Perhaps you have a chronic or difficult problem, or maybe you feel depressed or anxious. Before you begin therapy, there are important issues that you need to consider. For example, "How do I choose a therapist?" "How much will it cost and how long will it take?" "What kinds of therapies are there and how do they differ?" "What should I expect at my first session?"
What to Look For
It is important that you choose someone who respects your opinion, your input, and your individuality. One of the most important things to consider when entering a therapeutic relationship is whether the values of the therapist match your values.
Conflicts can occur when the client and therapist have different value systems or when there are misunderstandings about the level of conversational intimacy. Engaging the right therapist—someone with whom you are comfortable and trust—is important to ensure that you get the best treatment possible.
Where to Find a Therapist
Look for recommendations from your doctor or other healthcare providers, professional organizations, or friends. Healthcare professionals may be able to separate your physical problems from emotional ones. For example, Laura went for a physical checkup when her anxiety over moving to a new city and the birth of her second child made her irritable and chronically fatigued.
Her primary care physician could find no physical difficulties, and instead recommended that she talk with someone about her concerns.
"Although I didn't know my primary care physician well," Laura says, "he had an excellent grasp of my problems and talked about it in a way that made sense to me. The therapist he recommended also seemed to understand my issues and was able to help me."
How Much It Will Cost and How Long It Will Take
Check with your insurance company about coverage. Costs may be based several factors, such as location, the type of counseling you need, and for how long. Learn about payment arrangements in advance. For example, some offices may bill you by mail while others may require payment at the time of your appointment. If your are not fully covered or are uninsured, look for local resources in your area where you can get counseling for a reduced rate. These may include state or municipal services, community centers, or teaching hospitals. Your employer may also have services through an Employee Assistance Program.
The length of therapy can vary widely depending on your particular issues and your background. Treatment for mild or situational problems can be relatively short and might be accomplished in as few as 5-6 sessions. Chronic problems and long-term difficulties, however, may require a year or more before you feel that progress is being made. One way to monitor your progress is to formalize (in writing) a set of treatment goals. This ensures that both you and your therapist are working on the same issues. It also helps you assess the benefits for yourself.
When it comes time to end therapy, your therapist may encourage you to discuss your decision, but a good therapist should always respect your judgment about when it is time to go it on your own. Although the cost of therapy can affect the way you approach the process and what therapist you choose, the length of treatment should be based on more important factors.
What the Options Are
If you and your doctor feel that counseling is the right option, you can discuss therapy options and get a referral. There are different categories of professionals to help you reach your goals. Mental health professionals include:
- Psychiatrists —Physicians who have completed medical school, and a residency in psychiatry. They are licensed to prescribe medications. Some may also provide psychotherapy.
- Psychologists —Have a doctoral degree (PhD, DPsy, DEd) in clinical, educational, counseling, or research psychology. Most states issue licenses. Psychologists evaluate and treat emotional and behavioral problems, and provide psychotherapy.
- Certified or licensed social workers —Therapists who have a bachelor's, master's, or doctoral degree. Their education and training level determines the type of services they offer. Social workers can assess and treat psychiatric illnesses, and provide case management and psychotherapy.
- Mental health nurse —Have nursing degrees ranging from associate's to doctoral degrees. They offer a wide range of services based on their education, training, and license. Some can assess and treat psychiatric illnesses, provide case management, and in some cases prescribe and monitor medication.
- Licensed counselors —Have a master's degree in psychology, counseling, or similar field with two years of post-graduate training. They have licenses issued by the state and offer services for individuals, families and group therapy.
Therapies are generally divided into the following approaches:
- Behavioral therapy —This type of therapy looks to replace harmful behaviors with useful ones. It is often used in coordination with cognitive therapy, which is aimed at helping people recognize and alter distorted ways of thinking.
- Humanistic and experiential therapies —These therapies are based on the theory that people are growing and self-actualizing. Experiential therapists use emotionally-charged, experience-based techniques to effect change, while humanistic therapists concentrate on creating a safe place.
- Psychoanalytic and psychodynamic therapies —These therapies explore unconscious conflicts and defense mechanisms that hinder adult behavior.
- Family therapy or family systems therapy —This type of therapy is concerned with looking at the dynamics of relationships within the family unit.
- Marriage and family therapy —There are certain patterns of behavior, conflicts, or dynamics that are characteristic to specific families or couples. These patterns will be addressed in therapy and worked on through the therapeutic process and its goals. The most important factor is the “set of relationships” that couples or family members are part of.
- Integrative or holistic therapies —Therapies based on more than one approach. Elements are blended from different theories to fit individual needs.
In most cases, mental health professionals can offer you a range of treatment options. If you find something is not working, discuss it with your therapist. You always have the option of changing your mind and trying different therapies or therapists.
What to Expect at the First Appointment
Your first session, sometimes called an intake evaluation, will be unlike subsequent sessions. This is a time for your therapist to get to know you—what is important to you and what particular problems or difficulties have brought you into therapy. You will be asked about your family history and childhood, education, friends and social relationships, career, romantic relationships, and current living situation. The depth of this personal history will vary depending on your therapist. When the therapist has developed some understanding of you, he or she will ask if you have any questions. This is the time to raise questions you have about the therapist's training and theoretical orientation and experience with treating problems similar to your own.
Be aware that subsequent sessions may be complex. Facing what appears to be a singular issue can often veer off into many other directions. You may need to delve into areas of your life that you had not anticipated exploring.
What to Do If You Do not Like Your Therapist
You do yourself a disservice by staying with a therapist that you do not like. If you feel that your therapist is not listening to you, or is downplaying your problems, or has a value system that differs from your own, do not hesitate to talk about it. A responsible therapist has an obligation to either work it out to your satisfaction or to refer you to someone else. Use the same consumer-wise techniques you apply to consumer goods when you search for a therapist. It is not uncommon to try more than one therapist to find a good fit. Do not let this discourage you from moving forward with therapy. It is more important you get what you need from the best person available.
American Association for Marriage and Family Therapy
American Counseling Association
Canadian Psychiatric Association
Canadian Psychological Association
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For a healthy mind and body talk to a psychologist. American Psychological Association website. Available at: http://www.apa.org/helpcenter/talk.aspx. Accessed January 5, 2017.
Therapy and counseling. American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/prevention-wellness/emotional-wellbeing/mental-health/therapy-and-counseling.html. Updated May 2010. Accessed January 5, 2017.
Understanding psychotherapy and how it works. American Psychological Association website. Available at: http://www.apa.org/helpcenter/understanding-psychotherapy.aspx. Accessed January 5, 2017.
Last reviewed January 2017 by Michael Woods, MD Last Updated: 1/13/2015