User Needs When Choosing a Therapist: A Research Study
My Role
This project was completed during a UX Research Methods class in the HCI Master of Science program at DePaul University. I made the following contributions to this project:
Recruited participants for observations, interviews and surveys
Wrote portions of observation protocol, interview script and survey questions
Conducted two remote observations and two remote interviews
Analyzed observation, interview and survey results through coding and affinity diagramming
Wrote the findings
Executive Summary
Many Americans struggle with mental health, yet the process of searching for a therapist is particularly challenging, especially for individuals that are in a desperate mental state.
We began this study by observing eight participants. We asked our participants to use the internet to search for a therapist for a loved one, compare options, and make an appointment. To observe the behavior, we used a Zoom video-call to host the study and had participants share their screen over a 30-50 minute observation session.
We identified the following three themes: (1) Tools - Participants used a variety of platforms to search; (2) Search criteria - Participants used similar keywords during the search process; (3) Size of result set - Participants struggled to narrow down options in a large pool of results. They also had difficulty understanding information provided to help differentiate providers.
Following the observation phase, we interviewed an additional eight participants who had previously searched for a therapist. The interview questions focused on user motivations, behaviors, and pain points in regards to finding a therapist.. We recorded the interview sessions, transcribed them, and coded each interview individually in Atlas.ti. We then assessed the codes and defined themes.
Major findings include:
Ensuring a therapist was in-network and covered by insurance was the main concern for individuals when selecting a therapist. This implied that the solution should clearly communicate insurance coverage for suggested providers.
Users use a wide range of search criteria to narrow down large result sets, including location, availability, demographics, and common ground. This implied that the solution should narrow down results using user-specified criteria.
Users found credentials to be unclear, This implied that the solution should provide education around qualifications using straightforward language,
Participants used various search methods, indicating there is no central location to find the information they need to make an informed decision on an appropriate therapist. This implied that the solution should be a single, consolidated platform.
Referrals and reviews were cited by participants as an important and useful source of information when looking for a therapist. This implied that the solution should include a ratings and review feature to allow users to communicate and share experiences.
Even once users found a therapist, most of them had ended a relationship because it wasn’t the “right fit”. This indicates that the solution should provide information about the therapist’s personality and approach prior to making an appointment.
Methods
We recruited participants for the observation and interview phase in two ways: (1) CDM/COMM Participant Pool for Research and (2) our personal networks. For the survey phase, we recruited participants with (1) CDM/COMM Participant Pool for Research and (2) distributed the survey link via our social networks and our personal networks. For both the observation and interview phases, we observed eight participants through Zoom meetings where they gave their verbal consent to allow audio and video recording.
A total of 34 participants completed the survey, of which 3 results were discarded, as they did not meet the survey participation criteria of having previously seen a therapist. We analyzed survey responses from 31 participants, with a median age of 30-39. Of the respondents, 42% were between the ages of 20-29. 74.2% of participants were female, 19.4% were male, 6.5% selected “Other” or “Prefer not to say”.
Data Collection
We began the observation and interview with an introduction and each participant verbally consented to an Informed Consent to be audio and video recorded.
During the observation phase, we asked participants to list three qualities they looked for when choosing a healthcare provider (“therapist”). We then explained our scenario-based observation activity. We asked participants to demonstrate how they would search for a mental healthcare professional online. Participants shared their screens so we could observe the activities they performed to complete the tasks. We recorded their actions and we took notes. After completing the observation activity, we asked participants to stop sharing their screens and wrapped up with questions about their observation experience. We asked participants to share what they found challenging about finding a mental healthcare provider. We also asked if they would have done anything differently if observed in person. Observations lasted for 30-50 minutes.
During the interview phase, we conducted eight remote interviews through video-calls, which each lasted 40-60 minutes. Each participant was briefed on the purpose of the interview and verbally consented to be audio and video recorded. Participants were then recorded while being asked questions about how they searched for a therapist, how they evaluated and selected therapists, and their challenges throughout the process. After participants completed the interviews, we asked follow-up and demographic questions, and asked if they had any questions for us.
For the survey phase, we used Qualtrics to develop and host our survey. We collected 34 total responses between May 29, 2020 and June 1, 2020, and determined that 31 of 34 were usable. Participants had to previously have attended at least one therapy session. Participants answered a series of questions focused on search methods, selection criteria, and challenges The survey ended with participants providing demographic information, including as age, gender, and household income.
