7 Things to Know About Mental Health Counseling
Here are 7 things for you to know about mental health counseling so you can find the right support for your challenges. These are based on the most frequently asked questions from my clients, and provide information that deserves some more widespread clarification.
1. Therapy works with the right therapist
The stigma around mental health keeps people from sharing their recovery stories. This means many considering therapy don’t hear enough testimonials around its effectiveness, and may start therapy with skepticism, which slows down progress.
Even as the stigma lifts, I don't expect that our private insecurities and concerns will one day begin to be shared nonchalantly or at random. Do you share other personal health concerns with strangers?
I would encourage resourceful and intellectual readers like you to delve beyond overheard misconceptions and do your own research if you're still doubting therapy, especially if you're reflecting on potentially unfulfilling past experiences. You can fight the stigma —therapy works.
Sites like the Mighty showcase powerful stories by people like you and me sharing their experiences with personal health challenges. Oftentimes these stories can provide you with the words you're missing to describe your feelings to other people.
Celebrities like Trevor Noah, Tim Ferriss, and Lil Wayne have also admirably shared their mental health stories and used their public platforms to shine light on the more realistic, everyday faces of mental health (which often look fine).
These personal stories not only offer great reminders that recovery is real, but also confirm evidence-backed research on the effectiveness of therapy. A cornerstone meta-analytic study by Keith Dobson, for example, found that participants who received cognitive therapy for depression demonstrated more positive changes compared to those on a waiting list, not receiving treatment, trying other treatment approaches, or medication alone.
Another meta-analytic study by Horvath & Symonds examined the “Working Alliance” between clients and their therapists and found that the quality of the therapeutic relationship was the most predictive of outcomes, even more so than the therapists’ treatment approaches.
In other words, finding a compatible and appropriately specialized therapist is critical to therapy working for you.
2. Therapists specialize in different challenges and treatment approaches
Clients may be in therapy for years before patterns of overcontrol, ADHD, eating/body image issues, or OCD are uncovered. Not all therapists are specially trained in those areas and might not connect the dots until later. Untangling what’s going on takes time. Therapy can be like peeling an onion, especially since diagnoses often come in clusters.
That means people often have different therapists for different seasons in their life.
It can be tough to start with someone new when your focus changes, especially if you’ve made progress together in other areas and the therapist is motivated to learn and consult with others.
Mental health challenges have such different roots and require a therapist familiar with concerns similar to yours in order to know how to help you move beyond it —efficiently. They can ask you more powerful questions with more context and know specialized resources & coping methods.
“What may seem like just talking and listening is a research-backed science on healing.”
Most people outside of the mental health field don’t realize how many different therapy approaches there are or that each have varying degrees of potential effectiveness when treating specific mental health challenges.
The goal is to find a therapist who specializes in exactly your challenges and the most research-backed effective ways to treat them.
I'm not saying that there is only one treatment method that can help someone recover. People heal in different ways, and the ebb and flow of different treatment methods isn't so black and white either. Many therapists today integrate different approaches and lean towards a few they identify with the most.
Below are a few examples of therapy approaches developed and tested for addressing certain issues. This is an incomplete list though that changes as the field quickly evolves.
Each approach refers to therapy frameworks for your sessions and ways therapists conceptualize focus areas and treatment structures to help you feel better.
Depression / Anxiety:
Cognitive Behavioral Therapy,
Acceptance & Commitment Therapy,
Radically Open Dialectical Behavioral Therapy
Self-Esteem, Relationships, Co-Dependence:
Attachment theory,
Internal Family Systems,
Psychodynamic Therapies,
Emotionally Focused Therapy
Gottman Method
Dialectical Behavioral Therapy
Radically Open Dialectical Behavioral Therapy
Social Anxiety / Obsessive-Compulsive behaviors / Body-Focused Repetitive Behaviors:
Exposure & Response Therapy
Acceptance and Commitment Therapy
Cognitive Behavioral Therapy
Complex PTSD:
EMDR
Internal Family Systems
Trauma-Focused Cognitive Behavioral Therapy
Attachment Theory
Somatic approaches
Dialectical Behavioral Therapy
3. Licenses & Schools Make a Difference
Different training programs emphasize different schools of thought, design different curriculums, and require different practicum experiences that might not fit how you cope with stress. Do you want to learn tools and strategies through therapy? Tend to approach problems intellectually? For clients like that, more structured outcomes-focused therapy approaches would resonate, than what others might call “woo-woo”. What’s best for you is what works for you.
The training among therapists who are PhDs, MFTs, LCSWs, PsyDs, or LPCCs also varies widely, including the different focus areas within their curriculums (ie. statistics in research, family dynamics, or systemic issues), the length of their programs (2-6 years), or clinical counseling experience before becoming fully licensed. Given this, some cases may be better suited for a certain type of specialist.
Therapists also advance their practice after they finish school through years of supervised hours, continuing education courses, and counseling workshops, so reading through their training background is often reflective of their preferred treatment approaches as well.
4. Many of the best therapists are only accepting private pay/out-of-network insurance clients now
Every insurance company treats their providers differently, for example, by setting their rates reasonably, processing reimbursements reliably, and providing good customer service - or not. Some of these insurance companies are as beloved as Comcast for their questionable billing and service practices. Imagine spending hours chasing down a $60 payment...
