Is It Time for Therapy? What Next?

Most people know exactly what to do when there is something physically wrong with them. Think you have strep throat? You call your primary care physician, make an appointment, get checked, get treated. One course of antibiotics later, and you’re all better. But when the “something wrong” is not so easy to define, when it’s not physical, but psychological, many people aren’t sure what the next steps are. You might realize that you need to talk to someone, but you might not know what kind of professional you should see, how to find the right provider for you, and whether you’ll be able to pay for it. If you think it’s time for therapy, the following information should help you figure out what to do next.

Who Should I See?

If you feel like you’re ready for therapy, one of the first things you might be wondering is what type of mental health professional you should be looking for. While many people simply use the blanket term “therapist” to describe all mental health professionals, there are a lot of other titles that will come up when you begin your search. There are psychologists, counselors, psychiatrists, psychiatric nurse practitioners, and clinical social workers. So is there any difference between all of these types of providers? 

• Psychiatrists are medical doctors who specialize in diagnosing and treating mental illnesses. Because they are M.D.s or D.O.s, they are licensed to prescribe medication and may put more emphasis on the treatment of your mental health symptoms with medication than other providers; they may even refer you to another provider for more talk-based therapy. They may also be interested in looking at the physical symptoms of your psychological issues. 

• Psychologists do not have a medical degree; rather, they have a doctoral degree in psychology. Licensed psychologists offer counseling and psychotherapy, but they cannot prescribe medication.

• Counselors have a master’s degree in psychology, counseling, or a related field. Like psychologists, they can provide counseling and psychotherapy.

• Therapists, otherwise known as psychotherapists, are very similar to counselors. But there is actually a difference between psychotherapy and psychological counseling. Counseling tends to focus on specific issues, like addiction, grief, or stress; it may focus on developing techniques to address those concerns, and may end up being shorter-term. Therapy, on the other hand, tends to be more long-term and usually deals with a broader range of issues.

• Clinical social workers have a master’s degree in social work and can provide therapy like other mental health providers. They also have a knowledge of support services and national social welfare policy.
• Psychiatric nurse practitioners are registered nurses who have specialized in mental health services. Like psychiatrists, they can prescribe medication, but they may need to work under the supervision of a medical doctor. 

Now that you have an idea of what all of these terms mean, what type of provider should you be looking for? The truth is, the best option for you is always going to come down to who you are most comfortable with. You shouldn’t spend too much time worrying whether you might need medication: the provider you choose can help you to determine this. Think about whether you feel like you need to focus on specific issues or are looking for a longer-term, more all-encompassing therapeutic relationship. Also think about things like location, availability, price, and who you will work well with. Before you settle on someone, though, think about your budget and your options for paying for therapy.

Will I Be Able to Afford Therapy?

Unfortunately, one thing you will have to pay attention to before you choose a provider is cost. Can you afford to pay out-of-pocket? Great! You’ll only be limited by which providers are accepting new patients. But if, like many of us, you need assistance in paying for therapy, the first obstacle you’ll run into is the fact that many mental health providers don’t accept insurance. This is because insurance companies compensate them in a very different way from other providers. Don’t give up, though – you have options!

• Consult your insurance company – find out which providers they do cover, and call as many of them as you can. Providers who accept insurance often fill up fast but keep trying!

• Talk to your insurance company about reimbursement – some insurance companies will allow you to submit paperwork for partial reimbursement of the cost of therapy. Ask them first and see if they’ll accommodate you!

• Ask about a sliding scale – some providers offer sliding scales based on your ability to pay – there’s no harm in asking if your provider of choice will offer this to you!

• Consider online therapy – teletherapy has actually been a thing for quite a while, and there are even apps now like Talkspace and BetterHealth that you can try. These options tend to be much more affordable than in-person therapy. 

• Talk to providers about making a plan – you don’t need to be in therapy for years! Be upfront and honest with providers, and tell them that you’re looking for a more structured program that has an end date. 

• Look into trainee programs – if you live near an academic medical center, they might offer care in their clinic, which would be staffed by trainees like psychiatric residents. These trainees would be supervised by licensed professionals, but the therapy you receive would be much cheaper than usual.

• See if you have access to an employee assistance program – if you have employer-based insurance, you may be able to get counseling through an employee assistance program (EAP). 
• Try a collective – for example, Open Path Collective is a nationwide directory of therapists who offer their services at very low rates, after you pay an initial membership fee. 

How Do I Find a Provider?

You’ve got the lingo down, and you’ve worked out your payment options, but where do you go from there? Should you start googling and try to sift through the mountain of results? Your best bet is not to start a random search, but to use one of the following strategies:

• Talk to your primary care physician

• Contact any of the following organizations: American Counseling Association, American Psychological Association, National Association of Social Workers, National Board of Certified Counselors

• Consult free online resources and directories like Psychology Today

• Ask family or friends for recommendations – remember, though, not everyone has the same needs, and many mental health providers will not see close family or friends of patients. They may be able to point you in the direction of another trusted provider, though!
• Check out your insurance company’s website – as we pointed out above, this is a useful option for those who need to use insurance to help pay for services. 

Once you’ve narrowed down your options, it’s time to settle on a provider. That may seem like a daunting choice to make, but there are things you can keep in mind when deciding. 

• Start by asking to have a phone consultation first, or see if you can have an introductory session at a reduced rate. 
• When you speak to a potential provider, ask them questions about the type of approach they use. Is it structured or more open-ended? Talk-based or inquiry-based (meaning they would ask you questions to direct the session)? Do you think their approach would work for their issues? How long do they envision treatment lasting?
• Look for signs that they have the qualities of a good therapist. Are they warm, accepting, and empathic without talking too much about themselves? Do they make you feel safe and not judged? 

The search for a mental health provider can be quite a journey! But if you’ve made the decision to get started, that’s the first and most important step. You know that you are ready to do the work to change your life for the better, so you are also ready to do the work to find someone to help you along that path. You’ve got the tools to get started, so take that next step and find the help that you deserve.