Psychotherapy: Finding the right type of treatment for you

The statistics on mental health treatment 

According to the National Institute of Mental Health, nearly one in five adults in the United States live with one or more mental health conditions such as anxiety disorders, borderline personality disorder, or obsessive compulsive disorder. That number equates to about 46.6 million people in 2017, including children. With more than 47 million adults availing of mental health services like therapy sessions and telemental health services, not everyone who attends therapy has a mental illness, showcasing how stigmas about therapy can be false.   

In addition, many mental health symptoms can overlap, which might make it difficult to diagnose specific disorders accurately. With over 400 types of psychotherapy and various reasons to find emotional support, such as family problems or emotional distress, it can be confusing to know how to find the right counseling services and what type of professional provider like licensed marriage or other mental health professionals, can address your needs. For some, the choices of providers may be limited by health insurance and federal law.

A lot of individuals feel nervous before attending their first session in a group setting or one-on-one. However, feelings of discomfort can dissipate over time as the person receiving treatment develops trust with the professional and starts to feel comfortable. In many cases, symptoms improve once someone begins to make progress by taking medication, participating in their treatment approach and engaging in supportive psychotherapy or other therapies that promote self-awareness. 

What symptoms can benefit from therapy? 

The types of symptoms you're experiencing may help you narrow down the type of therapist you seek. If you've had similar symptoms in the past, you might already know your diagnosis. It can be helpful to consider a diagnostic evaluation if you haven't.

Many symptoms can be improved by talking therapies, cognitive-behavioral therapy, or other forms of treatment, like dialectical behavior therapy (DBT).

Symptoms in children and adults vary. Below are common adult mental health symptoms that might benefit from therapy: 

• Confusion 

• Prolonged depression, sadness, or irritability

• Feelings of extreme highs and lows

• Extreme fear or worry 

• Social withdrawal

• Intense anger or hostility 

• Delusions or hallucinations

• Difficulty coping with daily responsibilities 

• Suicidal thoughts*

• Substance use** 

• Changes in sleeping and eating habits

• Excessive complaints of physical ailments

• Fear of weight changes 

• Obsession over body image 

• Chronic stress

• Work stress

• Mental burnout 

• Relationship challenges 

*If you are experiencing thoughts or urges of suicide, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 988 to talk to someone over SMS. They are available 24/7 to offer support.

If your child or adolescent is experiencing the following symptoms, they might also benefit from therapy: 

• Changes in school performance

• Poor grades despite efforts 

• Intense worry 

• Panic attacks 

• Hyperactivity

• Persistent nightmares

• Persistent aggression 

• Frequent mood swings 

• Social withdrawal

Where to find a mental health provider 

There are many types of therapists and organizations where mental health providers work. Consider the following methods of reaching out for support. 

Your doctor 

When looking for a mental health provider, your primary care physician may be able to offer a referral. Primary doctors often have a patient's entire health history. Your doctor may understand your symptoms and know local psychologists with experience treating them. In addition, with a referral, the provider can reach out to you, so you don't have to search for one. 

Your insurance company 

Depending on your insurance plan, insurance companies may limit your options to a select group of mental health providers. Often, insurance companies refer clients to available therapists on their panel. If you have Medicaid or Medicare, you can choose your provider from a list and let your insurance company know which one you've selected. Veterans can call the Veteran's Administration for a referral.

Your employer 

Many employers utilize the Employer Assistance Program (EAP) the US government offers. An EAP is an employer-sponsored program designed to intervene in concerns that may negatively impact an employee's work performance. EAPs began as a secret program for helping employees report life challenges. However, your employer's program might include childcare, elder care, financial advice, legal advice, or crisis management. For most companies, these services are free. 

Many EAP programs offer phone, video, and email-based counseling support or coaching. Some EAP plans offer assistance for other services, including nurse lines, legal assistance, and adoption assistance. Plans may extend coverage to spouses, non-marital partners, and children living in the same dwelling as the employee. However, check your employee handbook for further information and note that many EAPs are not offered for long-term therapy. 

SAMHSA 

Another organization that can help individuals locate an appropriate mental health provider is the Substance Abuse and Mental Health Services Administration (SAMHSA). This organization often lists local support groups, and you can call them for resources regarding substance use. 

Local mental health organizations 

Many states have state-funded or low-cost mental health organizations that offer support for those in crisis or those seeking short-term counseling or case management. They can also provide sliding scale options. State-funded mental health programs are often obligated to serve those who meet specific criteria defined by the state.

What's the difference between provider credentials? 

Therapists and counselors obtain different titles based on their education and training. Below are the differences between them.

Psychiatrists

A psychiatrist is a medical doctor in psychiatry with special training in diagnosing and treating mental disorders. Psychiatrists are qualified to prescribe medications as necessary. Some psychiatrists limit their practice to medication management and diagnosis, while others offer therapy, sometimes called talk therapy. 

