Finding a Therapist

 

Introduction

Session 1

Mental Illness In The U.S.

Session 2

Symptoms To Watch For

Session 3

Avoidance: Why People Don't Get Help

Session 4

Finding The Right Therapist

Session 5

Types of Therapists

Session 6

Questions To Ask

Session 7

Finances

Session 8

Checking Credentials

Session 9

Is It Working?

Therapy. What most people don’t understand when they see or hear the word “therapy” is there are many specific types of psychotherapy, each with its own unique approach. It’s not one “size” fits all. And the type of psychotherapy that's right for you depends on your individual situation.

Therapy, you see, is short for “psychotherapy” -- a term people throw around for treating mental health problems by talking with a psychiatrist, psychologist or other mental health providers. It’s a pretty all-encompassing and simple word, for what in reality is a pretty complex treatment process.

According to the American Psychological Association (APA) therapy can exist in a variety of formats, including:

Individual: This therapy involves only the patient and the therapist.

Group: Two or more patients may participate in therapy at the same time. Patients are able to share experiences and learn that others feel the same way and have had the same experiences.

Marital/Couples: This type of therapy helps spouses and partners understand why their loved one has a mental disorder, what changes in communication and behaviors can help, and what they can do to cope.

Family: Because family is a key part of the team that helps people with mental illness get better, it is sometimes helpful for family members to understand what their loved one is going through, how they themselves can cope, and what they can do to help.

During psychotherapy, if done correctly (watch out for charlatans, see Session 7) you learn about your condition and your moods, feelings, thoughts and behaviors. Under the best of circumstances, the process will help you learn how to take control of your life and respond to challenging situations with healthy coping skills.

This mini-course take a two-sided approach: First, it is designed for those contemplating therapy (do you really need it?) and where to get the kind of effective help you need in your unique situation; and second, for students, this is a very basic course in helping and guiding those in need to the right therapist. At the conclusion of the course, find a resource list of links to relevant articles and websites devoted to different therapeutic courses of action.

Are you one of those people who think mental disorders are rare and happen to someone else?

Well, think again.

In fact, mental disorders are common and widespread. An estimated 54 million Americans suffer from some form of mental disorder in a given year.

Most families are not prepared to cope with learning their loved one has a mental illness. It can be physically and emotionally devastating.

If you think you or someone you know may have a mental or emotional problem, it is important to remember they can be helped (most of the time).

There are more than 200 classified forms of mental illness. Some of the more common disorders are depression, bipolar disorder, dementia, schizophrenia and anxiety disorders. Symptoms may include changes in mood, personality, personal habits and/or social withdrawal.

The statistics can be startling.

Mental health problems may be related to excessive stress due to a particular situation or series of events. As with cancer, diabetes and heart disease, mental illnesses are often physical as well as emotional and psychological. Mental illnesses may be caused by a reaction to environmental stresses, genetic factors, biochemical imbalances, or a combination of these. With proper care and treatment many individuals learn to cope or recover from a mental illness or emotional disorder.

The following are signs that your loved one, or just someone you know, you may want to speak to a medical or mental health professional.

In adults

  • Confused thinking
  • Prolonged depression (sadness or irritability)
  • Feelings of extreme highs and lows
  • Excessive fears, worries and anxieties
  • Social withdrawal
  • Dramatic changes in eating or sleeping habits
  • Strong feelings of anger
  • Delusions or hallucinations
  • Growing inability to cope with daily problems and activities
  • Suicidal thoughts
  • Denial of obvious problems
  • Numerous unexplained physical ailments
  • Substance abuse

In adults

  • Substance abuse
  • Inability to cope with problems and daily activities
  • Changes in sleeping and/or eating habits
  • Excessive complaints of physical ailments
  • Defiance of authority, truancy, theft, and/or vandalism
  • Intense fear of weight gain
  • Prolonged negative mood, often accompanied by poor appetite or thoughts of death
  • Frequent outbursts of anger

In younger children

  • Changes in school performance
  • Poor grades despite strong efforts
  • Excessive worry or anxiety (i.e. refusing to go to bed or school)
  • Hyperactivity
  • Persistent nightmares
  • Persistent disobedience or aggression
  • Frequent temper tantrums

Ok. You think you need help. Or, you know someone with a mental condition who needs help.