This means that your insurance company may affect your relationship with your therapist or make it harder for you to find a willing match. One example is a therapist whose hourly rate is $120 for out-of-network clients, $95 for one insurance, and $60 for another. The same hour of their counseling time can be valued at only half the rate by some insurance panels. As a result, many clients calling from networks who negotiated these lower rates will often find that the provider isn’t taking on any new clients from that panel.
For more experienced providers with a steadier stream of referrals, they often opt out of health insurance reimbursement headaches altogether, which also includes more required paperwork with updates on diagnoses and treatment plans.
Speaking of which, the current uncertainties around health care and pre-existing conditions means seeing someone out-of-network could also have other privacy benefits.
As a rising majority of clients have high-deductible health insurance plans now, it’s also worth mentioning that sometimes the rate of paying an out-of-network therapist out of pocket turns out to be lower than the in-network deductible. This means that seeing an in-network therapist at the same rate may still be paid out of pocket until that high deductible is met and your insurance kicks in. This means that sometimes with high-deductible plans, the actual costs may be one and the same whether you're seeing someone in or out of network.
For someone considering seeing a therapist a number of times a month, opting for an insurance plan that includes out-of-network coverage (PPOs, and not HMOs) or a Health Savings Account could also help subsidize your costs.
5. A Psychologist is not a Psychiatrist
The titles sound so similar that they’re often misunderstood to be interchangeable. As a result, so many people visit Psychiatrists’ offices and get frustrated that they’re immediately prescribed medications, without much of the talk therapy they expected.
Therapists (ie. PhDs, PsyDs, MFTs, LCSWs, LPCCs) are typically trained to treat through talk therapy approaches, whereas psychiatrists completed medical school and concentrate on psychiatric medication management. Psychiatrists’ tools for healing have largely been prescribing medications. More recently, psychiatrists are starting to offer therapy and medication management together. The costs may be higher though and availability lower.
Psychiatric medication is also a controversial topic. While some challenges are best treated with a combination of talk therapy and medication, there are many who prefer talk therapy or medication alone.
One way you could approach your mental health is trying talk therapy with a therapist first to see how much that could help things. Then, if things don’t improve as much as you wished, you can consider trying medication with the help of a Psychiatrist. Some start with medication first and then try therapy if they want a bit more support.
The ideal psychiatric medication typically has minimal side effects, and empowers you to feel like yourself again. Since medications presents differently for everyone though, this means finding the right medication often takes people some trial and error.
6. A Primary Doctor is not a Psychiatrist/Psychiatric NP
For better or worse, primary doctors often prescribe psychiatric medications and don’t always recommend consulting a Psychiatric provider for more specialized medication management. Many more people see a PCP than a Psychiatrist/Psych NP or Therapist though, so a PCP’s vast exposure to mental health challenges is undeniable.
On one hand, this has helped a lot more people feel better. Antidepressants, for example, have also now been used for a variety of other challenges beside depression, and prescribed at a significantly higher rate year-over-year.
It's important to know though that Psychiatrists often dive deeper into your psychiatric symptomatology and can provide more clarity into possible mental health diagnoses such as whether ADHD or Bipolar Disorder may be complicating things. The family history of mental health challenges would also be more likely to be explored which could prevent triggering the onset of a manic or psychotic episode, plus find you a more effective medication faster.
As you two search for a medication that helps make things easier for you, psychiatrists have a wider familiarity with psychiatric medication options (there’s ALOT), and often tread lighter with starting, increasing, or changing your medication dosages. Psychiatrists also frequently track symptoms with you on both qualitative and quantitative scales and check in with you more frequently around any changes in your prescriptions.
While primary care providers are on the front-lines for many mental health challenges, many would not be as familiar as a specialized Psychiatrist would be with the complexities of things like the interaction of cannabis and anti-anxiety medications, or expect to be as involved in your medication management. Psychiatrists are also more likely to coordinate care with your therapist - which can be a powerful way for your providers to team up to support you.
7. How to find the right therapist match for you
Step 1:
Consider your goals & what’s blocking you
What’s going on with me?
What’s not really working for me anymore?
What do I wish could be different?
How is this getting in the way of my life?
What’s holding me back right now?
Step 2:
Find your ideal specialist(s)
Are they located in an area convenient for you? Male/Female? Experienced enough relative to you?
Do they *specialize* in your challenges?
Do they practice the most effective therapeutic approaches for your goals?
Browse Psychology Today / Google / Yelp for potential options
Ask friends / family/ doctors for their recommendations
Any reviews online? In good standing with their licensing board?
Step 3:
Reach out to a few therapists for informational calls
Call around a few providers in order to find a match for your availability, budget, and personal preferences
Know that many therapists don't return calls when their practices are full, so calling a few at once may be a good way to go.
Ask about their experience/background? Career changer? Also offers coaching?
Do they accept your insurance? Can be flexible with rates if paying directly? Or offer sliding scale rates for special circumstances?
IN SUMMARY:
Therapy Works with the Right Therapist
Therapists specialize in different challenges and treatment approaches
Licenses & Schools Make a Difference
Many of the best therapists are only accepting private pay/out-of-network insurance clients now
A Psychologist is not a Psychiatrist
A Primary Doctor is not a Psychiatrist
You’re welcome to connect with me for a complimentary 15 minute consultation.
If you have any questions around counseling or finding the right therapist for you or a loved one, reach out anytime
Take care of yourself,
Lisa Andresen, LCSW
lisa@letstalkaboutanything.com
call/text: 415-890-3576