Maria constantly worried about what others thought of her, often felt overwhelmed with fear and stress, and once went to the emergency room because she thought she was having a heart attack. She was reassured by ER staff that she was not having a heart attack, but rather a panic attack, and was encouraged to seek mental health support.
If you have experienced anxiety, depression, or other mental health problems, or are going through a difficult life transition or stressful time, you may have sought or considered seeking psychotherapy. Psychotherapy is a general term for a therapeutic process to address psychological concerns. The term psychotherapy does not refer to a specific kind of theory or approach to helping. Counseling is a broader term that is used to describe this kind of help and refers to any situation in which someone seeks advice or counsel from an expert.
How does psychotherapy work?
Psychotherapy is typically a one-on-one meeting with a highly trained mental health professional. This professional should be licensed by the state to practice psychotherapy and have a Master’s Degree, a PhD, or an MD. At the first visit, the psychotherapist will conduct an intake session. In this session, the therapist will ask several questions to get to know you, hear why you think you need help, and discuss anything else you would like known. At the end of the intake, the therapist will give you feedback about his/her understanding of your situation and whether psychotherapy might help.
Sometimes the therapist will explain that you meet criteria for a mental health diagnosis, such as major depressive disorder, generalized anxiety disorder, or adjustment disorder. If you are diagnosed with a disorder, the good news is that there are a lot of empirically supported treatments for these disorders. For example, we know that cognitive-behavioral therapy, interpersonal therapy, and time-limited psychodynamic therapy work for depression.
Your therapist may suggest a combination of psychotherapy and medication. Medication can be prescribed by your primary care provider or a psychiatrist (a medical doctor who specializes in mental health). Some individuals meet with a psychiatrist first to get a specialized evaluation of their particular situation and to get medication recommendations. Some psychiatrists have training in psychotherapy and offer this in addition to medication management. Others focus primarily on medication and may refer you to a psychotherapist. Once a client is stabilized on medication, their prescription can often be managed in primary care.
Psychotherapy typically occurs in 45- to 50-minute sessions once a week or every other week. You and your therapist should develop mutually agreed upon goals for your work together. This will help you know what to talk about in therapy and will help track your progress. I often ask new clients, “What would you like to change or improve in your life?” to prompt them to think about goals for our work. Your therapist can help you focus on your goals and can ask the right questions to help you move toward improving your life.
Psychotherapists are legally and ethically obligated to protect confidentiality. Anything said in therapy stays there. There are important exceptions to confidentiality, which the therapist should discuss at the beginning of your first meeting. Meeting with a frequency of once a week or every other week is what I call a “working therapy.” After clients have done a 4- to 12-month course of therapy and feel a lot better, but still want support, they often transition to monthly visits. If you meet every three to four weeks, this is more of a “maintenance” therapy. Not much change can come from this, but any changes already made or the benefit from receiving supportive therapy can be maintained.
Like most quests these days, people often start their search for a therapist on the internet. Psychology Today , a popular and reputable national magazine, hosts a website for those seeking professional help. Therapists post profiles describing themselves and their practices, and individuals can search in their area for those who specialize in their concerns or issues. Even in a relatively small city, like Madison, there are a lot of options. Your primary care provider can be a good referral source, as can friends and family.
Unfortunately, people don’t always talk readily about being in psychotherapy, so it can be hard to hear about others’ positive experiences with a therapist. Once you start asking, though, you will be surprised how many people you know who have sought therapy. Like any profession, there are a lot of good therapists and some not so good. Also, finding the right fit is really important. In fact, research on psychotherapy suggests that the relationship between the therapist and client is the most critical agent of change.
What should I look for in a psychotherapist?
There are many considerations when seeking a psychotherapist. You should confirm proper training and licensing by the state. You want to make sure the therapist has expertise and interest in the particular problem you want to address. For example, most treat people with anxiety and depression, but you may need someone with special expertise in alcohol and drug problems, trauma, or bipolar disorder. You should seek a therapist who is sensitive to and knowledgeable about your particular background, culture, and identity.
A psychologist typically has had four to five years of graduate school, with training in the research and practice of psychology. Some psychologists also offer psychological testing and assessment for court, school, or health care referrals.
Other mental health providers, such as social workers, have typically had two years of graduate school. Social workers may be more likely to focus on the client in the context of the greater community and may be able to connect clients with resources they need.
Marriage and family therapists will likely look at a client’s problems in the context of their family system. High-quality psychotherapists come from all different backgrounds and training.
Services provided by mental health professionals include individual therapy, couples therapy, family therapy, and group therapy. If you are seeking couples or family therapy, make sure that you find a therapist who is trained and experienced in these specialties.
How to pay for therapy?
If you plan to use health insurance to pay for a portion of the cost of therapy, you should contact your insurance company to ask who you are permitted to see. When insurance companies contract with providers, they typically negotiate a lower cost for treatment. This means less cost to your insurance and to you, but it may mean that the therapist sees a higher volume of clients per week in order to compensate for less income per client. Therapists who do not contract with insurance companies usually cost more, but may see fewer clients per week and will likely have more availability.
What to expect.
Regardless of how you go to therapy, you want to feel respected and heard while you are there. Your therapist should be on time, give you full attention, demonstrate you are being heard with meaningful comments and questions, and convey respect and caring. Your responsibility as a client is to commit to your goals through reliably coming to your scheduled sessions, collaborating on doing your work, thinking about or working on the problems you discuss between sessions, and paying your bill.
What if psychotherapy is not helping?
If you feel like your therapist is not helping, you should discuss your concern. Explain what is and isn’t working, and request changes to accommodate you. If you find that your therapist is not a good fit, let it be known you would like to find someone new. If you can articulate what you are looking for, your therapist may even be able to refer you to another who would be a better match. This may seem hard to do, but it is excellent practice in giving feedback and ending relationships that are not working for you.
You have to recognize the difference between a therapist who is not helping and one who is challenging you to look at yourself and do the hard work necessary for personal growth. If you leave because it is uncomfortable, you miss a great opportunity for change. This is therapy: learning about yourself, creating change, and working towards a better life in the comfort of a caring, helpful, therapeutic milieu.
Elizabeth H. Winston, PhD, is a Madison psychologist who provides psychotherapy, psychological assessment, and consultation. elizabethwinston.com .