An effective therapist would develop a clear treatment plan with you that aims to meet objectively measurable goals within a certain time frame.

This is a great point and true for non-therapists as well. A good measure of whether or not someone helping you is providing you value is if you are progressively improving in measurable ways.

True for doctors, meds, physical therapists, coaches, you name it

This is very accurate. I worked 5 years in a BH Insurance company. We saw shitty providers all the time, and we were constantly having to play the game of deciding how much we (and our members) could tolerate before cutting the providers out of the network. Cutting too many providers doesn't correct bad actors or replace providers for people who need them and can cause backlogs if other providers aren't available to take on their patients.

The only thing we were able to do to correct many providers by changing their pay to a value based model, so providers would get paid more for better outcomes (and sometimes only paid when patients improve). It would increase pay a lot over standard rates. But providers fought that big time. They just wanted to do things their way and cash a check of a set amount with little or no oversight.

Better help is used by providers as a way to supplement their income, and they typically pay a bit less than conventional appointments because of the digital channels. However, Ive heard they have some issues with data security on their platform and their matching system is pretty flawed due to their network being somewhat ephemeral.

If you do want to seek therapy, remember you have multiple ways to get it covered. Your health insurance probably has some coverage, and your employer (in the US) likely has an EAP program which will have coverage for therapy for at least a few sessions (typically 3-12) sessions. It's worth looking into that before paying out of pocket.

One example that comes to mind is Better Help

During the pandemic, this company was heavily advertised across Twitch. Not surprised they pay shit wages. Wonder if they originally paid 2-3X market rate during the hype, but slowly clawed back the teaser rates in favor of the dog shit rates.

I have lifelong major depression, and got myself integrated into the mental health system of San Francisco (one of the better municipal systems available in the States). Since my insurance was government or state, it typically meant that I'd see interns for a year before they graduated and started their own practice. A friend of mine and I would joke that we were trainers in that our life drama was severe enough to convey to our trainees that life shit is real and that sometimes there are real risks (suicide, stalkers, toxic violent parents, etc.) but we personally were not likely to become a danger to ourselves or others short of natural disasters.

I also got to crush egos because it's not like the movies where the patient has a good cry and then is better. I've done a lot of crying and I'm still depressed as ever (more so as the world is literally burning, which limits my hope for a better future). I can manage my symptoms more or less, but I'm never going to be a happy self-sustaining good little citizen. And curiously, some of them see that as an end goal: You get Will Hunting to have a good cry and he's fixed. Not so much.

I eventually got lucky, and was able to find one of my old interns and resume with her while she was working on her PHD. I was a case in her thesis and got an ASD diagnosis out of it in my late forties (it's not helpful yet for navigating benefits, but is useful regarding directing my own symptom management). But most of my career as a patient is spending more than half a year getting my therapist familiar with my case and then the remaining months squeezing a bit of process out of it...

...Or just goofing off, since I absolutely have personal demons that don't want to be closely scrutinized, so it becomes too tempting to let my therapist get distracted by details that are entertaining to them. (My history in the BDSM and my burgeoning queerness are fun topics, as are my awareness of issues like the climate crisis, the plastic crisis, the police state, the surveillance state, the transnational white power movement and its uprising and takeover -- all of which were still commonly regarded as conspiracy theories / fringe hypotheses when I was in session.) Sometimes, we patients are so terrified of what our closeted shit says about us that we're not ready to open those doors. And sometimes the therapist doesn't want to look either, so we negotiate a diversion we can agree to distract us until later.

I stopped going to therapy shortly before the COVID-19 epidemic outbreak and lockdown so I get to start all over again in Sacramento. Hopefully, I'll find a permanent therapist (and a good match) early, but I suspect I'll be back to seeing interns again.

You nailed it. 💯

This is why I hate that "get therapy" has become a common meme. Most therapy is a scam in the US.