by Kevin Grold, Ph.D.
Many times your physician will refer you to a therapist that he or she knows personally. Sometimes the referral to a therapist is not based on familiarity with the therapist's ability or practice; rather it may be based on a personal friendship, a mutual referral arrangement, or geographic location (such as being in the same building).
The best way to locate a therapist is through a recommendation from someone who has a problem similar to yours and has had a good experience with that particular therapist. Since it is unlikely that your acquaintances will have a similar problem and be willing to tell you about their therapy, it is good to have other options.
For other potential therapists, you can contact a professional referral service. These can be found listed under "Mental Health" in your phonebook, or under the specific heading of the type of professional for which you are searching. Professional organizations maintain referral lists of qualified therapists. For instance, you could look up an organization for psychiatrists, psychologists, or marriage counselors. All of these organizations have the benefit of being able to help you find the appropriate match according to your specific type of problem and the therapist's expertise. If a therapist receives any complaints, the referral service is available to evaluate and resolve the dispute. If consistent problems occur, the therapist will be removed from the service. As most of the referral services require that the therapists maintain the highest level of professionalism, a therapist from a referral service has of necessity been exposed to extra screening.
Don't just accept the first therapist that you talk to. Wait for at least three therapists to return your call. The fact that your call is returned quickly does not imply that he or she is a good therapist. It may be preferable to see a therapist that is busy and popular. However, if a therapist does call you back quickly then that does not mean anything bad. Give yourself at least a day and a half to call three therapists to talk to them on the phone, and evaluate whether you find a sense of rapport.
Be careful to protect yourself. Just because someone says they are a therapist does not mean that they have had any training. People can call themselves a therapist, a psychotherapist, an analyst, a counselor, a marriage counselor, a hypnotherapist, or a sex therapist and not have had any formal training. Although very uncommon, it is nevertheless possible to practice as a psychiatrist in the United States without having obtained any specialized training more than a medical license.
The term "psychologist" is regulated by law which means that if a person says they are a psychologist, then that means that they have to be licensed in the state in which they practice. Again be careful because some therapists say they are a psychologist because they have a Ph.D. after their name (which means they are referred to as "doctor") but they are in fact licensed to practice under a specialty other than psychology. Thus a person with a Ph.D. in psychology from their graduate training may actually be state licensed as a marriage counselor. In some states, a marriage counselor can practice without being licensed. So how do you protect yourself?...By asking the following questions:
To a Psychiatrist: Have you had residency training in psychiatry and are you Board Certified by the American Board of Psychiatry and Neurology (more than 1/3 are Board Certified).
To a Psychologist: Are you licensed AS a psychologist? If not, under what license do you practice and what is your training?
To any other therapist: What is your license, degree, and training?
Before Calling The Therapist
First decide if you want a same-sex therapist or one of the opposite sex. If you are apprehensive about therapy then choose the sex of the therapist with whom you feel most comfortable.
Next find out how much you can afford for therapy. Assuming that therapy is once a week, then figure out how much can you afford to pay for four sessions in a month. If you have insurance, then contact your carrier and obtain in writing what they cover; i.e. if you have to see a specific therapist on their list, or if you have to see a particular type of therapist. Ask the carrier how much they pay for each office visit, and how many sessions they pay for. Also ask about annual and life time pay out limits. Now you are ready to contact the therapist.
Questions to Ask on the Phone
Ask the potential therapist if he or she has a few minutes to talk to you about therapy. If he or she is not available at that moment, then ask when you can call at a more convenient time. If you discover that they are too busy for this brief introductory talk, you may want to ask whether they are accepting new clients and when the first available appointment could be made. If it is too long until you can get an appointment and you feel the need to be seen immediately then ask for a referral to another therapist. The average wait is less than a week although rarely, with very busy therapists, it can be up to 6 months; so check with the therapist.
Does the therapist limit his or her practice to a particular type of client? Does the therapist do family or couples therapy if necessary? What type of therapy does he or she use? What type of experience, training, and license does the therapist have? Will the therapist read your history before you go to your first session? How long are the sessions, and how often does the therapist generally schedule sessions? And of course, what is the fee and will the therapist accept your insurance and how are co-payments handled? (co-payments are the amount that you have to pay beyond the insurance payment.) You can ask the therapist about a "sliding fee scale," which means that the fee may "slide" or vary according to your ability to pay or your monthly income.
Has the therapist ever had a license revoked or suspended; has he ever been disciplined by a state or professional ethics board and would he be willing to discuss it? You can call the state licensing board to check out his or her license, credentials, and any ethical violations.
Tell the therapist that you want to talk to a few other potential therapists and you will call back if you decide to make an appointment. Give yourself some time to think over and digest your feelings about the phone conversations. Then choose a therapist and make an appointment for an initial trial session. The first session should be used to help you decide if you WANT to work together.
