Choosing the right mental health therapist

Why is this choice so important?

Therapy is a collaborative process, so finding the right match-someone with whom you have a sense of rapport-is critical. After you find someone, keep in mind that therapy is work and sometimes can be painful. However, it also can be rewarding and life changing.

Can a therapist share what I have said during therapy?

You can rest assured that all mental health professionals are ethically bound to keep what you say during therapy confidential. However, therapists also are bound by law to report information such as threats to blow up a building or to harm another person, for example.

What are the steps for choosing a therapist?

1. See your primary care physician to rule out a medical cause of your problems. If your thyroid is "sluggish," for example, your symptoms-such as loss of appetite and fatigue-could be mistaken for depression.
2. After you know your problems are not caused by a medical condition, find out what the mental health coverage is under your insurance policy or through Medicaid/Medicare.
3. Get two or three referrals before making an appointment. Specify age, sex, race, or religious background if those characteristics are important to you.
4. Call to find out about appointment availability, location, and fees. Ask the receptionist:
* Does the mental health professional offer a sliding-scale fee based on income?
* Does he or she accept your health insurance or Medicaid/Medicare?
5. Make sure the therapist has experience helping people whose problems are similar to yours. You may want to ask the receptionist about the therapist's expertise, education, and number of years in practice.
6. If you are satisfied with the answers, make an appointment.
7. During your first visit, describe those feelings and problems that led you to seek help. Find out:
* What kind of therapy/treatment program he or she recommends;
* Whether it has proven effective for dealing with problems such as yours;
* What the benefits and side effects are;
* How much therapy the mental health professional recommends; and
* Whether he or she is willing to coordinate your care with another practitioner if you are personally interested in exploring credible alternative therapies, such as acupuncture.
8. Be sure the psychotherapist does not take a "cookie cutter" approach to your treatment-what works for one person with major depression does not necessarily work for another. Different psychotherapies and medications are tailored to meet specific needs.
9. Although the role of a therapist is not to be a friend, rapport is a critical element of successful therapy. After your initial visit, take some time to explore how you felt about the therapist.
10. If the answers to these questions and others you come up with are "yes," schedule another appointment to begin the process of working together to understand and overcome your problems. If the answers to most of these questions are "no," call another mental health professional from your referral list and schedule another appointment.

What is the difference between psychiatrists and clinical social workers?

Two kinds of therapists warrant special note: psychiatrists and clinical social workers. Psychiatrists are medical doctors and can prescribe medication. Clinical social workers are trained in client-centered advocacy and can assist you with information, referral, and direct help in dealing with local, State, or Federal government agencies. As a result, they often serve as case managers to help people "navigate the system." Clinical social workers and many other mental health professionals cannot write prescriptions. However, nurse practitioners that specialize in psychiatry and mental health can prescribe medication in most states. And, under a new law, psychologists in New Mexico can prescribe medications after receiving training (New Mexico State Legislature, 2002).

Source: SAMHSA's National Mental Health Information Center