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How To Choose A Mental Health Therapist

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Once you have decided to speak with a therapist, it is preferable to approach the decision which therapist to see as an active consumer. This can be difficult when you are in distress, but well worth doing. An active consumer would take the following steps. See the end of this article for information about paying for therapy.

Step 1: Determine what type of therapist to see: a psychiatrist, psychologist, social worker or counselor.

The types of therapists are:

  • Psychiatrists
    • A psychiatrist is a medical doctor who has completed medical school, internship and residency requirements who specializes in the mental aspects of illness.
    • A psychiatrist can prescribe medication and may have admitting privileges with a hospital.
  • Psychologists
    • A psychologist is a licensed mental health professional who has completed an advanced degree in psychology that usually includes clinical training and internships. Psychologists are either have a Masters degree or are Doctors of Philosophy (Ph.D.)
    • Psychologists cannot prescribe medication.
  • Social Worker
    • A social worker is a professional with a college degree who is trained to talk with people and their families about emotional and physical needs. Social workers have training and expertise in finding support services and financial assistance.
    • There are social workers who specialize in helping people with particular diseases, such as HIV or cancer.Social workers who specialize in cancer are known as Oncology Social Workers.
    • Social workers cannot prescribe medications
  • Counselor
    • Counselors are therapists with the least amount of education and training.
    • Counselors cannot prescribe medications.

To help determine which type of therapist to see, consider the following:

  • Determining the type of provider to see is a decision that is up to you. There is no right or wrong here. A Consumers Report survey found that most people reported feeling better with therapy, regardless of whether they were treated by a psychologist, a psychiatrist or a social worker.
  • What is important in therapy is that the provider you choose is someone with whom you feel comfortable working, and that the provider has the proper credentials for his or her discipline. Preferably the person recognizes the need to be flexible, using the approach best suited to the stage of your illness or your particular problem.
  • Consider seeing a therapist who specializes in helping people who are living with a life-changing condition -- preferably in your particular condition. Professionals who specialize in particular diseases will understand prognoses, treatments and side effects. For example, fatigue can be caused by a health condition or deprssion. The therapist should be able to recognize the difference.
  • To locate therapists or social workers who specialize in particlar:
    • Cancer, see the Association of Oncology Social Work www.aosw.org offsite link.
    • For therapists specializing in other diseases, contact the local or national office of your disease specific nonprofit organization.
    • Consultation-Liaison Psychiatrists are psychiatrists who specialize in working in situations involving other doctors, particularly with people with life changing conditions. Such doctors can now be board certified under the name: Psychosomatic Medicine. To locate such doctors, see: www.abms.org offsite link/
  • NOTE: If you are considering seeing a therapist to support a claim for Social Security Disability Insurance (SSDI), keep in mind that for determining disability, Social Security ranks therapists in the following order of preference:
    1. A psychiatrist
    2. A psychologist with a doctorate degree (Ph.D)
    3. A social worker or similar provider -- the greater the educational background, the better.

Step 2: Find potential therapists.

Many different roads can lead to finding the appropriate therapist for you.

  • Your doctor or specialist is a good source for a referral. He or she should be able to give you one or more names of therapists who are familiar with your health condition.
  • Family and friends can be a good source for referrals.
  • A local disease specific non-profit organization may be able to provide you with the names of therapists who are familiar with your condition.
  • If you attend a support group, you may be able to get the names of therapists from members of the group.(If you don't attend a support group, consider joining one at least for a test. To learn more, see: Support Groups.
  • The magazine, Psychology Today, has a list of therapists, psychologists and psychologists, together with a brief resume, their specialities and fees, available by zip code through www.psychologytoday.com offsite link.  Click on "Find A Therapist"
  • A professional Association. For example,
    • The National Mental Health Association. Call 800.969.NMHA, or visit their website at www.nmha.org offsite link.
    • The National Association of Social Workers can help you find a registered social worker. See www.socialworkers.org offsite link. Once at their site, click on "find a social worker."
    • The American Psychological Association can help you find a psychologist. Call 800.964.2000.
    • The American Psychiatric Association can help you find a psychiatrist. Call 888.357.7924.
    • The American Association of Pastoral Counselors can help you locate a therapist who also has in-depth religious/theological training.www.aapc.org offsite link.

Step 3: Contact the therapist before setting an appointment to find out if the person seems right for your needs. A brief conversation on the phone may give you a rough idea about whether a person is for you or not.

