•  Anxiety •  Brief Therapy •  Depression Center •  Panic Attacks •  Psychotherapy •  Stress

If you have an insurance plan with mental health benefits, it usually makes sense to start there. Call your insurance provider for a referral to a counselor within your plan. You may be asked to consult your primary care physician as well. Your doctor or benefits contact will need to know a little bit about your problem (you need help coping with your mother's death, for example) so he or she can recommend someone who deals with problems like yours. You'll call the therapist (usually a clinical social worker or marriage and family therapist, rather than a psychologist or psychiatrist), and set up an appointment. Before you decide to use your benefits, you should know that the therapist is required to report the details of your condition to your insurance company in order to obtain authorization for each session, as there must be a "medical necessity" in order for insurance to pay for therapy.

You may be responsible for a co-payment at each session(usually between $5 and $45), which is a portion of the fee not covered by insurance. After a few sessions, you'll decide whether you feel comfortable talking to this person and whether the number of covered sessions will be sufficient. (Frequently insurance plans will cover only 10 to 20 sessions a year for counseling.) If you want to try someone else or think you'll need a longer course of therapy, ask your counselor to refer you to other therapists who might better meet your needs.

If you don't have insurance or you decide not to use your benefits, you can get referrals to counselors from your doctor or religious adviser or someone else whose judgment you trust. Psychotherapy can be expensive ($45 to $200 per session depending on your geographical area), but many private therapists charge on a sliding scale. You can also find therapists asking lower fees at nonprofit clinics, community mental health centers, and religious-affiliated counseling centers.

And you don't necessarily need to see a psychiatrist or psychologist; clinical social workers, marriage and family therapists, Licensed Professional Counselors (LPCs), pastoral counselors, and even interns can be just as effective as their more expensive cohorts. If you live near a medical school with a psychiatric program, you might look into therapy with a "psychiatric resident" (a psychiatrist in training). These folks are MD's (they've completed medical school) who are beginning to counsel patients under the supervision of more experienced doctors. They generally charge $30 to $60 per session. The same holds true for social workers or marriage/family therapy interns.

Yes, Employee Assistance Programs are set up to support employees who need help for a variety of work-life problems. If you are caring for an aging parent and need help finding eldercare resources in your community, for example, or even if you just want to talk with someone about the extra stress you are dealing with, an EAP counselor will often be available to talk via phone 24 hours a day. EAP programs also offer help with child care referrals, relocation, and confidential counseling and referrals for alcohol and drug problems. Like the services provided by other therapists, EAP counseling is strictly confidential.

Most therapists don't stick strictly to one approach. Instead, they rely on a variety of techniques, and each one defines his or her methods a little differently. You don't need to know ahead of time which school of therapy is right for you, but you may want to have some idea of what's out there:

•Cognitive-behavioral therapists generally try to get results in six to ten sessions by helping you recognize and change unhealthy thoughts or behavior patterns.

•Interpersonal therapists also work on a short-term basis and may focus on communication skills such as learning to voice your feelings and needs effectively.

•Psychodynamic therapists typically want you to commit to a longer treatment period; they work on getting you to identify and understand your feelings and how they affect your behavior.

•Psychoanalysts generally want to see you a few times a week for several years; they aim to help you explore subconscious feelings that arise from experiences in your childhood. (Most therapists don't advertise a particular approach; psychoanalysts are the exception. They'll let you know what you're getting into up front.)

First find out the practical details:

•Whether they are currently taking new clients

•Where the office is located

•What time slots are available

•How much it costs and, if necessary, whether there is a sliding scale

Then briefly explain your situation. Tell the therapist:

•Whether you've been in therapy before

•How long you've been feeling bad

•What event may have triggered your current distress (a death, a breakup, or another trauma)

•And, if you know, which issues or destructive behaviors you want to work on (not getting along with your family, drinking too much, getting into abusive relationships, and so on)

Then ask the therapist to summarize how she or he might work with you. (Some will be reluctant to discuss this over the phone and may suggest that you come in to talk about it. You don't have to feel obligated to comply.) There isn't a single right answer to this question; the idea is for you to get a sense of how you feel about the person. As the therapist talks, does he or she put you at ease and inspire your confidence? Or does his or her manner or tone annoy you or make you anxious? Studies have shown that the patient's level of comfort and trust is more important to successful therapy than the counselor's therapeutic philosophy or ability level.

A good therapist will create an atmosphere of trust and safety. You should feel you're learning about the nature of your difficulties and how you might correct them. If after a few sessions you have doubts or don't feel you're getting anywhere, tell your therapist about it. Try to identify what's been helpful and what hasn't, and discuss whether you should stick with it or try someone else. You should expect some discomfort in therapy when difficult issues come up, but don't be afraid to move on if you're frustrated or resentful after each session or if you don't feel you can be honest and open with your therapist. Once you do find someone you like, check in every few sessions on how you feel you're working together -- and if you feel that you are headed in the direction of accomplishing your goals for therapy.

-- Kate Lee is a former associate editor at Consumer Health Interactive and researcher at Time Inc. Health. She is currently a senior editor at BabyCenter.

Further Resources

American Psychological Association
750 First Street NE
Washington, D.C. 20002-4242
Phone: (800) 374- 2721 or (202) 336-5500
http://www.apa.org

References

First published May 24, 1999
Last updated February 13, 2008
Copyright © 1999 Consumer Health Interactive

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