So, you've made the decision to seek therapy - congratulations!
No matter how you came about that decision, it is a huge step in taking care of yourself. Therapy can help you improve your mental health, create and maintain meaningful relationships, and deal with problematic behaviors, beliefs and feelings.
Entering therapy can be scary, mostly because it is a type of relationship that you may have never experienced before. You may be unsure what beginning therapy involves.
The focus of this page will be on people who are seeking voluntary, individual therapy. Here are some practical tips and advice for those starting the individual therapy process.
Does Going To Therapy Mean I'm Crazy!?
Most of the people that go to therapy are everyday people that have everyday problems and are being proactive about improving their life.
People go to therapy for a variety of reasons: depression, anxiety disorders, family problems, parenting, self-esteem, life purpose and sexuality - just to name a few! Contrary to popular belief, only a very small percentage of people in therapy have a serious mental illness. In fact, if you're afraid of being judged by others as crazy, then that might be a good thing to bring up with your therapist!
How Do I Find A Therapist?
Finding a therapist is not an exact science. Here are some tips for finding a therapist:
Ask your general practitioner for a referral - part of their job is to improve ALL parts of your health (which includes mental health!) If you feel comfortable with your GP, ask him or her for a recommendation but don't feel obliged to delve into why you want a therapist. Keep in mind that your GP may make recommendations based on what type of help you'd like or what type of symptoms you would like to relieve.
Ask family or friends. But, again, only if you're comfortable! It's good to keep in mind that you probably don't want to want to have the same therapist as your best friend or your mom. A therapeutic relationship is a very unique situation - it isn't like having a mutual friend. Nevertheless, asking your family and friends could help lead you in the right direction.
The Internet never fails!
- Check out www.psychologytoday.com, www.therapistfinder.com, and www.goodtherapy.org - they all have a "therapist finder" section where different therapists post their contact information, specializations, and a brief biography. You can search by location, specialization, credentials, or school of thought.
- Google a combination of words like "New York City, Therapist, Bipolar Disorder" and see what comes up. Most prominent and well-respected therapists will have a website that outlines their experience, specializations (if any), office location, fees (possibly), and contact information.
- See if there are any profiles that "speak to you," and contact them!
What Do All Of Those Acronyms Mean?
When you search for a therapist, there's a whole lot of alphabet-soup that follows a name. These different acronyms indicate various types of educational degrees, as well as certification credentials. To make it more confusing, most people simply use the term "therapist" to refer to any mental health professional.
Just as you wouldn't want an incompetent physician, you wouldn't want an incompetent therapist.
However, the letters after a therapist's name are not a guaranteed or reliable key to distinguishing good therapists from the bad. You need to decide who is the right fit for YOU, which may be unrelated to their degree.
That said, it's still vital that the therapist have professional training and credentials, so here is a general breakdown:
Ph.D. - A scientist/researcher and a practitioner, who sees clients in individual therapy but also may run psychological research studies and teach at the university level. In addition to providing psychotherapy, they may have advanced training in brain functioning tests, psychological testing and evaluation, learning disabilities, and research methods.
Psy.D. - A practitioner that focuses on working with clients to assess problems and apply therapeutic framework and techniques to help the client solve the problem.
M.D. - A psychiatrist that is also a licensed physician, who can prescribe psychotropic medications. There are some psychiatrists who only provide medication consultations, and there are others that also provide therapy. If your primary therapist is not a psychiatrist, it is very common for psychiatrists collaborate with other mental health professionals to manage medication while you focus on therapy with another therapist.
M.S.W. - Masters in Social Work. After licensing, they become an LCSW (Licensed Clinical Social Worker). These therapists have a minimum of a master's degree in social work. They are trained in psychological diagnosis, assessment and treatment, consultation, evaluations and research. M.S.W. therapists can work in a variety of settings including hospitals, clinics, agencies or private practice. They can provide therapy from a variety of therapeutic orientations.
M.S. or M.A. in Counseling or Counseling Psychology - A Masters of Science or Master';s of Arts degree. After licensing, they come either a LPC (licensed professional counselor) or LMHC (liscense mental health counselor).
