About Therapy

The decision to see a therapist is a very personal decision. Many times, people choose therapy during times of stress and emotional pain, and it may also be when you want to grow and mature.

The following are issues or experiences during which you might seek therapy:

• Undue, prolonged anxiety
• Depression or mood swings
• School problems or employment issues
• Loneliness
• Difficulties in relationships
• Life events: marriage, divorce, death, parenthood, blended family issues, retirement, aging process, adolescence, etc.
• Chronic physical illness caused by tension and stress
• Problems following traumatic events such as accidents, childhood abuse, etc.
• Problems with domestic violence or other forms of abuse
• Stress in the face of chronic or terminal illness or other health problems
• Constant worries or obsessions
• Excessive anger, frustration, or guilt with no resolution
• Self-destructive thoughts and behavior
• Problems with drugs or alcohol

The decision to call a therapist may be a difficult one but is viewed as a strength - not knowing the answers to all your life questions is normal. Whatever your reason for seeking therapy, a therapist will listen to your concerns and help you decide upon the most appropriate course of action.

At some point in our lives, we all run into problems that seem too big or too persistent to handle alone. Yet our pride and fears can get in the way of asking for help. Making the decision to find help is a sign of strength and courage. And help is available. In fact, it can make the difference between feeling that things are spinning out of control and gaining new tools to turn life around in positive ways.

Having taken that crucial first step to seek help, you may have some questions about therapy. You may wonder, for example, about sharing information that is very private - will it be kept confidential? What is the best way to go about finding the right therapist?

You can rest assured that all mental health professionals are ethically bound to keep what you say during therapy confidential. However, therapists also are bound by law to report information such as threats to blow up a building or to harm another person, for example.

Therapy is a collaborative process, so finding the right match - someone with whom you have a sense of rapport - is critical. You may have to shop around before you find someone you are comfortable with. After you find someone, keep in mind that therapy is work and sometimes can be painful. But it also can be rewarding and life changing.

Whether you seek help from a marriage and family therapist, a social worker, a psychologist, a psychiatric nurse, or a psychiatrist, the steps to choosing the right mental health practitioner for you will basically be the same.

1. See your primary care physician to rule out a medical cause of your problems. If your thyroid is "sluggish," for example, your symptoms - such as loss of appetite and fatigue - could be mistaken for depression.

2. After you know your problems are not caused by a medical condition, find out what the mental health coverage is under your insurance policy or through Medicaid/Medicare. Many employer-sponsored insurance policies have limits on mental health services and may cover only 50 percent of the costs of a fixed number of visits per year.

3. Get two or three referrals before making an appointment. Specify age, sex, race, or religious background if those characteristics are important to you. Your primary care physician and/or your faith leader probably knows mental health care workers in your area. Also, ask friends, colleagues, neighbors, and family members for referrals. Chances are you will find that several people in your circle of acquaintances have been, or are, in therapy and can refer you to a competent therapist. You may also review the therapists listed in our therapist directory, which may serve as an excellent resource in building your referral list.

4. Call to find out about appointment availability, location, and fees. Many mental health professionals schedule evening appointments so you do not have to miss work. Selecting a therapist whose office is easy to get to - either from work or home - also can make a difference in your progress toward improved mental health. Ask the receptionist:

   • Does the mental health professional offer a sliding-scale fee based on income?
   • Does he or she accept your health insurance or Medicaid/Medicare?
   
   

5. Make sure the therapist has experience helping people whose problems are similar to yours. You may want to ask the receptionist about the therapist's expertise, education, and number of years in practice.

6. If you are satisfied with the answers, make an appointment.

7. During your first visit, describe those feelings and problems that led you to seek help. Find out:

   • What kind of therapy/treatment program he or she recommends;
   • If it has proven effective for dealing with problems such as yours;
   • What the benefits and side effects are;
   • How much therapy the mental health professional recommends; and
   • If he or she is willing to coordinate your care with another practitioner if you are personally interested in exploring credible alternative therapies, such as acupuncture.
   
   

8. Different psychotherapies and medications are tailored to meet specific needs. Be sure the psychotherapist does not take a "cookie cutter" approach to your treatment - what works for one person with major depression does not necessarily work for another. The best therapists will work with you to create a treatment program - perhaps using a single approach, perhaps incorporating several different ones - that works for you.

9. Although the role of a therapist is not to be a friend, rapport is a critical element of successful therapy. After your initial visit, take some time to explore how you felt about the therapist. For example:

   • Was he or she someone with whom you felt comfortable?
   • Did he or she listen?
   • Did he or she seem to understand your concerns and address them?
   • Is this a person you feel you can trust?
   • Did he or she seem knowledgeable about your problem and suggest a therapy/treatment program that suits you?
   • Was the "chemistry" right?
   
   

10. If the answers to these questions and others you may come up with are "yes," schedule another appointment to begin the process of working together to understand and overcome your problems. If the answers are "no," call another mental health professional from your referral list and schedule another appointment.