After You Have Left Your First Session
Assess carefully your reaction to how it felt. Was the therapist open to the manner in which you presented your history? Did you get a sense that you could be comfortable with this therapist? Did you feel a sense of connection with the therapist? Remember that each therapist creates a different environment and you have to decide if the atmosphere felt right to you. Do you feel that you will be able to trust this therapist? Did the therapist push you to reveal things that were uncomfortable too quickly? Were your needs listened to? Did the therapist behave in a professional manner? Did you feel comfortable about the goals that you two were able to set? Did your therapist tell about how therapy works and were you able to set some goals.
What Does the Therapist Expect of You?
This varies from therapist to therapist but usually you are expected to:
1) Show up on time for appointments. Unlike other doctors that may keep you waiting for an appointment or that may accept you even if you show up late, a therapist has a specific hour set aside for you. If you are late, then you are missing out on time that was reserved for you. The therapist has no obligation to make the session run late because you showed up late. Most likely the therapist will have another client waiting to start at the beginning of the next hour. The therapist should not take phone calls or attend to any business other than yours during your therapy session.
2) Cancel appointments in advance so the therapist can reschedule (usually 24 to 48 hours). Usually therapists charge the full fee for missed appointments that are not canceled in advance because you are paying for the therapist's time that was allotted for you. Insurance will not pay for missed appointments.
3) Share your perceptions and feelings as openly and honestly as you can. This involves taking the risk of sharing your deepest fears and concerns--this will help you to make progress quickly.
4) Actively work on your issues with your therapist. Some people come into therapy with the attitude, "I'm here, now fix me." When in actuality the process has to be one of both of you working together.
5) Complete any "homework" which was assigned. (Homework is designed to help the benefits of therapy to extend beyond the therapy hour)
6) Think about and reflect on your therapy between sessions. Be ready to discuss thoughts that you have about the previous sessions or any insights that have come to you since your last session with the therapist. You may even want to start keeping a journal of your experiences. If you have tried but can't come up with any thoughts about the therapy then that is understandable.
7) Discuss with the therapist when you feel that you are finished with therapy BEFORE actually stopping.
If you follow these guidelines, you are not only living up to the expectations of therapy, you are also putting yourself in the best position to get the most out of the experience.
What Not to Expect
Don't expect a miracle cure from your therapist. Your problems have been with you for a long time and long-established patterns can take a while to change. Do not expect your therapist to be your friend outside of the therapy session. This can lead to complications with your therapy and should be avoided. You may wonder why your therapist does not acknowledge you in public. This is because your therapist wants to keep your relationship confidential. If you make the first move to say hello, then the interaction would likely be much different.
Also don't expect your therapist to attend parties or other functions. Some therapists will come to significant life milestones such as a graduation or marriage, but other therapists feel that it is not appropriate. Talk to your therapist about your feelings in regard to these matters.
What to Watch Out For
If you feel that the therapist is setting goals for you which are based on what the therapist considers is important for you to change and these goals are not your own, then be wary. At times therapists will unwittingly introduce their own unresolved issues which influence their treatment decisions. This is something to watch out for. For instance, if you mention that you are in an unhappy marriage and yet you are going to therapy to get over stage fright, and the therapist says you have to work on your marriage first, then he is a therapist to avoid. That therapist may be dealing with unresolved personal relationship issues which are influencing his or her judgement in regard to your treatment. This is rare, but it is something to be aware of.
Never let the therapist perform any action or ask you to do anything that is against your morals and values. If a therapist ever asks you to do something unacceptable and does not respect your wishes then leave immediately. Therapists are in a position of power and at times try and wield that power by saying "I know what is best for you." As with any profession, there are a small percentage of bad therapists who will abuse this power. Remember, never do anything that is against your values.
A therapist should never touch you without your permission. Some therapists will put their hand on your shoulder once they know you to offer support, but if such a gesture makes you uncomfortable then tell the therapist. If he or she does not respect your wishes then leave immediately.
If you ever have a particular problem or disagreement with your therapist, it is vital to bring this out in the open. Disagreements will inevitably arise, this is part of the therapy process. You should watch out for therapists who don't listen to your concerns or apologize for mistakes.
Therapists are expected to uphold the moral and legal standards of the community. Clients should be treated with dignity, respect, and fairness. The following are behaviors that are not ethical for a therapist: Any sexual approach is unprofessional for a therapist. Asking you to remove any of your clothes, or touching you in any way without your permission is unethical. Having romantic encounters or even asking to see you outside of therapy is also unethical. Be wary of therapists who try to elicit help from you for their own problems or charities or outside business interests. Therapists may bring up personal anecdotes to assist with your therapy, but the focus should not change to dealing with the therapist's problems.
The therapist may give you a reduced fee to help to accommodate your financial situation. When your situation improves it is customary to re-evaluate the circumstances and possibly pay the therapist's regular fee. But the therapist cannot increase his normal fees just because he feels you can afford a higher fee.
Though these situations are rare, if you believe that your therapist behaved in an unprofessional manner then discuss this behavior with the professional ethics committee of your state licensing board.
Kevin Grold, Ph.D. runs 1-800-Therapist, a resource for people needing help finding a certified therapist.