Understanding psychotherapy and how it works
Do you ever feel too overwhelmed to deal with your problems? If so, you’re not alone.
According to the National Institute of Mental Health, more than a quarter of American adults experience depression, anxiety, or another mental disorder in any given year. Others need help coping with a serious illness, losing weight, or stopping smoking. Still others struggle to cope with relationship troubles, job loss, the death of a loved one, stress, substance abuse, or other issues. And these problems can often become debilitating.
What is psychotherapy?
A psychologist can help you work through such problems. Through psychotherapy, psychologists help people of all ages live happier, healthier, and more productive lives.
In psychotherapy, psychologists apply scientifically validated procedures to help people develop healthier, more effective habits. There are several approaches to psychotherapy—including cognitive-behavioral, interpersonal, and other kinds of talk therapy—that help individuals work through their problems.
Psychotherapy is a collaborative treatment based on the relationship between an individual and a psychologist. Grounded in dialogue, it provides a supportive environment that allows you to talk openly with someone who’s objective, neutral, and nonjudgmental. You and your psychologist will work together to identify and change the thought and behavior patterns that are keeping you from feeling your best.
By the time you’re done, you will not only have solved the problem that brought you in, but you will have learned new skills so you can better cope with whatever challenges arise in the future.
When should you consider psychotherapy?
Because of the many misconceptions about psychotherapy, you may be reluctant to try it out. Even if you know the realities instead of the myths, you may feel nervous about trying it yourself.
Feeling depressed, anxious or angryOvercoming that nervousness is worth it. That’s because any time your quality of life isn’t what you want it to be, psychotherapy can help.
Some people seek psychotherapy because they have felt depressed, anxious, or angry for a long time. Others may want help for a chronic illness that is interfering with their emotional or physical well-being. Still others may have short-term problems they need help navigating. They may be going through a divorce, facing an empty nest, feeling overwhelmed by a new job, or grieving a family member’s death, for example.
Signs that you could benefit from therapy include:
You feel an overwhelming, prolonged sense of helplessness and sadnessYour problems don’t seem to get better despite your efforts and help from family and friendsYou find it difficult to concentrate on work assignments or to carry out other everyday activitiesYou worry excessively, expect the worst, or are constantly on edgeYour actions, such as drinking too much alcohol, using drugs, or being aggressive, are harming you or others
What are the different kinds of psychotherapy?
There are many different approaches to psychotherapy. Psychologists generally draw on one or more of these. Each theoretical perspective acts as a roadmap to help the psychologist understand their patients and their problems and develop solutions.
The kind of treatment you receive will depend on a variety of factors: current psychological research, your psychologist’s theoretical orientation, and what works best for your situation.
Your psychologist’s theoretical perspective will affect what goes on in his or her office. Psychologists who use cognitive-behavioral therapy, for example, have a practical approach to treatment. Your psychologist might ask you to tackle certain tasks designed to help you develop more effective coping skills. This approach often involves homework assignments.
Your psychologist might ask you to gather more information, such as logging your reactions to a particular situation as they occur. Or your psychologist might want you to practice new skills between sessions, such as asking someone with an elevator phobia to practice pushing elevator buttons. You might also have reading assignments so you can learn more about a particular topic.
In contrast, psychoanalytic and humanistic approaches typically focus more on talking than doing. You might spend your sessions discussing your early experiences to help you and your psychologist better understand the root causes of your current problems.
Your psychologist may combine elements from several styles of psychotherapy. In fact, most therapists don’t tie themselves to any one approach. Instead, they blend elements from different approaches and tailor their treatment according to each patient’s needs.
The main thing to know is whether your psychologist has expertise in the area you need help with and whether your psychologist feels he or she can help you.
Finding a psychologist
Once you’ve decided to try psychotherapy, you need to find a psychologist.
Why choose a psychologist for psychotherapy?
Psychologists who specialize in psychotherapy and other forms of psychological treatment are highly trained professionals with expertise in mental health assessment, diagnosis, and treatment, and behavior change.
