Engaging in the therapeutic process can be one of the most powerful and life changing experiences a person can go through. Many seek out therapy because they’ve struggled with depression, anxiety, mood swings, or addiction. Others have found that no matter what they try they can’t cope with major life changes or the indecision to make changes they know they want to make. Many have experienced a traumatic event and can’t seem to shake the effects no matter what they try. Couples engage in counseling when the problems in their relationship or marriage come to a head and it no longer seems as though they can fix them on their own. There are countless reasons that you or someone you may know wishes to see a therapist.
Whatever your reason is, one thing remains common to most first time therapy goers. It can be confusing and a bit overwhelming when trying to get started. Even after years of practicing as a therapist, there is still a certain level of discomfort I feel when going to see a new therapist for the first time. There’s absolutely nothing wrong with this and it’s quite normal. For most of us, it’s not part of our weekly routine to go up to a stranger and spill out our deepest secrets. Whether you are struggling with severe issues or are just looking for an unbiased opinion to find ways to improve your life, it’s important to push through this discomfort as the best things in your life will come from taking a chance and pushing yourself out of your comfort zone.
Unfortunately, I’ve found that it is rare that the media does a good job of portraying the process of therapy in a realistic way. Along with this, there is very little information offered to people who are not working in the field or already engaged in services how to actually get connected. This lack of information can make the task of initially engaging in the process of therapy seem like too much work to undergo, especially if you are already suffering.
I’m a firm believer that knowledge is power. In this article I’ll explain the basic ins and outs of finding a therapist and getting your butt in the chair. I’ll also give you a general idea of how the process will go and dispel some common myths about therapy.
I’ve made the decision to see a therapist but I have no idea how to find a therapist or how to get started. What do I do now?
If you plan to use your health insurance, most health insurance websites offer ways to search for providers in your area for specific services. If you prefer, the back of your insurance card will generally have a customer service number that you can call and a representative will help you find an agency or private practice and give you their contact information. This is generally the easiest way to find a therapist that you can be sure takes your insurance as not every therapist or agency will take all types of health insurance.
If you work for a company that provides you with health insurance, it is also worth it to ask your supervisor or the HR department if your company offers an Employee Assistance Program (EAP). Many companies offer programs at no charge to employees (essentially you’re already enrolled in it if you receive a benefit package from your employer) that offer several services (free classes, workshops, incentives for gym memberships, etc.) including a number of free therapy sessions with an agency that they contract with. In my experience, while many companies have these programs, some are better at advertising this to their employees than others, so it’s worth asking. If you’re uncomfortable asking an employee where you work about mental health programs, simply ask if your company has an EAP and ask for some literature regarding what services they provide.
While going through health insurance websites or EAP’s are these easiest way to go about getting connected, this is not the method that I recommend. Every therapist is different in their personality, their approach, and their level of skill. Unless you had no other options or no one to ask, you wouldn’t go to mechanic, hair stylist, tattoo artist, etc. without some recommendations from a trusted source. You can take the same approach when it comes to therapy. If you know anyone who works in the field as a therapist or social worker, ask them for recommendations. If you know anyone who has been in therapy before and you are comfortable asking them, ask for their recommendations. While not every therapist works well with everybody, this is generally a better way of improving your chances of getting a better fit. Of course, if you plan on using your insurance, you’ll have to make sure when you call that they do indeed take it.
One more common option that people use is the website www.psychologytoday.com (disclosure: I am not receiving any type of compensation for promoting this site.) This is a great website that acts as a search engine for therapists in your area. Therapists pay to have profiles on this site to help increase their business. Looking through profiles can give you a better idea of what each therapists specialties and philosophy regarding treatment are.
What Do the Letters Mean After a Therapist’s Name and Does this Matter?
The letters after a therapist’s name generally represent 1 and/or 2 things, their college degree and/or their professional license. In the United States you essentially have 2 types of mental health therapists: psychologists and master’s level therapists.
In order for someone to officially call themselves a psychologist, they need to obtain a Doctoral Degree and obtain a license.
License requirements for psychologists and master’s level therapists vary from state to state but essentially require passing board exams and working for several years under the supervision of an experienced psychologist (or licensed Master’s Level Clinician) after having obtained the necessary college degree.
Psychologists will most commonly have the following letters after their name: PhD, PsyD, Ed.D., and will include the title Licensed Psychologist.
Master’s level therapists who have the ability to work towards licensure have either graduated with a Master’s Degree in Psychology, a Master’s Degree in Social Work, or one in Marriage and Family Therapy. These therapists will generally have the following after their name: M.S., M.A., M.Ed., MSW
If they have obtained their professional license they will have additional letters after their degree (In some cases licensed Master’s level therapists choose to only list their license as it can be assumed they have a Master’s if they have obtained that license)
Many states in the United States use the following letters for licensed Master’s Level Therapists though some states have different titles and use different sets of letters. They are generally comparible.
LPC– Licensed Professional Counselor – Has Master’s Degree in Psychology and has met requirements for licensure.
LSW or LCSW– Licensed Social Worker/Licensed Clinical Social Worker – Has Master’s Degree in Social Work and has met requirements for licensure in their state.
LMFT– Licensed Marriage and Family Therapist – Has Master’s Degree in Marriage and Family Therapy and has met requirements for licensure in their state.
In PA and in some states, an LSW is a license a therapist with a degree in Social Work can obtain on the way to obtaining an LCSW. Essentially the LCSW is equivalent to the LPC and LMFT.
