Several years ago, Consumer Reports devoted an entire issue to the subject of psychotherapy. It published a study that found that, overall, psychotherapy works. But finding that kind of help can be a challenge. Almost daily I get e-mails or telephone calls from people who don’t know how to find a good therapist or don’t know how to assess the quality of treatment they are getting.
So, here is a primer that I hope will remove some of the mystery and confusion.
Because of today’s medical climate, you may have to start by contacting your insurance carrier to see if it pays for psychotherapy, if it has a list of providers you must choose from, and how much of your therapy will be covered. Some carriers will pay a percentage of the cost to see a therapist who is not on their provider list, and some will not. If this is an issue for you, then the insurance company is a good place to start.
Generally, the best way to find a good therapist is to talk to a friend or family member who has been in therapy and see if they were happy with their therapist. Other than a direct recommendation, the choices get more complicated.
Psychotherapy can be provided by social workers, psychiatrists, psychologists, family therapists, addiction counselors, nurse practitioners, and on and on. Each of these disciplines is represented by national organizations and most by state associations as well. Professionals in any of these disciplines could provide excellent therapy and many could provide poor therapy. What’s the difference?
Psychiatrists go to medical school and complete a psychiatric residency, so they can provide medication and are knowledgeable about medical issues. Most psychologists are trained in both psychological testing and psychotherapy.
On the issue of medication, many people begin by seeing a family practitioner and are placed on psychiatric medication and find great relief. However, treating psychological problems with medication can be complicated business. And if the medicine your family practitioner has given you does not work, then you should see a psychiatrist.
Social workers and some counselors may have received less graduate study, but the majority of their training is often focused on psychotherapy.
The most critical issue is finding a good therapist – not necessarily the right discipline.
So where do you find a good fit?
Psychotherapy starts with the initial telephone call. How does the person sound on the phone? Is he or she willing to find time to answer a few questions? Of course, a therapist’s income is based on time, so most cannot spend 30 minutes on the phone with everyone who calls, but it is reasonable to expect five minutes or so. Ask about credentials, whether or not the therapist has worked with previous clients with your problem, and what that experience was like. Inquire about fees and insurance.
If you decide to make an appointment, remember the first session is a mutual evaluation. The therapist will want to know about you – and you should want to know about the therapist. Explore his or her approach to psychotherapy and your problem; after a few sessions, it’s reasonable to ask for an estimate of how long your treatment will take.
I am generally hesitant to recommend a therapist who practices only one specific psychotherapeutic technique for everyone he sees. There are exceptions, though. For example, there are specific techniques that work well with phobias and anxiety disorders. Someone with a major psychiatric disorder such as schizophrenia or bipolar disorder should be on medication in addition to any other form of therapy. But generally, a good therapist integrates many types of therapy and works with the patient rather than the therapy model.
If you can afford it, spend a session or two with the new therapist before you commit completely. You should feel as though the therapist understands you or has the ability to do so. You want to make sure the therapist doesn’t come with too many assumptions about you and what you need. You should feel safe and in a caring place in which you are not judged. Ideally, you will see genuine curiosity and interest. If not, find another therapist before you get too deep into the process.
If you have been in therapy for weeks, months or longer and are frustrated, discuss your frustration. You should find that your therapist is open to a dialogue and that you are not being blamed for the problem. It is not unusual to feel some frustration in the process. Frustration is part of any relationship, and resolving these feelings through open dialogue can be very therapeutic.
The Consumer Reports study showed the benefits of therapy start to slow down after 18 to 24 months. If you still have questions about your treatment, discuss with your therapist the possibility of getting an outside consultation. Most good therapists will be open to this.
And bear in mind that not all emotional healing must take place inside an office. Sometimes things like meditation or yoga, community activity, music or massage can be quite therapeutic. A great deal of emotional pain is caused by unhealthy lifestyles. Unhealthy eating habits, working too hard, sleeping too little, eating or drinking too much, complaining, unreasonable expectations and holding onto resentment can all contribute to unhappiness. Sometimes changes in these patterns can be made without psychotherapy and can provide great emotional relief.