For people experiencing mental health problems - such as anxiety or depression - brief yet effective treatment options exist. For people with severe mental illness, treatment is also effective, although it may take longer and cost more. In either case, treatment works for most people and helps many recover and get on with their lives.

Private Insurance:
The majority of working Americans are covered under employer-provided health insurance plans. One type of plan is a standard indemnity policy: people are free to visit health care providers of their choice and pay out of pocket for their treatment. The insurance plan reimburses members for some portion of the cost. The other common plan is a managed care plan. Medically necessary care is provided in the most cost-effective - or least expensive - method available. Plan members must visit health care providers chosen by the managed care plan. Sometimes a copayment is charged to the patient, but generally all care received from providers within the plan is covered. In many states, managed care companies provide services for low-income Medicare and Medicaid beneficiaries.

Federal law requires most health insurance plans to provide the same level of coverage for mental health and substance-use conditions as they do for other medical conditions. This is called parity. But not all health insurance plans are required to follow federal parity law, and if your plan is subject to federal parity but medical coverage is very limited, mental health coverage may be similarly limited even in states with stronger parity laws. If you are unsure about your insurance plan benefits, ask your insurance carrier or agent, your plan administrator, or your human resources department.

For the Uninsured:
If you are not insured, or if your income is limited, you might try other strategies to pay for mental health care. Some providers, for example, have sliding-scale fees. Based on your income - and your spouse's, if applicable - the provider will reduce his or her fees. Other providers, if they are aware of your financial limitations, may be willing to negotiate a payment plan that you can afford or to lower their rates according to what your insurance plan pays. The latter is called a "write-off."

• Community-based resources - Many communities have community mental health centers (CMHCs). These centers offer a range of mental health treatment and counseling services, usually at a reduced rate for low-income people. CMHCs generally require that you have a private insurance plan or be a recipient of public assistance.

  Your church or synagogue can put you in touch with a pastoral counseling program. Certified pastoral counselors, who are ministers in a recognized religious body and have advanced degrees in pastoral counseling, as well as professional counseling experience. Pastoral counseling is often provided as a sliding-scale fee.

• Self-help groups - Another option is to join a self-help or support group. Such groups give people a chance to learn more, talk about and work on their common problems-such as alcoholism, substance abuse, depression, family issues, and relationships. Self-help groups are generally free and can be found in virtually every community in America. They have proven to be very effective.

• Public assistance - People with severe mental illness may be eligible for several forms of public assistance, both to meet basic costs of living and to pay for health care. Such programs include Social Security, Medicare, Medicaid, and disability benefits.

  Medicare is America's major Federal health insurance program for some people who are 65 or older and for some with disabilities who are under 65. It provides basic protection for the cost of health care. Two programs can help people who have low incomes receive benefits. These are the Qualified Medicare Beneficiary (QMB) and the Specified Low-Income Medicare Beneficiary (SLMB) programs.

  Medicaid pays for some health care costs for America's poorest and most vulnerable people. More information about Medicaid and who is eligible for it is available at local welfare and medical assistance offices. Although there are certain Federal requirements, each State has its own rules and regulations for Medicaid.

Psychiatrists:
A psychiatrist is a medical doctor who specializes in mental disorders, is licensed to practice medicine, and has completed a year of internship and three years of specialty training. A board-certified psychiatrist has, in addition, practiced for at least two years and passed the written and oral examinations of the American Board of Psychiatry and Neurology. Psychiatrists can evaluate and diagnose all types of mental disorders, carry out biomedical treatments and psychotherapy, and work with psychological problems associated with medical disorders. Like other medical doctors, they can prescribe medication. Child psychiatrists specialize in working with children; geriatric psychiatrists concentrate on helping the aged.

Psychologists:
Psychologists who conduct psychotherapy and work with individuals, groups, or families to resolve problems generally are called clinical or counseling psychologists. They work in many settings – for example, mental health centers, hospitals and clinics, schools, employee assistance programs, and private practice. In most states, a licensed clinical psychologist has completed a doctoral degree from a university program with specialized training and experience requirements and has successfully completed a professional licensure examination.

The field of psychology also includes those who specialize in such areas as testing, community organization, industrial relations, and laboratory research.

Clinical Social Workers:
Clinical social workers have master's or doctoral degrees in social work, at least two years of post-graduate experience in a supervised clinical setting, and have passed an examination required for state licensure. In addition to individual, family, and group counseling and psychotherapy, they are trained in client-centered advocacy. This includes information, referral, direct intervention with governmental and civic agencies, and expansion of community resources.

Marriage and Family Therapists:
Marriage and Family Therapist are state licensed as counselors to provide psychotherapy and counseling for families, couples, groups, and individuals. They have at least a master's degree, two years of supervised post-degree experience, and have passed a state comprehensive examination. Therapists with other licenses may also be qualified to conduct marriage and family therapy.

Professional Counselors:
Professional Counselors have at least a master's degree, two years of supervised clinical experience, and have passed an examination required for state licensure. In states without licensure or certification laws, professional counselors are certified by the National Board for Certified Counselors (NBCC). They provide quality mental health and substance abuse care to individuals, families, groups and organizations. They may be trained in a variety of therapeutic techniques and approaches.

