You’ve gotten all the information you can from friends and family, provider directories, and the Internet. In this last step, you’ll actually be talking with your potential therapists to get the information you need to make your decision.

Making the Calls

Unless a therapist specifically requests to be contacted by email, it’s best to give them a call. You get a better sense of context and personality from hearing a live voice.

Calling also gives you the opportunity to ask followup questions right away instead of having to wait for the therapist to return an email.

Preparation

Gather your Contact List, question cards, and a notepad or piece of paper for taking notes on your conversations.
If you’re nervous about making these phone calls, you might find it useful to create a script for yourself. If you get anxious, you can just refer to your script to get back on track.

Here’s an example:

OPENING: “Hi. I was wondering if I could ask you a few
questions about how you work?”
QUESTION 1
QUESTION 2
QUESTION 3
ANY FOLLOWUP QUESTIONS
CLOSING: “Thanks, I really appreciate your time. I’ve got a few things to consider, but if it looks like this is a good fit for me, I’ll give you a call back to set up an appointment.”

Calling

Obviously, therapists will not answer the phone if they’re working with another client, so be prepared to leave a message stating your name and phone number with a request for the therapist to call you back. If you’re not comfortable leaving this kind of information on a machine, just hang up and try to call back when you can talk to the therapist directly. If you get voicemail or an answering service, make a note of this fact in your notepad to avoid confusion later.

If you’re calling an agency or clinic, a receptionist might answer the phone. Simply explain that you’d like to speak with a particular therapist to ask a few questions and then continue as planned.

When you get to speak to a potential therapist, make sure you cover all of your Top Priority questions, but don’t be afraid to ask followup questions as well.

If the therapist you’re speaking with cannot provide the services you need, ask them if they can suggest a few colleagues who can. This is a good way to add more names to your contact list.

After your conversation is over, take some notes about the therapist’s responses to your questions. Also record your overall impressions or gut reaction. These notes can be a huge help in making a final decision.

If a therapist is unwilling to talk to you over the phone or insists that you make an appointment, just thank them for their time and move on to the next name on your list. You can always call back and make an appointment at a later time if that seems like a good option to you.

Making a Decision

Now that you’ve made your calls, take some time to look over your notes. Who best meets your needs and preferences? What were your reactions to the therapists you interviewed?

In all likelihood, you already have a good idea of who you’d like to work with at this point. If you’re stuck between a few different therapists who seem equally good, take a gut check. Who did you make more of a connection with?

If you’re still stuck, you might consider making a followup call and asking a few questions based on your lesser preferences as a sort of tie-breaker.

If you don’t like any of your choices, you have a few options: you can go back to your referral sources and try to find new therapists to consider; or, you can simply choose the best option from among those you’ve already spoken with. As mentioned earlier, you’re looking for a good therapist, not a perfect one.

Set Up an Appointment

Now that you’ve made your decision, it’s time to call and make your first appointment.

By taking the time and trouble to find a good therapist, you’ve gotten off to a good start and greatly increased your chances for successful treatment.

Congratulations, and good luck in your therapy!

You’ll spend some time with that stack of paper you’ve been working on for the last eight chapters, and pick up a few more tips along the way.

Activity 9

1. Gather together the index cards (or pieces of paper) that you completed for Activities 1-7.

2. Take some time to read through all your cards and think about which of these preferences are the most important to you. Review material from the earlier chapters if necessary.
3. Sort the cards by priority, from most important to least important.
4. Set aside your top three cards. We’ll call these your Top Priorities.
5. Read the sections in this chapter that correspond to your Top Priorities and complete the additional activities.

Kinds of Therapy

Your first step should be to eliminate the therapists on your list that don’t offer the kind of therapy you’re looking for. If you gathered information from an insurance provider list, an online directory, an agency directory, or an advertisement, you may find that the types of therapy providers are already listed.

If types are not listed in your source, it’s safe to assume that the therapist primarily provides individual therapy. Of course, that doesn’t mean that they don’t offer group therapy, couples therapy, or family therapy; it just means that you’ll have to ask to find out.

Activity

On the back of your Kinds of Therapy card, write a
question that you can refer to later when interviewing therapists. Some examples are provided below:

• Do you offer group therapy?

• Do you provide individual therapy?
• Do you work with couples?
• Do you provide family therapy?

Tips

• Because they have access to the appropriate facilities, therapists who work in agencies, clinics, and hospitals are more likely to offer group therapy.

• Marriage and family therapists are more likely to offer couples and family counseling than any other profession.

Payment

If you’re planning to see a provider that’s within your insurance or managed care organization’s network, this part should be very simple. Just restrict your search to the therapists listed in your insurance company or MCO’s provider directory or online directory.

Providers change from time to time, though, and your paper or online directory may not be completely up to date. If you’re considering a therapist that you don’t see in your directory, it can’t hurt to call them and see if they accept your insurance. You might just be pleasantly surprised.

If you have the option of going out of network and still receiving partial reimbursement, be sure to ask a potential therapist if they’re willing to help you submit the required paperwork and whether or not full payment is required up front.

If you’re paying out of pocket, you’ll want to know what a therapist’s session fee is, and if they work on a sliding scale.

Activity

On the back of your Payment card, write a question (or questions) that you can refer to later when interviewing
therapists. Some examples are provided below:

• Do you accept [your insurance type]?

• If I submit for partial reimbursement, can you help me with the paperwork?
• What is your fee? Do you offer a sliding scale?
• What forms of payment do you accept?

Settings

You may be able to get an idea of where a therapist practices just from looking at their directory listing or phone book entry.

It pays to be realistic about settings. If you live in an urban area and are restricted to public transportation, then you’ll want to find an office that’s within reasonable walking distance of a bus stop or subway station. If you’ve decided to seek a private office in the suburbs, however, you’ll need to budget for gas money or bus fare.

