote this post, way back in 2019, we could go to Starbucks, hug a stranger and go grocery shopping without looking like we’re about to rob the place. Since then a lot has changed thanks to the nasty complicated little virus that hit our shores in January 2020.

Anxiety and depression are WAY up, especially among college students (and recent grads). Access to counseling services is super limited – most therapists are totally or mostly only seeing clients via phone or video conferencing. So basically demand is way up while supply is way down. Even as states loosen restrictions, many providers are likely to maintain minimal in-person sessions. Even if students are permitted to head back to campus for Fall semester, university counseling centers (CAPS) will likely have reduced availability and services. Most will likely use virtual sessions. Most CAPS centers also are not allowed to work with students out of state. For example, if your son goes to Indiana University but is taking virtual classes from home in New York City, IU CAPS will not provide him online/phone counseling services since he is out of Indiana.

But your parental sixth-sense is nagging…”something is not right.” Maybe they’ve been acting differently from their normal chipper self. You may have gotten that vibe over the phone or when you visited during the semester, but now that they’re home, it’s pretty clear they’re not doing well. They may have less energy. They may be less engaging. They may even seem hyper-vigilant and worried a lot more but without a good reason. It’s time to reach out to a professional — but who should you call?

Home or School?

Let’s start with a tricky dilemma: Do you try to find a therapist around home or back at school? As of right now, nearly all counseling is virtual or phone which means, technically, it doesn’t really matter where the therapist (or your son or daughter) is located, they theoretically just need a device and internet. But, like the dilemma mentioned above with CAPS and providing service to out-of-state students, many providers are not permitted to provide counseling services out of the state in which they are licensed.

Benefits of a Home (Virtual) Therapist?

Though most counselors generally have about the same type of training (eg. graduate school, internships, life experience) there’s a benefit from working with a counselor from your hometown or geographical area.

There are cultural considerations, colloquialisms and personality traits that may lend themselves to a faster and stronger rapport between the counselor and the student, even if the counseling is over the phone or virtual. For example, when I get a call from a student or parent from the Philadelphia or New York area (which I’m from), there seems to be a quick “Oh, you’re an East Coast guy!” which generally means I talk a bit faster (faster than I should), communicate with sarcasm (probably more than I should), and make lots of East Coast references or use them as metaphors. I’m not proud of all of this, just observing that folks from the mid-Atlantic region seem to connect easier with me than my Midwest counterparts.

If your college student’s semester ended in mid-May and they’re heading back for the fall semester at the end of August, they’ll have 15 weeks of summer to work with a therapist at home. That’s a decent amount of time if they are available immediately and your college kid’s challenges don’t require more intensive intervention. Getting weekly counseling for that chunk of time could make a big difference and set your college student up for a positive transition back to campus in the fall.

As with pre-COVID-19 recommendations, the following obstacles still apply and are important to consider when looking for a local (or any) therapist: Is the therapist going on vacation or unavailable for a few weeks? Will there be any substantial disruptions during the summer or can they meet most weeks? Do they have any openings immediately or will you get waitlisted? Will they agree to work with someone for just the summer? Does your family have a vacation time planned that would get in the way of seeing the counselor? I also recommend clients ask therapists what their setup is for virtual sessions. Do they work from a professional office or home office? If they have a home office, how do they maintain professionalism and confidentiality? There was a recent article in a major newspaper by a counselor who casually mentioned that while she’s conducting her virtual sessions, her neighbor’s dog can be heard barking and she’s downgraded her wardrobe to a comfy t-shirt. While I totally appreciate her authenticity and transparency, I believe that counseling is more than just the information and processing we experience. I think that a therapist’s presence and performance (yes, performance) are important at creating an environment fertile for deep connection but with clear boundaries.

