Finding the Right Counselor or Psychotherapist for You
Would Group or Individual Counseling Be Better for Me?
It's an individual choice. While individual counseling can be important for some problems of certain types, experience has shown that group counseling can often be even more effective for most issues. Perhaps it is the opportunity to see that some of what we regard as our most terrible secrets or distasteful aspects of ourselves are really only common human experiences that is so helpful.
Embarrassment or shame keeps many people from taking advantage of group counseling. Overcoming these feelings about aspects of ourselves is an important part of living our lives more successfully. Group counseling is very helpful in this respect. It can also be less expensive, but may be harder to find at a time convenient to your schedule.
Locating Available Counselors or Therapists
There are many ways to find out about available therapists or counselors:
- Get referrals from the counseling center. We maintain a list of private therapists, clinics and other options.
- Ask friends and family members. Sometimes the right therapist for your friend may not be right for you, but it is a starting place. Some people do not want to "share" a therapist with someone they know.
- Get a referral from another professional source (e.g., your family doctor).
- Get a referral from your insurance company, HMO or EAP. Sometimes HMOs and EAPs provide counseling as part of their service. Often this service is limited to a set number of meetings.
Selecting the Right Counselor or Therapist for You
Whatever the source, you should meet in person with at least two or three therapists before deciding, unless your situation is an emergency. Make it clear to the therapist when scheduling an appointment that you will be meeting with several therapists before making a decision. (A good rule of thumb is to call at least four to six and meet with at least two or three.)
Approach your choice of therapist as a consumer. Many people feel intimidated by counselors. Try to avoid this pitfall. Sometimes people idealize their therapist. Therapists are human with strengths and weaknesses. Most are better at working with some kinds of clients than others. Find out as much as possible about several therapists before choosing one. It will cost you a small amount in extra fees, but this money is well spent. It will allow you to make a wise decision in choosing a good therapist for you.
What to Look for When You Call for an Appointment and During the Exploratory Session
The most important questions are the ones you will ask yourself: How do I feel about this person? Does he or she seem comfortable and compatible for me? Does he or she seem empathetic? Naturally, you will feel somewhat anxious with each of the therapists you meet, but there will be differences in your feelings toward each. Pay attention to these feelings. (Don't ignore your feelings. If you have a creepy or uncomfortable feeling, choose someone else.)
There are several questions that you should be sure to have answered when you make the appointment or during the first session. Be sure to write down notes about the answers to your questions so you can remember better later. Try to get at least some of your questions answered on the phone before scheduling an appointment so that you can follow up and spend more time on other issues in your meeting. The answers to some questions may actually determine whether you want to include a counselor in your list of several to meet.
- How long have they been in practice? More experienced professionals are not necessarily better therapists, but all things being equal, experience is desirable. It usually takes about eight to 10 years for therapists to master their trade.
- How much experience have they had with clients like you? With your kind of problem? Experience treating children or hospitalized patients does not necessarily translate into better help for a moderately depressed client. The more directly relevant the experience to your needs, the better. If in doubt, ask the therapist how they think their experience applies to their ability to treat you.
- What kind of training have they had? How long did the training last? When did they finish training?
- What degree do they hold? (See below.)
- How much supervised experience have they had? Who provided the supervision?
- What are their current supervision arrangements?
- What is their licensing and certification status?
- What are their fees? Is there a sliding scale (reduced fees for low-income clients)? Do they accept your insurance?
- Has the therapist ever been in treatment? What kind, how long? It is important for the therapist to have adequate understanding of their own issues and problems. Having been is treatment is very helpful in this regard. It also gives the counselor an appreciation of how a client experiences treatment.
- What kind of approach to therapy or counseling do they prefer? (See below.)
You want to make sure that you do not spend more than about one-third of the meeting discussing the therapist. It is very important to spend time talking about you and your problems and hearing what the therapist has to say about you. Unless your situation is an emergency, after you finish with your questions, make it clear to the therapist that you would like him or her to spend some time during your first meeting demonstrating how he or she would actually work with you in therapy (in addition to asking you questions or simply describing his or her approach).
