How To Find a Good Therapist in Roanoke, Virginia
There are a lot of bad therapists out there, and I want to help you to avoid wasting your time and money. I have had numerous clients tell me horror stories about their past bad experiences with therapy. Some of these experiences have been so atrocious that I was honestly surprised they were even willing to try again!
If you aren’t very experienced with therapy, or if you’ve never had a good experience, you might not know what to look for. My name is Adrien Monti. I have been a licensed therapist in Roanoke, Virginia, since 2008, and I’m going to offer you some tips.
First, I want to help you identify some RED FLAGS you might encounter if you’re with the WRONG mental health professional so you can get the heck out of there.
Second, I’m going to tell you what to look for in a CARING AND COMPETENT therapist / counselor.
Finally, I’m going to give you some suggestions on how to get started on your therapy journey.
Red Flags
Your session time is for you. Therapy is a safe space to focus on your thoughts, feelings, concerns, and goals. YOU should always be the focus. It’s okay for your therapist to tell you a little bit about themselves to break the ice or make a connection, but they should NOT talk about themselves at length. They especially should NEVER tell you their problems! They absolutely should never complain to you about any aspect of their job. If you find yourself listening even half as much as you are talking, consider moving on.
Your counselor should never push their religious or political beliefs on you. It’s okay if they let you know where they stand, but religion or politics should only come up if YOU bring it up. You should feel supported in exploring and expressing your perspective, and you should NOT feel like the therapist’s views are being pushed on you.
Your therapist should be professional. If he or she regularly cancels sessions, cuts sessions short, or is distracted or not paying attention, you’re not going to have a good experience. A little chatting is okay, but if it feels like the two of you are gossiping or just shooting the breeze for a long period of time, this is a waste of your session. If your therapist seems to be getting away with things you could never get away with in your job, that’s a bad sign!
Finally (and these are not only red flags, but should be reported to a regulatory board if they occur), your therapist MUST maintain your confidentiality. This is the law. And most important of all, your therapist should NEVER EVER hit on you!!!
Green Flags
It might take a little time to relax and build trust, but ideally you will feel some sense of ease and comfort in your counselor’s presence by the end of the first session. You should feel a sense of confidence that they are comfortable with whatever you share, that they are a competent adult with good judgment and wisdom.
Some therapists are fairly directive, offering recommendations and homework assignments. Others are more relaxed and let you take the lead. Either approach is okay, and you’ll want to consider what works best for you. Feel free to share what you prefer. A true professional will take your feedback, and answer honestly if they can deliver what you’re looking for.
It’s important that you come to sessions with some idea of what you want to talk about and what you hope to get out of the process. That being said, a skilled therapist will help you make connections you haven’t made on your own. You probably understand on an intellectual level what you need to do to make your life better, and maybe you even have friends and family you can talk with about your problems. Therapy should help you get BENEATH THE SURFACE and out of the cycle of thinking the same thoughts but not making any changes. Your therapist is here to help you access deeper emotions and get out of your head, if that’s something you’re looking for.
Most people come to therapy not only because they want to address specific symptoms (like depression, anxiety, low self-esteem, or body image issues) but because they want to feel more satisfied in life. A good counselor will focus not only on your trauma, but on your successes and where you’re already kicking ass. Therapy can have painful moments, but when it goes well, you’ll feel good about what you’re accomplishing.
Finally, I think you really need to LIKE your therapist. You might be able to dislike your doctor and still get the medication you need, but it’s hard to truly open up to a therapist you don’t care for. Part of therapy comes down to chemistry. A therapist can be competent, professional, highly skilled, and extensively trained, but if you don’t click with them, that’s okay! You are the customer and you can move on to someone who will be a better fit for you.
But Where ARE These Awesome Therapists???
If you feel comfortable asking friends for recommendations, this is a good place to start. You can also ask other professionals in your life, like your doctor. The Psychology Today website is a great place to browse a lot of profiles. You can filter for your insurance type as well as various specialties.