School Counselor

The benefits and considerations of finding a therapist around college look a lot different but may not be as immediately satisfying. One really important consideration is that establishing a relationship with a counselor before the start of a semester means you are likely to not get wait-listed. Most students leave spring semester with their fall class schedule nailed down, which means you could conceivably get ALL of the counseling sessions scheduled through till the end of the semester. Therapists generally appreciate this sort of predictability, especially if they specialize in college student counseling.

In my practice, I am typically full before the fall semester starts. This sort of planning also helps your son or daughter anticipate and plan accordingly if they want to join any clubs or if they will likely have a busy Greek-life schedule. Some students may even have their syllabi for the fall and know that certain big assignments, projects, or tests will make specific dates and times for sessions really challenging, which means they can move those sessions around to avoid those scheduling conflicts. I had one student do this last year — they were at the business school and had massive projects listed on their syllabi that they knew from other students would eat up big chunks of time. They contacted me two months in advance to move our fall appointments for those weeks. Wow.

The Search Begins

Now, how the heck does someone find a therapist? Regardless of whether you’re looking for a local therapist or someone near campus, I’ll go through some gritty details now on how to do it. Even if you’ve found one in the past, you may have simply googled “therapist” or “counselor” and your zip code and found a list of random providers that have offices in your zip code. They probably showed up on Psychology Today (the big daddy of mental health providers in the country).

Ok…I see the list

Ok…I see their head shots

Ok…I’m reading through their ‘About Me’ blurbs. But wait! They all seem the same with only minor differences. How does someone actually figure out not only who is good or not-so-good, but which ones specialize or treat the symptoms my college student is describing?

One thing to start off considering is that it’s difficult for many reasons to verify a provider’s expertise. For instance, you will find therapists that claim to treat all ages, all diagnoses (eg. Depression, Anxiety, Substance Abuse, Eating Disorders) and have expertise in all modalities (eg. DBT, CBT, Motivational Interviewing). I can assure you, they may have a basic understanding of those diagnoses and modalities, but they are far from deep experts.

Online databases are really good for two things:

• Finding a therapist within your zip code
• Finding a therapist that accepts your insurance (or at least use to)

Another good (…ok, somewhat good) resource is the database kept by your insurance company. Most insurers have client/patient portals where you can look up all the therapists within a geographic area and, obviously, accept your insurance. They rarely have much detail about the therapist but at least you can confirm they are in-network.

Alphabet Soup

While searching you will likely see a whole bunch of letters after someone’s name. That’s not just egomania about how smart they are – many licensing bodies require clinicians to list their degree (Masters, Doctorate or Medical Doctorate) as well as their license.

Here is a list of other credentials you may see after someone’s name and what they mean:

• LPA – Licensed Psychological Associate
• LCSW – Licensed Clinical Social Worker
• LCAS – Licensed Clinical Addiction Specialist
• LMHC – Licensed Mental Health Counselor
• LPCA – Licensed Professional Counselor Associate
• LMFT – Licensed Marriage and Family Therapist
• NCC – National Certified Counselor
• RN – Registered Nurse
• MS – Masters of Science
• MA – Masters of Arts
• MSW – Masters of Social Work
• DSW – Doctorate of Social Work
• Ph.D. – Doctorate of Philosophy
• Psy.D – Doctorate of Psychology
• Ed.D – Doctorate of Education
• MD – Medical Doctor
• DO – Doctor of Osteopathic Medicine

Now for a bit more detail on the most common types of mental health professionals you’ll run into on Psychology Today and other databases.

