Seven Steps in Choosing a Psychotherapist

All of us experience ups and downs in life. In fact, a broad range of emotional reactions is normal and healthy. However, when our emotions and behavior begin to bother us or someone else, it might be a good idea to do a self-evaluation. Any major change in mood, behavior, diet, or sleep patterns could be related to problems that are hard to control. Just getting through the day is not enough to solve these problems.

When relationships begin to suffer, work and school productivity decrease, and it becomes hard to get up out of bed to face each day, it is time to look for help. You may think that you are strong and can tough it out. But there are professionals who can help you get to the causes of the problems quickly and take positive steps to control them. This is not a sign of weakness. It takes strength to recognize that you cannot correct the problem by yourself.

I am a psychologist who practiced for fifteen years, and I can help you in the initial stages of searching for a psychotherapist. Actually, by reading this far, you have started on step one: identify the problem. There are seven important steps in choosing a psychotherapist.

1. Identify the Problem: You or other people may have noticed that your moods have changed. For example, you were happy and interested in daily activities before, but now you have lost interest. Your behavior is different, too. For example, you were calm before, but now you are irritable and your temper flares up easily. You may be eating too much but still have very little energy to meet your daily obligations. You stay in bed longer than you used to, but when you get up, you are not refreshed. It is important to pay attention to these changes and to monitor your thinking habits.

2. Rule Out a Medical Problem: Make an appointment with your physician for a check up. The changes you have recognized may be related to physical health. Tell your doctor details of your changes; be prepared with a list to make use of the time you have in the examining room. If you get a good bill of physical health but the problems persist, ask your physician for referrals to mental health professionals.

3. Locate Psychotherapists in or Near Your Area: Your physician's referrals are good for starting your selection. But, do not limit your choices. Identify all of the mental health resources in your community and in other locations. It may be necessary to travel to find the best professional for your unique situation. You can look at classified ads in the telephone directory and then call local hospitals and community mental health centers to ask for information. In addition, you can ask friends and family for their opinions about mental health services in general and psychotherapists in particular. People are usually willing to describe their own experiences with mental problems. Also, your health insurance plan should have a list of psychotherapists who are on the "panel" of credentialed providers.

4. Check the Credentials of the Psychotherapist: Although some psychiatrists (M.D.'s) provide psychotherapy, many offer medication consultation only. Information about the credentials of psychiatrists can be obtained through the state medical board. Psychologists (Ph.D.'s) are trained to conduct assessments with a variety of tests, diagnose mental disorders, and conduct group and individual psychotherapy. They often work in the same medical suite with psychiatrists. They provide information to the physicians to help them with prescriptions for patients and take on cases referred by the psychiatrists for psychotherapy. Psychologists' credentials can be checked by contacting the state psychology board. Clinical counselors and social workers can obtain licenses that allow them to diagnose and provide therapy. Their credentials can be checked by contacting the local mental health department.

5. Call the Provider's Office: You can tell a lot about the quality of service by the way you are treated on the phone. You should expect professionalism from all members of the staff. If you feel you are being treated like an unwanted customer in a department store, it probably is not the best environment for personal conversation. Professionalism means: Courteous interaction with staff, confidentiality in the office, scheduled appointments, and no 'stacking' of patients causing delayed sessions. There should be consistent respect for the person who is trying to get help.

6. Evaluate the Intake Interview: In smaller offices, the initial meeting is conducted by the licensed practitioner. This gives the professional the chance to identify your problem, form a tentative diagnosis, and develop a possible treatment plan. You have the opportunity to ask the provider questions and can determine if you will be able to work in that setting. In larger offices, an assistant may conduct the intake interview, usually guided by a written form, under the supervision of the licensed provider. The assistant is trained to ask questions in a way that will help the busy provider get a head start on your case. Then in a subsequent meeting, the provider will have an idea about the potential diagnosis and treatment plan. If you believe that you are not being treated in a professional manner, ask for a referral. The provider must give this to you without a challenge.

7. Establish a Contract: Ask the professional for a written contract. If the policy of the office is to make an oral agreement with patients, discuss the terms with the provider and ask for a copy of the treatment notes for the first session. You have a right to a copy of all of the progress notes that the provider uses to bill for services. The contract or progress notes should include a diagnosis, treatment plan with specific goals, the anticipated number of sessions, and the treatment type. The diagnosis is obtained from a code book that gives a category number for billing purposes. The code book (e.g., International Code of Diseases) relates to a reference book that has a list of symptoms for each of the coded psychological disorders (Diagnostic and Statistical Manual for Mental Disorders). Ask the professional for a copy of the code number and disorder description. The treatment method is usually listed in categories. The Cognitive/Behavioral method tries to change illogical thinking and self-defeating behavior often associated with mental disorders. Insight Oriented methods are used to help the patient get an understanding of unconscious conflicts and memories that may be causing symptoms. Supportive methods are used to help someone through a crisis.

These seven steps will allow you to take some action to help yourself. When the psychotherapy sessions continue, you can be confident that the stage is set for the most effective treatment experience. You may be thinking that you can hardly get out of bed, let alone try to accomplish all these steps. In that case, ask a friend or a family member to help you through the process.