Considering Some Practical Matters

psychotherapy and choices, costs, benefits, risks of using insurance, psychotherapists qualifications.

What you do may seem insignificant but it is very important that you do it.
  --Mahatma Gandhi


This article examines some of the practical realities of therapy-including the process of finding a well-trained, skilled psychotherapist, and the use of health insurance to pay for psychotherapy.


An advanced degree (such as Ed.D., M.D., M.S.W., Ph.D., Psy.D., or R.N.) does not automatically qualify a person to do psychotherapy. Qualified psychotherapists of all disciplines have gone through an extensive post-graduate training period to learn the many complex skills involved in practicing psychotherapy. Sometimes the training requires that the therapist undergo psychotherapy.

Most therapists-including psychiatrists, clinical and counseling psychologists, social workers, counselors, and psychiatric nurse practitioners continue to study after their graduate training has ended. Many elect to take far more courses than their licensing or certifying boards require. Most therapists routinely seek professional consultation from senior colleagues or peers as well.


Begin by considering your personal networks. Do you know people who have been in psychotherapy and have found it valuable? Can any of these offer a referral? Do you know any psychotherapists personally? Does your personal physician know well-trained psychotherapists in your area? Are there institutes in your city that provide post-graduate training for psychotherapists? Is there an Employee Assistance Program that might offer names of reputable therapists? Check the web site check the telephone book for listings of professional organizations (such as state psychological associations, a state chapter of the National Association of Social Workers, or a local Psychiatric Information Resource number). From sources like these you can develop a list of possible therapists.

It is often useful to call two likely-seeming names and make initial consultation appointments with each. Many therapists will suggest two or three exploratory sessions before you make a decision. You should consider carefully whether there is a good match between the therapist and you. Ask also if there is a good match between your goals and the therapist's thoughts about the work to be done.

You may feel comfortable with the very first therapist you interview. If that is the case, you can choose not to interview others. If the fit does not feel right, however, it is very important to continue searching until you do find someone with whom you feel respected, understood, and comfortable.


Be sure to ask about training and experience. Do not be afraid to ask whether they teach or supervise the work of others, what continuing education they pursue, whether they have regular training or consultation with professional peers.


Pay close attention to how you feel with the person. Aside from the initial awkwardness of revealing yourself to a stranger, do you feel comfortable and safe in his or her presence? Does she or he seem to treat you with respect and consideration? Is she or he warm enough to suit you? Are the questions the therapist asks on target for you? Can you see yourself working closely with this person over a period of time?

It is important to answer these Questions at the very beginning, because once the therapy gets underway, your feelings about the person may be complicated by other issues from your history and your life. As research on psychotherapy has demonstrated, a successful outcome and a strong therapeutic relationship go hand in hand.

When you have met the therapists on your list, take at least a day or two to make up your mind. After you tell your chosen therapist of your decision, it is a matter of courtesy to call the other therapists and let them know as well.


People generally want their therapy to be as quick and effective as possible, and today more people are talking about brief therapy techniques. Many researchers and psychotherapists call thirty sessions of therapy "brief." Other therapists refer to an even shorter period of time. It is important to know what a therapist means when referring to "brief therapy."

Research generally shows that therapy must be longer than a few sessions to be helpful. Studies show that at least six to eight sessions are necessary for any benefit to be measurable. The research that has proven that psychotherapy is beneficial was based on analyzing hundreds of studies that averages seventeen sessions or more.

Whether brief therapy works for you depends on what you are looking for from therapy and on the kinds of problems you bring to it. Many times people see a psychotherapist for just a few visits. This can be useful if the person is looking for a brief consultation or is dealing with a temporary crisis. Most therapists use brief therapy methods when they are appropriate. What is important is to make sure that your goals are accomplished.

As may be expected, long-standing, difficult, complicated, or more serious problems generally requires more time and patience. Long-standing problems and patterns rarely change overnight, and "quick fixes" do not produce sustainable changes. As an informed consumer, you should ask your psychotherapist about the length of therapy. Your therapist may not know the exact duration but can help you understand how therapy moves forward and how you can tell when it is complete.

Psychotherapists and clients together plan their work and assess its progress. They decide together when it is finished. For example, when you are finished, you are likely to understand the sources of your problems and can deal with them effectively. Indeed, you may encounter fewer problems in your daily life. You know how to take care of yourself, and maintain your mental health. You can tolerate the pain and difficulties that life sometimes brings-without developing symptoms like those that may have led you to therapy. You handle your relationships and your work well and find them satisfying.


Before you decide whether to use your health insurance to cover psychotherapy, consider two problems that have recently come to light.

Intrusion into the therapy process.

Psychotherapy works best when all I important communications remain between the therapist and the client (or clients in the case of family or couples therapy). This arrangement insures a safe environment where problems can be fully explored and privacy is secure.

Managed care is the name that has been given to insurance carriers or companies that try to contain costs by withholding some care. These companies have gotten in the middle of psychotherapy treatment. In an effort to decide who needs care and how much of it they need, managed care companies have appointed gatekeepers and reviewers to help with decisions about the therapy. Many psychotherapists believe that the gatekeeping and review functions interfere with the basic premise of the safe, confidential environment that is fundamental to the psychotherapy process. Some have argued that the gatekeeping function is damaging to the healing process itself. Many mental health professionals are concerned that cost containment is receiving a higher priority than mental wellness.

Some insurance and managed care companies, for example, encourage almost everyone to use an ultra-brief therapy that lasts only a few sessions. Unfortunately, there has not been any research showing this kind of therapy to be effective. It is clear that there is no single approach that is good for everyone or for every problem or goal.

Confidentiality of records. 

In order for you, as an individual, to get health insurance benefits, the therapist or clinician is required to make a formal diagnosis. This diagnosis becomes part of your permanent record, and it can be accessed by other insurance or managed care companies-or even by others who might be interested. In addition, insurance companies sometimes request detailed records and notes, presumably to insure that treatment procedures are "correct".

Once again, these private materials are potentially available to others.


To a policyholder in the state of Massachusetts, as an example, the typical insurance benefit available for outpatient psychotherapy is $500 per year. In Oregon, state laws on parity have been interpreted by many insurance companies to limit sessions to 20-25 per year. This amounts to the cost of relatively few sessions-perhaps 15%-50% of the one-year cost of once-weekly psychotherapy. Whether the benefits of filing a claim are worth the potential risks is an individual decision and require that you check the specifics of your insurance plan carefully.

If you are considering using your insurance for psychotherapy, it might be useful to ask your insurance carrier or human resources department to clarify policies regarding managed care, coverage for psychotherapy, treatment reviews, the accessibility of information, and clarification on how confidentiality is preserved.


As you weigh the cost of psychotherapy, it is important to consider the life goals you have not yet reached-your goals as they relate to your work, your relationships, or simply the day-to-day quality of your life. Because psychotherapy can help you make choices that will affect your entire future, it might be thought of as an investment in yourself-an investment on a par with education or other forms of self development. The positive effects of psychotherapy last a lifetime. Only you can decide whether the potential gains will compensate for your investment in money and time.


Mental health is not just the absence of "symptoms" it is full, flexible and creative human functioning.

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