­­­­­­­­­­­­­­­­­­­­­­What should I expect when working with a mental health professional?

There are many different types of mental health professionals. A psychologist is a person who holds a license from professional State Board, which regulates and ensures the highest educational and ethical standards for the field. A licensed psychologist holds a doctoral degree (i.e., Ph.D., Psy.D., Ed.D.) in psychology and has completed years of supervised clinical experience both pre- and post-degree. Psychologists have more years of training in the field of mental health than any other type of mental health professional. To maintain licensure, psychologists must routinely participate in continuing education to stay up-to-date with current research, clinical practice, and standards of care. There are several types of psychologists (e.g., Clinical Psychologists, Neuropsychologists, Developmental Psychologists, Counseling Psychologists, Forensic Psychologists) who offer different types of services. Psychologists in most states do not prescribe medications.

If you decide to work with a psychologist you will need to find one that you feel comfortable with. The therapeutic relationship between the client and therapist is an important factor in successful outcomes.

One way to find someone with whom you have a good fit is to interview potential psychologists. Many psychologists offer a free or reduced rate in-person consultation session, and all psychologists will answer some questions over the phone.

What should you ask when “interviewing” a psychologist?

• Are you taking new clients?
• Are you a licensed psychologist? How many years have you been practicing psychology?
• I have been feeling (anxious, depressed, etc.) and I’m having problems with (my marriage, eating, sleeping, etc.). What experience do you have helping people with these types of problems?
• What are your areas of expertise (e.g., working with children, couples, adults; treating which types of problems)?
• What kinds of treatments do you use, and have they been proven effective for dealing with my kind of problem or issue?
• What are your fees? (Fees are usually based on a 45-minute to 50-minute session.) Do you have a sliding-scale fee policy? (Sliding-scales are based on income and can reduce the financial burden for people paying out-of-pocket.)
• What types of insurance do you accept? Will you accept direct billing to or payment from my insurance company?
• What days and hours are you available for appointments?

You may have other concerns that are important to you, and now is the time to ask. For example, you may have a strong preference to work with someone who shares your religion or cultural background. If so, ask the psychologist about it. Psychologists vary in the amount of personal information they will disclose, but their responses may give you a better understanding of how well you would work with this person.

When you find a psychologist that seems like they might be a good fit, you can schedule your first session. Know that while some people feel comfortable with their psychologist in the first session, for many people it may take a few sessions for trust and comfort to build. This is perfectly normal since it can be challenging, and even scary, to open up to someone you have just met. Give it some time, but if after several sessions you still do not feel comfortable, then you should discuss this with your psychologist. Ultimately, it is okay to try to find a new provider with whom you have a better fit if this continues to be a barrier.

When you meet with a psychologist for the first time to begin therapy, you will be asked to sign a consent form for treatment, and your psychologist will explain any limits to confidentiality and answer any questions you may have. From there, the beginning sessions are usually focused on assessment, that is, gathering information about your past and present circumstances and the issues that led you to seek therapy. You may be asked to fill out some of this assessment information on forms that the psychologist will then review with you. Also, you will discuss your goals for therapy and some of the various options for interventions and strategies to help you achieve your goals.

Next, the work begins. What you put into therapy is what you will get out of it. There are many different types of psychotherapy and elements from different types of psychotherapy may be combined to tailor the treatment to your specific needs. Some types of psychotherapies have been researched more than others, and have more scientific support. Additionally, some have been shown to be more effective for treating particular problems. Overall, science has shown that psychotherapy works and has significant long term positive effects.

