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By: Stacey Glick-Novack, LCSW, LCADC, ACSW  Trying to understand and manage the mental health care system can be challenging and exhausting during a time when one already is struggling with their own personal issues. This article will clarify the initiation and beginning of psychotherapy treatment for you to make better informed decisions regarding your own healthcare.
What is psychotherapy?
Psychotherapy is a psychological treatment for people struggling with emotional and/or adjustment issues. It is a process that varies in length according to the needs of the individual and involves talking with a trained psychotherapist. People attend therapy to explore issues that impact their mental health, develop goals and learn coping strategies to get their lives back on track. Therapists work with clients to understand their thoughts, feelings and behaviors, and clinically plan accordingly to achieve desired outcomes. Psychotherapy is confidential, with exceptions, and can be provided to individuals, couples, groups and families.
Who can be helped by psychotherapy?
In order to improve quality of life, people tend to be proactive in their physical health. Your state of mind should not be any different. Consider this:
- If you injured your leg, you would work with a physical therapist to help the healing process.
- If you had a brain trauma, you would work with a speech therapist to re-learn language skills.
- If you suffered a heart attack, you would seek a nutritionist to recommend a healthier diet.
- If you are hurting on the inside, or unintentionally hurting the ones you love with your words or actions because of anxiety or depression, would you meet with a psychotherapist to understand yourself better and make positive changes in your life?
For most people psychotherapy can be helpful. Ask yourself the following questions:
- Are you flooded with emotions such as depression, anxiety and anger?
- Do you have difficulty expressing these confusing and uncomfortable feelings?
- Are you overwhelmed by your responsibilities or lack of motivation?
- Do you suffer from problems in your relationships at home, school or work?
- Are you having difficulty adjusting to a life transition?
If you answered yes to any of these questions, you may consider talking with a psychotherapist. Many people choose to begin therapy to resolve emotional problems and achieve a healthier sense of wellbeing.
How do I find a psychotherapist?
Psychotherapist is a general term used for any provider who provides psychotherapy. If you have health insurance, call the membership telephone number or search on the insurance company website for providers under different categories, such as a licensed clinical social worker (LCSW) or psychologist (PhD). Psychiatrists (MD) tend to onlv prescribe medication and do not generally provide psychotherapy session services. Obtain a provider from a pediatrician, general practitioner, or another medical care professional. Ask a trustworthy friend, family member, and/or school social worker. Keep in mind, it is just as important to ask people who they do not recommend. If searching on the internet, be aware of inaccurate information. Many sites are not started or maintained by the provider themselves. Make sure you view the official website of the therapist or a reputable provider directory site.
What should I look for in a psychotherapist?
Once you have a preliminary list, you can narrow down the providers by what is important to you. Do you want telehealth services? Telehealth is the practice of delivering clinical health care services using interactive audio and visual electronic devices (such as a cell phone, tablet or computer) where the therapist and client are not in the same physical location. Potential benefits with telehealth include increased accessibility, convenience of care, time efficiency, and it limits medical exposures. Do you want the location of an office to be convenient to your home, work or school? Are flexible times available? Do you feel more comfortable with a female or male therapist? Are the fees reasonable?
When calling for an appointment, it is important to confirm that the provider is in-network, if you are using that benefit. If contacting a small practice, you have a greater opportunity to speak to the therapist prior to making an appointment. Ask about the therapist's experience, education, credentials and professional affiliations. Inquire if the therapist believes your problems are in his/her scope of practice. Ask what percentage of their clients are struggling with your issue and are in your age range. Ask if the practice is part-time or full-time.
In the initial session, you will have an opportunity to see if you feel comfortable with the therapist. Is he/she easy to talk to? Do you believe he/she has a good understanding of your problems? If the relationship does not feel to be a good fit, you can make an appointment with a different therapist.
What does confidentiality mean in a therapeutic relationship?
All the information disclosed within sessions and the written records pertaining to those sessions are confidential and may not be revealed to anyone without your written permission, except where disclosure is required by state law. Some of the circumstances where disclosure is required by New Jersey law are: a reasonable suspicion of abuse or neglect towards a child or vulnerable adult; a client is gravely disabled or presents a danger to self, to others, or to property. Disclosure may be required due to legal proceedings. If a client places his/her mental status at issue in litigation initiated by the client, the defendant may have the right to obtain psychotherapy records and/or testimony by the therapist. In couples therapy, confidentiality does not apply between the couple. In the case of a minor 14 years and older, a therapist is not legally permitted to release information relating to the minor's sexually transmitted disease, termination of pregnancy or substance abuse without the minor's consent.
What should I expect during the first session?
