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David Baxter

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Here's what to ask when you're looking for counseling, therapy
Tuesday, March 7, 2006
By MICHAEL GRANBERRY, The Dallas Morning News

You feel helpless and sad. Overwhelmed. Your job isn't going well, nor is your marriage. Despite your best efforts, you can't seem to feel better. So what do you do?

Family and friends have done everything they can, but even they conclude it's time you saw an expert. The question is:

Who?

It's one thing to find a doctor when your throat is sore or your back hurts or your fever jumps to 102. It's quite another to find the right person to help with emotional problems ? a stranger, even, with whom you can share your innermost secrets.

How do you find such a person? Where do you begin? Dr. Russ Newman, executive director for professional practices at the American Psychological Association, or APA, says finding the mental-health practitioner best suited to you is much tougher than finding the right physician.

"And the reason it's tougher is that most people don't grow up knowing what a therapist or a psychologist or a psychiatrist is," he says, "whereas they do grow up knowing what a family physician is. You have a picture in your head based on experiences you've had, but most people haven't had the same experiences, or the same picture, when it comes to psychotherapy."

So, how do you develop the picture?

Common sense suggests you start with credentials. A psychiatrist is a medical doctor with more training than a clinical psychologist (who usually has a Ph.D. ), or a marriage and family therapist, or a licensed clinical social worker.

But does that mean a psychiatrist is right for you, simply because he or she has loftier credentials than the clinical psychologist your sister or your best friend raves about?

The short answer ? no.

"If you're dealing with problems in your life, or your marriage isn't going well, or you can't get along with authority figures at work, and you just want to talk to somebody, psychotherapy or counseling is probably the best option," says Dr. David Tyler, a professor of psychiatry at UT Southwestern Medical School. "But there's a lot of different flavors of that."

He contends that in today's mental-health environment, "a lot of folks who aren't shrinks can do just as good a job as psychiatrists ? and may be a lot cheaper. I'm talking clinical psychologists or social workers, who, if they've had the proper training, can do a tremendous amount of good."

Narrowing your choices
So what are the differences you need to consider in looking for your therapist?

Psychiatrists: They complete a four-year medical program, just as a surgeon or any other doctor, followed by a residency and a psychiatric internship that usually lasts at least four more years.

"Let's say your husband isn't sleeping or is openly talking suicide," says Dr. Tyler. "Well, then, he needs to see someone who has the ability to prescribe medication. That would be a psychiatrist."

Dr. Tyler, who doubles as vice chairman for clinical services at the medical school, agrees that finding the therapist who's right for you can be a big problem and one that gets scant attention in today's medical landscape.

Most psychiatrists are trained not only in psychotherapy and talk therapy but also in prescribing a wide range of psychotropic medications, such as anti-anxiety and anti-psychotic drugs, which help alleviate emotional or mental problems.

Clinical psychologists: They are required to complete a doctoral program in psychology or clinical psychology. A psychologist obtains a bachelor's degree, then begins a doctoral program that lasts about five years. Psychologists offer psychotherapy or talk therapy, but many also have advanced training in research methods and testing, which provide additional insight into brain functioning and-or learning disabilities.

With any therapist, Dr. Newman suggests you start with licensing. "You can't call yourself a psychologist unless you have a license to practice in that state." In Texas, you can verify the license of any psychologist by going to the Web site of the Texas State Board of Examiners of Psychologists.

Beyond that, the APA suggests asking, "How many years have you practiced psychology?" If you suffer from a specific issue (for example, anxiety, depression, eating or sleeping disorders), you should ask what experience the therapist has in dealing with such problems.

Licensed marriage and family therapists, known also as MFTs or LMFTs: At a minimum, most have a master's degree in psychology, clinical psychology, counseling psychology or marriage and family therapy.

Mary Ellen Durham, a licensed clinical social worker and a licensed marriage and family therapist, shares a private practice in Dallas with a clinical psychologist and a psychiatrist, to whom she frequently makes in-house referrals. The three have shared such a relationship for 20 years.

"We try to cover the waterfront," she says.

In her own work, she defines a marriage and family therapist as someone skilled in helping a patient navigate his or her relationships, with relationships being the key word.