Look for a person who:

  • Understands you and your situation.
  • You can speak to easily (even if it takes time to be completely open with the person
  • Makes you feel comfortable and with whom you can share your feelings – even if it takes a while to be able to talk about your inner-most feelings. As they say, it is not easy to unpack your bags in front of a stranger and it may take a bit of time.
  • That hears you and what you are saying.
  • You do not feel embarrassed talking to about your emotions.
  • Gives you homework or extra reading or ideas to chew on between appointments.
  • Accepts your insurance if you have it. (If you don’t have health insurance, do your best to get it. For information, click here)

Step 4: Prepare for the first session. To help maximize your limited time together:

  • Consider making notes about how you feel.
  • Note any situations that trigger negative (and positive) emotions.
  • Keep track of your questions and concerns in general, and with respect to the therapist. Questions you may want to ask the therapist include:
    • Whether the therapist is licensed in your state.
    • The person's experience working with people with your disease.
    • The therapist's educational background.
    • Financial questions such as:
      • How much does the therapist charge?
      • What if you cannot make a session?
      • Is the therapists services covered by your health insurance? If so, who sends the bills to the insurance company? 

Step 5. At the first session

  • Your first appointment with a therapist will be an opportunity to get to know each other.  Ideally, therapy involves a collaborative approach, meaning that you and the therapist work together to resolve any problems that you are having. It is important that you are comfortable with a therapist and are able to develop a rapport on some level. It is difficult to open up to someone you do not instintively trust and like.
  • During your initial visit, the therapist will likely ask you for some general background information, and will ask you to describe the reason(s) or feelings that led you to seek help.
  • The initial visit is also an opportunity for you to get some additional information from the therapist. After describing your situation, you may wish to ask:
    • What type of therapy/treatment program the therapist recommends.
    • If the recommended therapy has been shown to be effective for dealing with situations such as yours. Also, what you might expect from treatment.
    • How much therapy is recommended?
    • If the therapist is willing to coordinate your treatment with your primary care doctor, specialist, or other members of your health care team.
  • Also, during your initial visit, consider:
    • Is the therapist someone with whom you feel comfortable?
    • Does the therapist listen to you?
    • Does the therapist seem to understand your concerns?
    • Does the therapist seem to be someone you can trust?
    • Does the therapist seem knowledgeable about your problem and/or situation?
    • If your initial visit left you with the impression that the therapist was someone that you simply couldn't relate to or you had other concerns about the possibility of a working relationship with this individual, do not hesitate to contact someone else. Therapy doesn't work if you're not comfortable sharing your most intimate thoughts and feelings.
  • Keep in mind:
    • Finding a therapist that is right for you does not always happen on the first try.
    • Your time with a therapist involves a relationship. It takes time to develop a relationship with someone. Don't expect a deep emotional bond to develop in the first visit or even in the first visits.
  • NOTE: 
    • in mind that working with a therapist is a creating a relationship: if you have ideas about how to make the relationship better or more meaningful to you – share it. Sharing gives the person an opportunity to meet your needs. Don’t give it a “one and done.” 
    • If the fit with a particular therapist isn't good, try again until you find the right person for you.

Paying For A Mental Health Therapist

  • Private health insurance: Because of the Affordable Care Act ("Obamacare"), group and individual health plans must offer the same coverage for mental health treatment and for surgical and medical benefits.  If you have insurance, but are unable to afford the co-pay, ask if the provider will accept as payment in full the amount that your insurance plan pays.
  • Medicare
    • If you have Medicare Part A: Medicare Part A will help cover mental health care given in a hospital. Medicare Part A covers your room, meals, nursing and other related services and supplies.
    • If you have Medicare Part B: Medicare Part B will help pay for mental health services generally given outside a hospital. Medicare Part B covers inpatient and outpatient doctors' services, outpatient therapy services given by social workers and psychologists, laboratory tests, and partial hospitalization. For additional information on Medicare coverage, see: Medicare.
  • Medicaid: Medicaid coverage varies state by state. To determine if mental health benefits are offered by your state Medicaid program, seewww.cms.hhs.gov/MedicaidEligibility/downloads/MedGlance05.pdf offsite link.
  • No Insurance/Limited Income: If you do not have mental health coverage, or if your income is limited:
    • Look for a provider that has a sliding-scale fee -- basically a reduced fee based upon your income.
    • Talk to a provider about a payment arrangement or payment plan that you can afford.
    • Look for a community mental health center. These centers typically offer a range of mental health treatment and counseling services on a sliding-scale basis. You can look for a local center in your phone book, or can ask your doctor, or a local disease specific non-profit organization, for assistance in locating a center.
    • Ask your house of worship if they can put you in touch with a pastoral counselor. Pastoral counselors often provide counseling on a sliding-scale fee.
    • Ask if your local disease specific non-profit organization provides any counseling services. Some organizations offer free "crisis counseling" for a few sessions, and may work out a payment plan or sliding-scale fee for additional sessions.

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