M.F.T. - Marriage and Family Therapist. After licensing, they become an LMFT (Licensed Marriage and Family Therapist). This is a California-specific licensure.
Okay, I've Found A Therapist I Might Like - What Do I Do Next?
Once you have found someone that you think would be a good match for you, the first step is to contact them to set up an initial appointment. If you found the therapist online, there is probably contact information listed. Emailing or calling the therapist is normal and expected - that is how they get clients!
Making the first phone call can be the hardest part, but it will be well worth the benefit! Given that the therapist is probably in sessions, you will probably get an answering machine or possibly a receptionist. That makes it easy for you to be prepared! In either case, you should leave the following information:
- That you would like to talk to the therapist
- Your name and contact information (telephone or email)
- Some general times you can be reached
When the therapist calls back, you can decide if you would like to ask questions before your initial meeting to decide if you want to meet with him/her, or if you would rather set up an initial appointment and see how it goes.
Some therapists even offer a free short consultation! They understand that the relationship between the therapist and client (you) is of the utmost importance, so it is important to them that you two are the right match. Don't be afraid to ask the therapist if they offer a free (or discounted) consultation/initial meeting.
Feel free to ask the therapist for any special directions for finding his/her office location, waiting room procedures, parking availability, and anything else you might like to ask to make sure that you can comfortably find the office.
You can set up two to three (or more!) initial consultations with different therapists. This is very common. You may have to pay the full price for the session, but it's very important that you start to get a sense of what type of therapist will work best for you. One of the best ways to do this is to meet with several people!
Don't worry about the therapist knowing that you've set up a couple of appointments - they understand that this is part of the process.
What Should I Expect In My First Session?
Once you have made an appointment with a therapist, it is time to start thinking about what your first session might look like.
It's always a good idea to try to arrive at the office ten minutes prior to your scheduled appointment. It's a good time to catch your breath, read a trashy magazine, drink some water, and calm down.
When you arrive to the therapist's office location, there will probably be a waiting room. (Maybe you've prepared and already asked the therapist about waiting room procedures!). Because the therapist knows that it is your first consultation, there may be new-client paperwork waiting for you. You should fill this paperwork out while you're waiting for your appointment, if there's time.
The paperwork may include:
- Basic demographic and contact information
- Important medical history
- Current prescriptions/medications
- Emergency contact information
- Previous therapy experience
- Your presenting problems
- Drug and alcohol use
- History of trauma
- Your initial goals for therapy
There will most likely be a consent form that you should read thoroughly before you sign. The consent form may include information about canceling/rescheduling sessions, contact outside of scheduled appointments, procedures for psychological emergencies, and confidentiality. Feel free to wait until you are sitting with the therapist to review any of the paperwork or consent form, and ask any questions!
During the first meeting, the therapist will be interested in gathering information about your personal, social, occupational, developmental and psychiatric functioning, history and current concerns. She may ask questions such as:
- What are the main concerns or issues that bring you to therapy at this time?
- What have you done in the past in a similar situation that you have found helpful?
- What have you tried in the past that did not work?
- What are the main goals you want to accomplish by coming to therapy?
- What is it that you most want from a therapist?
- What qualities to do you seek in a therapist?
- How often would you like to meet and how long do you expect to come for therapy?
- Is there anyone else that you'd like to participate with you in therapy?
You can expect to do most of the talking. After all, this is about you! The therapist may not say anything at all for a while, or may give short interpretive or clarifying comments. She should be listening carefully.
The therapist may also ask for your permission to contact previous health providers, if she would like to learn about your past treatment. It is your choice whether you allow the therapist to contact your health providers. If you decide to allow it, make sure that you sign a consent form.
But, DON'T FORGET that this is also a time for YOU to ask questions of the therapist! Yes, the therapeutic process is all about you and your world, however it is important that you feel comfortable with the therapist in order to make progress!
Here is a list of possible topics:
- What is your licensure?
- What level of education do you have?
- What is your general therapeutic orientation?
- Do you give your clients homework assignments?
- Are you open to using expressive therapies (i.e. art)?
