Saturday, June 15, 2013

Finding the Right Therapist for Mental Health Problems


How do you choose a psychotherapist who is right for you? It’s an important question. If you are spending time, energy and money to make major changes in your approach to life then you want the right person to help you. Psychotherapy is a major personal investment, and research demonstrates that the relationship between the patient and the therapist is the single most important factor in recovery. But most of us realize there are thousands of therapists out there. Finding the right one can seem overwhelming, especially when you are already feeling unwell. Here are some simple ideas to get you started.

Consider if you plan to work through your insurance company or pay out of pocket for your therapy. Many good therapists take insurance but there are others who will ask you to pay them directly and then seek reimbursement from your insurance company on your own. Your insurance company may have a directory of therapists they work with, which is a good place to start. Larger clinics with many therapists will usually take many kinds of insurance, so these can be good resources if there are any in your area. Online directories (here are a few: http://www.goodtherapy.org/; http://www.therapynetwork.com; http://www.psychologytoday.com) are other referral resources that can provide basic information about therapists in your area. You may even be able to find feedback from other patients by looking online, although any online griping should be taken with a grain of salt.

Look for a therapist who is convenient to where you live and your working hours or other time commitments. Most psychotherapy will need to take place weekly, or at least every two weeks. Don't add stress over the difficulty of getting to your appointments to your current problems.
If you live near a university with a teaching hospital they may have clinics available in which you can see therapists in training. This is often a very good way to find a therapist. Often you will pay a reduced or sliding scale fee. Trainees are well advanced in their education by the time they see patients, are under close supervision by an experienced therapist (so that you get two therapists thinking about your problems, not just one), will be up to date on all of the latest information in their field, and usually bring excellent energy and dedication to their work with you.

Find a therapist with an appropriate educational background. Typical degrees for a therapist are in social work (MSW with qualification as LCSW), psychology (PsyD or PhD), counseling (LPC) or medicine (DO or MD with training in psychiatry). After the basic schooling therapists also have to serve an internship or residency under an experienced supervisor and must also pass licensing exams. Your therapist should be ready, willing and able to discuss his or her educational background and training with you and should have appropriate licensure documents posted in his or her office. It is important to note that many medical doctors who practice mental health care (called psychiatrists) are not well trained in therapy. The few who are often emphasize that training and tend to be very good, but do not assume that every psychiatrist will provide psychotherapy.

Talk to a prospective therapist about their experiences in practice. Many therapists will specialize in an area such as family therapy or posttraumatic stress disorder therapy. Obviously you would want to choose someone whose experience matches the challenges you are facing. Sometimes you can find this information online but it is usually good to speak directly to your prospective therapist about the types of problems they work with. Also discuss with a prospective therapist if he or she has a particular approach to psychotherapy. There are many different types of psychotherapy available. Some therapists are skilled at multiple approaches but other therapists specialize.

Arrange an initial consultation, and approach it as an interview. You and the therapist should both be learning about each other and deciding if you can work well together. The therapist will need to learn about who you are as a person and the circumstances of your life in addition to the current difficulties for which you are seeking help. The therapist should ask you questions but should also spend much of the interview time listening to you. You need to learn if the therapist listens well, appears knowledgeable, is caring and patient, and is someone you are comfortable speaking with about very personal matters. If you don’t feel comfortable with a therapist than no matter how well credentialed they are, this is not the right therapist for you. Choose someone else on your list and arrange another initial consultation.

The therapist should also be focused on you and your problems. Beyond answering reasonable questions about their training and experience, a good therapist will not talk too much about himself or herself. And anything a therapist does say that is personal should be brief and directly relevant to your problems and treatment – for example, giving parenting suggestions based on their own experiences. A therapist who freely shares many personal details and experiences is probably going to be more focused on his or her own issues than yours, and should be avoided.

Another option for psychotherapy is to use book based or online psychotherapy. These types of therapy are not as well studied at this point as working with a trained therapist and don’t allow you to develop that all-important relationship. On the other hand, they are often much cheaper and more readily accessible. There are many good books available for many types of problems. It is usually best to get a workbook, something that requires you to reflect on what you’re reading and attempt to apply it to your life. The series “Treatments that Work” from Oxford University Press has many different manuals that systematically take you through overcoming problems like insomnia, depression, and different types of anxiety disorders. You can also combine these approaches; working in person with a therapist to review and discuss the material in your workbook can help you learn faster. A good therapist can also gently point out your blind spots and keep you from missing or misapplying important points in the workbook.

An important note: If you are attempting to work through your difficulties using a book and are not seeing real and significant progress within 2-3 weeks then I suggest seeking a therapist. If at any time you feel suicidal, you should not be trying to work through your problems on your own. Seek help through an emergency department or the national suicide hotline (1-800-273-TALK) immediately.

So, to summarize – use your insurance company’s information or online resources to locate some possible qualified therapists. Pre-screen the information by looking at factors such as educational background, experience and feedback. Consider the first visit as an interview and if you don’t feel the therapist is a good match, keep looking!