Reliable information for your brain, about your brain

Sometimes the biggest hurdle to starting therapy is figuring out how to begin. And if you’re feeling particularly bad, the thought of finding a therapist can seem overwhelming.

If you want to keep it simple, go to the section, “Where to Look.” If you want to be an educated consumer, read on.

Index of topics:

Why do you want to start therapy?
Understand what is involved
Therapist qualifications
Licensed or not?
Therapist orientation
Where to look
Specialties and skills
Next steps

Why do you want to start therapy?

It is important to be clear about your reasons for starting therapy. Not only will the therapist ask you this question, it will help you select a therapist who has the skills to help you. Here are some typical reasons for starting therapy; however, you may have a combination of these:

  • you are feeling distressed and your distress is interfering with your daily life;
  • you are having relationship problems;
  • you have been engaging in some kind of self-destructive or harmful behavior;
  • you want to start or stop a new habit, or
  • you want to understand yourself and the reasons you behave and the way you do.
  • you want to figure out your life direction

Most therapists allot a certain amount of time (10-20 minutes, typically, and at no charge) to talk to potential clients over the phone. You’ll want to tell him or her the specifics about why you’re seeking therapy. For example, it’s okay to tell the therapist that you think you may be depressed, but even better to also say why: I’m having a hard time getting motivated to get out of bed in the morning and feel totally overwhelmed by simple tasks. It’s also a good idea to include your reason for calling now: it got to the point where my boyfriend said he was going to break up with me if I didn’t pull things together. And if it’s urgent, please let him or her know: I’ve been having thoughts of killing myself. There’s no need to go into all of the details of your situation. The therapist will ask you what he or she needs to know and it’s a good idea to leave enough time to ask the therapist questions as well (more on this in the next blog post).

Understand what is involved in therapy

Before you make the first call, ask yourself how committed you are to the therapeutic process. Is this a change you want to make, or are you doing it because someone else thinks you should? Good therapy is not something that is done to you; rather, in order to make real, lasting changes, you will need to take responsibility for your mental health and you need to be motivated. It can be hard work. It may bring up painful aspects of your past or present and for some, things may get worse before they improve. Although there are some circumstances when a person’s environment is the major contributor to the problem (such as in cases of child abuse or discrimination), it is important that you be willing to look at some not-so-pretty aspects of yourself and how you are contributing to the problem. By doing so, your chances of improving your life will be better. As a practical consideration, you will be investing a significant amount of time and money into this process, so make sure you’re ready to do the work.

Therapist Qualifications

There are many types of degrees that a therapist may hold. Here are a few of the ones I often see:

LPCs (Licensed Professional Counselor), LCSWs (Licensed Clinical Social Worker) and LMFTs (Licensed Marriage and Family Therapist) are common designations. If there is no “L”, it probably means they’re not licensed. These therapists have completed a Master’s degree, have supervised training, and have passed licensing exams. They typically focus on problems with the family and other mental health problems. Professionals with these degrees typically charge less for their services and, in my opinion, are often very good at what they do.

Most therapists with doctorates are called Psychologists and have either a PsyD or a PhD. They typically have at least two more years of course work than those with Master’s degrees as well as more hours of supervised, clinical training. Many psychologists conduct psychological testing but may not prescribe medication in most states. (If you are looking for a prescriber, you will likely need someone with a medical degree, such as a psychiatrist or a psychiatric nurse practitioner.) Psychologists with a PsyD have been trained in “applied work;” they have been trained, first and foremost, as therapists. In PhD programs, student are also required to research and write a dissertation which needs to be a unique contribution to the field of psychology. Although many PhD programs train their students to be practicing therapists (such as my program), others emphasize research over practice.

A psychologist resident (as in my case) has graduated with a doctorate. She is working toward licensure by meeting weekly with a supervisor to talk about her clients’ cases, discuss ethics and law, and sometimes learn new skills. She must also take licensing exams. Although psychologist residents (called post-docs in some states) are not yet licensed, the state board of psychologist examiners has several requirements: they must have their degree from an accredited institution, have a contract with their supervisor, follow the ethical standards that all licensed psychologists must follow, and much more. As a bonus to you, they typically charge lower fees than those who are licensed and often have sliding fee scales.  Also, you have the advantage of having two professionals who are looking out for you and making sure you are getting a high level of care.

Don’t discount junior therapists! They often are very motivated and enthusiastic about helping their clients and they have the training behind them to be helpful. If they have the qualifications you’re looking for, they are worthy of an interview, at least. You may find that they are a good match for you and your needs.

See Psychology Today’s description of credentials. The list is lengthy: http://therapists.psychologytoday.com/rms/content/therapy_credentials.html

Licensed or not?

A license is not a guarantee of competence, but it does offer some reassurance that the therapist has been appropriately educated and is bound by the state to practice ethically.

Therapist Orientation

A therapist’s theoretical orientation dictates how he or she will go about helping you reach your goals. If you see the phrase, “evidence based practice,” that’s a good sign.; it means that the therapist uses techniques that research has shown to be effective. It is a standard that all therapists should use. I recommend that you stay away from unproven, pseudo-scientific approaches, such as past-life regression, rebirthing, etc. I will write in more detail about different theoretical perspectives in future posts.