Other Things to Consider
- Convenience of the counselor's office location. It is usually not necessary to travel far out of your way to find a good therapist unless you live in a remote area. Try to find someone near home or work.
- Times available, that is, the compatibility of your schedule with that of the therapist.
- Promptness and courtesy of the therapist.
- Distractions and attentiveness (e.g., noise in the office, do they receive phone calls during sessions?)
Intake Assessment Meeting
Most therapists will conduct an intake assessment session before beginning treatment. The first step in helping you is to determine exactly what kind of counseling you need. You will be asked about what caused you to seek assistance, your background and so forth. Based on the information you provide, specific recommendations will be made.
Frequency of Meetings
This depends on the type of treatment approach (see below) and your condition. More serious or complex problems require more frequent treatment, in general. One meeting per week is the usual minimum frequency of meetings. Two meetings per week are a common recommendation when disturbing symptoms are involved or during a crisis. Psychoanalytic treatment often emphasizes frequent meetings (up to four or five per week). Be sure to ask what the therapist recommends for you.
What Happens if I Miss a Meeting?
It is important to attend each meeting from beginning to end. Be on time or early. Regular meetings are important to the effectiveness of counseling. If you become ill or have a conflicting obligation and must miss an appointment, you should call your counselor as far in advance as possible to reschedule. Counselors have different policies about charges for missed and canceled meetings. Be sure to get information about the policy of your counselor.
Consult your doctor for a check-up before beginning counseling to make sure your condition is not due to or made worse by a physical disorder. Many illness can affect mood, concentration and so forth.
Some conditions (e.g., depression, severe anxiety) require treatment with medication. The therapist should refer you to a psychiatrist for a medication consultation, if your condition warrants.
Experienced therapists charge a minimum of $100 to $175 per hour (and often more), with some psychiatrists charging up to $250 or more per hour. Average fees charged by experienced therapists are about $125 to $150 per hour. Group therapy costs considerably less.
Some therapists offer "sliding scale" fees (low-income clients are charged less). You should inquire if your income is moderate to low. Clinics often have lower fees than private practitioners. Training institutes have low fee referral services or clinics where therapists are receiving additional training in a specific treatment approach. (Sometimes these trainees can be quite experienced, but can also be newly trained. Be sure to ask.)
Usually the meeting hour is 45 to 50 minutes (to allow time for making notes and transition between clients).
Most therapists accept insurance. Most insurance covers only partial payment of therapy fees. Many therapists will ask you to pay first and submit bills for reimbursement by your insurance company.
Kinds of Counseling / Therapy Approaches
Many therapists specialize in one of the approaches below, but combined approaches (sometimes called eclectic) are common.
Short-term or Brief Therapy
Short-term or brief approaches emphasize a narrow focus on a specific problem or issue. Treatment is limited to from 10 sessions to six months.
Behavior therapy focuses more on specific behaviors (than underlying causes) and emphasizes concrete techniques to change those behaviors.
Cognitive therapy uses techniques designed to alter the way you think about yourself and your situation in order to make your thinking more adaptive.
Psychoanalytic or Psychodynamic Therapies
Psychoanalytic or psychodynamic therapies use the "transference" relationship between the therapist and client as the focus of treatment. Underlying emotional issues, which are leftover from childhood relationships with parents, are reworked in the relationship with the therapist. More than one meeting per week is often needed.
Gestalt therapy focuses on the client's "here and now" experience (rather than on the past) and uses a variety of techniques to promote awareness of and contact with aspects of experience and of the self that have been suppressed.
Humanistic approaches emphasize the real relationship between the therapist and client and tend to use feedback to clarify the client's thoughts and emotions.
Feminist approaches emphasize the social causes of difficulties experienced as a result of gender roles and uses techniques aimed at empowering the client to be free to gender role demands.
Psychoanalysis is an intensive form of psychoanalytic therapy requiring about three to four meetings each week for several years.
Group therapy uses meetings of from several to a dozen clients with one or two therapists. In some groups the counselor will work with each participant individually with comments from other participants. Other groups rely more on observations and discussion from participants with the counselor providing consultation as necessary to facilitate the work. Some groups combine these approaches.
