How to Find a Therapist?

Finding a therapist nowadays seems to be a lot tougher than finding any other kind of provider.  The mental health system is very convoluted and complicated. 

Psychiatrists:

There is a national shortage of psychiatrists.  These are the providers that prescribe medications for mental health.  Since there is such a shortage, however, your primary care physician or Physicians’ assistant (PA) can prescribe for routine things such as depression or anxiety.  If, however, bipolar disorder is suspected, or you are having trouble adjusting to the medications or the medications aren’t working, you are better off finding either a psychiatrist or a certified registered nurse practitioner who specializes in mental health, otherwise knowns as a PMHNP - psychiatric mental health nurse practitioner.   These specialists will do an intake, listen, and talk for a bit, and prescribe medicine.  For extended therapy, however, you need to find a therapist or mental health counselor to compliment the person who is writing your prescriptions for the best outcome

 Online counseling:

Counselors are people who fill in the spaces for the people who prescribe.  They do medication management - they ask about your prescriptions and give you advice on how/when to manage them and when to go back to your doctor.  They look at the patterns in your life to see how talk therapy can help.  There are many types of talk therapy and other therapy. 

Often counselors do not fall under your insurance because each state is different in the licensing, etc.  A person must be fully licensed to take insurance, so make sure your online counselor is fully licensed and ask for their identifying number each time you speak to ensure that you know who is on the other end.

 Online mental health counselors come in many shapes and forms.  Some are text messages or email only.  Some are videos.  Most are on a cash basis.  They tout that, “they are cheaper than insurance”, but often that claim is untrue. You can talk to your counselor about how to manage your mental health with the payments and a front office that really understand billing can assist you with understanding the benefits of your insurance - the one fee that you are already paying so why not utilize it?

 In-person counseling:

Counselors can be found under numerous directories - please keep in mind that these directories are often not up to date.  For instance, they may list that they take your insurance, but they do not.  To be certain, you can call the “behavioral health number” on the back of your insurance card and ask your provider for a list of counselors.  You can also ask your primary care physician, as these people often keep this list at the ready for their patients.  These doctors often know the best providers, including ones not affiliated with their own network, so this is a great source. They are the ones getting feedback about these counselors, both good and bad.

It’s best to find a counselor nearby who can do both virtual (when you need it) and in person and one who has backup emergency services, when you find yourself in need.  Find a practice that has a knowledgeable staff regarding your insurance and payment.  Ask who is the billing person on site with whom you can speak.  Ask about the counselor's years of experience and their supervision (a process where counselors share ideas on solutions to your issues).

 Ask a trusted source.

If you know a friend or relative who had counseling ask what they liked about it and what they didn’t like about it.  Compare that to your individual needs

 Think about what it is that you need most.

Do you need/want a counselor who listens?  All counselors listen, of course, but some offer advice.  Some are very direct.  Some offer specialties that address trauma, for instance.  Are the counselors available if you have an emergency?  Do they have backup people for when they are out of the office?  Is the office staff friendly and know what they are doing with insurance?

Types of Counseling

There are five (5) broad categories of therapy.

•           Psychoanalysis and psychodynamic therapies

•           Behavior therapy

•           Cognitive therapy

•           Humanistic therapy

•           Integrative or holistic therapy

Psychoanalysis and psychodynamic therapies:

Psychoanalysis is defined as a set of psychological theories and therapeutic methods, which have their origin in the work and theories of Sigmund Freud.  The primary assumption of psychoanalysis is the belief that all people possess unconscious thoughts, feelings, desires, and memories.

Behavioral therapy:

Looking at behaviors and suggesting ways around them involving habits and the desire to change.

Cognitive therapy:

Cognitive behavioral therapy (CBT) is a treatment approach that helps you recognize negative or unhelpful thought and behavior patterns.  CBT aims to help you identify and explore the ways your emotions and thoughts can affect your actions.

