the Right Counselor or Psychotherapist for You
people need counseling?
It is a common misconception to think
that only seriously ill or "crazy" people need counseling help. Studies
show that over eighty percent of people can benefit from counseling
at some time in their lives. So, it is normal to need counseling when
special concerns or difficult feelings arise. Most people have a problem
with anxiety, depression, stress, relationships, etc., at some point.
Don't put off seeking counseling or
therapy. If you are considering it, this is an indication that you probably
could benefit from the experience.
happens in counseling?
Generally, you will meet with a professional
counselor or therapist regularly for about forty-five minutes (longer
for groups) at the same time once each week. At these meetings, you
will discuss your concerns with the counselor.
The goal of counseling is to learn about
our habits and patterns of feeling and behavior and how they cause us
problems. We can then learn new habits and patterns which will be more
successful for us. Although it seems strange to think that we might
not know ourselves completely, experience has shown that many of the
problem-causing habits and patterns are things we have done all our
life and are so automatic that we don't even think about them as learned
or optional behavior.
Counseling provides a special setting
in which we can learn about ourselves. This can help us to be more effective
in our relationships with others and with ourselves. It takes time,
helpful observations and support to recognize and change our ways of
group or individual counseling be better for me?
It's an individual choice.
While individual counseling can be important for some problems of certain
types, experience has shown that group counseling can often be even
more effective for most issues. Perhaps it is the opportunity to see
that some of what we regard as our most terrible secrets or distasteful
aspects of ourselves are really only common human experiences that is
Embarrassment or shame keeps many people
from taking advantage of group counseling. Overcoming these feelings
about aspects of ourselves is an important part of living our lives
more successfully. Group counseling is very helpful in this respect.
It can also be less expensive, but may be harder to find at a time convenient
to your schedule.
I be helped in a group when everyone's problems are different?
Each individual is unique as are their
concerns. Still, as people we have a great deal in common. (We all grow
up in families. We all react to hurt in similar ways. We all have the
same basic capacity to grow and change.) While the problems people bring
to counseling can be quite different, the underlying issues which produce
these problems are often similar.
Groups provide a special setting in
which we can learn about ourselves, about others, and about ourselves
in relation to others. This can help us to be more effective in our
relationships with others and with ourselves outside the group. It takes
time, helpful observations and support from others to recognize and
change our ways of living.
available counselors or therapists
There are many ways of finding out about
available therapists or counselors:
- Get referrals from the counseling center: We maintain
a list of private therapists, clinics and other options.
- Ask friends and family members: Sometimes the right
therapist for your friend may not be right for you, but it is a starting
place. Some people do not want to 'share' a therapist with someone
- Get a referral from another professional source
-- e.g., your family doctor, etc.
- Get a referral from your insurance company, HMO
or EAP: Sometimes HMOs and EAPs provide counseling as part of their
service. Often this service is limited to a set number of meetings.
the right counselor or therapist for you
Whatever the source, you should meet
in person with at least two or three therapists before deciding, unless
your situation is an emergency. Make it clear to the therapist when
scheduling an appointment that you will be meeting with several therapists
before making a decision. (A good rule of thumb is to call at least
four to six and meet with at least two or three.)
Approach your choice of therapist as
a consumer. Many people feel intimidated by counselors. Try to avoid
this pitfall. Sometimes people idealize their therapist. Therapists
are human with strengths and weaknesses. Most are better at working
with some kinds of clients than others. Find out as much as possible
about several therapists before choosing one. It will cost you a small
amount in extra fees, but this money is well spent. It will allow you
to make a wise decision in choosing a good therapist for you.
to look for when you call for an appointment and during the exploratory
The most important question is the one
you will ask yourself: How do I feel about this person? Do they seem
comfortable and compatible for me? Do they seem empathetic? Naturally,
you will feel somewhat anxious with each of the therapists you meet,
but there will be differences in your feelings toward each. Pay attention
to these feelings. (Don't ignore your feelings. If you have a creepy
or uncomfortable feeling, choose someone else.)
There are several questions that you
should be sure to have answered when you make the appointment or during
the first session. Be sure to write down notes about the answers to
your questions so you can remember better later. Try to get at least
some of your questions answered on the phone before scheduling an appointment
so that you can follow up and spend more time on other issues in your
meeting. The answers to some questions may actually determine whether
you want to include a counselor in your list of several to meet.
- How long have they been
in practice? More
experienced professionals are not necessarily better therapists, but
all things being equal, experience is desirable. It usually takes
about eight to ten years for therapists to master their trade.
