Dear Michael:

            A friend of mine told me that he was tired of hearing me whine about the same problems over and over and that I should see a therapist. I’ve never gone to a therapist: what exactly do they do? And what’s the difference between a therapist, counselor, shrink and psychiatrist?

            Same old same old in San Diego

Dear Same Old:

Before I explain the difference between different kinds of “therapists”, let me 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 could 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?

I recommend that people consider us therapists as personal trainers for your mind. When you work out at the gym, hit a plateau and can’t progress any further, 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 – like me – does similar work for your mental state: when you’re “stuck” and can’t progress mentally, you need some expert help.  Friends, relatives and lovers can be helpful, but they have neither the training nor the objectivity and confidentiality that a good therapist does.

Therapists (psychotherapists, psychologists and psychiatrists) are regulated and licensed by the State of California. We have rigid continuing education requirements and can lose our licenses if we misbehave (e.g., have sex with a client, violate your rights to confidentiality. etc.)

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

A psychotherapist is a Licensed Clinical Social Worker (LCSW) or a Licensed Marriage and Family Therapist (LMFT). We are specifically trained to do psychotherapy, that is, therapy for your psychological issues. We do not issue prescriptions for any medications and rarely do psychological testing. Psychologists are also licensed by the State to do talk therapy (like psychotherapists), but often do psychological testing as well.  These folks often have the initials Ph.D. after their names. Psychiatrists are medical doctors (MDs) who specialize in mental health.  Their primary focus is usually in doing psychological evaluations and dispensing medications (antidepressants, anti-anxiety medications, etc.).

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 $300 an hour.  Psychologists and psychotherapists usually charge about $125-250 per hour, depending on their experience and specialized training. Some of us take insurance, others do not (myself, I take TriWest insurance for veterans who live in California).

How do you find a therapist that you like and is able to help you with your problem(s)?  Well…how did you find your doctor, dentist, chiropractor or acupuncturist?  Most of us ask our friends, family and co-workers for recommendations. You can also try Yelp or Google for possibilities.

Once you have some potential therapist candidates, I recommend that you come up with a list of questions to ask them before you call them up. Some of us therapists will speak with you on the telephone before your first appointment, others will not. I strongly recommend talking with a therapist on the phone for ten to fifteen minutes before you make an appointment; here are some questions to consider asking them:

  • “Are you comfortable working with people my age, gender, sexual orientation”?
  • “I am looking for help with (state your problem(s) or concern(s) as specifically as you can)…do you have experience with this?  If not, can you recommend someone who specializes in this area?”
  • “How often would you want me to come in?”
  • “Specifically, how would you help me?”
  • “Do you take my insurance?”
  • “How long would our sessions last?”
  • “Do you have a sliding fee scale?”
  • “How many times do you think I’d need to see you?”
  • “Do you have evening/weekend/early morning appointments?”
  • “How much do you charge for your sessions?”
  • If someone is too expensive for you, ask:  “Can you recommend someone else who is more affordable for me?  I can afford to pay ($—.00) per session.”

This is not an exhaustive list, but it’s a good start. Interview several therapists over the phone before you choose one to see in person. Keep your telephone interviews as focused as possible…ask your questions but don’t waste their time.

Once you have 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 a therapist that you really click with.  Don’t feel guilty if you don’t click with the first (or second) therapist you meet.  You may need to meet with two or three to find the right one. 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!