Activity

On the back of your Settings card, write a question that you can refer to later when interviewing therapists. A few examples are provided below:

• Do you have a private office, or do you share space with another therapist?

• Does the clinic have its own entrance, or is it in the hospital itself?
• Do you run groups in your office or do you take space in another building?

Tips

• Some therapists practice out of more than one location, so if you notice that a therapist you’re considering lists an office in a setting that you don’t prefer, go ahead and give them a call anyway. You might find that they offer other options.

Professions

Insurance and managed care organization directories willusually list a therapist’s profession, and some onlinedirectories do as well.

The initials after a therapist’s name can also provide a clue. Someone with MD or DO after their name, for example, is almost certainly a psychiatrist. (See the Appendix for morehelp with commonly used initials.)

Activity

On the back of your Professions card, write a question that you can refer to later when interviewing therapists. An
example is provided below.

• What is your profession?

Tips

• Because of financial and professional pressures, most psychiatrists focus on medication-related work, so it can be very difficult to find a psychiatrist who offers therapy.

• If your state doesn’t offer professional licensure in the area you’d prefer, consider a related type of professional. For example, if you’d prefer a marriage and family therapist, but your state doesn’t offer such a license, look for a professional counselor or a psychologist with a background in marital and family work.
• Be very cautious about considering an unlicensed therapist. Ask about education and experience.

Treatment Approaches

Though this book contains some of the most commonly used approaches, it does not cover every single option. Some techniques are very specialized, and new approaches are constantly being developed and refined. Don’t be afraid to ask a potential therapist questions about their approach and how it is similar or different from approaches you’re more familiar with.

Flexibility is important, especially if you live in a rural or isolated area. You may not be able to find a local therapist who practices the exact kind of therapy you prefer, but you may be able to find someone practicing a similar approach.

Activity

On the back of your Treatment Approaches card, write a question or questions that you can refer to later when
interviewing therapists. A few examples are provided below:

• How would you describe your approach to therapy?

• You say that you’re eclectic. Can you tell me what approaches or ideas you rely on most?

Tips

• Most therapists will say that they don’t rely on a single approach, so be prepared to follow up and find out more details about how they work.

• Insurance companies and managed care organizations favor some approaches over others; you may want to find out if your organization has any restrictions before making up your mind about an approach.

Experience

In addition to general experience, you may want to consider how long a therapist has been working specifically with the kinds of issues you’re dealing with.

Activity

On the back of your Experience card, write a question or questions that you can refer to later when interviewing
therapists. A few examples are provided below:

• How many years have you been providing therapy?

• Have you worked with people with problems like mine before?

Special Considerations

Determining a therapist’s gender should be simple enough, but other considerations may require a face-to-face meeting. Although age and race may be important considerations, you shouldn’t ask about these over the phone.

Activity

On the back of your Special Considerations card, write a question or questions that you can refer to later when interviewing therapists. A few examples are provided below:

• What’s your approach to working with a client’s religious beliefs?

• How do you feel about homosexuality?

Most therapists don’t advertise their services. Instead, they rely on word-of-mouth and referrals from other professionals. Finding a good therapist can take some digging, but it’s well worth the effort.

At this stage, just pick up as many names as possible. You’ll work to whittle this list down later, but it’s best to start with as many options as possible.

Doctors

Many people who experience psychological or mental health problems seek help from their primary care physician first. Doctors prescribe medications for some people, and refer others on to specialists. For this reason, your doctor probably knows about some of the local mental health professionals and should be willing to pass along a few
recommendations.

Because of professional courtesy and liability concerns, most doctors will not share any negative information about a potential therapist. Keep in mind that many doctors have a short list of “go to” therapists that they recommend for a majority of their patients, so you’re probably not going to get an exhaustive list of every available therapist.

Friends and Family

Be sensitive about who you approach for this kind of information. For some people, therapy is such an intensely personal and confidential experience that they don’t talk about it outside the office. Others feel a stigma attached to mental heath issues and would prefer to keep their treatment a secret.

Friends and family members who are willing to share are a great resource because they’re usually not shy about sharing their opinions. They can pass along information and impressions about therapists that you won’t get from professional sources.

Clergy

Members of the clergy help people with difficult personal problems all the time. Most refer to a counseling professional when the issues are more psychological than spiritual in nature.

The clergy are especially attuned to therapists’ attitudes toward religion and spirituality, so they can be a good source if you’re looking for a religious counselor or a secular therapist who understands your beliefs and can work with them respectfully.

Like doctors and other professionals, members of the clergy usually rely on a few trusted therapists for most of their referrals, so don’t expect a complete list of local providers.

Health care Professionals

Friends or acquaintances who work in health care may also be willing to share information about therapists they’ve worked with or heard about. Those who work in mental health settings will be especially well-connected to the local providers.

While speaking with health care professionals, keep in mind that their impressions can be influenced by issues that have nothing to do with the quality of the therapist’s work. A medical receptionist, for example, may hold a negative opinion of a therapist who is difficult to work with from an administrative standpoint.

Insurance Company/Managed Care

If you have medical insurance or belong to a managed care organization, you should have access to the organization’s provider directory.

In some cases, this will be a paper-based directory that is sent to your home on a periodic basis. You can find a lot of good information here, including names, contact information, profession, specialties, and whether or not the provider is accepting new clients.

Most organizations also provide this information to members on the Internet. Online listings will contain all the information available in the directory, along with the provider’s email or website address if available.

A powerful feature of the online directory is the ability to search for just those providers that meet your specific needs.For example, you may be able to search for marriage andfamily therapists who offer evening appointments within a 20-mile radius of your home.

To access the online directory, find your insurance or managed care organization’s website—usually listed on your membership card—and look for a link that says Find a Provider, or Member Services.