Some professionals might argue tooth and nail over the differences between the clinicians above and some might argue that everyone from their degree and or license type is better suited than others to be therapists. The reality is that degree and even license does not necessarily always indicate the amount of experience, skill level, and personal fit. It is safe to assume that if a therapist has the education and the license, they are capable of providing sound and ethical treatment. You will have to determine through their advertisement or your experience of them if they are good fit for you.
How Much Does Therapy Cost?
If you are using private insurance and your therapist accepts your plan, your insurance card will indicate either a mental health or specialist copay. You will pay this amount per session. If your insurance requires you to pay a deductible, you will have to pay full price until you have met this deductible (Usually $80-$120 per session out of pocket). Check with your insurance, as some plans do not require that a deductible be met for mental health therapy to be reimbursed.
If you are receiving government assisted insurance (Medicaid), in most cases, therapy sessions will be of no cost to you.
If you are paying out of pocket either because you don’t have health insurance or are electing not to use it, costs vary greatly depending on the agency, private practice, and what area of the country you are in. In Philadelphia where I have practiced, I have seen therapists charge on average between $80-$120 per hour.
I don’t have health insurance and I can’t afford $80-$120 a week for therapy. What do I do now?
This can be a very difficult position to be in. Many individuals make too much money to qualify for government assistance, but not enough to pay out of pocket for insurance if their employers don’t provide it. On a similar note, many of us have insurance, but the deductibles are too high and we can’t afford the out of pocket expense in order to meet the deductible.
Although this does limit your options there are still paths to get help. Some therapists (more often at smaller/private practices) are willing to work on a sliding-fee scale where they will charge you less than their usual rate for a pre-determined and mutually agreed upon amount of time before raising the rate back up to their usual rate.
Another is asking if agencies provide therapy groups, either general therapy groups or groups that are specific to the issue you are seeking help with. Group therapy is usually less expensive than engaging in individual therapy and can be just as beneficial. Some people, regardless of what they can or can’t afford, prefer the group setting and feel as though they get more out of it.
So I’ve found a therapist/agency and scheduled my first appointment. What should I expect?
Although every agency or practice has their own way of doing things, there is usually some form of intake procedure.
You can expect to fill out a good amount of paperwork for your first visit, especially if you are working with a larger agency. Paperwork usually includes things like the following:
Contact/emergency contact information, medical and mental health history, etc. These forms are generally similar to what you would have to fill out if you were scheduling your first appointment at a new Primary Care Physicians office.
Consent to Treatment: You are giving the agency or therapist permission to give you therapy.
Releases of information to your insurance company, primary care physician, and maybe some other entities. Everything that is written or discussed throughout the course of therapy is protected health information and must be kept confidential unless you give permission for the agency/therapist to disclose. Technically, until you sign this release, a therapist is not allowed to bill your insurance as the fact that you are even in therapy is confidential and would be kept from your insurance company unless you sign this.
Most therapists/agencies will have you sign a documents that explain your rights as a client, specific policies of therapist or agency, and an agreement regarding payment and billing for services.
It is important to know that you can revoke your releases of information at any time, though this may effect the therapist or agency’s willingness to work with you depending on their individual policies.
If you have connected with a larger mental health agency or community mental health center (Medicaid provider), it is likely that your first visit will not be with the person who will be your actual therapist, but a therapist whose job it is to conduct intakes. What an intake means is that they wil take the “first session” to discuss with you your reasons for entering treatment, obtain more information regarding your background, ask for any preferences regarding therapists, and discuss their recommendations for the best way to treat you. The intake worker will take this information and assign you to the therapist in the agency they believe will be the best fit for you. You will either have your first session with your therapist scheduled at the time of intake or in some instances, they will reach out to you to schedule your first session with them.
For smaller agencies and private practices, it is common that for your initial session, you will meet with your therapist as private practices and smaller practices generally don’t have separate therapists to handle the intake process. They will do the intake a little less formally, but will still likely review your reasons for entering treatment, get some background information, and discuss how they plan to work with you. They should answer any questions you have and work out a schedule with you for continuing therapy.
Okay, I understand how to get connected. What is therapy going to be like once I start going to sessions?
This answer will be a little vaguer than the others as no therapist works exactly the same way. In almost every case you will not be laying on a couch staring at the ceiling while the therapist sitting behind you out of view interprets the metaphors in your dreams and childhood. Most therapy offices have regular chairs. The therapist and you will sit facing each other and have a discussion. At the risk of oversimplifying the process, therapy sessions are generally dialogues back and forth between therapist and client regarding various issues that are on their mind and/or impacting their life.
Early on in treatment a good therapists will ask you what it is that you’re hoping to get out of being in therapy and identify a few goals. Some therapists and agencies will write up formal treatment plans stating your goals and how you and the therapist will work together to achieve them. For others this will be done informally and there may not be anything written.
Therapists are very different as at the end of the day, despite our titles and education, we’re just people. Some of us talk more than others. Some will ask a lot of questions and others less. Some will fill the session with dialogue if you are not talking, others will sit in silence with you. Some will be fairly direct in giving therapeutic advice and others refuse to in order to guide you to your own conclusions.
It’s important to know that you are the driving force for your therapy. As you work with your therapist you will gain more insight into what has been helpful for you in the session and what isn’t. So long as you speak up your therapist should adjust sessions to meet your needs or refer you to someone who may be a better fit.
If you’re considering therapy for the first time, you probably already have more than enough on your mind. I hope this post helped shined some light on the process in order to make it all seem a little less complicated and overwhelming. If you have any additional questions regarding therapy or the process of getting started, please let me know in the comment section or via email. I’ll do my best to help!
P.S. If any therapist is reading this and feels I’ve left anything important out, please add in the comment section and I will update. Thank you for all you do!
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