Choosing a Therapist
How do you know it’s time to find a counselor?
There are many reasons and good times, for seeking therapy, and there’s never a wrong time. Without question, therapy is called for when an individual is suffering severe symptoms (depression, anxiety, grief, etc.). If you are facing life circumstances that just seem overwhelming, that’s a great time to find a good counselor to talk to.
Many of us seek out therapy throughout the span of our lives, whenever we’re facing particularly difficult transitions, or we’re just ready to take the next step in becoming who we really want to be. Having an ongoing relationship with a skilled counselor who knows you well and whom you trust, is like having trusted family physician.
Does therapy work?
Yes. In a good therapeutic relationship, you should experience a very different and refreshing sense of being heard and understood. That, in itself, can be transformative and healing. And now we have scientific evidence to show that therapy has a positive impact on neurophysiology – brain chemistry and wiring that is intricately involved in our thoughts and emotional well being. If you’re curious about the data on this question, you might want to read “The Talking Cure: The Science behind Psychotherapy,” by Susan C. Vaughn, M.D. You should come away from your sessions with a clear sense of gradual progress toward the treatment goals that you and your therapist have agreed on. The progress varies, of course; you may experience clarity and determination that support quick progress, and you may face setbacks. The process is different for every individual and every situation.
If, after a reasonable period of time (perhaps 2-3 sessions) you feel the therapy is not helping, by all means, talk frankly with your counselor about your concerns. The sense of not being understood or supported in session may be the signal for an adjustment in how you and your counselor are working together. Or it may call for a referral to another therapist who could better meet your needs. Feelings of discomfort often accompany the hard work of therapy, but you should, nevertheless, feel safe and understood. And you should be able to identify clearly how the therapy is helping you. Talk with your therapist about your experience of the process of your therapy, and voice any concerns you have.
The terms “counseling” and “therapy” are generic terms and are used by almost all in our profession. “Psychotherapy ” is a word that is often used interchangeably with the words counseling and therapy, but in the state of Oregon, only a licensed professional (a counselor, social worker or psychologist) can technically offer to provide “psychotherapy.” However, if two professionals – one a professional counselor with a master’s or doctoral level academic training and the other a licensed psychologist – are both providing good therapy, there is little to no discernible difference between the two.
Counseling is a term often used to describe short term work, perhaps 4-12 weeks, with very clear goals, often focused on finding solutions for current problems. Therapy (or ) can imply a longer term, more insight oriented approach. The length of therapy truly depends on the issues being addressed and the motivation of the client. Longer term therapy is almost always called for when the client is dealing with severe symptoms, trauma, or enduring self defeating beliefs or behaviors.
Degrees & Licenses
Not all counselors are the same. There are many different paths of training one may take to become a therapist. There are professional counselors, who have completed master’s level academic studies, most often in counseling or psychology, and social workers (who hold master’s degrees in social work). There are practitioners who have substantial training and experience, but who are exempt from licensure requirements due to the specificity of their practice. There are also psychiatrists and psychiatric nurse practitioners (physicians and nurses with extensive training in mental health who are able to prescribe medications), Psychological Associates (who have master’s level training), and psychologists (who have completed a doctorate degree in psychology).
We urge you to seek out a professional who has at minimum, attained the academic training equivalent to a master’s degree (four years of undergraduate university/college education with post-graduate training and substantial supervised clinical experience). If you plan to see a counselor or therapist who is exempt from licensure requirements, you should be provided with clear, accurate information about the individual’s specific training and supervised experience.
Oregon law urges, but does not compel, counselors and therapists to pursue licensure. Licensure provides the benefit to the therapist of being eligible for payment through insurance companies. For the client, licensure is assurance of the academic credential, supervised clinical experience and continuing professional education of the therapist. A license also binds the professional to serious penalties for failure to comply with the ethical standards prescribed by law. For further information, visit the websites of the various state licensing boards: http://www.oblpct.state.or.us/ (counselors and therapists); http://www.obpe.state.or.us/ (psychologists); http://www.oregon.gov/BCSW/about_us.shtml (social workers). You will also find a number of professionals practicing with Wise Counsel & Comfort, who, by the specific nature of their practice, are not required to pursue licensure. Be sure when you begin with any counselor that you have adequate information about their training and experience and satisfactory answers to any and all questions you might have.
