Overview to Choosing the Right Therapist

Psychology is a strange profession that combines science with artistry.  While this is also true of other medical professions, the artistry and talent of the psychologist plays a large role in the effectiveness of the treatment.  Because of this, it is difficult to measure the skill of the psychological practitioner.  There are no concrete success rates or universal rating scales of talent from which to draw conclusions.  In the end, patients must rely on their own personal judgments of a practitioner’s knowledge and skill in a given domain.

What to Expect

Psychologists utilize many tools such as psychological tests, behavioral techniques, and monitoring equipment.  A patient may expect a wide range of approaches to a given problem.  Much of this is dependent on the practitioner, the patient, and the nature of the symptoms.  It is up to the patient to decide what approach and which therapist works best for them.

Currently, most reputable psychologists are not conducting neuropsychological testing because that requires hours of in-person work. There are online tests, but there is a loss of peripheral information and a lack of standardization for many of these tests. Some practitioners are taking advantage of the confusion caused by the large numbers of tests available, and are using fraudulent pseudo-examinations. I have seen some test reports first-hand based on nonexistent tests. These can do harm to people since they give a false impression of veracity and representation of one's neuropsychological/cognitive/academic/personality functioning. 

One thing to note:

Since insurance companies are allowing Zoom/Skype/phone sessions, they are also allowing people to seek services out of state. If you are interested in obtaining psychological services, feel free to expand your search nationwide. Most private practitioners are not doing in-person sessions. If you definitely want in-person services, and you want nights and weekends, your best bet is a clinic, especially outpatient clinics affiliated with hospitals.

How to begin

The first step to finding a therapist is getting a list of names.  Some sources of referrals include your physician, friends, and support groups.  An important thing to keep in mind is that psychologists have specialties, much like medical doctors.  Some psychologists only work with adults.  Some only perform testing.  For certain diagnoses, such as Autism or PTSD (Post-Traumatic Stress Disorder), it is important to obtain a psychologist who has specialized training or knowledge in that subject. Since disorders related to anxiety and depression are common, they are not considered to be specialties.

Screening through the initial session

Some psychologists may still be performing screening calls; however, we generally use the first session for screening, That first session includes obtaining a history of the patient. In private practice, please be aware that acceptance of a patient for an initial session does not mean that we are formally accepting the case, It is simply a part of the screening and intake process.

If you are making an appointment with a psychologist for a "screening" session, you must be aware that you are reserving a time slot that may be used by other patients. If you are going to cancel, you should let the therapist know as far in advance as possible so as to prevent blocking others from their services. If you do not give adequate warning (48 hours in most cases), you will be responsible for payment for that hour, since it is illegal and unethical for psychologists to bill insurance companies for what we call a "No Show" (late cancellation).

Is this a quack?

Unfortunately, there are many unqualified people who call themselves therapists or even experts.  If you are looking for a psychologist, make sure you are dealing with someone who is licensed as a clinical psychologist in your state.  Once you have established that, you need to assess the psychologist’s skills.  A license and experience does not necessarily mean a good practitioner.  Take a good look at the practitioner.  Do you think they can handle the complexities of your situation?  Do they have past experience with that situation?  Do they appear to have talent and artistry in psychology as a whole?  Beware of those who promise a magic cure.  There is no such thing, and that is not what psychologists do.  Finally, follow your own feelings.  If you think that there may be something wrong here, you may be right.

When to shop around

It is best to shop around before starting therapy. After the first month, reassess the situation to make sure you are satisfied with your progression.

If you feel a need to check out multiple practitioners simultaneously and bill insurance, you are able to do so as long as they are not billed for the same day.

No matter what, you should inform therapists that you are shopping, so they are able to add that to their records.

Setting up the first appointment

When you set up the appointment, make sure you show up at the scheduled time.  If you need to cancel, you should cancel well in advance.  Most likely you will owe for the hour (possibly at full hourly rate, not insurance rate) without proper notification.

First session

Try not to make an immediate judgment based on one session. If you decide to shop around while in therapy it is best to inform your therapist prior to treatment or during the first session.  At the end of the session, you will be asked if you want to set up another session. If you do not know, make sure to not take up a time slot right away, say that you will get back to the practitioner after you think about it.  If not, inform the therapist that you will be switching to another therapist. It is important to be honest, because therapists have a responsibility to keep files open until allowed to formally close. That means they will have to contact you and make sure you are okay, and take up time that should be used for their patients. Clinical psychologists undergo a great deal of training and do not take transfer elsewhere personally!


Ghosting

Ghosting is inappropriate when responding to a practitioner. In order to close cases (which, if you are ghosting, you probably would like to do), practitioners may need to straighten out their records, do last-minute billing of insurance or obtain copay or deductible from you (if you owe that, you are essentially falsifying records, since your insurance company assumes you paid that to the practitioner), and to get the okay from you to close the case (and possibly to see if you followed up on a referral or transferred the case somewhere else). Therapy is a different kind of business: we are responsible for you and keep our files open until we are allowed to close the case. Sometimes, for simplicity, we will close the case ourselves, but it is easier if you simply respond to messages from your practitioner.

Family/Marital sessions

It is recommended that folks utilize one therapist for family/marital individual therapy in order to best serve the family and to provide an informed treatment of all involved. So, if you are already in individual therapy with a practitioner, it makes sense to ask that individual for marital/family/other sessions for best service. Since this is a private practice, I may not always have time slots for this, so sessions may alternate or be temporarily arranged. If already in treatment, it makes sense for your practitioner to get a better understanding of family dynamics and see others in your family. If the practitioner refuses, this is a sign that the practitioner may have boundary issues.

Continued sessions

Continue to evaluate whether you think the treatment plan is progressing satisfactorily.  Remember that you play an important role in the success of the therapy.


Spacing out of scheduled sessions

As you progress, you may feel a need for sessions less frequently. You may opt for once every two weeks, once a month, and it may be that one day you will feel like you do not need sessions. If that is the case, you may quit, knowing that you may start sessions again when the need arises.