Does therapy work?

There is a great deal of research on this question, and the short answer is yes. According to the American Psychological Association, psychotherapy is effective at decreasing symptoms of depression and anxiety, as well as reducing related symptoms like pain and fatigue. In 1995 Consumer Reports conducted a large-scale survey to examine the effectiveness of psychotherapy as actually used in the real world. The results were striking: of the approximately 4,000 people who reported having seen a mental health professional, nearly all of them said they had gotten a lot better as a result. The study also showed that people improved more the longer they were able to remain in therapy, with improvement scores increasingly steadily from 1 month to 2 years.

What are the key differences among different therapeutic approaches?

There are many different therapeutic models and theories. One way of organizing them is to divide them into two groups: the psychodynamic approaches and the cognitive-behavioral approaches (please note this is a crude classification, and many approaches won’t fit neatly into either group). In general, psychodynamic therapies help clients work through thoughts and feelings about their relationships and experiences in life. A strong working alliance between therapist and client is considered to be critically important. In contrast, cognitive-behavioral approaches target specific symptoms, using a variety of techniques to develop more flexible and satisfying solutions. Here again, the alliance between therapist and client is very important, but less to mediate the working through of problems than to enhance client motivation and treatment success. Both types of approaches are valuable, and being able to use both allows great flexibility in the treatment process.

How do I choose a therapist?

There are a lot of factors that might influence your choice. You may have a preference for a particular therapeutic approach or a professional with a particular set of training experiences or degree(s). Practical considerations are also important, including scheduling availability, location, and fees.

All that said, probably the most important thing is that you sense you can establish a strong working alliance with your therapist. Usually it is possible to get a feel for this fairly quickly by meeting your therapist and starting to notice how it feels to work with them.

What are the differences between therapists with different degrees/training?

Many professionals serve as psychotherapists, and it can be confusing to understand how their training and services differ. A clinical psychologist has a PhD from a clinical psychology program, generally considered to be a strongly research-oriented program. This person will have conducted specialized research, produced a doctoral dissertation, and will also have a great deal of training in psychotherapy and psychological assessments. Other psychologists have PhD’s awarded from counseling psychology programs or school psychology programs; in many cases these are quite similar to clinical psychology programs but they tend not to focus as strongly on research or on psychological testing and assessment. Still others have a PsyD degree, which is granted by a specialized psychological training institute (i.e., not a university) and focuses on clinical work to the near exclusion of research.

A psychiatrist, in contrast, has gone to medical school and therefore has an MD degree. In Texas, only an MD can prescribe medication. Some psychiatrists do conduct psychotherapy, but more and more, given the exploding array of pharmaceutical medications, many psychiatrists focus on medication prescription and management. It can often be very helpful for a client to work with both a psychologist (for therapy) and a psychiatrist (for medication).

Still other kinds of professionals provide psychotherapy. For example, a Master’s degree in education, social work, or family therapy can provide the necessary training to become a licensed therapist (e.g., a Licensed Clinical Social Worker [LCSW] or Licensed Professional counselor [LPC]).

While a therapist’s degree will tell you about their educational training, it won’t say much about their skill or expertise as a therapist because these things are gathered over time through experience, effort and, probably most importantly, ongoing personal work.

How often will I meet with my therapist?

Usually therapists meet with their clients once a week. Depending on the intensity of a client’s symptoms and distress, it may make sense to meet more frequently. Meeting less than once a week is usually not recommended except when the therapeutic work is winding down. The reason for this is that meeting less can make it difficult to establish momentum and create a strong therapeutic alliance. That said, however, in some circumstances it may work just fine to meet less often; this is a decision best made on a case-by-case basis.

Should I use insurance to pay for my therapy?

Many insurance plans do provide coverage for a limited number of psychotherapy sessions and some psychological testing. You should know, however, that to do so they require the disclosure of personal information about you (e.g., your diagnosis) and mental health professionals have no control over this information once it is provided to the company. I am not currently on any insurance panels, but you may be able to recoup some of the costs of therapy by using your out-of-network benefits. Of course, by paying for your services privately, you avoid the difficulties associated with insurance plans.