If you’re looking for a particular specialty, you can google this and peruse the websites that come up. For example, people most often find me by searching “couples therapy Roanoke, VA” or “sex therapy, Roanoke VA” because these are my specialty areas. Often the first page or two of a google search is full of sponsored ads. Keep scrolling! The huge tech companies often pay their therapists very little, offer only telehealth, and you might not get the same quality as you will if you choose someone practicing independently or someone who is part of a small local agency.
Using Insurance
If you have Medicaid, your options will be more limited. You might need to choose a pre-licensed professional, which is someone under the supervision of a licensed person. This is not necessarily a bad thing. They have already completed a master’s degree, and they might have a lot of enthusiasm, being newer to the field. Sometimes you can find someone who worked in the field for years before going back for a master’s degree later in life, and actually has a lot of training and experience. Be aware that a pre-licensed professional cannot accept commercial insurance.
If you have commercial insurance, you will have a lot of options. Beware of mental health professionals who claim to do everything. If someone suggests they specialize in every condition under the sun, they might not have the in-depth training you need if you are looking to address a specific problem. Look for someone who not only checks a box on their profile, but actually mentions your issue in what they write about their experience and interests.
Is Private Pay Worth It?
If you are coming to therapy with a fairly common concern (anxiety, depression, self-esteem, life transition issues), you will almost definitely be able to find a professional who accepts your insurance. Take advantage of this! You pay a lot of money for your premiums and you should make use of your health insurance benefits.
If you have tried therapy through insurance and weren’t satisfied, or if you have something very specific you need help addressing, a private pay therapist can absolutely be worth it. For example, I am a certified sex therapist and I am very aware that most therapists get NO training on sex. I used to be one of them! Seriously, I finished my master’s degree and got my therapy license without having had a single class on human sexuality. If someone came to me wanting help with erectile dysfunction, porn addiction, difficulty with orgasm, or desire discrepancy in their relationship, I would have been clueless! It is only because I completed an extensive training and certification program in 2024 that I feel highly competent to assist my clients with a wide range of sexual concerns.
Because I have spent SO much time and money on specialized advanced training, and because some sexual issues aren’t covered by insurance anyway, my services are exclusively private pay. This also gives the advantage of total privacy if you don’t want your insurance company to have a diagnosis on record (that’s right, to bill insurance for therapy, the therapist MUST give you a documented diagnosis).
With the right therapist, depending on the length and severity of your struggles, you might be able to make progress in just a few sessions. When this is the case, it is DEFINITELY worth it to pay out of pocket rather than to spend time with a therapist who is judgmental, clueless, or just plain inexperienced about your specific issue.
Couples Therapy Versus Individual Therapy
If your main concern is your relationship, I recommend seeking out couples therapy from the start. Most therapists won’t transition from one to the other. For example, your personal therapist probably won’t start providing couples therapy to you and your partner, because he or she already knows you and won’t be able to be objective. Your partner would probably worry that the therapist would take your side, and this isn’t conducive to a good therapeutic relationship.
Couples therapists are harder to find in Roanoke than individual therapists. DON’T see someone for couples therapy who is not specifically trained and experienced in couples therapy / couples counseling, relationship therapy / marriage counseling (all terms that might be used interchangeably). Trust me, working with couples is a VERY specific skill set! I was terrible at it until I got LOTS of couples therapy training. If couples therapy is what you’re looking for, make sure this is an area of focus for your prospective therapist (not just a box checked on a profile, but something they talk about in detail).
Be prepared to consider paying out of pocket for couples therapy. Believe it or not, insurance companies reimburse therapists LESS for couples therapy (even though it requires more work and more training). For this reason, many couples therapists do not accept insurance.
When considering whether it is worth it to pay out of pocket for relationship therapy, I recommend envisioning how your life might be better or different if your relationship was more harmonious. I also recommend picturing how your life might change if your relationship doesn’t last. Couples therapy is often relatively short term in nature (six months to one year), so the time and money investment might be quite manageable. The end of a relationship on the other hand, especially if this means divorce, can be VERY expensive. As you weigh the pros and cons, you might conclude that it is worth paying for specialized, expert help for the good of your relationship.
