You need to find a therapist. Your life, your child, your marriage is suffering. But for many people, this task is daunting.
There's the alphabet soup of PhDs, PsyDs, MDs, MSs, and MSWs, not to mention all the labels -- psychiatrist, psychologist, marriage & family therapist, family counselor, licensed professional counselor, social worker.
It's true; all these therapists provide mental health services. But each brings different training, experience, insights, and character to the table. How can you find a therapist who is right for your needs?
Take heart, for the search will be worth the effort. "A good therapist, however you find them, is gold," Don Turner, MD, a private practice psychiatrist for 30 years in Atlanta, tells WebMD. "A good therapist is nonjudgmental, accepting, and patient. Otherwise, our patients are just getting what they grew up with."
First, let's look at the professional labels:
Psychiatrists: These are doctors who specialize in the diagnosis and treatment of mental or psychiatric illnesses. They have medical training and are licensed to prescribe drugs. They are also trained in psychotherapy, or "talk" therapy, which aims to change a person's behaviors or thought patterns.
Psychologists: These are doctoral degree (PhD or PsyD) experts in psychology. They study the human mind and human behavior and are also trained in counseling, psychotherapy, and psychological testing -- which can help uncover emotional problems you may not realize you have.
Cognitive behavioral therapy is the psychologist's main treatment tool -- to help people identify and change inaccurate perceptions that they may have of themselves and the world around them. Psychologists are not licensed to prescribe medications. However, they can refer you to a psychiatrist if necessary.
Social Workers: These are specialists that provide social services in health-related settings that now are governed by managed care organizations. Their goal is to enhance and maintain a person's psychological and social functioning -- they provide empathy and counseling on interpersonal problems. Social workers help people function at their best in their environment, and they help people deal with relationships and solve personal and family problems.
Licensed Professional Counselors. These counselors are required by state licensure laws to have at least a master's degree in counseling and 3,000 hours of post-master's experience. They are either licensed or certified to independently diagnose and treat mental and emotional disorders, says W. Mark Hamilton, PhD, executive director of the American Mental Health Counselors Association.
Counselors can help a wide range of problems, including depression, addiction and substance abuse, suicidal impulses, stress management, self-esteem issues, issues of aging, emotional health, and family, parenting, and marital or other relationship problems. They often work closely with other mental health specialists.
Sorting It Out
When you start your search, keep an open mind. A therapist does not need decades of experience -- or a sheepskin from an ivy-league school -- to be helpful, says Turner.
"It used to be that a psychiatrist was considered most qualified because he or she had more education," Turner tells WebMD. "But that's not true anymore. Some psychiatrists got their licenses 25 years ago and haven't kept up. Many psychiatrists who are trained today just handle medications. You can have a primary care doctor do that -- it's not like psychiatrists are indispensable!"
Turner refers patients to professional counselors and social workers when appropriate. They often specialize in counseling couples and families and coordinating group therapy sessions, he says. "Some are good, some aren't. Some are excellent."
"Credentials aren't everything," says Robert Baker, PhD, a psychologist and program director of the behavioral medicine unit at the Ochsner Clinic in New Orleans. "Even people with great credentials aren't necessarily great therapists. They may be smart, but that doesn't mean they have good common sense."
Where to Start?
Collect Names. "Don't start with three names from your managed care company," advises Avrum Geurin Weiss, PhD, author of the book, Experiential Psychotherapy: A Symphony of Selves. He is a child/adolescent psychologist and director the Pine River Psychotherapy Training Institute in Atlanta.
Very likely, you don't have the company's entire list of providers, Weiss tells WebMD. "Insist on getting the whole provider list. Then ask friends and colleagues if they know a psychologist or psychiatrist who could make recommendations from that list."
He gets plenty of calls from people who say, "I have Aetna insurance. I know you're not an Aetna provider, but can you look at my list?"
"They fax it to me, and I make recommendations. I do it all the time," he says.
- Call a university psychiatry or psychology department and ask recommendations of people trained in that program. "At least that way you know they're under scrutiny," says Turner.
- If you're moving to a new city, ask your current therapist for referrals, or have him check with colleagues.
- Call a large clinic; ask the receptionist for recommendations. "They know who specializes in what," Baker tells WebMD. "They can match you up pretty well."
- Check with friends and family.