Some of the most common orientations include psychodynamic/psychoanalytic; cognitive-behavioral (CBT); family systems; and eclectic. The kind of therapy that a therapist does can make a big difference in your experience.  It’s also important to know that while certain approaches have been endorsed by various psychological organizations as being most helpful for certain conditions, overall, the research says that one orientation is not more effective than another. Rather, what is most important is that you and your therapist have a strong working relationship. It’s also good to know that there is wide variability within each style, with some staying close to the original theories and techniques while many others incorporate bits of other orientations to supplement the therapy as they see fit.

Psychodynamic/psychoanalytic: If you want to understand the root cause of your problem, believe that examining your past can help you understand your problems, and value self-exploration, then this approach may work well for you. The dynamics of the relationship between the therapist and the client is an important focus of the work. You can expect the process be on the longer end of the time spectrum. Object-relations is a common variation of this approach.

Cognitive-Behavioral Therapy (CBT): CBT is focused on the “here and now.” While most CBT therapists will ask you about your past, the focus of the therapy is on helping you fix the problem rather than on understanding how it started. The therapist will help you examine your behavior and thinking patterns and teach you healthy, adaptive skills. Homework is often given between sessions. Insurance companies often like CBT because it is shorter term and research has shown that it is often effective. Mindfulness and Exposure Therapy are common variations of CBT.

Family Systems: This approach can be useful for individuals, but typically it is more productive to have more than one family member in session together. The therapist looks at systemic issues that maintain the problem and emphasizes how each person and his or her role in the family impacts everyone else.

Eclectic or Integrated: This designation essentially means that the therapist does not subscribe to a particular theory, but uses a combination of theories and techniques. Some therapists snub their noses at those who practice this way and truthfully, if the therapist is not very experienced, eclectic may be another name for confused. Still, there are plenty of good therapists who call themselves Eclectic. Be sure to interview all therapists before hand and don’t be afraid to ask how he or she would approach your case, and how soon would he or she expect you to improve? I’ll talk more about interviewing therapists in the next post.

Specialties and skills

In addition to a therapist’s degree(s) and theoretical orientation, referral services often include a therapist’s special skills and areas of focus. Skills may include biofeedback, EMDR (more on what this is in another post), exposure therapy for anxiety, hypnosis, and more. Areas of focus could include couple therapy, postpartum issues, sex therapy, pain management, addictions, or grief and loss. Although that can seem like a lot to sift through, chances are good that there are therapists who know how to help you with the problems you are facing.

Where to look

There are many ways to find a therapist. If you’ll be using insurance, I recommend checking with them first and finding out how many sessions they allow, how much your deductible and co-pays are, and whether or not there are other restrictions. If you choose not to use insurance, many good therapists offer reduced fees for those on a tight budget. If a therapist’s fees would prohibit you from getting help, ask them if they have a sliding fee scale.

If you use insurance, keep in mind that a mental health diagnosis may, sadly, be a stigma in the future and will be in your medical records. For that reason, some clients may prefer to pay “out of pocket.”

Your insurance company

If you want to use someone who is an “in-network provider,” your insurance provider can give you a list. You will likely pay more for those who are out-of-network, but if you can afford it, this will give you more freedom to choose someone you prefer.

Recommendations from Family or Friends

Some people prefer to get personal recommendations from friends and getting referral from a casual acquaintance is fine. However, it’s not a good idea when the person is someone close to you. While it can seem like a good idea to get a recommendation from someone who knows what it’s like to be in therapy with a particular professional, a good therapist will caution you against this and my even refuse to see you; when someone close to you shares your therapist, you may find that it can get complicated. Ultimately, you want to know that your therapist is going to be able to support you 100% and you don’t want to wonder where his or her allegiance lies. You also don’t want to feel as if you need to censor what you say or wonder whether or not your sister said anything about your recent argument in her session.

Professional organizations

The psychological association in your state has a referral service. In Oregon, for example, the Oregon Psychological Association has an online referral tool.  These days, it is fairly easy to find an organization that has information and support for those suffering from a particular problem. Many have referral services or directories. For example, I am currently a member of several, so you can find me through the Anxiety Disorders Association of America, the Oregon Society of Clinical Hypnosis, Postpartum Support International, and Baby Blues Connection.

Psychology Today

Psychology Today (PT), the popular magazine, has a big online presence. Of course, only those therapists who have signed up to be part of their directory will be listed.

Thumbtack

Thumbtack is a new service directory that is just getting off the ground (www.thumbtack.com). Like PT, only those who have signed up with them will be listed.

Colleges and Universities

Any institution that has a counseling center is likely to be able to give you a referral to a local therapist.

Search Engines

There are many tech-savvy therapists nowadays (or therapists who hire tech-savvy people), so they often have their own websites. Therapists’ websites often give you more information about them and the work they do. However, their sites are not always optimized to show up when you search for “Psychologist” in, let’s say, “San Jose California.” But if you find someone through another directory, oftentimes their website is listed. Be as specific as you can with your search, including your city and state, the problem area and/or skill you’re look for (depression, anxiety, biofeedback, etc.), and then something such as “therapist” or “psychologist.”

Next Steps

I recommend finding five therapists to call and interview, if you’re lucky enough to have that many to choose from. Sometimes a therapist can’t see you for three months and you can’t wait that long. Or, you find that the therapist you thought looked perfect on paper seemed like he misrepresented himself. You may also find that the last person on your list was the one you felt most comfortable with. So start with a pool of candidates and go from there.

What do you say when you call? What kinds of questions should you ask? What are you supposed to do in therapy? How confidential is it really? What is therapy like? Stay tuned for my next post to get the answers to those questions. In the meantime, be well and take care of yourself.

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