Data Analysis
During the observation phase, we utilized the contextual inquiry framework to sort our findings and identified how participants completed the tasks. Additionally, we prepared an affinity diagram using Stormboard to identify the common patterns participants used to research and compare therapists.
For the interview phase, we transcribed all interviews and individually placed the transcripts into an Atlas.ti project. We then inductively coded the transcripts and created an affinity diagram using Stormboard to identify the similarities between the codes. We created personas and spectrums representing the most pervasive themes.
For the survey phase, we used Excel and R Studio to further analyze survey data around the importance of insurance when seeking a therapist.
Hypothesis: Participants with insurance find it more important that a therapist is covered by insurance than those without insurance.
Findings
We organized our findings from observations, interviews, and surveys into three categories that describe the variety of approaches in how participants searched, the criteria they searched by, and challenges they encountered in finding and selecting therapists: (1) Methods and Tools; (2) Criteria for Therapist Selection; and (3) Common Challenges.
Methods and Tools
Multiple sources
The majority (6 of 8) of interviewees said they referenced multiple sources during their search for a therapist. These included insurance provider websites, therapy focused websites, referrals from doctors and personal recommendations. They said that information was fragmented between sources and was time consuming to sort through and evaluate, especially when they were starting the process of finding a therapist for the first time. Maria mentioned that there was not a single source that provided all the information she needed to choose a therapist: “The deep dark black hole of searching for a healthcare provider on the internet...a hodgepodge combination of Google maps, Google reviews, attempting to navigate my insurance provider’s healthcare portal”.
Personal references and reviews
63% (5 of 8) of observation participants said they prefered a reference to a therapist from someone they knew. Celeste looked for therapists that were affiliated with familiar hospital networks or practitioners. Interview and survey participants also mentioned that they relied on guidance from personal contacts, doctor recommendations, and patient reviews to narrow their search for a therapist.
Half of interviewees (4 of 8) made appointments with therapists they discovered through friends, coworkers and acquaintances. 50% (4 of 8) visited therapists based on referrals from a healthcare provider. Half of interviewees (4 of 8) looked for patient reviews on therapists.
The survey identified the tools that were most beneficial to participants in their search for a therapist. A 5-point Likert scale (1=Not at all helpful, 5=Very helpful) was used to gauge the usefulness of specific tools in participants’ search for a therapist. 52% of respondents indicated that referrals from friends, family and doctors were helpful. Respondents indicated that referrals from family and friends were very helpful (8 of 31) and helpful (2 of 31), and 6 of 31 indicated that doctor referrals were very helpful.
Internet search
Observation and interview participants conducted their internet search for a therapist in diverse ways. 63% (5 of 8) of observation participants searched for a therapist by location. Two observation participants searched for information on how to find a therapist. Alyson utilized her insurance provider’s website to look for a therapist. All eight observation participants and 63% (5 of 8) of interviewees used Google searches to learn more about therapy types and specific therapists. Three of eight interviewees visited Psychology.com and PsychologyToday.com for information. Maria and Lisa mentioned referencing an online therapist directory from these websites. Survey results indicated that just 13% of survey participants found Google searches very helpful (3 of 31) or helpful (1 of 31).
Criteria for Therapist Selection
Interview and survey participants searched for a therapist for different reasons and had a unique set of characteristics and qualifications when making their selection. Insurance plans and costs, location, availability, specialties, experience and shared connections were important factors.
Participants used a variety of criteria to narrow their searches and compare multiple therapists, including names, photos, bios and specialties of therapists.
Availability
Availability of a therapist played a significant role in interview and survey participants' selection. Half (4 of 8) of interviewees were concerned with finding therapists who had flexible hours since they needed to prioritize their work and school schedules. Riley said, “A lot of times they have normal work hours and if you don't work for a company where your schedule is flexible, it can be really hard to schedule appointments”. 74% of survey respondents said appointment times that fit their schedules were very important (16 of 31) or important (7 of 31).
Half (4 of 8) of interviewees indicated there was a sense of urgency in finding a therapist. Appointment availability was considered urgent when participants were in a compromised mental state and felt they could not wait for an extended period of time before their first therapy appointment. Carly recalled, “I was just so desperate and I needed help immediately. That was really important...if there was a really good recommended therapist but the wait was a month and a half, I wouldn't have gone to them”. Survey results supported this need. 52% of respondents said how soon they could meet with a therapist was a very important (7 of 31) or important (9 of 31) factor in their selection.
Location
Location was a key factor in selecting a therapist for interview and survey participants. The majority (7 of 8) of interview participants said location was a deciding factor in their selection. They looked for therapists near their homes, workplaces or schools. 68% of survey respondents said location was very important (9 of 31) or important (12 of 31).
