Text Box: Choosing A Therapist

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Text Box: Mental Health: Choosing A Therapist 
As Published in the June 2006 Honor Cord E-Zine (non-working link); as published by Phi Theta Kappa; contact the publisher for information on how to locate the archives.

By: Kurt D. LaRose  


    The decision to seek the help of a mental-health professional is usually a stressful and difficult process, which originates from interpersonal conflict. Familial difficulty, marital discord, substance abuse, sexual compulsions, academic problems, death and dying, depression, suicide, eating dysfunctions, financial problems, legal mandates, and a multitude of other variables motivate people to consider intervention. 
Do You Need a Therapist? 
    Research has long supported psychotherapy as an effective means of decreasing psychosocial dysfunction. However, the method of treatment is not always as critical to the effectiveness of the treatment as is the relationship between the professional and the person seeking help. A good working relationship begins, in part, with some degree of philosophical agreement. Understanding the professional perspective will be a key ingredient in a successful therapeutic relationship, and for you, the consumer, finding the right therapist will likely ensure quicker results. 
    Approximately 44 million people are affected by a mental disorder in the United States, making mental illnesses "the most common conditions affecting health today." With a U.S. population of 298 million people, more than 1 out of every 10 people has a diagnosable mental-health problem. Not everyone who sees a therapist necessarily has a mental illness, but professional intervention still may be needed. 
     It is important to first rule out physical problems that might be causing what appear to be emotional or psychological symptoms. A good place to begin is with the family physician and a complete physical exam. If a medical condition is not the cause of emotional distress, or if interpersonal conflict continues nevertheless, you should consider obtaining services from a therapist. 
    Finding a therapist is seldom as simple as opening the phone book and dialing a phone number -- your internal and external well-being are at stake, so should it be so easy? Many qualified professionals identify themselves as "psychotherapists" or "counselors," but learning the basics of their professional training will help you in deciding whom to see. The premise from which various professionals practice will provide you with an informed ability to choose. 
Types of Therapists 
    Most mental-health service providers have some things in common. They must be licensed to practice as a psychotherapist under state-licensing boards; most therapists are required to have accredited graduate degrees; most specialize in specific areas of expertise; and nearly all of them have credentials to diagnose mental illness. Psychiatrists, psychologists, clinical social workers, nurse practitioners, marriage and family therapists, and mental-health counselors all might work under the label of "therapist," but a universal title does not reveal the important differences between professionals. 
A psychiatrist is a medical doctor who often prescribes medications and can admit patients for hospitalization. Many people who see psychiatrists are treated with medicine(s) that require one or more prescriptions. When other mental-health professionals identify disorders that require medication assessment, referrals to psychiatrists are necessary. 
Psychologists are not medical doctors, but they do have doctoral degrees (a PhD). They do not, in most U.S. states, prescribe medications, but many psychologists provide psychotherapy. Psychologists are generally trained and skilled in quality assessments and testing instruments. 
Clinical social workers generally view mental illness through the lens of biological, psychological, sociological, and sometimes spiritual influences. The clinical social worker often provides therapy from a "Person in Environment" perspective and usually uses a nonpathological view based on a person's strengths. Interventions target the individual, with consideration of the family, group, community, and other social institutions. 
Mental-health counselors provide therapy using methods that are probably more "consumer-oriented" compared to other therapists. Their services are generally more affordable with lower hourly rates. 
Marriage and family therapists view mental-health issues most commonly within family systems. The distinction for marriage and family therapists is their emphasis on the marital or family influence as a primary consideration in relationship to a person's presenting emotional problem(s). 
    Other mental-health professionals who label themselves as "play therapists," "art therapists," or "music therapists" must first be licensed by a government authority as a mental-health provider. Afterwards, additional certification is obtained privately from national membership associations. Clinical social workers, mental-health counselors, and marriage and family therapists commonly use art therapy and music therapy in institutional settings (hospitals, assisted-living facilities, and group homes), whereas play therapy is commonly used with children and adolescents. 
    Once you have decided that professional psychotherapy is needed, after seeing the family physician and gathering information about the different kinds of mental-health providers that offer services, the next step is to contact a provider who practices in a manner that you believe to be consistent with your personal preferences and goals. Usually, the first contact is made via telephone, although some mental health services are being sought via the Internet (a relatively new prospect and one in need of further research). 
Choosing a Therapist 
    When you contact the therapist, you should ask a lot of questions. The questions indicate to the professional the degree of thought and intention given to the prospect of mental-health services, while providing an early forum for open dialogue. Most professionals are happy to answer questions about their services. If they are not inclined to respond to your questions, you might want to seek other providers. 
    A few questions you can begin with: What is the cost of therapy? If billing health insurance, will the therapist include a mental-illness diagnosis? If insurance is not accepted, is there a sliding fee? What does the therapist think about second opinions? What are the therapist's views on the use of medications? Will there be a written treatment plan with a suggested number of sessions, or will treatment informally guide itself? What are the rules of confidentiality? If children are being treated, are the rules of confidentiality the same, and is a current background check needed? What is the area of expertise for the therapist? What kind of license does he or she have? What determines success or failure? 
    After therapy has started, continue to seek information about what is happening in sessions. For example if the professional begins talking about certain disorders, ask if he or she has made a diagnosis. In the case of mental-illness diagnoses, it's equally important for the consumer to be informed about the disorder, its symptoms, and its treatment. 
  Assessment, diagnosis, and treatment will be addressed in my next Mental Health Series article for the Fall 2006 Honor Cord. 

References
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Carlbring, P. and G. Andersson. (2006). "Internet and Psychological Treatment.
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Code of Ethics of the National Association of Social Workers , (1996). "Preamble"
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Hewitt, J. and M. Coffey. (2005). "Therapeutic Working Relationships with People
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Saleebey, D. (2002). The Strengths Perspective in Social Work Practice (3rd ed.).
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