You can also call the customer/member service line for your organization and ask to speak with a representative who can help you find providers. The operator will have access to the most recent listings and updates, but you may not get all the information that you would from a directory or a website.

Online Listings

There are several good online directories not associated with any insurance company or managed care organization. You can access a current list of verified directories at howtofindagoodtherapist.com.

Phone Books

As you read earlier in the book, choosing a therapist based solely on an advertisement is never a good idea, but the phone book can be an excellent source of names, addresses, and phone numbers. In some cases, professions and specialties are listed as well.

Agency Directories

If you’re seeking services through an agency or a community counseling center, the organization may provide you with a list of available therapists. The amount of detail available varies widely from
organization to organization.

Activity 8

On a separate piece of paper, write Contact List. Then write down names, contact information, and notes about every therapist you’re considering.

In most situations, you’d be sued for making a hiring decision based on gender, ethnicity, religious outlook, or sexual orientation. When hiring a therapist, however, these may be acceptable considerations.

Gender

Most male and female therapists can work well with clients of either gender, so you’re in good shape if you don’t have a strong preference either way. If you do have a preference, however, you need to consider where it comes from.

You may feel that you can relate better to a therapist of the same gender; or you may prefer a therapist of the opposite gender to gain a new perspective.

You could have strong feelings about this topic if you were the victim of abuse. If you were sexually abused by a man, for example, you may not be comfortable working with a male therapist. On the other hand, you may actually seek out a male therapist as a way of helping you regain some of your trust in men.

Marital therapists are attuned to different communication styles and are particularly skilled at working with clients of both genders. If you’re still concerned about fairness and balance, however, you can seek out a co-therapy team in which a male and female therapist work together with you and your spouse.

Single-sex men’s groups and women’s groups are also available. These groups may deal with gender-specific or general issues, and are built around the assumption that people are more willing to be open with people of their own gender than they would in a mixed-sex group. If this point of view makes sense to you, a single-sex group might be the way to go.

Sexual Orientation

If you’re gay or bisexual, you’re probably concerned with finding a therapist who will understand and respect your lifestyle. Most therapists are comfortable working with clients of any sexual orientation, and some specialize in working with gay and bisexual clients. Some therapists have personal or religious objections to homosexuality, though, so it’s best to ask about this up front.

You can also find specialists that help clients deal with issues of sexual or gender confusion. Others focus on working with transsexual and transgendered clients.

Race, Ethnicity, and Culture

Most therapists can work successfully with people of different backgrounds. Choosing a therapist of a different race, ethnicity, or culture can be a great way to break stereotypes and gain new perspectives.

Your therapist may not be an expert on your background, however, so be prepared to explain aspects of your experience that are relevant to your therapy. Most therapists are eager to learn and will appreciate your efforts.

If you’ve been the victim of racism or discrimination, you may have a difficult time working with a therapist of a different background.
The important thing is to find a counselor you can trust. Unless you feel comfortable enough to open up, therapy isn’t going to help much.

Religion and Spirituality

If religion or spirituality is an important part of your life, then you know that your faith goes beyond your belief in the supernatural; it profoundly influences your perspective and just about every aspect of your life.

Obviously, you want to find a therapist who respects andunderstands your beliefs, but it’s important to know that a therapist doesn’t necessarily need to share those beliefs in order to work with you successfully.

In secular counseling, you are the authority on your own beliefs, and you should be prepared to share those elements of your faith that are relevant to your therapy.

It’s important to understand the distinction between this kind of therapy and religious-based counseling.

In religious-based counseling, you look to your therapist to provide faith-based expertise. Religious texts and teachings form the basis of the work your therapist does with you, and very often, mutual prayer will be an important part of your treatment.

Religious counselors may or may not be officially associated with a church, temple, synagogue, or mosque. Some rely almost exclusively on religious material, while others combine religious and spiritual teachings with mainstream psychological approaches. Most wil be happy to explain their philosophy if you ask.

Religious counselors may be licensed professionals, but this is not a requirement, so you’ll want to ask questions about experience, education, and qualifications.

Age

As mentioned earlier, age is not always a good indicator of professional experience, but you may still have a preference in this area.

Be aware that there are exceptions to every stereotype. It’s very common to find older therapists with lots of enthusiasm and openness to new approaches. You may also discover younger therapists with more life experience than you’d expect.

Activity 7

At the top of an index card or small piece of paper, write Special Considerations. Below that, make a note of your preferences about these special considerations.

If you’re in the workforce, you probably know that there’s more to experience than just the number of years on the job. This chapter will give you some idea of what to look for in terms of therapist experience.

Raw Numbers

The simplest way to look at experience is in mathematical terms: how many years has a particular therapist been “on the job?” Even this is a little trickier than it seems at first.

Suppose a therapist tells you they have “ten years of experience in the mental health field.” Was the experience full-time or part-time? Did they deliver therapy for all ten years, or did they work in health care administration for five of those years?

Estimating experience based on age isn’t a safe bet, either, because many people choose counseling as a second career. A 30-year-old therapist may have twice as much experience as her 60-year-old colleague.

Specialty Experience

Like medical doctors, some therapists pursue a specialty while others remain “general practitioners.” Unlike medical doctors, though, many therapists choose to straddle the line between these two categories, keeping a general practice while at the same time pursuing special training and experience in certain kinds of problems.

Because therapists deal with such a wide variety of issues, it’s important to consider how much experience a therapist has with the problems you’re facing. You may decide that a therapist with three years of experience focusing on your area of concern is a better choice than a therapist with twenty years of general experience.

Population/Modality Experience

Just as therapists work with different sorts of problems, they also work with different sorts of people. A person who has spent the last twenty years working primarily with adults, for example, may not be competent to treat children without special training and supervision.

If you’re seeking group therapy, couples therapy, or family therapy, it’s important to know a therapist’s experience level working in those formats.