"Anyone who comes into therapy," says Ms. Durham, "is having relationship difficulties, whether with a family member, or a spouse, or a child, or a co-worker in the workplace, or a friend. These can be situational or emotional. We try to address what's going on currently, then go back ? to the family of origin or previous relationship differences that need to be explored and resolved. But the immediate need is to get this person, or this couple, or this family, functional again."

Licensed clinical social worker: Most have a minimum of a master's degree and are skilled in matching individuals and families with social services. They most often work in hospitals, clinics and agencies but may also work as therapists in private practice.

The APA suggests that, regardless of whom you pick, questions are imperative and you might even request an initial interview. Suggested queries:

? What are your areas of expertise?
? What kinds of treatments do you use?
? What are your fees?
? What types of insurance do you accept?
? Are you affiliated with any managed-care organization?
? Do you accept Medicare or Medicaid?

Which brings us to our next category:

Cost

? In Texas, psychiatrists typically charge upward of $150 for what's known as a "50-minute hour." Newcomers may believe the appointment is for an hour, so don't be surprised if the therapist ends the session at 50 minutes. Dr. Tyler says psychiatrists at UT Southwestern charge $175 for a 50-minute hour.

Just as Texas is a less expensive place than other parts of the country, so too is therapy here cheaper than it is on the West or East Coast. Dr. Tyler knows of psychiatrists in New York City who charge between $400 and $500 for a 50-minute hour. Regardless of where you obtain treatment, insurance plans should cover some of the cost.

"You get a lot more bang for your buck here," says Ms. Durham.

? Most clinical psychologists in the Dallas area charge upward of $100 for a 50-minute hour. Again, most insurance plans will defray the expense.

? Licensed clinical social workers and marriage and family therapists in the Dallas area charge upward of $90 for a 50-minute hour.

? Teachers and-or ministers or rabbis can also be helpful and should, of course, be free. Quite often, they're a good place to start. Dr. Tyler says you should never underestimate the power of such people to help you, or to offer referrals.

"You don't need a psychiatrist with a medical degree to get good psychotherapy," he says. "Look for people who've had the right training," regardless of who they are.

In selecting a psychiatrist, start with "the letters after the name on the door," he says. "If you or a loved one is experiencing major depression or is manic-depressive, that's pretty serious. Try to stick with somebody who's board-certified. They will be listed that way on their card or in the phone book."

In his guidebook, How to Choose a Good Doctor, Dr. George D. LeMaitre says board certification is a "minimum standard" for choosing a health-care professional. But he warns against putting too much stock in other credentials, such as Ivy League degrees or a floor-to-ceiling wall full of awards.

"No amount of documentation with medical credentials says a thing about professional excellence," writes Dr. LeMaitre. "You just cannot measure the quality of human service by quantitative means."

Ms. Durham says, "That's so excellent ? and so true."

Where to start
Initially, the search for the right therapist is going to feel daunting. So where might you turn to make it easier?

Word of mouth: Do the obvious. Turn first to friends and family members, who may be able to suggest a therapist who worked wonders for them. But beware: Just because Dr. Feelgood worked blissfully for them doesn't mean he'll be worth a hoot for you.

Your insurance provider: Most company health plans offer a mental-health option, albeit one that won't be as good as coverage for simple medical care. Typically, most provide a list of in-network providers who require a co-payment. Should you choose to go "out of network," you'll pay more. Many doctors follow a sliding-scale formula based on the patient's ability to pay. Resolve all payment issues before you begin.

Referrals from other health-care professionals: Dr. Gregory Graves, the medical director for Dallas Metrocare Services, recommends starting with your family physician, who he believes should even conduct your initial evaluation.

Professional organizations: The Dallas County Medical Society, the Federation of Texas Psychiatry,the American Psychiatric Association and the American Psychological Association are just a few of the agencies that can steer you in the right direction.

Ms. Durham says similar Web sites cover the other specialties: the Texas State Board of Social Worker Examiners and the Texas State Board of Licensed Marriage and Family Therapists.

Warning signs
When you're close to picking someone, how do you check for warning signs? You could query the aforementioned organizations to see whether the person you're considering has had a complaint filed against him or her. More Internet-savvy consumers may even be able to search court records.

In the case of psychiatrists, it's a bit easier, though hardly foolproof. Dr. Tyler recommends turning to the Web site of the Texas State Board of Medical Examiners. That way, you can see whether any medical doctor (psychiatrist or otherwise) has incurred a complaint, has ever lost his or her license, etc. Civil suits and criminal activity are also listed. But, he says, it's only a start. Your own good sense will always be your best guide.