- How much experience have
they had with clients like you? With
your kind of problem? Experience treating children or hospitalized
patients does not necessarily translate into better help for a moderately
depressed client. The more directly relevant the experience to your
needs, the better. If in doubt, ask the therapist how they think their
experience applies to their ability to treat you.
- What kind of training have
they had? How long did the training last? When did they finish training?
- What degree do they hold?
- How much supervised experience
have they had? Who provided the supervision?
- What are their current
- What is their licensing
and certification status?
- What are their fees? Is there
a sliding scale (reduced fees for low
income clients)? Do they accept your insurance?
- Has the therapist ever been in
treatment? What kind, how long? It is important
for the therapist to have adequate understanding of their own issues
and problems. Having been is treatment is very helpful in this regard.
It also gives the counselor an appreciation of how a client experiences
- What kind of approach to
therapy or counseling do they prefer? (See below.)
You want to make sure that you do not
spend more than about one-third of the meeting discussing the therapist.
It is very important to spend time talking about you and your problems
and hearing what the therapist has to say about you. Unless your situation
is an emergency, after you finish with your questions, make it clear
to therapist that you would like them to spend some time during your
first meeting demonstrating how they would actually work with you in
therapy (in addition to asking you questions or simply describing their
things to consider
- Convenience of the counselor's office location. It
is usually not necessary to travel far out of your way to find a good
therapist unless you live in a remote area. Try to find someone near
home or work.
- Times available--the compatibility of your schedule
with that of the therapist.
- Promptness and courtesy of the therapist.
- Distractions and attentiveness (e.g., noise in the
office, do they receive phone calls during sessions?)
Most therapists will conduct an intake
assessment session before beginning treatment. The first step in helping
you is to determine exactly what kind of counseling you need. You will
be asked about what caused you to seek assistance, about your background,
and so forth. Based on the information you provide, specific recommendations
will be made.
This depends on the type of treatment
approach (see below) and your condition. More serious or complex problems
require more frequent treatment, in general. One meeting per week is
the usual minimum frequency of meetings. Two meetings per week are a
common recommendation when disturbing symptoms are involved or during
a crisis. Psychoanalytic treatment often emphasizes frequent meetings
(up to four or five per week). Be sure to ask what the therapist recommends
happens if I miss a meeting?
It is important to attend each meeting
from beginning to end. Be early or on-time. Regular meetings are important
to the effectiveness of counseling. If you become ill or have a conflicting
obligation and must miss an appointment, you should call your counselor
as far in advance as possible to reschedule. Counselors have different
policies about charges for missed and canceled meetings. Be sure to
get information about the policy of your counselor.
Consult your doctor for a check-up before
beginning counseling to make sure your condition is not due to or made
worse by a physical disorder. Many illness can affect mood, concentration
and so forth.
Some conditions (e.g., depression or
severe anxiety) require treatment with medication. The therapist should
refer you to a psychiatrist for a medication consultation, if your condition
Experienced therapists charge a minimum
of $100 - 175 per hour--often more--with some psychiatrists charging
up to $250 or more per hour. Average fees charged by experienced therapists
are about $125 - 150 per hour. Group therapy costs considerably less.
Some therapists offer 'sliding scale'
fees (low income clients are charged less). You should inquire if your
income is moderate to low. Clinics often have lower fees than private
practitioners. Training institutes have low fee referral services or
clinics where therapists are receiving additional training in a specific
treatment approach. (Sometimes these trainees can be quite experienced,
but can also be newly trained. Be sure to ask.)
Usually the meeting hour is 45 - 50
minutes (to allow time for making notes and transition between clients).
Most therapists accept insurance. Most
insurance covers only part payment of therapy fees. Many therapists
will ask you to pay first and submit bills for reimbursement by your
of counseling / therapy approaches
or brief approaches emphasize
a narrow focus on a specific problem or issue. Treatment is limited
to from ten sessions to six months.
focuses more on specific behaviors (than underlying
causes) and emphasizes concrete techniques to change those behaviors.
therapy uses techniques
designed to alter the way you think about yourself and your situation
in order to make your thinking more adaptive.
or psychodynamic therapies use
the ('transference') relationship between the therapist and client as
the focus of treatment. Underlying emotional issues which are left over
from childhood relationships with parents are reworked in the relationship
with the therapist. More than one meeting per week is often needed.
therapy focuses on the client's 'here and now' experience
(rather than on the past) and uses a variety of techniques to promote
awareness of and contact with aspects of experience and of the self
which have been suppressed.
approaches emphasize the real relationship between the therapist and
client and tend to use feedback to clarify the client's thoughts and
approaches emphasize the social causes of difficulties experienced
as a result of gender roles and uses techniques aimed at empowering
the client to be free to gender role demands.
is an intensive form of psychoanalytic therapy requiring about three
to four meetings each week for several years.
uses meetings of from several to a dozen clients with one or two therapists.
