Wednesday, March 23, 2011

How To Find A Good Therapist

It's a difficult, yet brave and courageous moment when someone makes the decision to pursue mental health therapy. More difficult than the decision to go to therapy is the decision of who to choose as a therapist.

So, how does someone find a good therapist?

Types of Therapists
First, it is important to think about the type of therapist you think is best for your presenting symptoms and issues. There are many kinds of mental health therapists, but sometimes understanding "who does what" can be confusing. Here is a list to help identify the specialties and degrees therapists can hold.

In the United States, Doctors of Philosophy (Ph.D.), Doctors of Psychology (Psy.D.), or Doctors of Education (Ed.D.) must complete at least four years of post graduate school, however, only those who have been licensed can call themselves Psychologists. Licensed practicing psychologists are specifically trained in the mind and behavior as well as diagnosis, assessment and treatment of mental, emotional, and behavioral disorders. The treatment provided is "talk therapy". It is important to know that not all psychologists are experienced therapists. Some specialize in areas such as statistical research or industrial psychology, and may have little experience treating people. Therefore, it is important to inquire about the caliber of clinical experiences. Generally speaking, most psychologists do not prescribe medication.

Social Workers

Clinical Social Workers (C.S.W.) usually have earned at least a Masters' Degree, which is two years of graduate school, and some Social Workers obtain a doctoral degree (D.S.W. or Ph.D.). Clinical Social Workers credentials may vary by state, but these are the most common: B.S.W. (Bachelor's of Social Work), M.S.W. (Master's of Social Work), A.C.S.W. (Academy of Certified Social Workers), or D.C.S.W. (Diplomate of Clinical Social Work). Although there are exceptions, most licensed clinical social workers generally have an "L" in front of their degree (L.C.S.W.) communicating that they are a Licensed Clinical Social Worker. Clinical Social Workers also receive training in the prevention, diagnosis, and treatment of mental, behavioral, and emotional disorders. Their goal is to enhance and maintain physical, psychological, and social functioning in who they treat.

A Psychiatrist completes a medical degree (M.D.) like any other physician, followed by a four-year psychiatry specialty. Psychiatrists prescribe medication yet sometimes do psychotherapy with patients. Psychiatrists, unlike Psychologists, have the background and experience to understand how the body and the mind as a whole react when psychiatric medication is given, and have extensively studied the total body including brain biochemistry, tissues, glands, and organs, leading to a fundamental understanding of how these all interact and react to the patient's environment in mental health and mental illness.

Marriage Family Therapists & Professional Counselors
Licensed Marriage and Family Therapists (L.M.F.T.), and Professional Counselors (L.P.C.) usually have two years of graduate school and have earned at least a Masters' Degree such as: M.A. (Master of Arts), M.S. (Master of Science) or M.Ed. (Master of Education). Marriage and Family Therapists have additional specialized training in the area of family therapy.

Certified Counselors
Certified Counselors are typically trained in drug or alcohol abuse specialties. A Certified Addiction Counselor (C.A.C.) or a Certified Alcohol Counselor, (C.A.C.) may have a I, II, or III added to their degree signifying the level of training in counseling (CAC-I, for example). A C.A.C. Counselor may or may not have a master's degree. Counselors are trained for supportive therapy. C.A.C's work within the field of alcoholism and substance abuse, providing education, consultation, counseling, aftercare, recovery and advocacy.

Religious/Theology/Pastoral Counselors
These are counselors who are clergy, pastors or who have a Master of Divinity (M.Div.) degree, or a Doctorate in Theology (Th.D.) from a seminary or rabbinical school, with additional training in therapy. These spiritual counselors are trained in both psychology and theology and thus can address psychological, religious and spiritual issues.

Counseling Nurses
Psychiatric Nurses and Nurse Practitioners comprise a growing segment of mental health treatment professionals. They display the credentials R.N. (Registered Nurse), R.N.P. (Registered Nurse Practitioner) or M.S.N. (Masters of Science in Nursing). A Psychiatric Nurse is a registered nurse with a master's degree who has been trained in individual, group, and/or family psychotherapy. The Psychiatric Nurse and the Nurse Practitioner view individuals from a holistic perspective, taking into account both physical and mental health needs while focusing on human behavior.

From Word of Mouth To Yellow Pages
Now that you know the kind of therapists with which you wish to work, how do you choose one?Here are a few ways that can provide leads to a good therapist.

Word of mouth: Asking a friend or relative that you trust can be a great way of finding a reliable therapist. When a clinician is highly regarded, there is usually a buzz in the community about him or her.

Professional Referrals: Contacting your general physician, or inquiring with school guidance and special service staff if you are looking for someone to work with your child are good ideas. Contacting local psychological, psychiatric or counseling organizations can be very helpful in pointing you in a direction as well.

Online Resources: Many professional organizations and grassroots organizations offer referral resources. There are also mental health websites like Psychology Today's Therapist Directory that can help you narrow down a search.

Insurance Company: If you have an insurance company, another suggestion is to call them directly and ask them to give you a few names of therapists in your area, and ones that specialize in the disorders or issues with which you are experiencing.

Religious Organizations: Many churches and temples have outreach programs where the person in charge can help you find a therapist.

