How to choose a psychologist

At some time in our lives, each of us may feel overwhelmed and may need help dealing with our problems. According to the National Institute of Mental Health, more than 30 million Americans need help dealing with feelings and problems that seem beyond their control — problems with a marriage or relationship, a family situation or dealing with losing a job, the death of a loved one, depression, stress, burnout or substance abuse. Those losses and stresses of daily living can at times be significantly debilitating. Sometimes we need outside help from a trained, licensed professional in order to work through these problems. Through therapy, psychologists help millions of Americans of all ages live healthier, more productive lives.

Consider therapy if...

• You feel an overwhelming and prolonged sense of helplessness and sadness, and your problems do not seem to get better despite your efforts and help from family and friends. 

• You are finding it difficult to carry out everyday activities: for example, you are unable to concentrate on assignments at work, and your job performance is suffering as a result. 

• You worry excessively, expect the worst or are constantly on edge.

• Your actions are harmful to yourself or to others: for instance, you are drinking too much alcohol, abusing drugs or becoming overly argumentative and aggressive.

What is a psychologist and what is psychotherapy?

Psychologists who specialize in psychotherapy and other forms of psychological treatment are highly trained professionals with expertise in the areas of human behavior, mental health assessment, diagnosis and treatment, and behavior change. Psychologists work with patients to change their feelings and attitudes and help them develop healthier, more effective patterns of behavior.

Psychologists apply scientifically validated procedures to help people change their thoughts, emotions and behaviors. Psychotherapy is a collaborative effort between an individual and a psychologist. It provides a supportive environment to talk openly and confidentially about concerns and feelings. Psychologists consider maintaining your confidentiality extremely important and will answer your questions regarding those rare circumstances when confidential information must be shared.

How do I find a psychologist?

To find a psychologist, ask your physician or another health professional. Call your local or state psychological association. Consult a local university or college department of psychology. Ask family and friends. Contact your area community mental health center. Inquire at your church or synagogue. Or, use APA's Psychologist Locator service.

What to consider when making the choice

Psychologists and clients work together. The right match is important. Most psychologists agree that an important factor in determining whether or not to work with a particular psychologist, once that psychologist's credentials and competence are established, is your level of personal comfort with that psychologist. A good rapport with your psychologist is critical. Choose one with whom you feel comfortable and at ease.

Questions to ask

• Are you a licensed psychologist? How many years have you been practicing psychology?

• I have been feeling (anxious, tense, depressed, etc.) and I'm having problems (with my job, my marriage, eating, sleeping, etc.). What experience do you have helping people with these types of problems?

• What are your areas of expertise — for example, working with children and families?

• What kinds of treatments do you use, and have they been proven effective for dealing with my kind of problem or issue?

• What are your fees? (Fees are usually based on a 45-minute to 50-minute session.) Do you have a sliding-scale fee policy?

• What types of insurance do you accept? Will you accept direct billing to or payment from my insurance company? Are you affiliated with any managed care organizations? Do you accept Medicare or Medicaid insurance?

Finances

Many insurance companies provide coverage for mental health services. If you have private health insurance coverage (typically through an employer), check with your insurance company to see if mental health services are covered and, if so, how you may obtain these benefits. This also applies to persons enrolled in HMOs and other types of managed care plans. Find out how much the insurance company will reimburse for mental health services and what limitations on the use of benefits may apply.

If you are not covered by a private health insurance plan or employee assistance program, you may decide to pay for psychological services out-of-pocket. Some psychologists operate on a sliding-scale fee policy, where the amount you pay depends on your income.

Another potential source of mental health services involves government-sponsored health care programs — including Medicare for individuals age 65 or older, as well as health insurance plans for government employees, military personnel and their dependents. Community mental health centers throughout the country are another possible alternative for receiving mental health services. State Medicaid programs may also provide for mental health services from psychologists.

Credentials to look for

After graduation from college, psychologists spend an average of seven years in graduate education training and research before receiving a doctoral degree. As part of their professional training, they must complete a supervised clinical internship in a hospital or organized health setting and at least one year of post-doctoral supervised experience before they can practice independently in any health care arena. It's this combination of doctoral-level training and a clinical internship that distinguishes psychologists from many other mental health care providers.

Psychologists 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 persons qualified to practice psychology as defined by state law. In most states, renewal of this license depends upon the demonstration of continued competence and requires continuing education. In addition, APA members adhere to a strict code of professional ethics.

Will seeing a psychologist help me?