- Do you have any areas of speciality?
- How long do you typically see clients?
- Do you take insurance?
- Are you available for short phone sessions or email correspondence outside of scheduled appointment times? Do you charge for these?
- What is your position on medication?
- Do you mainly listen, or do you also give your own opinions?
- Do you usually take notes?
Towards the second half the of the session, the therapist should talk to you about whether or not she feels that you would be a good match to work together. She should propose a therapeutic plan, including an appointment schedule, fees, and any other logistical details.
At this point, you can decide whether to continue with this therapist. You are under no obligation to continue with anyone. If you're unsure by the end of the first session, it's perfectly okay to say "I will call you in the next couple of days if I decide that we are a good match."
Is This Therapist Right For ME?!
Scientific research has proven that therapy is effective. But did you know that the effectiveness doesn't depend on the therapist's techniques, education or school of thought? It isn't! At least 60% of the value of therapy lies inherently in the relationship between the client (you) and the therapist. That means that finding a therapist that is right for YOU is extremely important.
- What does it feel like for you to be with the therapist? Do you feel comfortable? Safe? Is talking easy? Is she warm or emotionally removed?
- Do you feel like you can trust the therapist?
- Can the therapist explain how she can help you?
- Does the therapist have previous experience with your particular issues? Do you feel like she is qualified to help you reach your goals?
- After the session, did you leave the therapist’s office better than when you entered?
At the end of the day, go with your gut. If you have a bad feeling about one therapist, don't go back! It may take a couple of different sessions before you really start feeling comfortable with someone. Don't be afraid to schedule a second or third session, just so make sure that you are confident in your choice.
Just remember that YOU make the decision on who is right. And you are completely capable of making that decision!
Is What I Say Confidential?
In general, yes. There are laws that protect the communication between a client and therapist. No information will be disclosed to anyone without your written permission.
However, there are some important exceptions:
- Suspected child abuse, dependent abuse, or elder abuse.
- Client is threatening serious physical harm to another person.
- Client intends to harm him/herself.
In these cases, the therapist is required by law to report this to the appropriate authorities - this is called "mandated reporting."
Will The Therapist Take Notes?
Therapists are required to have a written record that shows the progress of therapy with the client. Usually, they will write their notes once you've left the session and keep note-taking during the session to a minimum. If, at any time, your therapist is taking notes to the point where you don't feel like she is actively listening to you, that's a problem - you can bring it up!
Some therapists use note-taking as a tool to help them remember the content of your session. Taking notes allows them to record information verbatim, record important details, and provides a written record of the session.
During your first session, the therapist will be more likely to take notes but once you continue for several sessions, the note taking might decrease.
Always remember that you are allowed to discuss your concerns about confidentiality or note taking with your therapist. Your comfort and safety are of the utmost importance in this relationship.
Does Insurance Cover Therapy?
In some cases, insurance plans can help cover the cost of therapy. Check directly with your insurance company to inquire about your plan's coverage.
Here are some questions that might be helpful to ask:
- What about my mental health benefits under my plan?
- What amount will insurance cover per therapy session?
- How many sessions are covered?
- Can I go to an out-of-network provider? Will my insurance pay?
- Do I need prior approval from my primary care physician?
- Will I need the therapist to give me a diagnostic evaluation for insurance purposes?
Some Tips For Surviving Your First Session:
Don't schedule something for immediately after your appointment. You might want some time to decompress, think things through, stuff like that.
Only say what you're comfortable with saying - you don't have to go into everything in your first session.
Write down a list of what you'd like to tell the therapist. If, during the session, you get too anxious, you can give this list to the therapist to give her a starting point.
If you can't bring yourself to say something, ask the therapist if you can write it down. Many therapists have pen and paper for this exact purpose!
If you're unsure where to start, tell your therapist that you need some help or guidance.
Remember that you are always in control of what and how much you say.
Bring a comfort object with you.
Find a comfortable sitting position. If you don't like where the pillows are, move them!
Be gentle with yourself. You are making a huge step in healing your emotional pain.
Treat yourself to something special after your appointment. You deserve it.