The Nightingale Center

8 Important Tips for Choosing a Therapist

by Dr. Lois Nightingale

1. In choosing a professional with whom you plan to discuss your most personal issues, one who you trust to give you direction and assistance, it is important to first spend some time considering what results you would like to see if therapy was successful from your own perspective. Remember no one can change someone else. We can only choose to help change ourselves, and a person has to first be uncomfortable with the way their life is going before they are open to alternative ways of doing things. There is, however, a very good chance that if one person changes what they contribute to a situation others around them will not only begin to respond differently but may also be motivated to have a different life for themselves.

2. After becoming clear about what you would like to obtain from therapy it is then important to consider what are the most important qualities you want in a therapist working with you or those you love. Educational qualifications are important to many people. The following is an outline of the most common types of psychological counselors and the academic and experiential qualifications of each:
   • Psychiatrist: A Psychiatrist is a Medical Doctor who after completing an M.D. has had 3 years of specialty training in mental disorders. A board-certified psychiatrist has, in addition, practiced for 2 years and passed the written and oral examinations of the American Board of Psychiatry and Neurology. Most Psychiatrists only handle medication prescriptions for patients. Some psychiatrists have taken further training to conduct psychotherapy, and of those, most have been trained in psychoanalysis, which is an analytical and individual process-focused therapy. Medical continuing education is required to maintain their licenses.

   • Clinical Psychologist: A Clinical Psychologist has a Ph.D. in psychology and has completed a doctoral dissertation, as a contribution to new research and information in the field of psychology. He or she has completed at least two years of working with clients under supervision. They then must pass written and oral examinations. Psychologists are also required to complete continuing education classes to renew their licenses. The license of Clinical Psychologist has the widest scope of practice for psychotherapists, including, prevention and treatment of emotional and mental disorders with individuals, children, adolescents, couples, families and groups with personal, social, emotional or behavioral problems. They are licensed to do assessments, psychological testing and interpretation and hypnosis. They may have hospital admitting privileges, do forensic evaluations and be expert witnesses in a court of law. Psychologists cannot prescribe medications.

   • Registered Psychological Assistant: A psychological Assistant is training to be a Clinical Psychologist. He or she has a Masters degree, is finishing or has finished their Ph.D. and is in the process of collecting the above mentioned 3000 hours. They are under the direct supervision of a Psychologist who has been licensed for at least two years.

   • Educational Psychologist: An Educational Psychologist has a Masters degree and an Ed.D., a doctorate in education. They also have completed 3000 hours under the supervision of a licensed supervisor and then passed a written and an oral test. Their training primarily focuses on learning and social problems in school-age children. A School Psychologist is recognized in many states and is a Masters level license.

   • Licensed Social Worker (LCSW): A Licensed Social Worker has a 2-year Masters Degree in Social Work plus 1,000 hours of clinical placement and 3200 hours of post Masters clinical supervision. They are then required to pass comprehensive written and oral examinations. Their training focuses on social work, such as family intervention and the welfare of children. They provide individual, group, family, child, marital, and adolescent therapy. They generally practice in family service agencies, HMO hospitals, employee assistance programs, mental health clinics, courts, and health center.

   • Marriage, Family and Child Counselor (MFCC): A Marriage Family and Child Counselor or Therapist, as they are most often referred to, holds a Masters degree in counseling and has completed 3000 hours of supervised counseling. They must also pass a written and an oral examination. Their license allows them to counsel individuals, couples, children, adolescents and groups with relationship problems. They are also required to attend continuing education classes for license renewal.

   • Registered Intern: An MFCC Intern is working on or has finished a Masters degree in counseling and is working toward licensure by collecting the 3000 hours to be eligible to sit for the licensing exams for Marriage, Family and Child Counselor. They are practicing under the direct supervision of a licensed therapist and treat relationship issues.

   • Psychiatric Nurse: Psychiatric-mental health nurses are registered professional nurses who have specialized training at the Masters level or above. They conduct individual, family and group consultation and education. A few are in private practice, but most practice in hospitals, community mental health centers and other agencies.

