How to choose a therapist- Part 1

December 16, 4:19 PMDC Family ExaminerRisa Sanders

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With the New Year on the horizon and all those resolutions being considered, thoughts often turn to starting therapy. Choosing a therapist can feel confusing.  What's the difference between a Psychiatrist and a Psychologist? Are all therapists the same? What's the right kind of therapy for me? How long will it take? What should I expect? These are just a few of the questions most people have. Therapy is a significant investment of  time, money and emotions, so the choice of a therapist ought to be made with careful consideration. There are numerous categories of licensed clinicians, but given space considerations, I will only be able to address Clinical Psychologists, Psychiatrists and Licensed Clinical Social Workers in this series of articles.

Where to begin?

•  First, I feel it's important to work with a therapist that is licensed by a professional, state licensing board. This helps ensure at least a minimum level of education and supervised training and experience. It also provides a vehicle for checking for complaints and addressing ethical/practice violations if that were to occur. Furthermore, most insurance plans won't reimburse if the provider isn't licensed. If you wish to verify a therapists' licensure status, check with your state licensing board. There are separate licensing boards for Psychologists, Psychiatrists and Clinical Social Workers.

1.  For Psychologists, try www.dhp.virginia.gov/psychology/ ; in Maryland, go to www.dhmh.state.md.us/psych/ ; and, for DC and all 50 states, see www.ceunit.com/psychologistsstateboards.htm .
2. Each state has a medical board that regulates the licensing of Psychiatrists. Try www.dhp.virginia.gov/medicine/ , and www.ama-assn.org/ama/pub/category/2645.html .
3. Social Workers licensure status for all states and DC can be found by visiting www.aswb.org/resources.shtml and clicking on the link to social work regulatory boards.

•  Where to find a therapist? Like all referrals, make inquiries. Ask friends, your physician, your Minister or Rabbi, try to ask multiple sources, ask questions when making the initial contact (see below for some areas to inquire), check your instincts, verify credentials (see licensing boards above), remember that one size does not fit all.  The therapist that worked well for your friend may not be for you. A referral is not necessarily an endorsement, so you need to do your own assessment, and listen to your instincts too. Some places to begin might include the following professional organizations:

1.  The National Register of Health Service Providers in Psychology, www.nationalregister.org/ 
2. The Virginia Psychological Association, www.vapsych.org
3. The Maryland Psychological Association, www.marylandpsychology.org  
4. The DC Psychological Association, www.dcpsychology.org
5. The National Association of Social Work, www.socialworkers.org
6. The Psychiatric Society of Virginia (a chapter of the American Psychiatric Association) http://www.psva.org/resources_links.htm 
7. The Maryland Psychiatric Society, www.mdpsych.org
8.  Your local chapter of the American Mental Health Association, www.nmha.org
9. Most communities also have community mental health resources, funded by the state and/or county, in order to provide services on a sliding fee scale to lower income clients. Some of these resources along with other educational info. can be found at www.nmha.org/go/go/find_therapy

The beginning of any therapeutic relationship should include a clear discussion that includes the following items. This list isn't exhaustive,and is in no particular order, but will help get you started.

• fees- including willingness to accept insurance assignment; your co-pay, if any; check on your annual climits of benefits; find out what the policy is on missed, or late canceled appointments; Remember- your therapist can only see one client per hour, so late cancellations are a problem. It's not unusual for these appointments to be billed to you directly, and insurance will not reimburse for those. Most therapists expect payment at the time service is rendered, unless they are a member of your health insurance preferred provider panel.

• privacy and confidentiality- discuss the limits of confidentiality upfront, so you are comfortable and clear about this extremely important issue. Laws are different about what is considered "privileged" or confidential in every state. Every state has laws which require disclosure under certain circumstances. If you see a therapist as part of a couple, or family, talk about what the differences in confidentiality might be relative to individual therapy; discuss limits that may relate to minors who are in therapy;understand what, if any, information will be relayed to your insurance company. Understand the differences in confidentiality that relate to custody evaluations or forensic assessments.

• setting realistic expectations- it's rare to be able to give clients a date certain by which therapy will conclude. Nonetheless, you can discuss what your role is as the client; whether there will be "homework" to complete; if you belong to a managed care plan that only covers a limited number of visits, discuss what can realistically be accomplished in that time; address plans for transition to community support or other methods of follow-up; discuss the type of treatment you will receive and how that is appropriate for the symptoms/issues you have.

• Inquire about your therapists experience with the age group/symptoms/diagnosis that you are presenting.. Some therapists only have training working with adults, and others may have far more experience working with younger children, but not teens. Find the right therapist for the needs you have.Don't be reluctant to ask questions. Have you worked with this problem before? What is your theoretical training, and what does the literature show is the most effective form of treatment for this problem/issue?Some states require additional certifications to provide hypnosis, sex therapy and sex offender treatment. Learn what your state requires by visiting the licensing board website and asking questions.

• Clear Boundaries- your therapist should never ask you for favors, attempt to engage you in a social/romantic/sexual relationship, or take advantage of you in any way.

Please see my next article in this series to learn more about the definitions of various theoretical orientations (What's the difference between a behavior therapist and a psychoanalyst?), and differences among therapists (What is the difference between a Psychiatrist and a Psychologist? What do Social Workers do?).

 Disclaimer: This column is not in any way intended as therapeutic or professional advice and cannot substitute for thorough assessment and treatment by an appropriate professional. In the case of mental health issues and concerns, please seek help from a qualified health care provider. This column represents my personal opinion and does not reflect professional opinion/advice, nor does it reflect an endorsement of any provider or organization. Thank you.