Finding a Therapist  by J. Lamar Freed, Psy.D.

Dr. Freed is a Gero-Psychologist in private practice in the northern Philadelphia Suburbs.   He has been diagnosed with MS since 1993.

Choosing a professional to discuss emotional or psychological problems is an important decision. Making the step involves acknowledging that your own resources have been tapped out. It says that the efforts of friends and family, as much as they may have tried, need to be supplemented by the efforts of an expert in this area. It says that you have decided that you need help. So you should be careful and make sure that when you pick a professional, you get the help you need.

If you have a disease like Multiple Sclerosis (MS) it is not such a shock to reach such a decision point. MS causes stresses and complications in life that go beyond the normal stresses and strains we all face. Indeed, recent research suggests that as many as 90 percent of people with MS suffer from anxiety and as many as 50 percent suffer from depression. It would surprise no one if a research study someday finds that a comparatively high percentage of people with MS have consulted a mental health professional at one time or another.

To start, find out what help is available. People to ask include trusted family and friends, your physician, the people you have met at your MS support group, or others who would know the mental health resources in your community. If you have some time and flexibility, look in the Yellow Pages and make a few phone calls to get a sampling of what is available in your community. What you are likely to find is a large range of organizations and individuals who provide psychotherapy.

The next thing to do is to think about what you want from a therapist. Do you know you want weekly supportive talking therapy with someone? Do you know you want someone who will find a medication that may help? Do you want someone who will try to fix whatever is going on in the shortest time possible? Do you have confidence in one or another approach to psychotherapy from past experience or philosophical affinity? Or are you, like most people who go into therapy for the first time, unsure what exactly you need or want?

Psychiatrists: Psychiatrists are physicians with specialized training in mental health. After  medical school, they go to a three- or four-year residency -- a  kind of apprenticeship -- in psychiatry, where they learn to manage mental health problems. These residencies are always based in hospitals, so psychiatrists are most thoroughly trained in managing the most severe symptoms, usually using medications.

Psychologists: Psychologists have training specifically in human behavior. They  train in four- or five-year programs in psychology with specialty areas in clinical, school, educational, industrial/organizational, and many others. Usually a one-year internship follows or may be integrated into the program. While all licensed psychologists will have the same core areas of training, there is some variation in the amount of time spent in training on the specific skills used in the evaluation and treatment of mental health problems. Psychologists trained in clinical psychology are the most directly trained to work with mental health problems, but those with other training are also qualified, often by virtue of clinical internships, by specialty post-doctoral training, or by years of supervised experience. A few states still license psychologists with only master's degrees, but in most states a licensed psychologist must have a doctoral degree. It is important that you ask about these issues if they make a difference for you, or to your insurance company.

If you know what you want, then you should eliminate those people who do not offer it. If you want only talking therapy, you would rule out those psychiatrists who limit their practice to medications. If you want medications, you should only work with a psychiatrist or another professional who will coordinate with your primary physician to find the right medication. If you have specific goals or preferences, find those people in your area who share those goals for therapy. If you are uncertain, you may want to choose someone on the basis of whether they've helped someone else you've known or are recommended by someone you trust.

Often at this point there will be an obvious choice and the next consideration is working out insurance considerations. If there isn't an obvious choice then you have to choose between a range of available people. Either way, insurance considerations become important.

Usually insurance companies will reimburse for the services of any licensed mental health professional, including psychiatrists, psychologists, and social workers. There may be a separate category for nurse practitioners, addictions counselors, or mental health counselors who are sometimes covered. It is important to know this before you schedule your first session or you may be obligated to pay the full charge..

The question to ask your insurance representative in this area is who it will reimburse and how much it will cover. Even if the insurance company does not have a limited panel of providers, it will still limit reimbursement to professionals with a certain set of credentials. There are some differences between insurance companies in this area, so it's important to ask. Find out if there is an upper limit to how much they will cover per session. Find out if there is a maximum yearly amount they will cover or if there is a maximum number of sessions. There may be a maximum lifetime amount, but usually this is only relevant if you are going to be hospitalized or if you are planning to see your therapist for more than ten years.

Social Workers: Social workers train specifically in the tradition of social work. They go to two- or three-year programs to get a master's degree, usually an MSW in social work. The designation LCSW means licensed clinical social worker, and in most states this is the degree that insurance companies recognize. In some States social workers must work under supervision for several years before  licensure.

Other counselors: Marriage and family counselors Pastoral counselors Addictions counselors Mental Health Counselors Specialist Nurse Practitioners Qualifications and reimbursement for these practitioners vary widely.

Finding a therapist is the first step toward getting help with the problems that have gone beyond your own and your personal community's ability to solve. There are other steps as well. While they won't be covered here, it is important to remember that in the area of mental health, the patient is still his or her own best advocate. If your therapy is not going the way you expected or the way the therapist told you it would, be sure to discuss this with your therapist. If you are not satisfied, get a second opinion. Even when you are consulting experts, you are ultimately responsible for the direction of your own health care.