   • Pastoral Counseling: These are members of the clergy, some have specialized training in psychology, counseling or social work. They provide inexpensive counseling but it is important to evaluate psychological counseling from anyone with little or no training in psychotherapy.

   • Lay Counselor: A Lay counselor is an unlicensed person who offers counseling through an organization such as a church, temple, nutritional program, self-help group, school, etc., or just on their own. Anyone can call themselves a counselor or therapist, so be sure to ask about training, credentials, certificates, internships, qualifying exams, liability carriers, insurance reimbursement, length of experience and their "scope of practice". Don't be afraid to ask what their intended outcome is for treatment and how many people they have treated with your particular concern.

   Remember all licensed therapists are ethically required to list their license numbers in advertising. For instance: Licensed Clinical Psychologists' numbers start with PSY…, licensed Social Workers' license numbers start with LCS…, and MFCCs' license numbers start with MFC…

3. Finding a therapist with whom you feel comfortable is very important. Sometimes this may mean asking a potential therapist about their views on topics of importance to you. Most therapists have been trained to be as objective and accepting as possible, but they are still human. You may want to know how long they have been in practice, do they have any specialties that they write or speak about. You may want to know if a therapist has experience raising children of their own or if they use scientifically based treatments. Just taking the time to have a brief conversation over the phone with a potential therapist can give you a great deal of information about your comfort level in working with him or her.

4. Knowing the background and specialties of a therapist can help you make your decision. A therapist should be able to provide you with an outline or brief summery of their experience. Look to see how long he or she has been treating people with your specific concern. Look for community service and other indications that he or she is genuinely concerned about people. If you have a preference for a particular type of therapy, look to see if he or she has had personal training and experience in that therapeutic intervention.

5. A therapist should also be willing to tell you his or her fees up-front. You may be responsible for looking into your own insurance or HMO to see if or how much is covered by your carrier, but the therapist should let you know what his or her customary fee is, and on what terms that fee is expected. Do they bill insurance for you? Are all fees due at time of service? Is there a discount if you bill your own insurance? Can you put the fee on a credit card or pay it off over time? Don't be afraid to ask the financial questions, you are hiring this professional to help you.

6. Most therapists are very conscientious when it comes to client confidentiality, but some policies differ from office to office. If you are in a special circumstance such as, a divorced parent or the parent of an adolescent in therapy, you may want to ask the therapist what his or her policy is regarding disclosure to family members in these situations. You may want to know how your records are kept after termination of therapy and for how long. Some therapists must disclose client conversations with case managers if they are reimbursed by an HMO or third party insurance. If you have concerns about your privacy and confidentiality be sure to ask the questions you need answered up-front.

7. Phone policies differ between therapists. Many times the first contact you will have with a therapist is by phone, and during the course of therapy there are often phone contacts made between therapist and client. An initial call to a therapist's office should be returned within twenty-four hours during business days or the following business day if placed during a weekend. Ask up-front what the therapist's policies are regarding phone calls. Does he or she return your calls in a timely manner? Does he or she carry a pager in case of emergency? Are there hours when a live person answers the phone? Does the therapist charge for phone calls during non-business hours or for calls over a certain length of time? Who covers for them when they are on vacation?

8. Trust your intuition. If you feel uncomfortable with a therapist after a couple sessions don't keep hoping it will change. Talk about it with the therapist and if you still do not feel rapport and a sense of trust, try another therapist. One of the reasons psychotherapy is successful is the relationship between the therapist and client, if this relationship is not good, therapy has little chance of working.

Therapy can be a life-changing experience or an exercise in frustration. As with any professional service, care must be taken in choosing the professional you trust. Talk to friends about things they found valuable in their therapists. Spend time reading about the kind of therapy you would like to receive. Be an educated consumer. This is your life and you deserve to have a great one!

Healing Right: Choosing the Right Therapy that Works for You, by Michael Hurd

© 1998, Lois V. Nightingale, Ph.D., Clinical Psychologist, (lic.#PSY9503) director of the Nightingale Center in Yorba Linda. For more information call 800-9-HELP 2 U (800-943-5728)