According to a research summary from the Stanford University School of Medicine, some forms of psychotherapy can effectively decrease patients' depression, anxiety and related symptoms such as pain, fatigue and nausea. Research increasingly supports the idea that emotional and physical health are closely linked and that seeing a psychologist can improve a person's overall health.

There is convincing evidence that most people who have at least several sessions with a psychologist are far better off than individuals with emotional difficulties who are untreated. One major study showed that 50 percent of patients noticeably improved after eight sessions, while 75 percent of individuals in therapy improved by the end of six months.

How will I know if therapy is working?

As you begin therapy, you should establish clear goals with your psychologist. You might be trying to overcome feelings of hopelessness associated with depression or control a fear that is disrupting your daily life. Remember, certain goals require more time to reach than others. You and your psychologist should decide at what point you may expect to begin to see progress.

It is a good sign if you begin to feel a sense of relief, and a sense of hope. People often feel a wide variety of emotions during therapy. Some qualms about therapy that people may have result from their having difficulty discussing painful and troubling experiences. When you begin to feel relief or hope, it can be a positive sign indicating that you are starting to explore your thoughts and behavior.

Examples of the types of problems which bring people to seek help from psychologists are provided below:

A man in his late 20s has just been put on probation at work because of inappropriate behavior towards his staff and other employees. He has been drinking heavily and is getting into more arguments with his wife.

Once the contributing factors that may have led to the man's increase in stress have been examined, the psychologist and the man will design a treatment that addresses the identified problems and issues. The psychologist will help the client evaluate how he coped with, and what he learned from, any earlier experiences he had with a similar problem that might be useful for dealing with the current situation.

Functioning as a trained, experienced and impartial third party, the psychologist will help this client take advantage of available resources (his own as well as other resources) to deal with the problem. The psychologist also will assist this client with developing new skills and problem-solving strategies for confronting the problem he faces.

Crying spells, insomnia, lack of appetite and feelings of hopelessness are some of the symptoms a woman in her early 40s is experiencing. She has stopped going to her weekly social activities and has a hard time getting up to go to work. She feels like she lives in a black cloud and can't see an end to the way she feels.

The symptoms of depression are extremely difficult to deal with, and the causes may not be immediately apparent. Significant life changes — such as the death of a loved one, the loss of a job or a child's leaving home for college — may contribute to depression. Psychologists have a proven track record in helping people deal with and overcome depressive disorders.

A psychologist will approach the problems this woman presents by addressing why she is reacting the way she is reacting now. Does she have a history or pattern of such feelings, and, if so, under what circumstances? What was helpful to her before when she dealt with similar feelings, and what is she doing now to cope with her feelings?

The psychologist will work to help the client see a more positive future and reduce the negative thinking that tends to accompany depression. The psychologist also will assist the client in problem-solving around any major life changes that have occurred. And the psychologist may help facilitate the process of grieving if her depression resulted from a loss.

Medical problems may contribute to the symptoms the woman is experiencing. In such cases, medical and psychological interventions are called for to help individuals overcome their depression.

William, a successful businessman, has been laid off from work. Instead of looking for a job, he has gone on endless shopping sprees. He has gotten himself into thousands of dollars of debt, but he keeps spending money.

What can be more perplexing than someone who does the opposite of what appears to be reasonable? William's friends and family members will likely be confused by his behavior. Yet, such behavior is not unfamiliar to psychologists who understand bipolar disorders. Of course, any psychologist would have to do a thorough evaluation to be able to understand the apparently contradictory behavior William exhibits. Following an evaluation, the psychologist might conclude that the behavior actually is a symptom of a depressive or some other form of mood disorder.

Typically, the best results for such a condition have come from treatment that combines medication and therapy. Although psychologists do not provide medication, they maintain relationships with physicians who are able to assess a patient's need for appropriate medication. The psychologist offers understanding of human behavior and psychotherapeutic techniques that can be effective in helping William deal with his disorder.

Scott, a teenager, has just moved across town with his family and has been forced to transfer to a new high school. Once an excellent student, he is now skipping classes and getting very poor grades. He has had trouble making friends at this new school.

For most teenagers, "fitting in" is a critical part of adolescence. Scott is attempting to make a major life transition under difficult circumstances. He has been separated from the network of friends which made up his social structure and allowed him to feel "part of the group."

Young people often respond to troubling circumstances with marked changes in behavior. Thus, an excellent student's starting to get poor grades, a social youngster's becoming a loner or a leader in school affairs losing interest in those activities would not be unusual. A psychologist, knowing that adolescents tend to "test" first and trust second, will likely initially spend time focusing on developing a relationship with Scott. Next, the psychologist will work with Scott to find better ways to help him adjust to his new environment.