Licensure laws usually don’t specify who a therapist can and cannot work with, so it’s up to you to ask about experience and training.

Other Factors

Just like in any other field, there are therapists who simply punch the clock. For these people, thirty years of experience is really just one year of experience repeated thirty times.

Other therapists take an active interest in their work, however, and work hard to learn new things. Here are some activities that demonstrate an above-average commitment to professional growth:

• Membership in professional organizations

• Teaching classes or leading workshops
• Writing articles and books
• Conducting research

Activity 6

At the top of an index card or small piece of paper, write Experience. Below that, record your preferences
concerning therapist experience.

The last time anyone bothered counting them, there were more than 250 treatment approaches in all. By now, there are certainly many more. In fact, there are almost as many treatment approaches as there are therapists. This chapter will explore some of the most commonly available approaches available today.

Art Therapy

Art therapy is based on the idea that the creative process can help you express emotions, work through traumatic experiences, manage stress, gain insight into how you interact with others, and enhance your self-awareness.

In this form of treatment, you are encouraged to engage in drawing, painting, sculpting, or photography. Your therapist guides you through the process and helps you explore the thoughts and feelings expressed through the art you create.

Art therapists believe that people can share ideas through visual art that they may find difficult to share in words. For this reason, you may be asked to complete art-based assessments designed to help your therapist learn about your feelings, problems, and personality.

In addition to what you learn about yourself through art, you may find the act of expressing yourself creatively therapeutic in itself.

Don’t avoid art therapy because you think you lack talent. Art therapy is not an art class. Your therapist works with people of all skill levels, and is not concerned with judging the technical merit of your work.

People of all ages can benefit from art therapy. Some art therapists report great success in using these techniques with older adults and even entire families.

Art therapy is most commonly practiced in agency settings, but can occasionally be found in hospitals, clinics, nursing homes, schools, and private practices.

Behavior Therapy

You probably won’t be surprised to learn that this kind of therapy focuses on your behaviors. According to the behavioral approach, the best way to change your thoughts and feelings is by changing your behaviors.

Suppose you were seeking therapy because you have a crippling fear of dogs. Your therapist won’t ask you about your early experiences with dogs or probe for the unconscious roots of the problem. Instead, you’ll start gathering data and applying techniques to extinguish the fear.

Behavior therapy emphasizes the use of proven techniques designed to break the chain between unwanted behaviors and the triggers and reinforcers that maintain them.

In the example mentioned above, your therapist may begin by asking you to rate a variety of dog-related experiences in terms of how anxious they make you feel. You will then be taught relaxation techniques and asked to practice them while you’re exposed to increasingly anxiety-provoking situations until eventually, you can pet a dog without much anxiety.

This approach adopts a scientific viewpoint, but don’t make the mistake of assuming that all behavior therapists are cold, uncaring people in white lab coats.

Behavior therapy is practiced in hospitals, clinics, community agencies, school-based programs, and private practices. Because it is highly structured and time-limited, you may find that your insurance company is especially willing to reimburse for behavior therapy.

Cognitive-Behavioral Therapy

You’ll find that the cognitive-behavioral approach shares certain ideas and techniques with behavior therapy, but its primary focus is on thinking rather than behavior. This approach holds that your feelings are not caused by external events, but by your thoughts about those events.

Suppose a friend compliments you on your appearance. If you think, “That was nice of her. I guess I do look pretty good today,” you’ll probably feel happy and grateful. On the other hand, if you think, “She’s just saying that because she’s my friend. I look terrible,” you’re likely to feel sad and resentful.

Since your thoughts influence your feelings, persistent patterns of negative thinking can cause emotional and psychological problems. Cognitive-behavioral therapy teaches you to take charge of your feelings by taking charge of your thoughts.

Your therapist will start by helping you identify your thoughts and explore how they influence your feelings. Eventually you’ll learn to dispute negative thoughts and replace them with more helpful ones.

Cognitive-behavioral therapy is currently one of the most popular forms of treatment available and is commonly practiced in almost any setting.

You might also hear about rational-emotive behavior therapy, cognitive therapy, or dialectical behavior therapy. These are different “flavors” of cognitive-behavioral therapy, but they are all based on the same core ideas.

Eclecticism

You’ll find that some therapists don’t identify with any single theory. Instead, they pick and choose ideas and techniques from multiple approaches. They may identify themselves as eclectic or integrative.

This can be a very effective approach, but it creates a challenge for potential clients. You may appreciate a therapist’s eclecticism but still want to get some idea of what therapy will be like before you make a decision.

Fortunately, most eclectic therapists are more than willing to share their ideas and talk to you about how they work. Just ask.

Each group offers something a little different in terms of education, training, and philosophy, but you might be surprised to learn that there’s no evidence that any group is more effective than the others. What it boils down to, then, is personal preference, and that’s a good thing. After all, it’s your therapy.

I’ll tell you a little bit about all of these professions, but first let’s clear up a tricky language question.

What’s the Difference?

While therapists may engage in heated discussions about the difference between therapy and counseling, no one quite agrees on exactly what the differences are. Unless your therapist (or counselor) has a strong opinion on the matter, you can use these terms interchangeably the way I have in this book.

Likewise, most therapists use the term client to refer to the people they help, but psychiatrists and others who work in medical settings prefer patient. Again, it’s more a difference of style than anything else, but if you have a preference, be sure to tell your therapist.

Licensure

Does having a driver’s license mean that someone is a good driver? Of course not, but it does mean that a person has met the minimal qualifications and passed a test. Most importantly, though, since the state issues the license, it can also take it away from a driver who is unsafe or reckless.

Likewise, professional licensure doesn’t guarantee you a good therapist, but it does tell you that they’ve met the minimum qualifications and passed a test. And, just like a driver’s license, it gives the state a way of holding a therapist accountable. Since licensed therapists have more to lose than unlicensed therapists, they have more motivation to act ethically and competently. In almost all cases, only licensed therapists qualify for insurance reimbursement.

