Prompt: How could therapy clients be connected to potential therapists to increase the likelihood of goodness of fit?
Proposal: A therapy match-making service.
Process
Background
A few years ago, I had a therapist who was thoughtful but as time went on, I felt that our conversations were becoming rote and we weren’t digging into deeper issues. But I didn’t know what to say to him because I was not exactly sure what I wanted him to do differently. I explained the situation to my friend Emily who is also a psychologist and she explained that his style was too directional and I would work better with a therapist who was more psychodynamic. I was interested but not sure how to find someone with that approach and she sent me a link to the Baltimore Washington Center for Psychotherapy and Psychoanalysis. I realized through this encounter that I was very lucky I had Emily because as a professional, she could take my vague dissatisfaction and translate it into something actionable. Also, she knew the inside lingo of therapeutic services and knew where to point me so I could find the best match with a new therapist.
But what about someone who’s never tried therapy before or only had one disappointing experience? How would they know where to find a therapist they would work well with? Without a friend like mine to guide them, they would be facing down confusion and barriers alone.
Barriers
For people who are interested in mental health treatment, there can be many barriers to getting effective care: lack of health insurance or lack of health insurance coverage for mental health treatment, feeling stigma related to seeking mental health treatment, being overwhelmed by the variety of therapy options, a poor experience with past counseling, and most intimidating, a mental illness that could make it impossible to seek, schedule, and attend treatment. Given that our health care system is a maze of conflicting information, a person who having difficulty in their day-to-day life would be overwhelmed if they needed to call 30 providers to get an appointment with a therapist or advocate for their treatment to administrator.
Research
I surveyed the mental health landscape and there are several resources that try to offer mental health services to clients and ensure a “goodness of fit” between therapists and clients. But often, they are either too direct and promise you will have a therapist immediately without assuring them the therapist would be a good match, or they are too vague, such as PsychologyToday profiles where almost every therapist claims to work on every mental health issue and it is difficult for a layman to judge options. Some sites try to provide guidance about how to find a good therapist but, as I did, clients often lack the self-awareness and the vocabulary to describe their symptoms. They are more likely to say, “I feel miserable” or “I don’t know what’s wrong with me” than describe their past issues and identify appropriate treatments.
Service Offering
My service is Therapy Match and it hosts a centralized matchmaker who takes people who are interested in therapy and using their extensive expertise and network to find the type of therapists who would best serve the client.
The matchmaker is warm, kind, and an expert at interviewing clients so that they get a full picture of the clients’ lives. The matchmaker is open-minded about all approaches towards therapy and sees the value and shortcomings of every modality. The matchmaker has extensive experience as a mental health practitioner. Finally, the matchmaker is enthusiastic about her clients developing a fruitful relationship with their therapist.
Workflow
The Therapy Match workflow has five basic parts: the consultation, the distillation, the search, the recommendations, and follow-up.
The consultation: The client pays a fee for a 30-minute phone appointment with the matchmaker. This is what therapists call an “intake” where clients describes themselves and the therapist skillfully collects data and asks for more detail in certain areas.
The distillation: The matchmaker distills the consultation information into a concise summary and determines what therapy approach would be most helpful for the client.
The search: The matchmaker begins an extensive search for mental health workers that they feel would be a good fit for the client, keeping in mind the best treatment approach, as well as factors like the client’s insurance information, cost limitations, and location.
The recommendations: The matchmaker assembles three good candidates for the client and goes over why they think each therapist could be helpful for the client and then leaves them to make the first call.
Follow-Up: The matchmaker contacts the client in one month to check if they have made any appointments and if they have begun seeing a recommended therapist. If the client has begun seeing a therapist, the matchmaker sends an anonymous feedback survey to the client and wishes them well. After that, there is a final call 6 months after the initial consultation to check if the client has started therapy and is satisfied. If the client has not begun a relationship or is otherwise dissatisfied, the therapist offers to do another paid consultation to see what barriers exist for the client and offer new recommendations.
User Testing – Clients
I showed this rough process to several people as potential clients. Taking their feedback, I found that the main issue was defining the role of the matchmaker. Who was this person and what were their abilities and limitations? People who were tested as potential clients were curious about the matchmaker’s qualifications to give recommendations. These testers also wanted the matchmaker to follow up with them and demonstrate commitment to finding them a good potential match. Rather than the matchmaker using their expert opinion to give three great recommendations and then stepping back, the client wanted her be a more involved presence who could be an advocate for them.
User Testing – Therapists
I also showed this rough process to potential therapists who would be contacted by the matchmaker and they were also interested in the matchmaker but expressed more hesitations about their role. At one point, I considered having the client choose a therapist from the recommended 3 and the matchmaker schedule the initial appointment, but while clients might like that, therapists felt that was too much handholding from the matchmaker and the client must demonstrate some willingness to engage in the process, even it’s just being willing to pick up the phone. Also, all therapists would like to consider themselves open to feedback and would hope that if the client is dissatisfied with their treatment, the client will bring it up with the therapist. Because of this, they were concerned that the matchmaker could become a second therapist or otherwise interfere with the therapy relationship. However, most clients know that it can be incredibly hard to be direct with therapist about being dissatisfied and they would like help from a compassionate advocate like the matchmaker to help them. To address this, I added a one-month follow up call and the ability to contact the matchmaker again after 6 months if they are dissatisfied with the therapist. If the client is dissatisfied, the matchmaker will first coach the client on how to bring up their dissatisfaction with the therapist. If the client is still dissatisfied, they can pay for another consultation and set of recommended therapists. To ensure trust, the matchmaker will never put conditions on the client that they must call a therapist or they must attend a certain amount of sessions in order for the matchmaker to be their advocate.
Key Insight
The key tension I saw was the role of “handholding.” In general, potential clients are intimidated by the barriers to therapy and would like significant interaction and coaching from the matchmaker to ensure they have a good fit with their therapist. Therapists would like to see clients be fully engaged in the process and imagine that they will empower each client to the point where they are fully comfortable with the therapist. So they fear the matchmaker as someone who will interfere with the client’s process. To address both of these needs, I designed the matchmaker to be both a trusted guide in the process who attends to vulnerable clients while making space for therapists to build their own relationship with the client.
