Where to start when you do not know what kind of help you need

Most guidance assumes you already know what you are looking for. Often the hardest step is earlier: something is wrong, and the professions all sound similar.

Start here.

First: is this urgent?

If you are thinking about ending your life, or you are worried about your immediate safety, that is not a directory problem. 988 — call or text, United States, any hour, free. Or text HOME to 741741. An emergency room is also an appropriate place to go.

This site is a directory and cannot respond to emergencies.

If you are in danger from another person, the National Domestic Violence Hotline is 1-800-799-7233, or text START to 88788.

If it is not urgent

Answer these in order. The first one that fits is your starting point.

Do you want medication, or have you been told you might need it? → A psychiatrist or a psychiatric nurse practitioner (PMHNP). Or your primary care physician, who can prescribe for common conditions and is usually far quicker to see. No therapist prescribes. See who can prescribe.

Do you need something on paper — for a school, an employer, a court, a disability claim? → A psychologist, for formal evaluation. A therapist’s opinion in a session note is generally not accepted where an evaluation report is required. See what a psychological evaluation involves.

Is the problem mainly between you and someone else? → A marriage and family therapist, or a clinical social worker or counselor experienced in couples and family work. See couples and family therapy.

Is it a child, and is the difficulty about school, self-care or motor skills rather than mood? → Possibly occupational therapy rather than mental health, and possibly through the school district at no cost. See occupational therapy for children.

Is it substance use? → SAMHSA’s National Helpline, 1-800-662-4357, is free, confidential, 24/7, and does treatment referral. It is a better starting point than a general directory.

None of the above — you feel bad, or stuck, or something has happened and you want to talk to someone. → A therapist. Which of LCSW, LPC or LMFT matters much less than most people assume — see what the licence letters mean. Search on availability, cost and whether they have worked with your kind of situation.

Then: how hard will the search be?

Before making a list, look up your area on this site. The figure at the top of every place page is providers per 10,000 residents, with your place marked against the rest of the state.

• Above the state median — a shortlist of five or six and a round of calls is a reasonable plan.
• Below it — plan differently from the start: widen the geography, consider telehealth anywhere in your state, and look at community mental health centres and training clinics rather than only private practice. See what to do when your area has very few therapists.

Knowing this before you begin is the point of the number. It converts “why is this so hard” into “this is a supply problem and here is the route around it.”

The order that wastes least time

1. Check what your insurance covers and get the in-network list, if you are using insurance. Insurance and networks.
2. Cross-check that list against everyone actually registered in your area, here. Names on both lists first.
3. Call or email six to ten, and ask about availability before anything else. What to ask.
4. Ask everyone who says no for a referral. Therapists know who has openings.
5. Verify the licence of whoever you book with. Two minutes. How.

Six to ten contacts sounds like a lot. In a tight market it is realistic, and knowing that in advance is better than discovering it after three unanswered voicemails and concluding the problem is you.

What to expect once you get there

The first appointment is intake and usually does not feel like therapy. That is normal. What happens in a first session.