Advanced Practice Registered Nurses

Education

Advanced practice registered nurses have a bachelor’s degree in nursing and a master’s degree in an advanced nursing practice field.

Experience

Advanced practice nurses undergo extensive supervised clinical experience as part of their education. In addition, most advanced practice nurses have prior experience in providing individual and group therapy as psychiatric nurses before enrolling in their master’s program.

Licensure

Advanced practice nurses are licensed in most states. In addition to the educational and experiential requirements listed above, most states require certification from a national body for licensure. In addition to practicing therapy independently, advanced practice nurses can prescribe medication.

Typical Settings

• Clinics

• Hospitals
• Private/Group Practices

Typical Initials

Academic: RN, MSN
Credentials: APN, ARNPP, ARPN, MHN

Art Therapists

Education

Art therapists have a master’s degree in art therapy or a closely-related field. Some art therapists choose to pursue doctorate degrees in counseling or psychology, with a specialty in art therapy.

Experience

Art therapists undergo supervised clinical internships and practicums during their education. This is typically followed by two years of supervised clinical experience helping clients through expressive arts.

Licensure

Very few states offer professional licensure specifically for art therapy. Most art therapists seek licensure in another field, such as professional counseling, marriage and family therapy, or clinical social work. Some art therapists pursue board certification from a professional organization.

Typical Settings

• Clinics

• Hospitals
• Non-Profit/Community-Based Organizations
• Private/Group Practices

Typical Initials

Academic: MA, MC, MS, PhD, EdD
Credentials: ATR, ATR-BC, LCPC, LPAT, LPC, LMHC

Clinical Social Workers

Education

At a minimum, a clinical social worker must have a master’s degree focusing on developing practical clinical skills. Some clinical social workers choose to pursue advanced academic study and research by earning a doctorate degree in social work or a counseling-related field.

Experience

Clinical social workers participate in a variety of supervised clinical experiences as part of their education. Those seekinglicensure pursue at least two years of supervised clinicalexperience after graduation.

Licensure

Clinical social workers are licensed in most states. In addition to the educational and experiential requirements listed above, state licensure requires passing a written examination.

Typical Settings

• Clinics

• Community-Based/Non-Profit Organizations
• Government Agencies
• Hospitals
• Private/Group Practices

Typical Initials

Academic: DSW, MSW, PhD
Credentials: ACSW, CSW, LCS, LCSW, LICSW

Drug and Alcohol Counselors

Education

Drug and alcohol counselors may have an associate’s degree, bachelor’s degree, master’s degree, or doctorate degree in a variety of counseling-related fields.

Experience

Requirements vary according to location, licensure type and work setting, but most drug and alcohol counselors undergo supervised clinical experience as part of their education, in addition to supervised on-the-job experience.

Licensure

Licensure and registration laws vary widely from state to state, so you should speak with individual counselors about theircredentials and background. Many drug and alcohol counselors seek board certification from a professional organization.

Typical Settings

• Clinics

• Community-Based/Non-Profit Organizations
• Government Agencies
• Private/Group Practices
• Rehabilitation Clinics and Centers

Typical Initials

Academic: AA, AS, BA, BS, MA, MS, PhD, EdD
Credentials: ADC, CAC, CASAC, CATC

Marriage and Family Therapists

Education

Marriage and family therapists have a master’s degree, which focuses on clinical skills. Some marriage and family therapists pursue a doctorate degree in marriage and family therapy, counseling, or psychology.

Experience

Marriage and family therapists undergo a supervised clinical practicum and internship as part of their education, as well as least two years of supervised clinical work experience after graduation.

Licensure

Marriage and family therapists are licensed in most states. In states that don’t offer this license, marriage and family therapists pursue licensure in a closely-related field such as professional counseling. In addition to the educational and experiential requirements listed above, licensure requires passing a written examination.

Typical Settings

• Clinics

• Community-Based/Non-Profit Organizations
• Private/Group Practices

Typical Initials

Academic: EdD, MA, MC, MS, PhD
Credentials: LCPC, LMFT, LPC, LMHC, MFCC

Pastoral Counselors

Education

Educational requirements vary widely depending on religion and denomination. Most pastoral counselors complete relevant coursework in theology, psychology, or counseling.

Experience

Because of the diversity of religious institutions, there are no consistent experiential requirements. Most people who hold themselves out as pastoral counselors have undergone some supervised counseling experience, however.

Licensure
Very few states actually license pastoral counselors. Some pastoral counselors seek licensure in another discipline such as professional counseling or marriage and family therapy, though this is not considered necessary to practice in a religious setting. You should speak with individual counselors about their background and credentials.

Typical Settings

• Churches

• Community-Based/Non-Profit Organizations
• Hospitals

Typical Initials

Academic: DMin, MA, MDiv, MS, PhD
Credentials: CCPT, CpastC

Professional Counselors

Education

At a minimum, professional counselors have a master’s degree focusing on clinical skills. Some counselors pursue a doctoral degree in counseling, counselor education, or psychology.

Experience

Professional counselors undergo supervised clinical experiences as part of their education as well as two years of supervised clinical employment after graduation.

Licensure

Professional counselors are licensed in almost all states. In addition to the educational and experiential requirements listed above, licensure requires passing a written examination.

In a few states, professional counselors are licensed in two tiers: first-level counselors can practice under supervision, while second-level counselors practice independently.

Typical Settings

• Clinics

• Community-Based/Non-Profit Organizations
• Hospitals
• Private/Group Practices

Typical Initials

Academic: MA, MS, MC, PhD, EdD
Credentials: LCPC, LMHC, LPC

Psychiatrists

Education

Psychiatrists attend four years of medical school followed by a year of internship and four years of residency. Some psychiatrists pursue advanced specialty training through a fellowship.

