How to Choose a Psychotherapist

Maybe you've been suffering from depression for a long time. Or maybe you've suddenly experienced a loss, such as the death of a loved one, that has turned your world upside down. Whatever the reason, you've decided you need to talk someone. But to whom? The relationship between a therapist and client or psychiatrist and patient is an intimate, difficult, and important one. That relationship will determine how much you get out of therapy-- or whether you get anything out of therapy at all. So it's vital that you choose wisely.

Difficulty: Moderately Challenging

Instructions

Things You'll Need:

• a directory of local psychotherapists from your health insurance plan
• pen and paper (to write down questions you want the therapist to answer during your first session as well as to jot down your impressions of the therapist)

1. If you have health insurance, get a list of your in-network mental health providers. Many insurance plans have websites equipped with "doctor-find" search tools that will help you narrow down psychotherapists by location, specialty, and gender.

2. There are many different kinds of mental health care providers with many different kinds of training and different treatment philosophies. Take some time to think about the kind of practitioner you'd like to talk to and what you hope to get out of your sessions. If you have been suffering from long-term depression, experiencing severe symptoms such as hearing voices or suicidal thoughts, or have mental illness in your family, you may want to consult a psychiatrist who is qualified not only to conduct talk therapy but to prescribe medication. If you want to get over a phobia-- such as a fear of flying or a fear of speaking in public-- you may find it more helpful to consult a cognitive behavioral therapist. If you're mourning the loss of a loved one, a clinical social worker or psychologist who specializes in grief counseling would be a good choice.

3. There are many other factors to consider when choosing a therapist besides training and treatment philosophy. Would you prefer to talk to a man or a woman? Would it bother you if your therapist were significantly younger--or older-- than you? Also think about how frequently and at what time of day you would prefer to go to therapy. Some people see their therapist two or more times a week. Some people prefer to see their therapist once or twice a month to "check in." Also, will you be going to see your therapist on your lunch hour at work? Then you'll want to find a therapist with an office close to your workplace. If you work at home, on the other hand, you'll prefer to find a therapist who sees clients closer to your residence.

4. If you have friends who've been in therapy for whatever reason, ask for recommendations. They will be able to tell you about their own therapists as well as ask their therapists for a list of practitioners who have expertise in handling the issues you wish to discuss.

5. Once you have a list of about four or five potential therapists, make an appointment with each. Consider the initial appointment an informational interview. Be prepared to explain your reasons for seeking therapy but spend most of the session asking questions. Find out whether the therapist has experience addressing the issues important to you. Try to get a general idea of how the therapist would approach your problems. Ask about the therapist's education, professional activities, and treatment style. Does he or she believe it's important to spend time discussing your childhood and family relationships? Or does he or she think it's better to concentrate on the present moment? This initial session is also a good time to ask about the therapist's policies regarding payment, appointment cancellations, and insurance reimbursement.

6. After you've met with each of the therapists on your list, decide which one you'd feel most comfortable talking with. In the end, you may make a "gut" decision-- you may instantly feel a bond with one of the therapists you consult. But even if you come away with a strong preference for one of the therapists you visited, sill take the time to carefully consider the pros and cons of each one. Consider all the factors that are important to you-- experience, training, sex, age, etc. Sleep on it.

7. Once you've chosen the therapist you'd like to work with, call his or her office to make an appointment. Be sure to thank the other therapists and let them know that, at least for the time being, you won't be making another appointment.

8. As you move forward with your therapy sessions, keep careful note of how you feel about your progress and your relationship with the therapist. If, after two or three sessions, the therapist does or says something that disturbs you, address the matter immediately. Don't act hastily-- conflict and discomfort in the therapeutic relationship are to be expected and can actually be the impetus for substantial progress in addressing your issues. But if you and the therapist ultimately cannot resolve the matter to your satisfaction, don't stick around too long. Remember, the whole point of going to therapy is to get help. If the therapist you're currently seeing is unable to give you that help, don't feel scared, awkward or guilty about finding someone else who can.

Tips & Warnings

• Most health insurance plans have some coverage for psychotherapy. Some states have mental health parity laws that require plans to offer mental health benefits equivalent to those offered for other kinds of health care.
• If you do not have insurance or cannot afford traditional therapy, there are still options. If you are a student, therapy may be available to you at low or no cost. In addition, universities, medical schools, and training institutes for mental health professionals often have free or sliding-scale clinics. Sessions are conducted by advanced students working towards degrees in psychiatry, psychology, or social work under the supervision of more experienced practitioners.
• Also consider group therapy if individual therapy is prohibitively expensive. In addition, there may be a support group out there that addresses your issue. And don't underestimate the usefulness of twelve-step programs or similar programs if you have a problem with addiction or an eating disorder.
• Before you go on your informational interviews with those practitioners on your list of potential therapists, be sure to write down notes about the issues you would ultimately like to discuss in therapy as well as a list of questions you would like to ask the therapist. Be sure to jot down notes about the therapist's answers and other impressions you have immediately after the session so that you can refresh your memory when you sit down to decide which of your potential therapists you will actually being seeing on a regular basis.
• If you choose to attend a support group, take precautions. The best support groups are those with a leader or moderator who is a licensed therapist and/or who has extensive experience in the field. Informal support groups can be free-for-alls where certain individuals may dominate discussion or say hurtful or unhelpful things to fellow group members. You may also encounter individuals who are not as committed as you are to working on their issues or who are there for ulterior motives-- to pick up members of the opposite sex, to research a book, etc. A formal support group moderated by a professional will have a screening mechanism for members, and the moderator's job is, in large part, to make sure everyone gets heard and that no one person dominates or offends other is the group.
• Always make sure that any therapist you consult is properly licensed under the laws of the state you live in. Once you ascertain that the therapist is licensed and by whom, you should check to make sure that they therapist has not been the subject of disciplinary action. Many state-run licensing organizations have online databases that consumers may check for information regarding a therapist's disciplinary past. There are also many online sites like www.healthgrades.com that gather information about malpractice suits brought against psychiatrists and other practitioners. Your insurance company may also be able to provide you with this background information.

Resources

• Dear Shrink
• About Psychotherapy
• Psych Central

[Zhenya]

on 5/23/2008 Psychiatrists these days receive very little training in doing psychotherapy. Expect to get a prescription from a psychiatrist and that's about it. If you need or want psychotherapy, consult one of the other kinds of mental health professionals.