After graduating from a four-year undergraduate college or university, psychologists spend an average of seven years in graduate education and training to earn a doctoral degree. That degree may be a PhD, PsyD or EdD.
ReferralAs part of their professional training, psychologists must complete a supervised clinical internship in a hospital or organized health setting. In most states, they must also have an additional year of post-doctoral supervised experience before they can practice independently in any health care arena. It is this combination of doctoral-level training and clinical internship that distinguishes psychologists from many other mental health care providers.
Psychologists pass a national examination and must be licensed by the state or jurisdiction in which they practice. Licensure laws are intended to protect the public by limiting licensure to those who are qualified to practice psychology as defined by state law. Most states also require psychologists to stay up-to-date by earning several hours of continuing education credits annually.
In addition, APA members adhere to a strict code of professional ethics.
How do I find a psychologist?
If you plan to use your insurance or employee assistance program to pay for psychotherapy, you may need to select a psychologist who is part of your insurance plan or employee assistance program. But if you’re free to choose, there are many ways to find a psychologist:
Ask trusted family members and friends.Ask your primary care physician, obstetrician/gynecologist, pediatrician, or another health professional. If you’re involved in a divorce or other legal matters, your attorney may also be able to provide referrals.Search online for psychologists’ websites.Contact your area community mental health center.Consult a local university or college department of psychology.Call your local or state psychological association, which may have a list of practicing psychologists organized by geographic area or specialty.
Or use a trusted online directory, such as APA’s Psychologist Locator service. This service makes it easy for you to find practicing psychologists in your area.
Psychologists may work in their own private practice or with a group of other psychologists or health care professionals. Practicing psychologists also work in schools, colleges and universities, hospitals, health systems and health management organizations, veterans’ medical centers, community health and mental health clinics, businesses and industry, and rehabilitation and long-term care centers.
Selecting a psychologist
APA estimates that there are about 85,000 licensed psychologists in the United States. How can you find the one who’s right for you?
Psychologists and patients work together, so the right match is important. Good “chemistry” with your psychologist is critical, so don’t be afraid to interview potential candidates about their training, clinical expertise, and experience treating problems like yours. Whether you interview a psychologist by phone, during a special 15-minute consultation, or at your first session, look for someone who makes you feel comfortable and inspires confidence.
But it’s also important to check more practical matters, too.
What should you ask yourself?
When you’re ready to select a psychologist, think about the following points:
Do you want to do psychotherapy by yourself, with your partner or spouse, or with your children?What are your main goals for psychotherapy?Will you use your health insurance or employee assistance program to pay for psychotherapy?If you’ll be paying out of pocket, how much can you afford?How far are you willing to drive?What days and times would be convenient?
What should you ask a psychologist?
You’ll need to gather some information from the psychologists whose names you have gathered.
The best way to make initial contact with a psychologist is by phone. While you may be tempted to use email, it’s less secure than the telephone when it comes to confidentiality. A psychologist will probably call you back anyway. And it’s faster for everyone to talk rather than have to write everything down.
Psychologists are often with patients and don’t always answer their phones right away. Just leave a message with your name, phone number, and brief description of your situation.
Once you connect, some questions you can ask a psychologist are:
Are you accepting new patients?Do you work with men, women, children, teens, couples, or families? (Whatever group you are looking for.)Are you a licensed psychologist in the state where I live?How many years have you been practicing?What are your areas of expertise?Do you have experience helping people with symptoms or problems like mine?What is your approach to treatment? Have the treatments you use been proven effective for dealing with my problem?What are your fees? Do you have a sliding-scale policy if I can’t afford your regular fees? Do you accept credit cards or personal checks? Do you expect payment at the time of service?Do you accept my insurance? Are you affiliated with any managed care organizations? Do you accept Medicare or Medicaid?Will you accept direct billing to or payment from my insurance company?What are your policies concerning things like missed appointments?
