How to Find a Therapist

Your personal physician, local university or med school, HMO, managed care company, clergy, family social service agencies, community mental health centers, mental health specialists, university medical school, hospital clinic, local chapters of national associations of psychologists/social workers/psychiatrists, or private psychiatric clinics can provide help or referrals. Or, if you know someone who has used counseling or therapy services, you may want to ask them who they go to, how they found them, and whether they would recommend them. A study by Consumerıs Report indicated a higher satisfaction rate among people who located therapists or counselors through personal or professional referral over those who located help through ads, health care provider lists, or clinics.

The Consumerıs Report study of November, 1995 reports that while many people feel more comfortable bringing their mental health issues to their primary care physician, only 1 in 4 people who sought advice from their primary physician were sent on to a mental health professional. Their extensive survey shows that primary physicians tend to treat for a shorter period of time, were less likely to correctly diagnose a mental health problem, and far more likely to prescribe medication but less likely to prescribe the correct medications for the appropriate dose or time period. Their report also shows that primary physicians do not tend to reach the same level of perceived well-being for their patients as compared to levels achieved by mental health professionals.

If you are a member of an HMO or managed care provider, you may ask the Human Resources staff to help you. Confidentiality will not allow them to tell you what other employees are utilizing mental health services, but they may be willing to ask those who are utilizing services to contact you, so that you may learn something about their experiences with the therapists on your provider list. Often you need a referral from your primary physician.

Challenges and treatment techniques can, to some extent, be different in different age group.

The Consumerıs Report of November, 1995 indicates that people were just as satisfied whether they saw a social worker, psychiatrist, or psychologist. People who used their primary physician were generally helped, but not to the perceived degree that others felt who saw a mental health professional.

Psychiatrists are medical doctors who have completed 3 years of residency following their other medical school requirements. All are trained in psychiatric diagnosis and pharmacotherapy, with a varying amount of experience in outpatient psychotherapy. Psychiatrists can prescribe medications, and are the only ones in this group who are specifically trained to spot medical problems which could contribute to a mental health problem.

Social workers typically do 2 years of field work to receive their masterıs, with a variety of focus areas and requirements which change from one university to another. Psychologists with Ph.D., Psy.D., or Ed.D. are licensed professionals with doctoral level training, typically including internship in a mental health facility and supervised post- doctoral experience. Marriage and family therapists may have a masterıs or doctoral degree, or may have another professional degree with supervised experience in the specialty.

Professional Councilors are decreased in some states. Like social workers, they have master's degrees and experience. In Florida, professional counselors who specialize in mental health counseling or Family Therapy may be Licensed Mental Health Counselors (LMHC's) and or Licensed Marriage and Family Therapists (LMFT's). In most states they obtain the Licensed Professional Counselor (LPC) credential.

Psychiatric nurses have advanced degrees and can provide psychotherapy, working as an active part of a therapeutic team.

While "therapist" is usually a term reserved for those with specific licenses or training, be aware that the term "counselor" is sometimes used by someone who lacks a masterıs degree, advanced training or certification. Counselors may be appropriate for a great many issues, but you may wish to ask for the personıs credentials. It is appropriate to ask your prospective therapist about his/her training and experience. In fact, there is evidence to suggest that those who actively "shop" for their therapist are ultimately more satisfied with their recovery.

Again according to Consumerıs Reports, self-help groups seemed to be of some to moderate help to some people, most notably the self-help provided by Alcoholics Anonymous, with or without accompanying individual therapy.

Once I identify a therapist, what can I expect?

If you are seeing a psychiatrist, psychologist, social worker, or professional counselor expect to see them weekly over a period of several months. Expect that you will work together to identify some of the issues, and develop a plan to help, albeit perhaps only roughly defined at first.

If your therapist recommends a very brief intervention, you may wish to ask if this was determined by restrictions from your insurance coverage. (Unfortunately, mental health care is often not covered as completely by insurance plans as most ³other² medical problems.) If so, you may ask about the cost involved to pay for expanded care yourself if you have not achieved the state of well-being desired at the end of treatment. With a public or nonprofit organization, a sliding scale or discounted fee may be available.

If you are receiving help from a community mental health agency, do not be surprised if you are expected to have an "intake interview" prior to your first counseling session. These organizations are required to keep extensive documentation for their public funding sources. Sometimes they need to resolve issues of services needed and fee scale prior to beginning services. Sometimes, too, demand for services is high and it may take longer to get into your first session than it would with private care. Too, if you are seeking help for a child or foster child, expect that the counselor may want family participation in the treatment.

Whoever you are seeing, it is appropriate for you to expect to be able to build a rapport with your counselor. Just as with a primary care physician, you should be able to expect that your counselor will work with you to understand the mental health issue and to build a treatment plan. The first several sessions may be difficult, as you begin to talk about things that you rarely share with others, but after 3 or 4 sessions you should begin to feel comfortable with your counselor.

Many people expect or hope for a "quick fix" when they begin counseling. It is important to realize that your treatment will take time, and that you need to commit to your own well-being. Donıt expect anything to happen unless you are actively participating in your treatment. After 3 or 4 sessions with your counselor, you should feel comfortable sharing information, and you should feel as if you are moving in the right direction.

Once you have identified a counselor, give the relationship a chance to work. Your treatment will be more effective if rapport exists between you and your counselor. If you find that you cannot work with a counselor, it may be appropriate to change counselors. Honor your appointment, (and your prescribed medications), especially on days you feel lousy enough that you may not wish to.ecting

The answer to this question depends somewhat on how serious or extensive your problems are, and how quickly your therapist finds the ³route² that works for you. Some evidence supports brief- intervention therapy for a variety of problems for some people. Brief intervention is being used more often, as the effectiveness is becoming more apparent, more therapists are trained in the techniques, and managed care and insurance further restricts long-term coverage. Long-term, ongoing therapy is usually reserved for serious and/or persistent mental illness. Often, a time-line for services is proposed when your counselor develops your treatment plan. And while a weekly visit is common, sometimes this is based on consistency of scheduling and input, rather than therapeutic necessity.

A Consumerıs Report survey of November, 1995 shows support for the effectiveness of long-term therapy over short-term, with more help received by those who felt the worse at onset of services and stayed in therapy longer than 6 months. Additionally, while primary physicians were a source of some assistance, seeing a therapist, counselor or mental health professional proved far more helpful. This report suggests that family doctors may fail to accurately diagnose mental health issues as often as 50% to 80% of the time, send only 1 out of 4 on to a mental health professional, and sometimes prescribe psychotropic medications for too short a time or in inappropriate doses.

Some people quit therapy before they are feeling their best. If you are tempted to quit because of finances, but your therapy is working for you and is not complete, talk to your therapist about the problem. Your therapist may be able to make payment arrangements, or may be able to recommend a group alternative.

Luckily, even if your managed care company restricts your visits to fewer than you would like, studies show that the early sessions of therapy can be the most effective, and on average, half of people in therapy showed improvement after only 11 sessions.

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