Psychiatric Nurses:
Psychiatric nursing is a specialized area of professional nursing practice that is concerned with prevention, treatment, and rehabilitation of mental-health-related problems. These nurses are registered professional nurses, and those who have advanced academic degrees at the master's degree level or above can become advanced practice registered nurses (APRNs). APRNs are qualified to practice independently and provide the full range of primary mental health care services to individuals, families, groups and communities. In most states, psychiatric nurses in advanced practice have the authority to prescribe medication.

Mental health professionals use a variety of approaches to give people new tools to deal with ingrained, troublesome patterns of behavior and to help them manage symptoms of mental illness. The best therapists will work with you to determine a treatment plan that will be most effective for you. This sometimes involves a single method or it may involve elements of several different ones, often referred to as an "eclectic approach" to therapy.

Keep in mind that new research can yield rapid and dramatic changes in our understanding of, and approaches to, mental disorders.

The following is a brief description of the methods mental health professionals most commonly use:

Behavioral Therapy:
As the name implies, this approach focuses on behavior - changing unwanted behaviors through rewards, reinforcements, and desensitization. Desensitization is a process of confronting something that arouses anxiety, discomfort, or fear and overcoming the unwanted responses. Someone whose fear of germs leads to excessive washing, for example, may be trained to relax and not wash his or her hands after touching a public doorknob. Behavioral therapy often involves the cooperation of others, especially family and close friends, to reinforce a desired behavior.

Biomedical Treatment:
Medication alone, or in combination with psychotherapy, has proven to be an effective treatment for a number of emotional, behavioral, and mental disorders. The kind of medication a psychiatrist prescribes varies with the disorder and the individual being treated. For example, some people who suffer from anxiety, bipolar disorder, major depression, obsessive compulsive disorder, panic disorders, and schizophrenia find their symptoms improve dramatically through careful monitoring of appropriate medication.

Cognitive Therapy:
This method aims to identify and correct distorted thinking patterns that can lead to feelings and behaviors that may be troublesome, self-defeating, or even self-destructive. The goal is to replace such thinking with a more balanced view that, in turn, leads to more fulfilling and productive behavior. Consider the person who will not apply for a promotion on the assumption that it is beyond reach, for example. With cognitive therapy, the next time a promotion comes up that person might still initially think, "I won't get that position..." but then immediately add, "unless I show my boss what a good job I would do."

Cognitive-Behavioral:
A combination of cognitive and behavioral therapies, this approach helps people change negative thought patterns, beliefs, and behaviors so they can manage symptoms and enjoy more productive, less stressful lives.

Couples Counseling and Family Therapy: These two similar approaches to therapy involve discussions and problem-solving sessions facilitated by a therapist - sometimes with the couple or entire family group, sometimes with individuals. Such therapy can help couples and family members improve their understanding of, and the way they respond to, one another. This type of therapy can resolve patterns of behavior that might lead to more severe mental illness. Family therapy may be very useful with children and adolescents who are experiencing problems.

Coping with serious mental illness is hard on marriages and families. Family therapy can help educate the individuals about the nature of the disorder and teach them skills to cope better with the effects of having a family member with a mental illness - such as how to deal with feelings of anger or guilt. In addition, family therapy can help members identify and reduce factors that may trigger or worsen the disorder.

Group Therapy:
This form of therapy involves groups of usually 4 to 12 people who have similar problems and who meet regularly with a therapist. The therapist uses the emotional interactions of the group's members to help them get relief from distress and possibly modify their behavior.

Interpersonal Psychotherapy:
Through one-on-one conversations, this approach focuses on the patient's current life and relationships within the family, social, and work environments. The goal is to identify and resolve problems with insight, as well as build on strengths.

Light Therapy:
Seasonal affective disorder (SAD) is a form of depression that appears related to fluctuations in the exposure to natural light. It usually strikes during autumn and often continues through the winter when natural light is reduced. Researchers have found that people who have SAD can be helped with the symptoms of their illness if they spend blocks of time bathed in light from a special full-spectrum light source, called a "light box."

Play Therapy:
Geared toward young children, this technique uses a variety of activities - such as painting, puppets, and dioramas - to establish communication with the therapist and resolve problems. Play allows the child to express emotions and problems that would be too difficult to discuss with another person.

Psychoanalysis:
This approach focuses on past conflicts as the underpinnings to current emotional and behavioral problems. In this long-term and intensive therapy, an individual meets with a psychoanalyst three to five times a week, using "free association" to explore unconscious motivations and earlier, unproductive patterns of resolving issues.

Psychodynamic Psychotherapy:
Based on the principles of psychoanalysis, this therapy is less intense, tends to occur once or twice a week, and spans a shorter time. It is based on the premise that human behavior is determined by one's past experiences, genetic factors, and current situation. This approach recognizes the significant influence that emotions and unconscious motivation can have on human behavior.

Click here to learn more about these approaches and others in our Mental Health Library.