Here are some of the most common psychotherapies with a brief definition:

• Cognitive Behavioral Therapy (CBT):  As explained by the National Institute of Mental Health (NIMH), “CBT is a blend of two therapies: cognitive therapy (CT) and behavioral therapy. CT focuses on a person’s thoughts and beliefs, and how they influence a person’s mood and actions, and aims to change a person’s thinking to be more adaptive and healthy. Behavioral therapy focuses on a person’s actions and aims to change unhealthy behavior patterns. CBT helps a person focus on his or her current problems and how to solve them. Both patient and therapist need to be actively involved in this process. The therapist helps the patient learn how to identify distorted or unhelpful thinking patterns, recognize and change inaccurate beliefs, relate to others in more positive ways, and change behaviors accordingly. CBT can be applied and adapted to treat many specific mental disorders”.¹ There is significant research support for CBT effectiveness, and for many people, CBT may be equally or more effective than medication and demonstrates better long-term effects. There are various forms of psychotherapy that fall under the umbrella of CBT. Examples include: Dialectical Behavior Therapy, Rational Emotive Behavior Therapy, Cognitive Processing Therapy, Prolonged Exposure, and Acceptance and Commitment Therapy.
• Interpersonal Therapy (IPT): NIMH describes IPT as being “based on the idea that improving communication patterns and the ways people relate to others will effectively treat depression. IPT helps identify how a person interacts with other people. When a behavior is causing problems, IPT guides the person to change the behavior. IPT explores major issues that may add to a person’s depression, such as grief, or times of upheaval or transition. IPT varies depending on the needs of the patient and the relationship between the therapist and patient. Basically, a therapist using IPT helps the patient identify troubling emotions and their triggers. The therapist helps the patient learn to express appropriate emotions in a healthy way. The patient may also examine relationships in his or her past that may have been affected by distorted mood and behavior. Doing so can help the patient learn to be more objective about current relationships”.¹
• Family Focused Therapy (FFT):  NIMH describes that FFT was “designed with the assumption that a patient’s relationship with his or her family is vital to the success of managing the illness. FFT includes family members in therapy sessions to improve family relationships, which may support better treatment results”.¹ There are several styles of family therapy that aim to work with facilities to improve the overall functioning of the family unit, as well as enhance the wellness of individual family members.
• Psychodynamic Psychotherapy: According to NIMH, “historically, psychodynamic therapy was tied to the principles of psychoanalytic theory, which asserts that a person’s behavior is affected by his or her unconscious mind and past experiences. Now therapists who use psychodynamic therapy rarely include psychoanalytic methods. Rather, psychodynamic therapy helps people gain greater self-awareness and understanding about their own actions. It helps patients identify and explore how their nonconscious emotions and motivations can influence their behavior”.¹ The duration of psychodynamic psychotherapy is typically longer than other forms of therapy.

Psychotherapy for children will vary depending on the needs and developmental level of the child. Many of the above psychotherapies have been successfully adapted for working with children and adolescents. Play therapy is often used when working with young children.¹ Play therapy involves using toys and games to help a child identify and talk about his or her feelings, and provides a mode of communication with the psychologist. The psychologist can better understand a child’s problems by watching how he or she plays.¹ Additionally, the parents may be involved in therapy depending on the age and needs of the child.

How long will psychotherapy last? The duration will vary based on your needs and the type of psychotherapy you are engaging in. You can discuss what the estimated duration of therapy will be, and this may change over the course of therapy depending on how you are progressing toward meeting your goals. CBT’s are often briefer than other types of psychotherapy, and may last anywhere from 6 to 20 sessions on average, however, treatments for certain conditions may take longer. If you are using insurance coverage, then you may want to find out how many sessions will be covered. Discuss this with your psychologist when determining treatment strategies. Sometimes, the number of sessions covered can be extended with a letter from your psychologist.

How will you know when it is time to end psychotherapy? Identifying the right time to end therapy is something that you and your psychologist should discuss multiple times over the course of your work together. You will know when the end is nearing well head of time, so that the conclusion is not abrupt or unexpected. This will also allow you to solidify the changes you have made and develop relapse prevention skills so that you will be well equip to manage challenges you may face in the future. Psychotherapy should end when you have reached maximum benefit from the treatment and/or you have reached your goals.

¹ Psychotherapies. Retrieved August 23, 2013, from http://www.nimh.nih.gov/health/topics/psychotherapies/index.shtml