In Person in Roanoke, or Telehealth?
Either option can work! I personally prefer to meet with clients in person if they are in the Roanoke area. It's wonderful to sit down in a cozy, comfortable office with no distractions and fully focus on YOU. Going to a therapist’s office can feel like a little vacation from the real world.
The advantage of telehealth is that you can connect with specialists who don’t live in near Roanoke. For example, I’m licensed to see clients who live anywhere in Virginia. I am one of less than 30 AASECT certified sex therapists in the state, so people can access me online who don’t have a certified sex therapist in their area.
Online therapy works great as long as you have a private comfortable space free of distractions and a strong internet connection.
Whether you meet in person in Roanoke or online, I HIGHLY recommend that you make sure you will not be disturbed! Your therapy time is too important for interruptions. Silence your devices, take off your smart watch, and make sure you cannot be overheard. You DESERVE to focus on YOURSELF!
Getting Started
I recommend emailing several therapists who meet your criteria. Sadly, only some will get back to you, so it’s good to cast a wide net. Emailing can be better than calling because mental health professionals spend a lot of time in sessions and have limited availability to answer the phone. I suggest sharing your name, age, insurance type, scheduling needs, and a VERY brief description of your issue (such as, “affair recovery” or “navigating an open relationship”).
Once a counselor gets back to you, you can ask if they offer a free consultation. If so, I recommend taking advantage of this option. A free consultation is NOT therapy, so you won’t do a deep dive into your issues. Think of it more as a meet and greet and a chemistry check. A free consultation can be a good way to get a sense of whether you feel comfortable with new person. You’ll probably have the option to book a first session during the free consultation, but if you’re on the fence, feel free to think it over and get back to them. You might find it useful to participate in a free consultation with more than one professional.
Once you have a first session scheduled (also called an intake session), you’ll probably be asked to complete some paperwork in advance. Make sure to do this! Your therapist needs you to sign off on consent forms and provide some information up front so they can be well prepared for your first session.
Determining Compatibility
Can you be sure after a first session if you’re a good fit to work together? I don’t think so. Or rather, I think you can know right away if you are NOT a fit, but it can take a little longer to see if things are going to work out. After a first session, you should feel like the therapist is interested in your issues and wants to help you, as though the therapist is capable of understanding you (even if they don’t fully understand yet), and ideally, you should come away with a sense of hope that therapy will be helpful to you. If you feel at all judged, dismissed, or looked down upon, this is NOT the therapist for you. Be wary of anyone who gives aggressive or pushy advice in a first session. Ideally they will take time to get to know you before making strong recommendations.
The therapy setting can be confusing, because the therapist is the expert, with years of training and experience, but YOU are the customer! Only you can truly know what feels right for you, and even an amazing therapist can’t read your mind.
In my experience, it takes three or four sessions for both the counselor and client to really get a feel for the work together and to have a good plan in place. If at any point you aren’t feeling good about the sessions or the fit, feel free to speak up and explain what isn’t going well and what you would prefer. Sometimes this will make a world of difference and you’ll get on the same page. Other times, this will reveal that you might do better to find another therapist.
Breaking Up With Your Therapist
First off, don’t feel guilty if you have to give us the boot! I assure you, we can handle it. We get a lot of training in school that the old cliché, “It’s not you, it’s me,” is true when someone fires us. We simply can’t be the perfect therapist for everyone and we won’t take it personally!
The number one way that clients break up with me is to ghost me, and being ghosted is a bummer.
I LOVE it when a client actually tells me that they want to take a break or quit therapy, or even that they have found a new therapist who can help them more effectively. I truly appreciate the opportunity to review the work we have done together, identify the progress my client has made, and wish them all the best in their next chapter! A healthy good-bye can be truly satisfying.
Conclusion
I hope this was helpful! Please contact me if I can answer any questions or offer additional guidance. Let me know if you’d like to schedule a free consultation for sex therapy or couples therapy in person in Roanoke, Virginia or online anywhere in Virginia.