Dear Michael:

            A friend of mine told me “I’m tired of hearing you complain all the time about the same problems. You should see a therapist.”  I’ve never gone to a therapist: what exactly do they do? And what’s the difference between a therapist, psychologist and psychiatrist?

            Same-old, same-old in San Diego

Dear Same-Old:

Before I explain the difference between different kinds of “therapists”, let’s address the question “under” your question: do I need professional help? Just because your friend is tired of hearing you complain doesn’t mean you need a therapist’s help. Your friend could simply be intolerant or cranky. Consider:

  1. How do I know if a therapist would be helpful to me?
  2. What kinds of therapists are out there?
  3. How do I find a therapist who’s a good “match” for me?

Therapists are personal trainers for your head. When you work out at the gym and hit a plateau, if you’re smart, you stop doing the same old unproductive routine and get a trainer to help you move to the next level. A therapist does similar work for your mental state: when you’re “stuck” and can’t progress mentally, you need expert help. Friends, relatives and lovers may have good intentions, but have neither the training nor the objectivity and confidentiality that a good therapist does.

If you have a problem that is not going away – for example, your self-esteem continues to be low after years of trying to feel better about yourself, you can’t get over your ex, or you feel depressed and anxious – a therapist may be helpful.

A psychotherapist is a Licensed Clinical Social Worker (LCSW) or a Licensed Marriage and Family Therapist (LMFT). These good people are specifically trained to do psychotherapy, that is, talk therapy. Psychologists also licensed do talk therapy and may do psychological testing as well. Psychiatrists are medical doctors who specialize in mental health and focus on psychological evaluations and prescribing medications for anxiety and depression).

You can go to any of these for “therapy”, but note that each has their own specialty.  Psychiatrists are usually the most expensive, often charging upwards of $325 an hour.  Psychologists and psychotherapists usually charge between $125-250 per hour, depending on their experience and specialized training.

How do you find a therapist that you like and can help you with your problem(s)?  Well…how did you find your doctor or dentist? Most of us ask our friends/family and Ms. Google or Mr. Yelp for recommendations.

Once you have found some potential therapists, create a list of questions to ask them and then call them up. Most therapists – including me – will speak with you on the telephone before your first appointment. Here are some questions to consider asking them:

  • “I am looking for help with [state your concerns as specifically as you can], do you have experience with this? If not, can you recommend someone who does?
  • “How would you help me?”
  • “How often would you want me to come in?”
  • “How long would our sessions last?”
  • “How many times do you think I’d need to see you?”
  • “How much do you charge for your sessions?”
  • “Do you take my insurance?”
  • “Do you have a sliding fee scale?”
  • “Do you have evening/weekend/early morning appointments?”
  • If someone is too expensive for you, ask: “Can you recommend someone else who is more affordable for me? I can afford to pay $—– per session.”

Once you’ve done your telephone interviews, pick one or two therapists and schedule an appointment. Tell them during your appointment that you are looking for a therapist and may see another therapist (or two) in order to find one you really click with. Don’t feel guilty if you don’t click with the first (or second) therapist you meet: it’s your time and money, so make sure you feel comfortable with who you choose. Then, get ready to face your problems and change your life!