If you have particular concerns that are deal-breakers for you, ask the psychologist about them. You might want to work with a psychologist who shares your religious views or cultural background, for example. While some psychologists are more open to disclosing personal information than others, the response will give you important information about whether you’ll work well together.
While you’re assessing a psychologist, he or she will also be assessing you. To ensure that psychotherapy is successful, the psychologist must determine whether there’s a good match when it comes to personality as well as professional expertise. If the psychologist feels the fit isn’t right—perhaps because you need someone with a different specialty area—he or she will refer you to another psychologist who can help.
How can I pay for psychotherapy?
If you have private health insurance or are enrolled in a health maintenance organization or other type of managed care plan, it may cover mental health services such as psychotherapy. Before you start psychotherapy, you should check with your insurance plan to see what is covered.
Thanks to the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, group insurers of more than 50 employees that offer mental health and substance use services must cover both mental and physical health equally. That means insurers are no longer allowed to charge higher copays or deductibles for psychological services or arbitrarily limit the number of psychotherapy sessions you can receive.
However, insurance companies vary in terms of which mental health conditions they cover. That means some insurance policies may not cover certain mental health disorders.
Getting startedYour employer may also offer an employee assistance program. These programs typically offer one to eight sessions of mental health treatment for free or at a very low cost. Your spouse or partner may also be eligible for these benefits.
Government-sponsored health care programs are another potential source of mental health services. These include Medicare for people age 65 and older and people with disabilities, as well as health insurance plans for military personnel and their dependents. In some states, Medicaid programs may also cover mental health services provided by psychologists.
Other options include community mental health centers, free clinics, religious organizations, and university and medical center training programs. These groups often offer high-quality services at low cost.
What should I ask my insurance company?
Look on the back of your insurance card for a phone number for mental or behavioral health or call your insurance company’s customer service number. Before your first psychotherapy appointment, ask your insurer the following questions:
Does my plan cover mental health services?Do I have a choice about what kind of mental health professionals I can see? Ask whether your plan covers psychologists and what kinds of treatments are covered and excluded.Is there a deductible? In some plans, you have to pay a certain amount yourself before your benefits start paying. Also ask how much the deductible is, what services count toward your deductible and when your deductible amount starts over again. Some deductibles re-set at the first of the year, for example, while others re-set at the beginning of your employer’s fiscal year.What is my copayment? Your plan probably requires you to pay for part of treatment yourself by paying either a set amount or a percentage of the fee directly to your psychologist for each treatment session.Is there a limit to the number of sessions? Unlike group or employer-based insurance that must provide mental health parity, private insurance does not. It may only be willing to pay for a certain number of sessions.
Making your first appointment
You may feel nervous about contacting a psychologist. That anxiety is perfectly normal. But having the courage to overcome that anxiety and make a call is the first step in the process of empowering yourself to feel better. Just making a plan to call and sticking to it can bring a sense of relief and put you on a more positive path.
Psychologists understand how difficult it can be to make initial contact. The first call is something new for you, but it’s something they handle regularly. Leave a message with your name, your contact number, and why you are calling. It’s enough to just say that you are interested in knowing more about psychotherapy. Once your call is returned, they’ll lead a brief conversation to get a better sense of what you need, whether they are able to help, and when you can make an appointment.
You might be tempted to take the first available appointment slot. Take a few minutes to stop and think before you do. If it does not fit with your schedule, you can ask if there are other times available that might fit better for you.
What factors should you consider?
You’ll need to think about the best time of day and week to see your psychologist. Factors to consider include:
Your best time of day. Whether you’re a morning person or a night owl, know when you’re at your best and schedule your appointment accordingly.Work. If you have to take time off from work, ask your human resources department if you can use sick leave for your psychotherapy sessions. You might also want to schedule your first appointment later in the day so you don’t have to go back to work afterward. If you have an upsetting topic to discuss, you may be tired, emotionally spent, puffy-eyed, or distracted after your first session.Family responsibilities. Unless your children are participating in treatment, it’s usually not a good idea to bring them along. Choose a time when you will have child care available.Other commitments. A psychotherapy session typically lasts 45 to 50 minutes. Try to schedule your session at a time when you won’t have to rush to your next appointment afterward. Worrying about being late to your next commitment will distract you from your psychotherapy session.