Couples or Marriage Therapy
Couples or marriage therapy focuses on problems in a marriage or other love relationship by improving partners' understanding of each other's needs, facilitating communication and exploring unstated assumptions about the relationship. Consider attending a marriage or relationship education program before beginning counseling. It will help you understand your issues better and start your therapy on a fast track.
Premarital counseling focuses on partners' expectations for their marriage, communication and any other issues of concern. There is quite a lot of variation in how different providers approach premarital counseling. The usual brief session with your officiant is often not sufficient. Consider attending a skill-based premarital education program as an alternative or supplement to counseling. You'll cover all the basics at less cost, and can focus on any special concerns in counseling, if necessary.
Family therapy addresses problems that occur in a family context. Treatment sometimes involves identifying how one or more members are expressing problems of the whole family.
Self-help groups are not professional counseling, but they can be helpful, especially in providing additional help for people who have had common experience. There are groups for issues related to alcohol or other substance abuse, for survivors of abuse or assault, and for many other issues. The counseling center maintains a list of available self-help resources.
Psycho-educational Workshops or Seminars
Psycho-educational workshops or seminars are situation- or topic-oriented educational programs, such as couples communication, marriage or premartial education, and parenting skills programs. These programs provide orientation, information, skill building and other benefits in an efficient, supportive setting. It is often quite helpful to attend such a program before beginning counseling. Then you won't have to spend valuable one-on-one time with your counselor on basic education and skills, so you can get to help for your concerns more quickly.
Biblio-therapy, like self-help, can be an important adjunct to (but not a substitute for) counseling or therapy. Reading books about therapy and about the kind of problem or issue you are experiencing can give you a head start on treatment. Remember, the less time your counselor has to spend teaching you about therapy and basic information about your kind of problem, the more time you can spend directly on your concerns.
Kinds of Academic and Professional Training for Therapists
Before beginning or while receiving training in a specific approach to therapy or counseling, most therapists or counselors receive academic training following their undergraduate baccalaureate and receive a graduate degree from a college, professional school or university.
Doctoral-level clinical and counseling psychologists take graduate courses for the equivalent of three full years and also receive practical training during that time. They prepare a research dissertation or case study. Most complete a yearlong full-time internship in a professional setting. The Ph.D., Ed.D. or Psy.D. degree is granted to psychologists. New York licensing requires an additional year of supervised experience and an examination. Other kinds of psychologists require additional training to conduct therapy. Practitioners with master's degrees in psychology (M.S. or M.A.) are permitted to practice in educational and other organizational settings and in New York are licensed for independent practice after about three years of supervised experience. Many psychologists seek additonal institute training.
Psychiatrists attend medical school and receive a medical degree (M.D.). They then complete several years of internship and residency training as supervised practical experience. Medical training does not specifically prepare physicians to conduct psychotherapy, so most need additional training at a special residency or training institute. Because psychiatrists are physicians, their training and malpractice insurance can be expensive, and this is usually reflected in higher fees. Unless you need medication (which can only be prescribed by a physician), this may not be the most cost-effective option.
Social workers take graduate courses, which include some practical training, for the equivalent of two full years and receive a master's degree in social work (M.S.W.). CSW and ACSW certifications require additional supervised experience and an examination. Social work training does not provide extensive training to conduct psychotherapy, so most social workers need additional training at an institute. Because the academic training period is brief, fees may be somewhat more moderate.
When Is Enough Enough?
Give therapy a chance. Consider the first couple of months as a trial period. It usually takes at least that long to experience progress, depending on your problems and issues.
Progress is usually inhibited by changing from one therapist to another frequently. On the other hand, if you have been in treatment for a year or more and are not making progress, you might consider making a change. You should discuss this issue with your current therapist. Although you might find this embarrassing, they may be able to point out areas of progress that you have not been focusing on.
In considering when to discontinue treatment, ask yourself whether the problems that caused you to seek therapy have been resolved and whether any additional problems or issues have come to your attention that you may wish to resolve. Also consider the advice of your therapist. A frank discussion of the advisability of terminating treatment is usually useful.
Remember that no decision about counseling or psychotherapy is irrevocable. While you may seek advice from others, decisions to begin and end treatment and the choice of therapist are yours alone.