Starting Therapy 101

Are you looking to start therapy? Maybe you’ve had services in the past but are looking to re-engage. Or maybe this is your first time and you don’t know where to start. Whatever experience you have had with pursuing mental health services, it can be overwhelming to know where to begin. The reality is, not all therapy is the same. Let’s take a closer look at the differences in treatment types, clinician training and credentials, and ways to obtain a referral.

What’s with all the letters?

Based on a clinicians training level, type of education program, licensure status, and state licensing boards different designations will appear after their name.

Licensed Psychologist (PsyD or PhD) - a doctoral level licensed clinician who has completed a 5-year doctoral program, in addition to several training placements and a fifth-year full-time residency. It was previously required for psychologists to also complete a post-doctoral fellowship once their degree was obtained.

LPC- a licensed professional counselor who has completed a master’s degree in counseling or a related field, in addition to a supervised clinical internship placement. To obtain licensure status in PA, these clinicians have completed several years of direct care training experience while under the supervision of a licensed professional. A counselor who has not yet achieved licensure may have credentials of MS or MA.

LMFT- a licensed marriage and family counselor who has completed a master’s degree with specific training in marriage, couples, and family-based services. To obtain licensure status, these clinicians have completed several years of direct care training experience while under the supervision of a licensed professional. A counselor who has not yet achieved licensure may have credentials of MS or MA.

LCSW- a licensed clinical social worker who has completed a master’s degree in social work and several years of direct care training experience while under the supervision of a licensed professional. A counselor who has not yet achieved the clinical component, may have credentials of LSW.

What type of therapy is best for me?

There is a wide array of treatment modalities and each clinician has their own specialized training and niche. An overview of common treatments will be outlined below. Certainly, this is not an exhaustive list, and you can work with your clinician to identify what might best address your therapy needs.

CBT- Cognitive-behavioral therapy is an evidence-based treatment approach that focuses on the impact of problematic, dysfunctional thinking patterns on emotions and behaviors. This modality helps individuals identify their thoughts and how realistic/helpful they are and practice modifying interpretations in order to better manage emotional distress and choose to engage in more adaptive behaviors. This is a goal-oriented, problem focused approach that emphasizes clinician-client collaboration and guided discovery. This approach has been proven in many research studies to be highly effective for a variety of mental health conditions including mood disorders, anxiety disorders, substance use disorders, trauma, etc.

Of note, there are a number of CBT treatment protocols that are highly effective for specialized conditions (e.g., exposure therapy for anxiety and phobias, prolonged exposure and cognitive processing for PTSD, etc.) These therapies also fall under the CBT umbrella given their focus.

DBT- Dialectical-behavior therapy is a highly effective evidenced based practice developed by Marsha Linehan based on a dialectical and biosocial theory of psychological disorders. This approach blends CBT with practices like mindfulness skills and interventions. The approach is highly skills based, focusing on four main skill modules including mindfulness skills, distress tolerance skills, emotion regulation skills, and interpersonal effectiveness skills. This approach is helpful for anyone having difficulties regulating their emotions, managing particularly strong emotions, and navigating relationship challenges.

ACT- Acceptance and Commitment Therapy is another evidenced based treatment modality backed by clinical research. ACT is an action-based modality focused on identifying one’s core values and focusing on aligning life choices with those values. ACT integrates mindfulness-based strategies and encourages individuals to notice and embrace thoughts/feelings instead of actively fighting to change them. ACT promotes psychological flexibility through the acceptance and mindfulness strategies and behavior changes.

How do I find a therapist?

Now the hard part of trying to locate a therapist. You can first start off by determining whether you intend to use insurance benefits of pay out-of-pocket for services. There are pros and cons to each of these avenues.

Insurance

Pros--- Insurance plan can assist in finding a provider near your location, lower fee (co-pays tend to be less expensive)

Cons---Potentially longer wait for services as not all clinicians accept insurance, requires information like diagnosis to be provided to insurance company, may limit the number of sessions

Self-Pay

Pros---Flexibility in length of service as treatment is not regulated by insurance company, usually quicker access to begin services

Cons---Higher fee than using insurance

If you choose the self-pay option, or even if you want additional information on a provider you may have been referred to, Psychology Today is a great online database. Note that if your insurance policy does include out-of-network benefits, many self pay providers can assist you in submitting for possible reimbursement towards those benefits. Your insurance company would be able to provide more information regarding your specific plan.

What should I expect in the first appointment?

During the first session, your clinician may review relevant consent forms and policies and procedures. Confidentiality is also reviewed, which entails discussing what information may be shared and what information is protected.

Some clinicians may facilitate a formal clinical interview, asking questions about your presenting concern and relevant medical and behavioral health history. Your clinician may also discuss a tentative course of treatment or initial plan. While it is helpful for the clinician to ask questions to gather information, it is equally important for you, as the client, to ask questions and obtain clarification around anything. This is your therapy!

What if I don’t feel a connection with my therapist?

Trust, respect, and comfortability are critical components to the therapeutic relationship between clinician and client. Research shows that treatment outcomes are positively impacted by an effective working relationship. With that said, it is not uncommon for individuals to feel that there is a poor fit between themselves and their therapists. We encourage you to provide feedback to your therapist to discuss what modifications could be made to ensure your therapy proves to be a more helpful experience.