Connection
Interviewees sought common ground with their therapists, to help them build connections, and create a safe space for sharing personal information. Specific qualities differed based on each participants’ goals, which could be categorized into seeking assistance with a specific psychological condition or a major life event. The majority (7 of 8) of observation participants and most (7 of 8) interview participants were female and searched for female therapists, indicating a potential gender preference. Riley said, “I just feel a lot more comfortable talking to women than I do men. So one of my primary goals was just making sure that I had a female rather than a male therapist”. Hannah and Lisa searched for therapists who were the same race as them. Riley and Maria searched for young therapists, close to their ages.
Survey responses supported interview participants’ need for making a connection with their therapist. 65% of respondents indicated that therapeutic style was very important (17 of 31) or important (3 of 31).
Insurance
Insurance was a prevalent factor in the therapist search for observation, interview and survey participants. The majority (7 of 8) of observation participants and most (7 of 8) interview participants identified the importance of finding a therapist who accepted their insurance plan. The focus on insurance led 3 of 8 participants to search for therapists directly on insurance company websites. Two participants (Tom and Riley) mentioned the importance of insurance providers from a cost perspective. Valerie said the presence of familiar insurance carriers added “validation to therapy websites”. 5 of 8 interviewees utilized their insurance provider websites specifically to look for in-network therapists. Hannah said, “If they aren't covered at all and their cost is not something I can do, then I'm going to take them off my list. So I initially go to insurance and find out what's covered first”. Half of interviewees (4 of 8) said they left a therapist because their insurance or Employee Assistance Program benefits were no longer accepted.
A 5-point Likert scale (1=Not at all important, 5=Very important) was used to gauge the importance of insurance in participants’ selection of a therapist. The results showed that 63% of respondents considered covered by insurance as very important (15 of 31) or important (4 of 31). 61% of respondents (19 of 31) confirmed that the last therapist they saw accepted their insurance.
We assessed the perceived importance of insurance by taking the scores of a 5-point LIkert scale (1=Not at all important, 5=Very important) as the dependent variable of a Mann-Whitney U test. Our grouping variables were survey participants whose last therapy appointment was covered by insurance (n=20) and participants whose last appointment was not covered by insurance (n=5). There was no significant difference in the perceived importance of insurance between the two groups at the alpha level 0.5 (u(23) = 74.5, Z = 1.71 , p = 0.088). The mean ranks of individuals with and without insurance coverage was 11.78 and 17.9 respectively. This does indicate statistical significance.
Credentials and specialties
Observation participants and interviewees compared therapist credentials and specialties. Half (4 of 8) of observation participants looked at years of experience and educational backgrounds of therapists. They examined schools that therapists attended, specific degrees and academic distinctions. All eight participants searched for bios to learn more about the therapists they found, which included information about the types of patients treated, and areas of specialty. Half (4 of 8) interviewees sought out therapists with specific specialties, such as treatment for depression and anxiety or experience with specialized groups like families and LGBT individuals. 55% of respondents indicated that credentials were very important (6 of 31) or important (11 of 31).
Common Challenges
Participants experienced three primary challenges in their searches. These included uncertainty in how to narrow down and analyze the large quantities of information about therapists scattered across sources, difficulty locating the specific information they were searching for, and deciding if a therapist was the right fit.
Some information is hard to judge online
Even when observation and interview participants could find basic contact, insurance, cost and appointment information for a therapist, the available information did not help them understand therapists’ personalities and communication styles. Observation participant Valerie mentioned, “There are just certain things that you can’t really tell online, like trustworthiness and bedside manner”. Half (4 of 8) of interviewees said information about personality and therapeutic approach were necessary to give them an idea if they would connect with a therapist or not. These interviewees acknowledged that getting a feel for these qualities before meeting them a therapist in person was challenging, since this type of information was often unavailable or did not translate online. Lisa explained, “It's hard to decide on a therapist until you've met them face to face and yeah, just get an idea of who they are, what they're like, their communication style”.
When asked how confident they were that the last therapist they chose would be a good fit for their needs, 42% of survey respondents indicated they were very confident (10 of 31) or confident (3 of 31), though 61% of respondents said knowing whether or not a therapist would be a good fit was very challenging (14 of 31) or challenging (5 of 31).