What are the first steps?
Your first steps in finding the right therapist will depend both on the circumstances you face and your plan for payment. If you are insured and have mental health benefits, your first step should be a call to your insurance company. You will want to find out the benefit available to you as well as whether diagnosis and pre-authorization is required. The insurer may direct you to a website which will list the professionals from which you may select. Other insurance companies will have no list, but allow you to see only licensed professionals in certain academic fields.
Whether you are using insurance benefits or choosing to pay out of pocket (see “What does it cost?” below), a second step will be to get on the phone (or on the web) and contact several therapists you would like to consider. Ask questions! What is this professional’s experience with the issues you are facing? What methods might they use? What are their fee policies and availability? And perhaps most important, is it possible to meet face to face for even a few minutes to see if this is a good match, and would there be a fee for that brief meeting or would it be complimentary?
Pay close attention to your gut reactions to these conversations; Do you sense the counselor is genuinely hearing and understanding you? Is she or he respectful, courteous, open? While academic credential, degrees and licenses are all important and practical considerations, your intuition is important, too. Studies demonstrate that perhaps the most important and best indicator of a successful outcome of therapy is the rapport or “connection” between the client and the counselor. You must be able to let down your guard and trust your therapist with the most personal and private of your concerns. We’re often more open and trusting with our counselors than we are with the closest of our friends and loved ones. So – choose carefully.
What does it cost?
While fees to see a therapist in our community often average $70 to $150 per hour, good therapy is available in our community for substantially less than that. The professionals in practice at Wise Counsel & Comfort all welcome your questions about finances, and will do their best to work with you to discount their fees, or refer you to other qualified professionals whose fee scales are within your means.
If you are using insurance benefits for your therapy, ask whether a co-pay is required, and how much it is. Be sure, when you speak with the insurer, that you ask all of your questions; you don’t want to begin therapy and then find out a month or two later that the services will not be paid for. If your insurance is paying for your therapy, the therapist will communicate directly with the insurance company about you, your needs, payment for services, and the progress of treatment.
Many, even those with insurance benefits, choose to pay out of pocket for their therapy for a variety of reasons. One is that when counseling is paid for by an insurance company, an employe of the insurer is ultimately the one who decides when your therapy begins, and when it is no longer medically necessary. It’s not unusual for an insurance company to authorize about six sessions for the average request. Paying your counselor directly ensures that the decisions about when to begin and end therapy will be made exclusively by you and your therapist. Another concern is often voiced about the risk of accidental disclosure of personal information as records are exchanged between your therapist and the insurer. While there are strict laws with regard to patient confidentiality and privacy of records, it is clear that the fewer people who have access to your records, the smaller the risk of accidental disclosure.
If you are paying out of pocket, your counselor will discuss the fee with you during the initial telephone conversation or office visit. Most will have a standard fee and will offer sliding fee scales based on financial need; others allow you to set your own fee within a prescribed range. Be frank in sharing your concerns with regard to the fee arrangements. It is important that the stress of the fee not outweigh the benefit you will receive from the therapy.
Theories, Methods & Styles of Therapy
Many therapists have an eclectic approach in their work, tailoring their interventions to the unique needs of each individual. All mental health professionals with academic training of master’s degree or above have studied a broad array of theoretical models. Some hold firmly to a particular theoretical orientation (like psychodynamic, gestalt or existential) or use only specific interventions (like hypnotherapy or cognitive-behavioral strategies).
The question of which kind of therapy is more effective is an interesting one. Cognitive therapies tend to be slightly more statistically effective in treatment of depression, and behavioral therapies tend to be somewhat more helpful for individuals with severe anxiety or phobias. Other than that, studies demonstrate time and again that all are equally effective. The sense of “connection” you have with your therapist is often far more important in predicting “successful outcome,” than the theoretical orientation or specific methods that he or she uses.