How should I prepare for the appointment?
Once you’ve made an appointment, ask your psychologist how you should prepare. A psychologist might ask you to:
Call your insurer to find out what your outpatient mental health benefits cover, what your copay is, and whether you have a deductible. If you don’t get this information ahead of time, your psychologist may ask you to come to your appointment a little early so he or she can help you verify your benefits.Fill out new patient paperwork for your psychologist. Your psychologist may have a website with forms you can download and fill out before you arrive at your appointment. If not, you can ask your psychologist to get you the forms and fill them out at home rather than while sitting in the psychologist’s waiting room. Your psychologist may also provide a packet of materials covering logistical issues, such as cancellation fees and confidentiality.Get records from other psychologists or health care providers you’ve seen.You may also want to prepare a list of questions, such as the average treatment duration, the psychologist’s feelings about medication, or good books on your issue.Learn about therapy. If any of your friends have done psychotherapy, ask them what it was like. Or read up on the subject. If you’ve had psychotherapy before, think about what you liked and didn’t like about your former psychologist’s approach.Keep an open mind. Even if you’re skeptical about psychotherapy or are just going because someone told you to, be willing to give it a try. Be willing to be open and honest so you can take advantage of this opportunity to learn more about yourself.Make sure you know where you’re going. Check the psychologist’s website or do a map search for directions to the psychologist’s office.
Going to your first appointment
It’s normal to feel nervous when you head off to your first psychotherapy appointment. But preparing ahead of time and knowing what to expect can help calm your nerves.
What should I bring?
A typical psychotherapy session lasts 45 to 50 minutes. To make the most of your time, make a list of the points you want to cover in your first session and what you want to work on in psychotherapy. Be prepared to share information about what’s bringing you to the psychologist. Even a vague idea of what you want to accomplish can help you and your psychologist proceed efficiently and effectively.
Going to your first appointmentIf you’ve been referred by another professional, such as a physician or attorney, notes about why they did so can be helpful. If a teacher suggested that your child undergo psychotherapy, you might bring in report cards or notes from his or her teacher. Your psychologist can also call these professionals for additional information if you give written permission. Records from previous psychotherapy or psychological testing can also help your new psychologist get a better sense of you.
If you’re on any medications, jot down which medications and what dosage so your psychologist can have that information.
It can be difficult to remember everything that happens during a psychotherapy session. A notebook can help you capture your psychologist’s questions or suggestions and your own questions and ideas. Jotting a few things down during your session can help you stay engaged in the process.
Most people have more than a single session of psychotherapy. Bring your calendar so you can schedule your next appointment before you leave your psychologist’s office.
You’ll also need to bring some form of payment. If you’ll be using your health insurance to cover your psychotherapy, bring along your insurance card so your psychologist will be able to bill your insurer. (Some insurers require psychologists to check photo IDs, so bring that along, too.) If you’ll be paying for psychotherapy out of pocket, bring along a credit card, checkbook, or cash.
What should I expect?
For your first session, your psychologist may ask you to come in a little early to fill out paperwork if you haven’t already done so.
Don’t worry that you won’t know what to do once the session actually begins. It’s normal to feel a little anxious in the first few sessions. Psychologists have experience setting the tone and getting things started. They are trained to guide each session in effective ways to help you get closer to your goals. In fact, the first session might seem like a game of 20 questions.
Sitting face to face with you, your psychologist could start off by acknowledging the courage it takes to start psychotherapy. He or she may also go over logistical matters, such as fees, how to make or cancel an appointment, and confidentiality, if he or she hasn’t already done so by phone.