Finding the right fit
Observation and Interview participants mentioned that they were looking for therapists whose approach and personalities would compliment their own, and help them achieve their therapy goals. Dee explained, “What do you expect out of this? You need to have an answer for that because that's when you're going to find out what kind of therapist you have”. Half (4 of 8) of interviewees said they needed to feel comfortable speaking openly and feel that they were in a safe space with their therapist. Connecting with a therapist through common backgrounds and interests gave participants more confidence that they could build a relationship with that therapist. 3 of 8 interviewees mentioned they were looking for therapists to hold them accountable, and take the lead in sessions.
Half (4 of 8) of interviewees said they were dissatisfied with their therapist’s communication or therapy style, and left to search for one that better matched their needs. They sought out therapists who were more attentive, provided motivational tools and implemented their preferred communication styles. Maria mentioned that even when she knew a therapist was the wrong fit, she struggled to decide if finding a new therapist was worth the effort: “It's like one, you have to make the conclusion that this probably isn't the right match for me. But then also the search process is so daunting that it's like, well, is it bad enough that I want to go back into that process?”
Switching therapists was common practice amongst interview and survey participants. The majority (6 of 8) of interviewees said they switched therapists because they were not the right fit. Four of eight interviewees said they thought trying multiple therapists before finding one they connected with was a natural part of finding the right therapist. Hannah said, “It's not an exact science, so finding someone is a puzzle...it's a process and sometimes that process can be because you start trying different people”.
Survey results indicated that 58% (18 of 31) of participants had switched therapists at some point. A 5-point Likert scale (1=Not at all important, 5=Very important) was used to gauge which factors were most influential in a participant’s decision to leave a therapist. 39% of respondents said a therapist who was not a good personality fit was a very important (8 of 31) or important (4 of 31) reason for leaving. This tied as the highest ranking reason for ending a relationship with a therapist, along with no longer needing a therapist. When asked how challenging it was for respondents to end a relationship with a therapist, 58% of respondents indicated that this was very easy (13 of 31) or easy (5 of 31). 81% of survey participants (25 of 31) said they ended a therapeutic relationship that was not a good fit.
Information in many different places
Searching for a therapist yielded a large number of results for observation and interview participants to sort through. 3 of 8 observation participants struggled to choose search terms that produced the results they were expecting and entered various terms until they found the information they were looking for. The educational degrees and certifications of therapists were confusing for observation participants Celeste and Valerie, who were unsure where to find clarification of how these aligned with specialties. Celeste said more information about this would help narrow her search.
The amount of information about therapists was overwhelming for some interviewees, especially those who were searching for a therapist for the first time. 3 of 8 participants mentioned that it was challenging to know where to begin their search for a therapist. Maria and Lisa said there was so much available information across multiple sources, that it was difficult to review. 3 of 8 interviewees, including Lisa, mentioned that their compromised mental state made the search process even more challenging, “When you're really in that depressed state, it's hard to do even the smallest things”. Similarly, survey results indicated that 32% of respondents found it very challenging (1 of 31) or challenging (9 of 31) to sort through and compare information from multiple sources.
In some cases, participants searched for more specific or personal information about therapists that was not readily available. The majority (6 of 8) of observation participants struggled to locate specific information they were looking for, which included therapist directories, specialties, therapist photos and customer reviews. When participants searched for reviews, they were often difficult to find or not from sources they considered credible.
Summary of Findings
Selecting a therapist is an extremely personal experience based on the specific needs of each participant. Participants took different approaches to searching for therapists, but focused primarily on online searches and personal references. They narrowed their searches based on insurance, location, therapist availability, and therapeutic and communication style of therapists. Even when participants selected therapists who met their search criteria, they found it difficult to know if they would have the type of connection they were seeking with a therapist before meeting them. If patients did not think that their therapist was a good match, they often continued their search for a better fit.
Profiles
To help us understand the goals and pain points that potential users might face when searching for a therapist, we created three personas that exemplify how they would interact with our product to search for and select a therapist.
Feature Matrix
Limitations and Future Work
Our observations, interviews and surveys had several limitations that included a small sample size and female majority. Our sample size consisted of eight people in both the observation and interview phases and 31 survey participants. The majority (38 of the 47) of our participants were female. Our observations and interviews were conducted remotely (through video-call), which limited what we could observe. Also, in our observations, our scenario-based protocol in which participants searched for a therapist for a loved one, potentially added a layer of abstraction. There may be differences in how participants searched for someone else, versus how they would search for themselves.
For future endeavors, we plan to conduct diary studies, recruit a more sexually and fiscally diverse set of participants, and explore how couples searching for a relationship therapist may behave differently than users seeking treatment for themselves.