When you see someone on the street, passed out, clutching a bottle in a paper bag, shouting at themselves in a subway car – whether it’s L.A, New York, Dallas or your home town – you wonder why they don’t just get help.

Chances are you know or have seen someone who has a mental health issue. Surely, you think, this person would want to get treatment. In all these scenarios, what are the reasons why people who need treatment don’t get it?

The answers may or may not surprise you.

According to mental health experts, those surveyed who did not receive treatment identify the following barriers (respondents were allowed multiple answers):

If you've never seen a mental health worker before, you may not know how to find one who suits your specific needs. What follows are things to keep in mind as you search for help.

Start here. Most mental health providers are professionals who have either a master's degree or more advanced education and training. Make sure that the mental health provider you choose is licensed to provide mental health services. Note that services offered depend on the provider's training and speciality area.

Some other factors when making your choice among the various types of mental health providers:

Your concern or condition.

Most mental health providers treat a range of conditions, but one with a specialized focus may be more suited to your needs. For example, if you have an eating disorder, you may need to see a psychologist who specializes in that area. If you're having marital problems, you may want to consult a licensed marriage and family therapist. In general, the more severe your symptoms or complex your diagnosis, the more expertise and training you need to look for in a mental health provider.

Whether you need medications, counseling or both.

Some mental health providers are not licensed to prescribe medications. So your choice may depend, in part, on your concern and the severity of your symptoms. You may need to see more than one mental health provider. For example, you may need to see a psychiatrist to manage your medications and a psychologist or another mental health provider for counseling.

Your health insurance coverage.

Your insurance policy may have a list of specific mental health providers that are covered or only cover certain types of mental health providers. Check ahead of time with your insurance company, Medicare or Medicaid to find out what types of mental health services are covered and what your benefit limits are.

Below are the most common types of mental health providers. Some specialize in certain areas, such as depression, substance misuse or family therapy. They may work in a variety of different settings, like private practice, hospitals, community agencies or other facilities.

Psychiatrist

A psychiatrist is a physician — doctor of medicine (M.D.) or doctor of osteopathic medicine (D.O.) — who specializes in mental health. This type of doctor may further specialize in areas such as child and adolescent, geriatric, or addiction psychiatry. A psychiatrist can:

  • Diagnose and treat mental health disorders
  • Provide psychological counseling, also called psychotherapy
  • Prescribe medication

Psychologist

A psychologist deals with thoughts, emotions and behaviors. Typically, they hold a doctoral degree (Ph.D., Psy.D., Ed.D.). A psychologist:

  • Can diagnose and treat a number of mental health disorders, providing psychological counseling, in one-on-one or group settings
  • Cannot prescribe medication unless he or she is licensed to do so
  • May work with another provider who can prescribe medication if needed

Psychiatric-mental health nurse

A psychiatric-mental health nurse (P.M.H.N.) is a registered nurse with training in mental health issues. This care worker should have at least a master's degree in psychiatric-mental health nursing. Don’t get thrown by all the letters after the name. Other types of advanced practice nurses able to provide mental health services include a clinical nurse specialist (C.N.S.), a certified nurse practitioner (C.N.P) or a doctorate of nursing practice (D.N.P.). Mental health nurses:

  • Vary in the services they can offer, depending on their education, level of training, experience and state law
  • Can assess, diagnose and treat mental illnesses, depending on their education, training and experience
  • Can — if your state law allows — prescribe medication if they're an advanced practice nurse

Physician assistant

A certified physician assistant (P.A.-C.) practices medicine under the supervision of a physician. Physician assistants can specialize in psychiatry. These physician assistants can:

  • Diagnose and treat mental health disorders
  • Provide psychological counseling, also called psychotherapy
  • Prescribe medication

Licensed Clinical Social Worker

If you prefer a social worker, look for a licensed clinical social worker (L.C.S.W.) with training and experience specifically in mental health. These individuals must have a master's degree in social work (M.S.W.), a Master of Science in social work (M.S.S.W.) or a doctorate in social work (D.S.W. or Ph.D.). These social workers:

  • Provide assessment, psychological counseling and a range of other services, depending on their licensing and training
  • Are not licensed to prescribe medication
  • May work with another provider who can prescribe medication if needed

Licensed professional counselor

Training required for a licensed professional counselor (L.P.C.) may vary by state, but most have at least a master's degree with clinical experience. These counselors:

  • Provide diagnosis and psychological counseling (psychotherapy) for a range of concerns
  • Are not licensed to prescribe medication
  • May work with another provider who can prescribe medication if needed

OK. You think you might have found the right therapist for you…or someone you know. Here, according to the A.P.A. and Web M.D. are just a few of the key questions you should ask your prospective therapist.

