Therapy is the best. We’re feel strongly about that. Now that I’ve found a therapist I like, I go once per week for an hour.

But that’s the catch—you have to find a therapist and make an appointment first. That can be really hard.

There aren’t enough counselors to treat every patient

As of 2017, nationwide, there are only enough psychiatrists to treat 30.52 percent of the population. In Washington, only 21 percent of people who need psychiatric care would be able to see a psychiatrist.

Of course, that doesn’t give you the full picture. After all, psychiatrists are regular doctors—MDs—who are also fully trained mental health practitioners. They’re medical specialists in the same way as a cardiologist. Under ideal circumstances, a patient will see a psychiatrist a few times at the beginning of their treatment, and intermittently afterward.

The psychiatrist assess your condition and recommend a course of treatment, which is usually a combination of talk therapy and psychiatric drugs. The mental health care provider patients work with most often is their therapist, who is usually a psychologist, social worker, or licensed mental health counselor.

There aren’t enough of those people, either, especially not in rural areas. One in five people in the United States have a mental illness, but there just aren’t enough providers to treat people. King County has more mental health providers (this includes psychologists, counselors etc.) than any other county in Washington, but the ratio of providers to King County residents is 290:1. (That’s way better than the national average, by the way.)

There’s just no way for everyone who needs mental health treatment to get it: 60 percent of people who need mental health care don’t. And, of course, it’s especially hard for people of color and poor people to get mental health care.

How to find a therapist

Many insurance policies don’t cover therapy, which is the most essential element of mental health care. That’s especially true of the bare-bones policies that many of us buy from ACA exchanges.

Also, plenty of providers aren’t in the network for cheap insurance—if they accept insurance at all. I’ve been treated by a number of providers who have put the onus on me to get reimbursed. Which may or may not happen, since most policies will only pay for an in-network counselor.

Speaking of which: it’s hard to find a counselor you want to work with. Therapy is a relationship that will, ideally, last for a long time. You need to find someone you trust and have rapport with. Otherwise, you’re not going to be frank with them—which is the whole point. You have to want to tell your therapist about your problems for therapy to work.

There are also logistical concerns. If you want to have weekly or biweekly therapy, you need to have a therapist who works during your free time, and is in a location you can get to. I worked with a wonderful therapist for a long time, but I eventually had to find a different counselor, because her office was a two hour round trip from my work and home. I couldn’t afford to give up three weekday hours, including the session, every week.

And there’s scarcity: pretty much every counselor has a full caseload, due to the shortage of people in the profession. Ideally, you’ll have the same time slot for therapy every week, but some counselors might not be able to make that happen. You could wait a while to work with a therapist who you like.

It can take a while to find a therapist who you like, who has the time to talk to you, and you can get to on a regular basis. That’s hard work in the best of circumstances. If you’re deeply depressed, anxious, or otherwise in bad shape, shopping for a therapist is daunting. The effort to get treatment, in a system that’s rigged against you, is really, really hard if you’re already having trouble just getting out of bed, eating, and grooming yourself.

It’s hard for me to stay in therapy—and I really want to be there

If I’m in therapy, I am a healthier and better person. I’ve had a hell of a time staying in it this year, though.

In March, I was laid off, which meant I lost my solid, above average insurance. I had to sign up for the cheapest insurance I could find on the exchange. My therapist didn’t take that insurance, so I was cut adrift at the time when I needed to go to therapy the most, having all sorts of depression and anxiety from, you know, being unemployed all of a sudden. It was brutal.

My wife was able to get me onto her insurance at her new job a while later. But I had to find a new counselor anyway: my old therapist was an hour away from the rest of my life, and she switched her billing to reimbursement only. I had to start over on a year’s worth of treatment.

So it was back to the shopping stage. It took me two months to find a therapist I liked, and another three weeks for him to find time in his schedule to see me on a regular basis. Plus, we’re starting from scratch. I’m starting therapy over, in a sense.

But I still count myself lucky. For one, I work remotely, which means I can set my own schedule and go see my therapist in the middle of the day. I don’t need to make excuses to my boss, or find a babysitter, or find the rare provider who does sessions on weekends. It’s no problem for me to do therapy every Wednesday at 2:30 and work a little bit later into the evening. Most people don’t have those advantages.

I also have excellent private health insurance through my wife’s job. If you’re on Medicaid/Apple Health, you need to jump through all sorts of bureaucratic hoops to qualify for regularly scheduled therapy. And, if you’re on Medicaid, you don’t need me to tell you that the providers who take Medicaid are overworked: if you try to get into therapy on Medicaid, you’re going to have to wait. And you probably won’t get to shop around and find the therapist who will help you the most.

In short: if you need therapy, I hope you can get it. It really does help. Living with depression, PTSD, anxiety, and the rest is really hard. Even with professional help, it takes dedication and determination to manage any of those conditions.

The trouble is, it can take the same grit to get care in the first place. I don’t want to discourage you from getting help if you need it. But don’t discourage yourself, either. Getting to the therapist’s couch is hard, and it’s not your fault if you can’t get there right away.

Stick with it. I’m rooting for you.