Some therapists, especially those working from a psychoanalytic perspective, will disclose very little if any personal information with their clients. Others are more comfortable sharing information that is either neutral, or that they strongly feel would be helpful to the client. But the boundaries of the professional relationship should always be defined by the client’s needs – not the therapist’s need to share. Be cautious about continuing in therapy with someone who seems to be talking more about their own life than yours.
Can I be friends with my therapist?
Healthy therapeutic relationships will have many of the signs of a healthy personal relationship: trust, honesty, respect, understanding and so forth. A relationship between therapist and client is truly one of the most personal and emotionally intimate in our lives. Understandably, some clients long for a personal version of that relationship to extend into life outside the therapy session. But it must not.
First, it is almost always an ethical violation for a therapist to engage in a “dual relationship with a client. This means having two different kinds of relationships at the same time that could put the client at risk. A simple example: If the therapist hires his client to do a job, and it’s done poorly, the therapist’s irritation would likely get in the way of the client’s therapy. Or, if the therapist doesn’t show up to a gathering the client has invited her to, the client may have hurt feelings that could well interfere in the therapy. These are simple examples with very real, very important risks. Even casual outside connections can lead to misunderstandings that can complicate the therapy process.
But can you be friendly with your therapist? Of course, and in many small communities it would be impractical, nearly impossible, not to have a friendly “public” relationship with your therapist. But don’t be surprised if you see your therapist in public and he or she does not greet you. We work hard to guard your confidentiality and greeting you in public might require that you answer questions like, “Who was that?” If you haven’t shared your counseling experience with your companion, that could put you in an uncomfortable situation.
A therapist can never engage in a romantic or sexually intimate relationship with a client. This is, perhaps, the most severe ethical violation a mental health professional can engage in. A relationship between a therapist and client must have both trust and objectivity. Sexual contact with a client violates both of these prerequisites and has been found to be clearly harmful to therapy clients. We strongly urge you to cease contact with any mental health professional who engages in such behavior and report him/her to the appropriate licensing boards or authorities.
What if I need medication?
Mental illness are disorders of brain chemistry, and while adjustments in your behaviors, your thoughts, your attitudes, your beliefs, and so forth can all work in concert to support healing, sometimes it’s just not enough. If you are working in therapy on the management of symptoms of a mental illness (depression, anxiety, etc.), and find that after a reasonable time, perhaps 2 to 6 weeks, the symptoms have not lightened, your therapist may suggest you consider the option of medication. Medication doesn’t replace therapy – it’s not an “either/or” situation. Medication alone is rarely the answer, but it can be a helpful support as you work hard in therapy to move toward recovery.
The referral will generally be made to a psychiatrist or psychiatric nurse practitioner, since they are the most comprehensively trained in the management of symptoms. On occasion, your primary care physician may prescribe. Your therapist will ask you to sign a release giving your permission for the therapist and prescriber to consult about what medication would best meet your needs.
Almost always, you will experience some mild side effects, and these will decrease over time as the benefit of the medication sets in. But if your side effects are really bothersome, or, if after a reasonable trial period, the medications just don’t seem to be helping, be sure to consult with your prescriber. Some people with chronic and serious symptoms need to be on stabilizing doses of psychiatric medications all their lives – just like those of us with high blood pressure or diabetes. Others benefit from a brief term with medication, and gradually reduce the dose once we feel more stable.
How long does therapy last?
The average “brief” therapy is perhaps two to four months in length. Longer term therapy can last several months, a year or even longer. Regardless of the length, a successful course of therapy results in a trusting relationship between the client and therapist such that, as the years go by, it only takes a quick phone call to re-establish the connection.
If you have other questions about the process of finding a therapist, please email me here and I’ll do my best to respond within a few days. Best wishes to you in finding exactly the right therapist who will meet your unique needs.