Experience
Psychiatrists undergo extensive supervised clinical experience during the last two years of medical school, internship, residency, and fellowship.

Licensure

All states license medical doctors. In addition to the education and experiential requirements listed above, doctors must pass a medical or osteopathic examination. Most psychiatrists seek board certification through a professional organization.

Psychiatrists are licensed to practice medicine, which may include providing psychotherapy and prescribing medication. Under no circumstances should you accept services from an unlicensed medical doctor.

Typical Settings

• Clinics

• Hospitals
• Private/Group Practices

Typical Initials

Academic: MD, DO

Psychoanalysts

Education

Psychoanalysis is a psychotherapeutic approach, but one can also choose to be licensed as a psychoanalyst in New York State. A licensed psychoanalyst must have at least a master’s degree in a psychology-related discipline, and extensive postgraduate training through an approved psychoanalytical institute.

Experience

Licensed psychoanalysts must undergo an extensive period of supervised post-graduate clinical work. Psychoanalysts also undergo personal psychoanalysis.

Licensure

In addition to the educational and experiential requirements listed above, licensed psychoanalysts must pass a written examination. In most states, psychoanalysis is practiced by other licensed professionals who have undergone training, supervision, and analysis through a psychoanalytic institute.

Typical Settings

• Clinics

• Hospitals
• Private/Group Practices

Typical Initials

Academic: MA, MS, MC, PhD, EdD, MD, DO
Credentials: LP, NCPsyA

Psychologists

Education

Psychologists have a doctorate degree. The PhD emphasizes clinical and research skills; the PsyD program focuses on clinical skills. Some psychologists pursue advanced postdoctoral training.

Experience

Licensed psychologists undergo supervised clinical internships and practicums during their education. Most psychologists undergo at least two years of supervised clinical experience after graduation.

Licensure

In addition to the educational and experiential requirementslisted above, psychologists must pass a written exam. Many psychologists seek board certification through a professional organization.

Typical Settings

• Clinics

• Community-Based/Non-Profit Organizations
• Hospitals
• Private/Group Practices
• School-Based Programs

Typical Initials

Academic: PhD, PsyD
Credentials: LP, LCP

Pre-Licensed Therapists

All licensed professionals undergo a period of supervised clinical experience. During this period, they provide services under the supervision of a licensed professional and are held to the same professional and ethical standards as a licensed professional.

Though pre-licensed clinicians do not qualify for insurance reimbursement, they typically offer services at a discounted rate.

Unlicensed Therapists

Various licensure and registration laws protect certain practices and titles, but in most states no law prevents an unqualified person from simply calling themselves a therapist and seeing clients.

It’s not safe to assume that all unlicensed clinicians are unqualified or incompetent, however. Some therapists work without a license because no license is available for their discipline in the state in which they practice. Other unlicensed therapists are experienced professionals who work in settings in which licensure is not required.

Before considering working with an unlicensed therapist, you should ask questions about the person’s education, experience, and background.

Dissatisfied clients have little legal recourse against an unlicensed therapist if they feel they’ve been injured or defrauded.

Activity 4

At the top of an index card or a small piece of paper, write Professions. Below that, record your top three
choices of profession.

• Advanced Practice Registered Nurse

• Art Therapist
• Clinical Social Worker
• Drug and Alcohol Counselor
• Marriage and Family Therapist
• Pastoral Counselor
• Professional Counselor
• Psychiatrist
• Psychoanalyst
• Psychologist

If your surroundings make you feel uneasy or unsafe, you’re probably going to remain closed off. On the other hand, if you’re comfortable with the space, it makes it much easier to open up to your therapist.

Different settings work for different people, so this is your opportunity to get a feel for things before you walk through the door for the first time.

Private Practice Offices

These are the kinds of offices you usually see on television or in the movies. Most real private offices are quite a bit smaller than those Hollywood sets, however. Large wood-paneled rooms covered with tasteful artwork and long rows of bookcases are very impressive, but the cost of renting such luxurious space is usually passed on to the client in the form of higher session fees.

If you find yourself in more modest surroundings, keep in mind that while leather furniture and antiques are pleasant, they don’t actually make therapy more effective.

Large group practices have a reception area and waiting room, very similar to what you’d see at a dental or medical practice. If you’re sensitive about privacy and confidentiality, you need to be aware that there will probably be other clients in the waiting area with you.

Smaller practices usually have a small, private waiting room and many single-person practices have no waiting room at all. On request, your therapist can probably schedule buffer time between sessions for added privacy.

The decor of a private office reflects the therapeutic approach and personality of the therapist. Styles range from very formal, with straight-backed chairs and academic credentials on the walls, to very homelike, with overstuffed recliners and craft decorations.

In most private offices, you’ll have access to a private bathroom. In some buildings, however, you may have to share a bathroom with other tenants.

Hospital Clinics

While most hospitals have outpatient clinics, the type of space can vary from place to place. Some clinics are located in the hospital interior, and are treated just like any other department. Other clinics have separate parking lots and entrances and feel more like self-contained agencies or group practices.

Hospital-based clinics usually have easier access to medical resources than other settings. Communication between psychiatrists and non-medical therapists tend to be better in this setting, for example. In addition, if you’re taking medication, you may appreciate the convenience of getting your medication checkups and therapy in the same location.

You need to be aware of any strong feelings you have about hospitals. If you look at hospitals as clean, safe places staffed by caring experts, then the hospital setting has obvious advantages for you. On the other hand, if you experience high levels of anxiety just walking through the door, you need to consider how that might get in the way of your treatment. (Of course, if getting past your anxiety is your goal, this setting would be ideal.)

Hospitals have reception and waiting areas, so you will probably come in contact with other clients. Private bathrooms are usually available.