Psychiatrist. A psychiatrist is a physician (doctor of medicine [M.D.] or doctor of osteopathic medicine [D.O.]) who specializes in mental health. This type of doctor may further specialize in areas such as child and adolescent, geriatric, or addiction psychiatry. A psychiatrist can perform the following though they primarily prescribe medication:

• Diagnose and treat mental health disorders
• Provide counseling
• Prescribe medication

Psychologist. A psychologist is trained in psychology — a science that deals with thoughts, emotions and behaviors. Typically, a psychologist holds a doctoral degree (Ph.D., Psy.D., Ed.D.). A psychologist:

• Can diagnose and treat a number of mental health disorders, providing counseling, in one-on-one or group settings
• Cannot prescribe medication unless he or she is licensed to do so
• May work with another provider who can prescribe medication if needed

Licensed Clinical Social Worker. If you prefer a social worker, look for a licensed clinical social worker (L.C.S.W.) with training and experience specifically in mental health. A licensed clinical social worker must have a master’s degree in social work (M.S.W.), a Master of Science in social work (M.S.S.W.) or a doctorate in social work (D.S.W. or Ph.D.). These social workers:

• Provide assessment, counseling and a range of other services, depending on their licensing and training
• Does not prescribe medication
• May work with another provider who can prescribe medication if needed

Licensed Professional Counselor or Mental Health Counselor. Training required for a licensed professional counselor (L.P.C.) and (L.M.H.C.) varies slightly by state, but most have at least a master’s degree with clinical experience. These counselors:

• Provide diagnosis and counseling for a range of concerns
• Does not prescribe medication
• May work with another provider who can prescribe medication if needed

Background Checks

When I encourage folks to conduct background checks, I’m not talking about running their info through the FBI to find out if they are criminals. When considering whether to work with a therapist, google their name, look up their info on the state licensing board’s website (if the state has one), and ask for clients or colleagues that could provide a referral. Asking for a referral is a bit unorthodox and most therapists wouldn’t know how to respond but it doesn’t hurt to ask. When prospective clients ask for referrals, I explain that because of HIPAA rules, I can’t just hand over a previous client’s contact info. What I can do is contact previous clients and ask if they would be willing to provide feedback to the prospective client. It’s tricky since I want to protect privacy and not put any sort of burden on the client.

Questions to Ask

Real simply put, when you are looking for a therapist, think of it like interviewing someone for a job (counseling).

Treat it like a hiring interview and have a plan. Here is the list of questions you need to ask when considering whether or not to work with a therapist (print this off if needed):

What training do you have to treat the issues I described?

Please give me an example of how you would work with me on the issues I described?

What are your communication policies between sessions?

Have you ever had your license suspended or removed in this or another state?

How do you use technology in your practice? Is your agency able to provide weekly and 24 hr reminders prior to sessions?

If I need a different type of care or different level of care, what’s your experience in working with referral sources?

Are you in-network, out-of-network with my insurance? Do you have someone in your practice that files claims and works with insurance?

And for virtual and phone counseling, do you work from a professional office or home office? If you have a home office, how do you maintain professionalism and confidentiality?

First Session

First, make sure all the necessary intake forms and payment information is completed and the counselor has verified he or she received them. Next, for the first and ALL virtual and phone sessions, I recommend clients check their apps/settings/login stuff 30 minutes prior to sessions. For in-person sessions, show up early and come with any additional questions, concerns, goals or obstacles regarding your issues. I love it when parents show up with a page or more of thoughts, questions and random ideas. It’s also helpful if they email me prior to the first session so I have more context than just my online intake form. It not only helps me zero-in on a diagnostic impression but also helps me understand how the family operates and what their values are. If this is a session set up for your college kid, be confident and let the therapist know you want to sit in on the first 30 minutes to download some history and concerns from your perspective. It’s also a great time to sign a release of information so the therapist can legally speak with you between sessions.

Final Notes

One of the best uses of a therapist for summer break is helping parents understand what’s going on with their college student and what is the most effective intervention. Developmentally appropriate emotions and behaviors can often look similar to mental health challenges. For example, when is smoking weed just ‘normal college kid behavior’ and when is it a clinical issue? Your college student’s therapist can help differentiate between the two. Consistently working with a good therapist over summer break can help your college student feel supported and stabilized, set them up for a great fall semester while also helping parents feel more confident their kiddo is on a healthy path.