Perhaps you have a chronic or difficult problem, or maybe you feel depressed or anxious. Before you jump into therapy, there are important issues that you need to consider. For example, "How do I choose a therapist?" "How much will it cost and how long will it take?" "What kinds of therapies are there and how do they differ?" "What should I expect at my first session?"
It is important that you choose someone that respects your opinion, your input, and your individuality. One of the most important things to consider when entering a therapeutic relationship is whether the values of the therapist match your values.
Conflicts can occur when the client and therapist have different value systems or when there are misunderstandings about the level of conversational intimacy. Engaging the right therapist—someone with whom you are comfortable and trust—is important in ensuring that you get the best treatment possible.
Look for recommendations from your doctor or other healthcare providers, professional organizations, or friends. Healthcare professionals may be able to separate your physical problems from emotional ones. For example, Laura went for a physical checkup when her anxiety over moving to a new city and the birth of her second child made her irritable and chronically fatigued.
Her primary care physician could find no physical difficulties, and instead recommended that she talk with someone about her concerns.
"Although I didn't know my primary care physician well," Laura says, "he had an excellent grasp of my problems and talked about it in a way that made sense to me. The therapist he recommended also seemed to understand my issues and was able to help me without putting me on any sort of medication."
Check with your insurance company about coverage. Costs may be based several factors, such as location, the type of counseling you need, and for how long. Learn about payment arrangements in advance. For example, some offices may bill you by mail, others may require payment at the time of your appointment. If your are not fully covered, or are uninsured, look for local resources in your area where you can get counseling for a reduced rate. These may include state or municipal services, community centers, or teaching hospitals. Your employer may also have services through an Employee Assistance Program.
The length of therapy can vary widely depending on your particular issues and your background. Treatment for mild or situational problems can be relatively short and might be accomplished in as few as 5-6 sessions. Chronic problems and long-term difficulties, however, may require a year or more before you feel that progress is being made. One way to monitor your progress is to formalize (in writing) a set of treatment goals. This ensures that both you and your therapist are working on the same issues and helps you assess the benefits for yourself.
When it comes time to end therapy, your therapist may encourage you to discuss your decision, but a good therapist should always respect your judgment about when it is time to go it on your own. Although the cost of therapy can affect the way you approach the process and what therapist you choose, the length of treatment should be based on more important factors.
If you and your doctor feel that counseling is the right option, you can discuss therapy options and get a referral. There are different categories of professionals to help you reach your goals. Mental health professionals include:
Therapies are generally divided into the following approaches:
In most cases, mental health professionals can offer you a range of treatment options. If you find something is not working, discuss it with your therapist. You always have the option of changing your mind and trying different therapies or therapists.
Your first session, sometimes called an intake evaluation, will be unlike subsequent sessions. This is a time for your therapist to get to know you—what is important to you and what particular problems or difficulties have brought you into therapy. You will be asked about your family history and childhood, education, friends and social relationships, career, romantic relationships, and current living situation. The depth of this personal history will vary depending on your therapist and his or her particular theoretical orientation. Once the therapist has developed some understanding of you, he or she will ask if you have any questions. This is the time to raise questions you have about the therapist's training and theoretical orientation and experience with treating problems similar to your own.
Be aware that subsequent sessions may be complex. Facing what appears to be a singular issue can often veer off into many other directions. You may need to delve into areas of your life that you had not anticipated exploring.
You do yourself a disservice by staying with a therapist that you do not like. If you feel that your therapist is not listening to you, or is downplaying your problems, or has a value system that differs from your own, do not hesitate to talk about it. A responsible therapist has an obligation to either work it out to your satisfaction or to refer you to someone else. Use the same consumer-wise techniques you apply to consumer goods when you search for a therapist. It is not uncommon to try more than one therapist to find a good fit. Do not let this discourage you from moving forward with therapy. It is more important you get what you need from the best person available.
American Association for Marriage and Family Therapy
American Counseling Association
Canadian Psychiatric Association
Canadian Psychological Association
Different approaches to psychotherapy. American Psychological Association website. Available at: http://www.apa.org/topics/therapy/psychotherapy-approaches.aspx. Accessed January 13, 2015.
For a healthy mind and body talk to a psychologist. American Psychological Association website. Available at: http://www.apa.org/helpcenter/talk.aspx. Accessed January 13, 2015.
Mental health professionals: Who they are and how to find one. National Alliance on Mental Illness website. Available at: http://www.nami.org/Content/ContentGroups/Helpline1/Mental_Health_Professionals_Who_They_Are_and_How_to_Find_One.htm. Accessed January 13, 2015.
Psychotherapy for depression. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 26, 2014. Accessed January 13, 2015.
Therapy and counseling. American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/prevention-wellness/emotional-wellbeing/mental-health/therapy-and-counseling.html. Updated May 2010. Accessed January 13, 2015.
Understanding psychotherapy and how it works. American Psychological Association website. Available at: http://www.apa.org/helpcenter/understanding-psychotherapy.aspx. Accessed January 13, 2015.
Last reviewed January 2015 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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