In some groups the counselor will work with each participant individually
with few comments from other participants during the work. Other groups
rely more on observations and discussion from participants with the
counselor providing consultation as necessary to facilitate the work.
Some groups combine these approaches.
or marriage therapy focuses on problems in a marriage
or other love relationship by improving partners' understanding of each
other's needs, facilitating communication and exploring unstated assumptions
about the relationship. Consider attending a marriage or relationship
education program before beginning counseling. It will help you understand
your issues better and start your therapy of a fast track.
counseling focuses on partners' expectations for their
marriage, communication and any other issues of concern. There is quite
a lot of variation in how different providers approach premarital counseling.
The usual brief session with your officiant is often not sufficient.
Consider attending a skill-based premarital education program as an
alternative or supplement to counseling. You'll cover all the basics
at less cost, and can focus on any special concerns in counseling, if
addresses problems that occur in a family context. Treatment sometimes
involves identifying how one or more members are expressing problems
of the whole family.
Many therapists specialize in one of
these approaches, but combined approaches (sometimes called eclectic)
are not professional counseling, but they can
be helpful, especially in providing additional help for people who have
had common experience. There are groups for issues related to alcohol
or other substance abuse, for survivors of abuse or assault, and for
many other issues. The counseling center maintains a list of available
workshops or seminars are situation- or
topic-oriented educational programs, such as couples communication,
marriage or premartial education, and parenting skills programs. These
programs provide orientation, information, skill building and other
benefits in an efficient, supportive setting. It is often quite helpful
to attend such a program before beginning counseling. Then you won't
have to spend valuable one-on-one time with your counselor on basic
education and skills, so you can get to help for your concerns more
like self-help can be an important adjunct to (but not a substitute
for) counseling or therapy. Reading books about therapy and about the
kind of problem or issue you are experiencing can give you a 'head start'
on treatment. Remember, the less time your counselor has to spend teaching
you about therapy and basic information about your kind of problem,
the more time you can spend directly on your concerns.
of academic and professional training for therapists
Before beginning or while receiving
training in a specific approach to therapy or counseling, most therapists
or counselors receive academic training following their undergraduate
baccalaureate and receive a graduate degree from a college, professional
school or university.
Doctoral-level clinical and counseling
psychologists take graduate courses for the equivalent
of three full years and also receive practical training during that
time. They prepare a research dissertation or case study. Most complete
a year long full-time internship in a professional setting. The Ph.D.,
Ed.D. or Psy.D. degree is granted to psychologists. New York licensing
requires an additional year of supervised experience and an examination.
Other kinds of psychologists require additional training to conduct
therapy. Practitioners with masters degrees in psychology (M.S. or M.A.)
are permitted to practice in educational and other organizational settings
and in NY are licensed for independent practice after about three years
of supervised experience. Many psychologists seek additonal institute
attend medical school and receive a medical degree (M.D.). They
then complete several years of internship and residency training as
supervised practical experience. Medical training does not specifically
prepare physicians to conduct psychotherapy, so most need additional
training at a special residency or training institute. Because psychiatrists
are physicians, their training and malpractice insurance can be expensive
and this is usually reflected in higher fees. Unless you need medication
(which can only be prescribed by a physician), this may not be the most
take graduate courses, which include some practical
training, for the equivalent of two full years and receive a Masters
degree in Social Work (MSW). CSW and ACSW certifications require additional
supervised experience and an examination. Social work training does
not provide extensive training to conduct psychotherapy, so most social
workers need additional training at an institute. Because the academic
training period is brief, fees may be somewhat more moderate.
Remember, most therapists also receive
post-graduate training in a specific treatment approach from a training
is enough enough?
Give therapy a chance. Consider the
first couple of months as a trial period. It usually takes at least
that long to experience progress, depending on your problems and issues.
Progress is usually inhibited by changing
from one therapist to another frequently. On the other hand, if you
have been in treatment for a year or more and are not making progress,
you might consider making a change. You should discuss this issue with
your current therapist. Although you might find this embarrassing, they
may be able to point out areas of progress that you have not been focusing
In considering when to discontinue treatment,
ask yourself whether the problems that caused you to seek therapy have
been resolved and whether any additional problems or issues have come
to your attention that you may wish to resolve. Also consider the advice
of your therapist. A frank discussion of the advisability of terminating
treatment is usually useful.
Remember that no decision about counseling
or psychotherapy is irrevocable. While you may seek advice from others,
decisions to begin and end treatment and the choice of therapist are