If you decide to seek therapy at a hospital-based clinic, be sure to arrive early for your first appointment. You may need some extra time to find parking and locate the clinic within the hospital.

Agency/Counseling Centers

Some agencies and counseling centers—especially those associated with hospitals or medical systems—are clean, bright, and modern. Others, unfortunately, have a shabby and outdated appearance.

Keep in mind that a center’s physical appearance reflects its level of funding; it is not an accurate guide to the quality of the services it offers. Good therapists practice in bad offices, and vice versa.

Almost all agencies and counseling centers have reception areas and waiting rooms. These common areas can get busy and crowded at times due to the steady stream of clients, caseworkers, insurance representatives, and government officials coming in and out of the building to attend meetings and consultations.

Though it can be off-putting at first, this busy environment does offer some advantages. Community counseling centers usually understand local issues better than other providers, and their connections in the government and non-profit communities means that they can get you access to people and services you wouldn’t have known about otherwise.

Another advantage of this setting is that most agencies and community counseling centers are located in buildings designed specifically to deliver services, with thick, soundproof walls and large rooms available for group meetings. Bathroom facilities will be shared with clients from other offices.

School-Based Programs

College and university-based counseling services are usually available to all enrolled students, not just those who live on campus. Larger universities will have waiting rooms and be somewhat similar to the agency setting described above. Smaller colleges may have just one office, similar in most ways to a private practice setting.

Counseling services for school-aged children vary by locality, but therapy will be delivered in a private room in the school building itself, or in a private office in the community.

Community/Religious Spaces

Counseling is offered in churches, community centers, senior centers, or just about anywhere else in which private space can be set aside. Buildings with ample parking and large meeting spaces are particularly popular choices for group therapy sessions.

Waiting rooms and reception areas are rare, but because these spaces serve multiple purposes, you’re very likely to encounter other people from the community.

Your Home

Some family therapists will work with you in your residence. If having a stranger in your home causes you anxiety, remember that your therapist is a professional providing a service, not a guest to be entertained.

Activity 3

At the top of an index card or a small piece of paper, write Settings. Below that, make a note of the two settings you’d most prefer.

• Private Practice Office

• Hospital Clinic
• Agency/Counseling Center
• School-Based Program
• Community/Religious Space
• Home

I placed this chapter near the front of the book because I’m a realist. Money can be a very big deal. Most former clients will tell you that their therapy was worth every penny; but make no mistake, those pennies do add up.

It’s important to have some idea of what things are going to cost and how much you can afford to spend before you make your first appointment. The therapist’s office is no place to experience sticker shock.

Insurance

If you have insurance through an employer or a government program, a good first step is to figure out what kind of mental health coverage you have. Specifically, look for information about Outpatient Psychotherapy or Outpatient Counseling.

To get this information, look through your insurance paperwork, check out the insurance plan’s website, or call a service representative. Here are some questions to keep in mind:

• Does my plan cover therapy?

• For how many sessions will I be covered?
• What is my co-pay for each session?
• Does my plan only cover certain providers?
• Does my plan only cover certain kinds of therapy?
• Does my coverage change if I go outside the network?
• What sort of paperwork will my therapist and I be required to submit?

Remember that the goal of an insurance plan is to spread the risk of healthcare costs out over a large group of people. To keep costs down and make a profit, insurance companies seek to restrict payments for any services that are not considered medically necessary. For this reason, it can be difficult to get coverage for family or couples therapy. Individual therapy related to a specific diagnosis, on the other hand, is usually approved.

Managed Care

Managed care organizations such as healthcare maintenance organizations (HMO) and preferred provider organizations (PPO) are like insurance plans except that they also take responsibility for managing and coordinating health care delivery.

If you’re a member of an MCO, find out what kind of coverage you have for Outpatient Psychotherapy or Outpatient
Counseling. Check out your plan’s paperwork or website, or call
a service representative. Keep these questions in mind:

• Does my plan cover therapy?

• Do I need a referral from my primary care physician?
• For how many sessions will I be covered?
• What is my co-pay for each session?
• Do I have a deductible? How much is it?
• Does my plan only cover certain providers?
• Do I have partial coverage if I choose to go outside my network?

As the cost of health care continues to rise, managed care organizations are becoming increasingly popular because of their ability to keep costs down.

Just like insurance companies, managed care organizations control expenses and make money by limiting services, so be prepared to jump through some hoops to get the coverage you need. Dealing with the bureaucracy can be frustrating, but it pays to be persistent.

Self-Pay

Depending on what part of the country you live in, the full cost of therapy can be anywhere from $60-$300 per session, with most therapists charging somewhere in the $80-$120 range.

If these numbers scare you, don’t panic. What you actually pay out of pocket may be quite a bit less than the full price.

Almost all hospitals, clinics, and community agencies charge according to a sliding scale. In other words, you may pay less than the full fee depending on your income, number of dependents, and so on.

Don’t make the mistake of thinking that sliding scales are only for the benefit of the very poor. In reality, most working-class and middle-class clients will also qualify for a reduced fee.

You also may not realize that even many private therapists offer a sliding scale or reduced fee program for clients who could not otherwise afford therapy. Remember that it never hurts to ask.

If you have serious financial difficulties, you may be provided services free of charge. If you can’t track down these opportunities, contact your county’s mental health or social services program.

Believe it or not, paying out of pocket offers a few real advantages. Because you’re making a personal investment in therapy, you’re likely to have more motivation and make progress more quickly than someone who can simply coast from session to session with no financial consequences.

Employee Assistance Programs

Many employers—particularly large organizations—offer employee assistance programs. These programs can offer anything from legal advice to substance abuse rehabilitation. Some EAPs also offer counseling services.