Psychologists

According to the American Psychological Association (APA), psychologists are therapists, professors, researchers, and mental health professionals with doctorate degrees. The American Psychological Association notes their training involves passing exams upon graduation and a supervised practice internship before they can practice independently. Psychologists can perform assessments and evaluations, diagnose, specific disorders, and provide psychotherapy treatment. They can also do research or teach courses at a university. 

Licensed professional counselors

Licensed professional counselors (LPCs) earn a master's degree in psychology, counseling, or a related field. They complete a certain number of state-required clinical hours under supervision before practicing independently under a license. Professional counselors can perform assessments and evaluations, make diagnoses and provide psychotherapy to treat people using various treatment approaches. 

Mental health counselors

Mental health counselors are another term for a licensed practicing counselor. They earn a master's degree and meet the same requirements as LPCs. The title is different, as some state licensing boards use different terminology. Mental health counselors may also be actively involved in web based programs.

Clinical social workers

A clinical social worker holds a master's degree in social work. They also practice in a supervised setting before becoming independently licensed. Licensed clinical social workers can provide psychotherapy. Many also work in non-profits and humanitarian organizations or in health care. 

Certified alcohol and drug use counselors

Those who earn the designation of certified alcohol and drug use counselors have specific clinical training in substance use. Drug and alcohol use counselors may have a bachelor's degree but receive supervised practice and training. They are limited to practice within substance use situations, focusing on treating clients with a mental disorder related to addiction. Some licensed professional counselors and other professionals obtain this license as well. However, counselors can work with substance use disorders in any case, utilizing various treatment approaches.

Marital and family therapists

A marital and family therapist is a professional therapist with a master's degree. They have specialized educational training in marital and family therapy. Marital and family therapists may provide individual and group counseling, assess, and diagnose couples and families. 

Pastoral counselors

Pastoral counselors are clergy people who have had training in clinical pastoral education. They're trained to provide independent and group counseling and apply a treatment approach that integrates spiritual guidance with mental health support. However, ensure any counselor you visit has a license to practice mental healthcare in their state, regardless of religious or spiritual affiliation. 

What can I expect from an appointment with a therapist?

Feeling hesitant or fearful about your first appointment with a therapist can be expected. However, unsettling feelings may diminish or disappear after the first few sessions as you get to know the provider. You can also let your therapist know if you're feeling uncomfortable. 

The initial contact with your therapist can often consist of a screening where you'll spend a few minutes chatting on the phone or in an office. During an initial consultation, you might have the opportunity to ask any pressing questions and discuss the therapist's approach to working with clients, as well as their treatment philosophy. If everything goes well, you can schedule an appointment or meet with someone else. According to the publication Psychiatric Times, a strong therapeutic alliance is crucial for effective treatment, so it is important to ensure that you feel comfortable with your therapist.

During the first visit, you may discuss the concerns or symptoms that led you to schedule an appointment. Your therapist may ask questions about your personality, your home and work life, and your relationships. They can also let you know if they need you to go through any evaluations for a diagnosis. After your first couple of sessions, your therapist can start developing a treatment plan. They may also indicate how many sessions to expect and discuss payment arrangements and future scheduling. 

You might not start treatment for one or two sessions. The first few sessions often focus on building a professional relationship and establishing goals. Note that therapy can be uncomfortable at times. As treatment continues, you may feel relief from your symptoms and gradually progress toward your therapy goals. 

Should I try support groups? 

Once you've started therapy or counseling, you may seek additional support between counseling sessions. Peer support groups can be a valuable way to make friends and discuss your concerns with others experiencing similar situations. Your mental health provider may also offer support groups. 

The National Alliance on Mental Illness (NAMI) offers support groups across the country for people living with mental illness and families of people who live with mental illnesses. Those diagnosed may also benefit from drop-in centers or hotlines where they can talk to someone immediately. 

Counseling options 

If you struggle to find an in-person provider within your budget or that can provide accommodations to your needs or schedule, you may also benefit from meeting with an online therapist. Online therapists have the same credentials and licensing as in-person therapists and can provide many of the same therapies. 

Many studies have compared the efficacy of traditional therapy against online therapy and found them equal in terms of quality and effectiveness. In a study published in the Journal of Psychological Disorders, online cognitive-behavioral therapy was found to be a practical and effective form of mental healthcare. The study's authors found that CBT delivered through the internet could treat symptoms of panic disorder, generalized anxiety disorder, major depression, and social anxiety disorder.

Online therapists are uniquely trained and qualified to offer therapeutic resources through modalities such as video conferences, phone calls, and live messages. If you're interested in meeting with a provider, consider signing up for a platform like BetterHelp for individuals or Regain for couples. Both platforms offer a growing database of counselors trained in various therapeutic modalities.