The therapist will conduct an assessment by gathering past and present information. After the evaluation, the therapist will discuss with you his/her working understanding of your problems and provide recommendations. Recommendations may include which level of care, type of treatment and theoretical approaches will be most beneficial for you. Additional referrals may be suggested, such as scheduling an appointment with a primary care physician, nutritionist, and/or psychiatrist. Names for self-help groups and community resources may be identified.
What does 'level of care' mean?
There are several different levels of psychiatric care. The lowest level of care is Outpatient (OP). The client is able to utilize a therapeutic relationship and maintain healthy functioning between scheduled outpatient appointments. This usually consists of a 50 minute individual session one time a week.
The level of care above this is an Intensive Outpatient Program (IOP). The client requires a more intensive treatment program than can be provided in a traditional outpatient setting. This usually consists of group treatment, generally 3 hours a day, sometimes several times a week depending upon the status of the client. These programs schedule treatment after work/school hours for the client to continue with his/her daily routine.
The level higher is called a Partial Hospital Program (PHP). Like an IOP, this program allows the client to benefit from an interdisciplinary treatment approach in a group setting. However, this client is not appropriate to continue his/her usual day activity. The client tends to have not made sufficient clinical gains and/or shown deterioration within a lower level of care.
Lastly, the highest level of care is inpatient psychiatric hospitalization. The client is assessed as needing daily monitoring and ongoing multidisciplinary therapeutic interventions. This client exhibits severe psychiatric symptoms (such as a harm to self and/or others) which cause significant social, educational and/or occupational impairment.
What should I expect from the second session?
Your therapist will develop a treatment plan with you to include short term and long term objectives. Besides clarifying your expectations, this plan serves as a baseline for monitoring improvement, maintaining focus, and verifying medical necessity for treatment to secure reimbursement from an insurance company or Employee Assistance Program (EAP).
What about the proceeding sessions?
Your therapeutic relationship will move toward achievement of desired goals. The therapist will challenge some of your assumptions and/or perceptions and propose different ways of looking at, thinking about or handling situations which cause you unwanted emotions and/or behaviors. During the course of treatment, the therapist is likely to draw on various psychological approaches according to your issues.
How long will my treatment take?
The length of therapy varies depending on your problems and issues. When you learn to manage your challenges and achieve your goals, therapy is concluded. For this reason, therapy may be short term. You may uncover additional objectives to grow and desire to continue with therapy. For this reason, therapy may be longer. During treatment, you may need a higher level of care or a different type of psychotherapy and be recommended for alternative treatment. Most likely, you and the therapist will agree that you reached your desired outcomes, and a date will be set to conclude therapy.
How do I pay for treatment?
The most common method of payment is from your medical health insurance. Your employer may offer an additional benefit called an Employee Assistance Program (EAP). You would receive free sessions to be used for recommendations, referrals and/or for brief interventions. Private pay is an option in which a fee is pre-determined by the therapist.
How do I determine benefits from my insurance company?
Benefits can be found online for most major health insurance companies, but navigating the sites tends to be confusing and time consuming. Call member services phone number on the back of your current insurance card. Listen for prompts for 'coverage and benefits.' Ask the representative for behavioral health benefits for outpatient office visits and/or telehealth sessions. Find out if there is a deductible. If so, how different is it for an in-network or out-of-network provider? (The in-network deductible will be significantly cheaper.) If so, has the deductible been met? If not, how much is remaining? And what date does the deductible restart again?
If there is no deductible or the deductible has been met, ask how much the copay is. Sometimes a therapist is considered a specialist and sometimes not, depending upon your policy. If there is no copay, ask if there is a percentage portion per session that you are responsible for. This is called co-insurance. This percentage will be significantly cheaper if the therapist is in-network. At the end of the call, request a reference number and the name of the representative for your records.
If the provider is in-network, he/she will submit the claims for you. If the provider is out-of-network, you will send the claims to the insurance company. Once claims have been processed, you will be informed, by mail or online, of the "official" rate in the Explanation of Benefits (EOB). Be aware when you renew your insurance policy, the insurance identification number on the card may remain the same but your benefits may change.
How do I know if I have an EAP benefit?
Ask your human resource department or check your employee handbook. The EAP representative will determine if you meet the requirements and how many sessions are allotted to you for a specific time period. He/she will provide you with an authorized therapist and an authorization number which will be used in submitting claims to the EAP company. You will not be responsible for any payment or to submit any claims. It is emotionally and financially advantageous for continuation of care to use a therapist who is an approved EAP provider and on your insurance provider list, in case you choose to continue in treatment after the EAP sessions are used. About the Author...
Stacey Glick-Novack, LCSW, LCADC, ACSW, is a practicing telehealth psychotherapist in New Jersey, New York and Florida who specializes in anxiety, depression and life transitions.
Click here to contact or learn more about Stacey Glick-Novack Last Update: 9/2/2024
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