Yellow Pages: Many times I get calls from people who look me up in the Yellow Pages. With nowhere else to turn, people cold-call with the hopes of finding a good therapist. This experience can be frustrating and may lead you down a bumpy road of contacting therapists who do not specialize in what you need. If possible, try one of the other strategies listed above to help you find a good therapist.

The Initial Phone Call
Once you have a few names, find the time to call each one and talk on the phone with him or her. You can get a great feel for a professional during this informal chat. If you make a connection on the phone, arrange for an appointment to consult with the therapist. I call this "the meet and greet" consult where I get to meet the potential patient, assess the symptoms and issues and make sure that my training and expertise are appropriate for the necessary treatment. This is a time where the potential patient gets to know me as well, how I will work and also learns about my approach to treatment and the parameters of therapy. Though comfort and connection are necessary factors, so too are making sure that the therapist of your choice is educated, seasoned and a specialist in what you are seeking.

Questions to Ask: Most therapists will welcome the opportunity to answer any questions that you may have. Here are some of the most important ones to consider:

1. What is your professional training and degree?

2. How much specialized training and experience have you had with what I am seeking help for?

3. What theoretical school of thought do you follow?

4. How long are the sessions?

5. What is the cost of each session?

5. How does insurance work with mental health therapy?

6. What is your policy on cancelled appointments?

7. Have you been in therapy yourself? If so, how long?

8. Is it possible to reach you after hours in the event of an emergency or crisis? If so, how?

9. Do you receive regular supervision on your cases or belong to a peer supervision group?

10. What professional organizations do you belong to?

Good Therapy
Once these bases are all covered, and you settle into treatment, you should slowly begin to feel an expansion within yourself. Your awareness will widen, your feelings may swell, and you may find yourself thinking in new ways about your situations and life experiences.

Therapy may be tough on occasions, but in time, you should start learning techniques to help change, shift or remedy symptoms. That's how the arc of good therapy progresses. Last, but not least, always, ALWAYS, be sure that the professional you choose to work with is a licensed mental health practitioner.


Anonymous said...

I would just add that one can get a PhD in clinical social work (as opposed to a DSW)!!!

HP said...

Great post Deb. Wondered about how it all worked in the US.

Dr. Deb said...

I will add that. I had a feeling I might have missed some specialty degrees. Thanks for the input.

Is it very different by you?

Wanda's Wings said...

Great suggestions. Some of the questions I would have never thought to ask. I will be moving and looking for a new therapist some time this year. I have had some bad luck in the past.

Xmichra said...

How to get into therapy here works differently (as far as I am aware). You can't just call up a person here. Usually, if you are insured, the insurance broker assigns you a person. Particularily annoying when all the available people in your area are backed by religious affiliations, or on the far side of newaged thinking. You kinda don't have much of a choice, or variety.

Helpful tools here though, if the avenues are there to go through.

Kahless said...

I guess also though that a good therapist for one person is a disaster for another.

Flannery said...

Very informative

Dr. Deb said...

It can be hard to find the right therapist. I;m glad the questions in this post can help you in the future.

Yikes, no choice? That's awful.

That's true. I know I have been helpful with many clients, but that I also didn't succeed with others.

Thanks for commenting. Hope you'll visit again.

Xmichra said...

I was actually mandated to receive therapy when I was pregnant with Isabella. I had lost my grandmother very suddenly to cancer, and had almost miscarried with Bells. So my work insurance made me go to grief counseling. I tried to explain that the woman I was sent to see was a devout Christian, and we didn't see eye to eye (she was a psychologist, but was all about praying to the lord) so I was given the choice of two other people. One female who was a clinical psychologist (dealt more with bi-polar disorder than grief) and a man who was quite the hippy! He was cool, and I got along with him okay. But I thought he was more "out there" than I was so it was hard to take him seriously (though he came with a long string of credentials).

There are other therapists/councilors in my town, I was just not allowed to deviate from the Insurance companies preference. Not exactly what I would call a healthy choice.

Anonymous said...

I have been worried about finding a new therapist if and when I decide to continue therapy. These are good questions to ask if I can get the courage to do so. Great post and helpful!

Dr. Deb said...

I am just speechless about your experience. To know that this is how the process works where you live is not comforting. I'm so sorry you had such a negative experience. And on top of everthing else you were dealing with!

It is hard starting with a new therapist. I've been there too.

OHN said...

I had to chuckle to myself when reading what to find out when you talk to a potential therapist.....the two times that I have felt compelled to seek guidance, my first thought was to find someone that could work fast and get to the bottom of things in 2-3 sessions :-)
I am sure that says something about

~Just me again~ said...

Good article. X is right. If you don't have coverage, you can go to the government run one, and they take you to intake. Interview you, and match you up with one close to your needs. I've you have coverage, or at least in my company. They only cover certain therapists...they have to be approved. I was lucky with my last therapist. She looks like DIanne Keaton, lol...but she's amazing.

jerrybob58 said...

I live in a very small rural community. 10,000 in NW Iowa. I went to counseling 20 years ago and received just the help I needed. He has long since moved and I have never found anyone else who good reputation in our community. Today I found this very helpful. I thought I would look for someone at the University of Iowa? What is yoopinion of using a University to find a couselor/therapist? My daughter lives there so it would make the journey across state worthwhile.

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How To Find A Therapist said...

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