Do not fail to ask questions. Getting the wrong, ineffective therapist can only add to the problems of the patient.

  • Are you a licensed psychologist?
  • How many years have you been practicing psychology?
  • I have been feeling (anxious, tense, depressed, etc.) and I'm having problems (with my job, my marriage, eating, sleeping, etc.). What experience do you have helping people with these types of problems?
  • What are your areas of expertise — for example, working with children and families?
  • What kinds of treatments do you use, and have they been proven effective for dealing with my kind of problem or issue?
  • What are your fees? (Fees are usually based on a 45-minute to 50-minute session.) Do you have a sliding-scale fee policy?
  • What types of insurance do you accept? Will you accept direct billing to or payment from my insurance company? Are you affiliated with any managed care organizations? Do you accept Medicare or Medicaid insurance?

Many insurance companies provide coverage for mental health services. If you have private health insurance coverage (typically through an employer), check with your insurance company to see if mental health services are covered and, if so, how you may obtain these benefits. This also applies to persons enrolled in HMOs and other types of managed care plans. Find out how much the insurance company will reimburse for mental health services and what limitations on the use of benefits may apply.

If you are not covered by a private health insurance plan or employee assistance program, you may decide to pay for psychological services out-of-pocket. Some psychologists operate on a sliding-scale fee policy, where the amount you pay depends on your income.

Another potential source of mental health services involves government-sponsored health care programs — including Medicare for individuals age 65 or older, as well as health insurance plans for government employees, military personnel and their dependents. Community mental health centers throughout the country are another possible alternative for receiving mental health services. State Medicaid programs may also provide for mental health services from psychologists.

After graduation from college, psychologists spend an average of seven years in graduate education training and research before receiving a doctoral degree. As part of their professional training, they must complete a supervised clinical internship in a hospital or organized health setting and at least one year of post-doctoral supervised experience before they can practice independently in any health care arena. It's this combination of doctoral-level training and a clinical internship that distinguishes psychologists from many other mental health care providers.

Psychologists must be licensed by the state or jurisdiction in which they practice. Licensure laws are intended to protect the public by limiting licensure to those persons qualified to practice psychology as defined by state law. In most states, renewal of this license depends upon the demonstration of continued competence and requires continuing education. In addition, APA members adhere to a strict code of professional ethics.

As you begin therapy, establish clear goals with your psychologist. You might be trying to overcome feelings of hopelessness associated with depression or control a fear that is disrupting your daily life. Remember, certain goals require more time to reach than others. You and your psychologist should decide at what point you may expect to begin to see progress.

It is a good sign if you begin to feel a sense of relief, and a sense of hope.

People often feel a wide variety of emotions during therapy. Some qualms about therapy that people may have result from their having difficulty discussing painful and troubling experiences. When you begin to feel relief or hope, it can be a positive sign indicating that you are starting to understand your thoughts and behavior.

Further Reading

To find a psychologist, ask your physician or another health professional.

Call your local or state psychological association. Consult a local university or college department of psychology. Ask family and friends. Contact your area community mental health center. Inquire at your church or synagogue. Or, use APA's psychological locator [please link to http://locator.apa.org ] service.

Once you have a few names go ahead and google them. If they have a blog or a website, explore them. Often you can get a sense of who they are by what they write or what is written about them. Just keep in mind that many good, well-qualified therapists are not on the web. Not finding them there is not a reason to rule them out. Caveat: Do not look for a therapist on craigslist!

On choosing a therapist: http://psychcentral.com/therapst.htm

http://www.apa.org/helpcenter/choose-therapist.aspx