Typically, these services are limited to a certain number of sessions, and may deal only with specific issues. If you have an EAP where you work, it’s worth checking out. You may get the services you need at no cost to yourself.

School-Based Counseling Programs

If you’re a college or university student, you probably have access to your school’s counseling center. Since the center is funded by your tuition and fees, services will be provided to you without an additional per-session fee.

Most school-age children have access to tax-funded counseling services through their school district. Contact a guidance counselor to see what options are available.

Health care Savings Programs

Most employees now have the option of putting away a certain amount of their income on a tax-free basis to cover health care costs, including therapy fees or co-pays.

There are several kinds of accounts available, so contact your human resources or benefits manager to learn more about the options available to you.

Activity 2

At the top of an index card or a small piece of paper, write Payment. Below that, write how you plan to pay for services. You may choose more than one option.

• Insurance

• Managed Care
• Self-Pay
• Employee Assistance Program
• School-Based Program
• Health care Savings Program

Below that, write down how much you can realistically afford to pay out of pocket for services on a weekly basis.

I can pay _____ a week for therapy.

Over the next ten chapters, that mental image is going to get a lot bigger. The kind of therapy you’ve seen on TV is available, but you might be surprised at how many other options are out there.

Individual Therapy

When you say the word “therapy” or “counseling,” this is the kind of approach most people think of. If you choose individual therapy, you will work one-on-one with your therapist in a private office, usually for one 50-minute session a week.

Just because you’re the only client in the room, though, you can still expect to spend time talking about and working on your relationships—a vital part of any counseling experience.

Advantages

• Because there are only two people involved, individual therapy offers the most privacy and the greatest assurance of confidentiality.

• Your therapist will be focused entirely on you and your needs for the entire session.
• You can typically work out a time that works best for your own schedule without having to coordinate with other people.

Disadvantages

• Individual therapy is more expensive than group therapy.

• The therapist only has one source of information about your life.
• You only have one source of feedback and support.

Group Therapy

If you choose group therapy, you’ll probably start with an individual interview with the therapist to make sure you’re a good fit for the group.

Groups range in size from 3-12 members, with the average being around 6-8. Typically, the entire group, along with the therapist, meets once a week for about 90 minutes in a large meeting room. Because of the space necessary, it’s not unusual for groups to take place in community centers or church social spaces.

Advantages

• Group therapy is typically much less expensive than individual therapy.

• Working with other people is especially helpful for social and communication problems.
• You get more than one source of feedback and support.

Disadvantages

• With so many people involved, it’s much harder to maintain confidentiality.

• Your individual problems are not the sole focus of treatment.
• You’ll have to compromise to find a date and time that works for the entire group.

Couples Therapy

Sometimes called marital therapy, marriage counseling, or relationship therapy, the focus here is primarily on the relationship between two people.

You and your partner will meet with a therapist to discuss your problems and work on ways to improve your relationship. Although rare, some therapists will work with each member of the couple in individual sessions as well.

Like individual therapy, sessions are usually held once a week for about 50 minutes in a private office.

Advantages

• If you’re dealing with major problems in your marriage or relationship, this form of counseling offers the most focus.

• When both partners participate, the therapist gets more information and can observe how you relate to each other. This can greatly improve the effectiveness of treatment.

Disadvantages

• You may not feel comfortable revealing embarrassing things about yourself with your partner present. Your partner may feel the same way.

• If your partner is resistant, it could block you from getting the help you need.

Family Therapy

Family therapy usually takes place in a private office, but increasingly, family therapists are offering services in the home. In either case, you can expect at least one 50-minute session a week. With this form of therapy, it’s not uncommon to have multiple or extended sessions as well. If you choose this approach, you may work with more than one therapist.

Your therapist might work with the entire family, subgroups within the family, individual members, or some combination of these arrangements.

Advantages

• If your family is having problems, this may be the most effective approach.

• Working with the entire family gives each member an opportunity to share information and be part of the solution. This can lead to a greater sense of
  commitment.

Disadvantages

• Some members of the family may resist treatment, which will limit progress.

• You may not feel comfortable sharing certain things about yourself in front of your family; other family members may feel the same way.

Activity 1

At the top of an index card or a small piece of paper, write Kinds of Therapy.
Below that, write down the kind of therapy you’d most prefer.

• Individual Therapy

• Group Therapy
• Couples Therapy
• Family Therapy

It seems like such a simple statement, but it’s taken several decades of research to confirm that most people do, in fact, benefit from therapy.

Some of this research has also addressed the trickier question of how therapy works. As it turns out, the relationship between the therapist and the client plays a huge role.

Given the importance of this relationship, doesn’t it seem odd that anyone would choose a therapist from the phone book?

Well, maybe not so odd. People going through serious difficulties can have a hard time just getting out of bed, much less trying to learn to shop for a therapist. Even those who do have the motivation often give up because they just don’t know what they’re looking for.

If you’re reading this book, you probably know what I’m talking about. Resist the temptation to pick someone from an ad or call the first number your doctor gives you. Choosing a good therapist takes more effort than opening a phone book, but it’s not as difficult as you might imagine.

This book will walk you through the process step-by-step and give you all the information you’ll need to make an informed decision.

Please read the book in order the first time through without skipping pages or jumping from chapter to chapter. Of course, you can always go back and review sections after you’re done. It’s also very important to complete all of the written exercises.

The book is short and simple, so you’ll probably be ready to make your first appointment in a few days. Feel free to move at your own pace, but try not to fall into the procrastination trap. Remember, you’re looking for a good therapist, not a perfect one.

Just one more thing before we get started. If you’re going through a major crisis, don’t wait to get help. Call 1-800-784-2433 or your local crisis hotline. If you feel like you might hurt yourself or someone else, go immediately to the nearest emergency room or call 911.

Let’s get started. As any smart shopper will tell you, the first step in getting what you want is knowing what you want.