"If you sit down and somebody makes you feel terrible, or they're arrogant or abusive, hey, just leave," says Dr. Tyler.

What should happen
In most cases, the person you select should be able to help you. In a recent study by the Stanford University School of Medicine, psychotherapy was found to be remarkably effective in decreasing patients' depression, anxiety and related symptoms such as pain, fatigue and nausea. The study showed that 50 percent of patients noticeably improved after eight sessions, while 75 percent of individuals in therapy improved by the end of six months.

But as the American Psychological Association says, finding "the right match" will do the most, by far, to ensure the best results.
 

Peanut

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Most clinical psychologists in the Dallas area charge upward of $100 for a 50-minute hour

I think I should move to Texas :)

psychiatrists in New York City who charge between $400 and $500 for a 50-minute hour

:eek: :shock:? Wow, it is hard to believe how expensive it is.? That cost is enough to give someone more mental problems then they came in with.
 

Rosa

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Just a little more info,..some mental health conditions fall under parity laws in some states which require insurance companies to treat the mental health visits the same as regular doctor visits. In other words, they can't limit the amount of visits or charge more for copays and most important to me-they couldn't make me go to their select few providers-I was able to stay with my Psychitrist.
Rosa
 

vi

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Hi!

I took your advice and looked up my ex-counsellor to see if he is registered with the CCCA. NO, he isn't!

I also looked for prospects while I was at it, but wonder if there is any program in my town that is covered by OHIP, and won't require a referal?

So far, I applied at the Women's College, and they spoke with my ex-counselor. Needless to say, they saw me through his eyes and treated me in a manner to let me KNOW so. How does one get out of that scenario?

This guy might have been on the right track with his diagnosis(??), but I don't want
to deal with his style of execution! Is it possible that he deliberately poisons my chances, with the hope that I will return to his practice? According to his schedule, he does not have many clients... -Or that he is convinced of his diagnosis and approach and is recommending that the next place take up where he left?

How does one get around to finding help? I cannot go through my last physician. This one admitted to not being qualified to help. I asked that she refer me. She said she knew no one. I found 2 prospects. I asked that she fax them a referal. One of the two was decent enough to phone me to warn me that I should find another doctor because this one faxed them saying that I was a fraud!!! (I told her that I was on disability, meaning that I had ALREADY been evaluated by a social worker/backed by a psychiatrist from an out patient clinic). I have yet been able to find another woman doctor who would take me as a patient.

What is really frustrating is that there is a lot of discrimination even in the medical field. If you don't look or sound wonderful, they lift their noses at you with unmasked disgust. Ah for shame!!!
 

David Baxter

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wonder if there is any program in my town that is covered by OHIP, and won't require a referal?

You can try calling your local hospital but it's doubtful - most OHIP covered programs do require a physician's referral.

Is it possible that he deliberately poisons my chances, with the hope that I will return to his practice?

I would think that would be highly unlikely.
 

ladylore

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And a bit more information to add to the mix:2cents:

I remember talking many people who started having major axiety attacks because the little things/details were not covered in the first couple of sessions to set the stage/boundaries.

So here are other questions that are a good idea to ask any counsellor/psychiatrist you are considering:

1. What type of therapy do they do? Have them tell you what its about.
2. How often will the appointments be? For example assuming you will be seen weekly and it turns out otherwise can cause anxiety, so ask.
3. How do they handle client crisises? Do they have an emergency number they can be reached at?
4. If the counsellor or psychiatrist/psychologist works with others the superivision should be apparent. If they work in private practice, who do they consult with when they have questions about cases?

I remember in college having a few profs that taught the course as if the students already knew the basics and we didn't. - Well, at times us cousellors forget to that we also need to remember the little things, and at times it slips our minds to go over them. So, to set boundaries for yourself, take the initiative and ask the small questions to.

Ladylore
 

coffeegirl

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How do you know if the therapy is working with the therapist or that things are going well with the psychiatrist? :confused:

I had one therapist flat out tell me that she was not capable of treating me due to all of the issues I had and that I needed to seek more advanced help from a psychiatrist and psychologist. So, I did. Since, I have seen the same psychiatrist and therapist for five years.

Please help me here. I know this might be a very strange point to ponder.

Coffeegirl
 

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