If you're embarrassed about asking for help, get over it, advises Weiss. "Get past the stigma. The outcome's too important."
Also, check with professional associations to learn about a therapist's expertise -- whether they provide psychotherapy, if they treat children, etc. The American Psychological Association and the American Psychiatric Association both provide such lists for people wanting to find a therapist.
The First Appointment
Ask questions: How long has the therapist been in practice? How many patients have had your problem? What were the results? Ask about policies, fees, payment. "But don't bargain hunt for mental health care," says Weiss.
"You find a therapist in the same way you choose any health care professional," he tells WebMD. "They must be professional, credentialed, and competent, with no lawsuits against them. And they must be an intuitive fit -- you can't underestimate the absolute value of feeling a good intuitive match with somebody. Also, if you ask them questions about themselves, and they get defensive, go somewhere else."
Another important point: Has your therapist been in therapy? "I'm shocked at the therapists who have never undergone personal psychotherapy," Weiss tells WebMD. "They have to have resolved their own issues, or they will steer you away from things they are not comfortable with. They may also bring their own issues into your therapy."
- Do I feel reasonably OK with this person? "Feeling totally comfortable isn't the best criteria, because if you're too comfortable, you're just chit chatting, and that doesn't help you," says Baker.
- Is the therapist really listening to me? Is he or she asking enough questions? Especially in the first sessions, the therapist should be asking many questions, to become acquainted with you and the issues you are dealing with.
- Has the therapist asked what outcome you want from therapy -- how you want your life to be? How will you know when you get there, if neither the patient nor the therapist has established a goal?
- Do you feel satisfied with the therapist's resources? For example, do you have to find your own therapy group? Or is your therapist checking with colleagues about a group appropriate for you?
- Does what the therapist say make sense? Does it seem like bad advice? Does it help you or not?
Baker says patients don't always like his suggestions -- yet he knows from intuition and experience that its good advice.
Example: Your husband uses profanity constantly when talking to you; you want him to quit. Baker suggests that you mirror your husband's behavior -- you use profanity the next time he does -- a technique he knows will work. "People are always resistant to that, they don't want to 'sink that low,' but then they're amazed at how well it works," Baker says. "It's not that you should take up bad habits, but that he stop his."
"It's tough finding a good child psychotherapist," says Weiss. "Not many people have much experience working with adolescents. You can end up with a therapist trained to work with adults, but they work with adolescents because they have an adolescent or because they like working with adolescents."
A pediatrician can often make a referral, he tells WebMD. "I warn people about school counselors making referrals; they are overwhelmed and busy, don't follow up to see if good work is happening."
Also, check with other parents. "I recommend that parents identify two or three therapists that they find acceptable, then let your kid pick from among them. That's so they have a voice in this," Weiss advises.
Eugenio Rothe, MD, professor of psychiatry at the University of Miami and director of the Child and Adolescent Psychiatry Clinic at Jackson Memorial Hospital, offered his insights.
Pediatricians and professional counselors should not be treating a child for attention deficit hyperactivity disorder (ADHD), he tells WebMD. "More than 75% of children with ADHD are treated by a pediatrician or primary care doctor. But studies show that 40% to 60% of those children have another psychiatric diagnosis. How can a pediatrician [or counselor] diagnose that?"
"Professional honesty is very important -- referring patients to other professionals when you're not trained to handle the problem," says Rothe. "Many psychologists feel very threatened by psychiatrists, that they will lose the patient if they make a referral. But they're doing a disservice by not getting patients get the help they need."
Psychiatrists understand both the body and the brain, and that's a critical difference, he explains. "Depression may begin with a situational problem in your life, but that event causes chemical changes in your brain. Once those chemical changes are established, you have a chemical imbalance. If you treat depression as something abstract, you won't get to the fact that it's a chemical imbalance that needs be treated."
He retells one landmark court case: A man with what's known as "agitated depression" wore out three pairs shoes from pacing for more than six months in a mental health facility. Talk therapy was not helping, so he signed himself out, went to a psychiatrist, got medications, and got completely better in six weeks.
"He sued the hospital, said he hadn't received appropriate treatment, and he won," says Rothe.
The lesson for therapists: You are making a patient suffer unnecessarily if you don't treat the depression effectively -- or if you don't help them find a therapist who can.