 Humanistic therapy:

Humanistic therapy adopts a holistic approach that focuses on free will, human potential, and self-discovery.  It aims to help you develop a strong and healthy sense of self, explore your feelings, find meaning, and focus on your strengths

Integrative and holistic therapy:

Holistic therapy is a type of therapy that addresses the “whole” person.  This kind of therapy integrates spiritual, physical, mental, and emotional forms of well-being.  Its goal is to help individuals develop a deeper understanding of themselves on all these levels.

 A good counselor can address all these types of counseling.

 Think about your goals ahead of time.

 What do you want to accomplish in therapy?

Studies have found that when you and your therapist both work together toward the same goals, your outlook will be better.

If you think medication may help with your symptoms, you’ll want to find a psychiatrist or practitioner who can prescribe medications.

 If you’ve heard that cognitive behavioral therapy (CBT) or eye movement desensitization and reprocessing (EMDR) therapy have been effective for others with your condition, you’ll want to look for a therapist with certifications or specialized training in those treatment approaches.

If you want to be part of a supportive network of people who understand your experiences, you may want to consider looking for a therapist who’s involved with support groups or group therapy sessions.

 Your goals may change as you work with a therapist. It’s OK to talk with your therapist about changing the direction of your treatment plan as your needs evolve.

 The American Psychological Association suggests a few questions for you to consider asking your therapist during your first session:

•           Are you a licensed psychologist in this state?

•           How many years have you been in practice?

•           How much experience do you have working with people who are dealing with [the issue you’d like to resolve]?

•           What do you consider to be your specialty or area of expertise?

•           What kinds of treatments have you found effective in resolving [the issue you’d like to resolve]?

•           What insurance do you accept?

•           Will I need to pay you directly and then seek reimbursement from my insurance company, or do you bill the insurance company?  *

•           Are you part of my insurance network?

•           Do you accept Medicare or Medicaid?

•           How long are the sessions?

•           Are in-person sessions available?

•           Are emergency appointments available?

•           What if my counselor is out of town?

Why a licensed counselor? 

To become licensed, individuals must adhere to a strict standard of what we call “supervision” where we literally practice our trade and go to another professional (that we pay for ourselves) to critique us. 

  Paying for it

Please be wary of practitioners who say, “You need to pay me directly and then seek reimbursement from your insurance company”. PLEASE BE VERY WARY OF THIS STATEMENT.  If you understand how insurance works, you understand that the odds of you getting reimbursed are about .05% on a good day.  If a practitioner is not “in the network” - in other words, if they currently do not have a contract with your insurance company, then your benefits would be considered “out of network” with this practitioner.  BY DEFINITION, THEY ARE NOT IN THE NETWORK, BECAUSE IF THEY WERE THEY WOULD BE REQUIRED BY THEIR CONTRACT TO TAKE YOUR INSURANCE.

For example, I may have a $4000 “in-network deductible” and a $10,000 “out-of-network” deductible.  Of course, all my current doctors are “in-network” with my insurance company, so when I file my claim, it will go towards my $10,000 out-of-network deductible.  You will never get paid!   Many practitioners who do not deal with insurance do not understand this.

 Ask your counselor or their staff to check your benefits first or better yet create a log-in to your insurance company and check your own benefits.  They are under the category “outpatient mental health” or “behavioral health” and see what your deductible is.  Once I had a $4000 medical deductible with a $0 mental health deductible!  There are all kinds of plans out there.  A good office can assist you in this process.

 After you determine your budget then find a counselor who is willing to work within it.  For example, if you can only afford counseling once a month, set this up.  Counseling should solve problems, not become a “forever thing’.

 I hope this article helps.  Once you find the right counselor at the right counseling office, then you can make great strides.  You will be able to recognize patterns in your life and begin to reverse them.  You will be able to feel better and improve your life. 

 Your life doesn’t have to remain in the chaotic swirl!