What’s it like working with a therapist?
What’s it like working with a therapist?
Today’s blog was a request from a former colleague—she thought it might be helpful to offer insights to people who are considering entering into therapy for the first time. She explained that she knew numerous people who have failed to follow through with their plan to begin therapy, despite really struggling with their mental health. I hope that this post will provide some insights about what one can expect to increase their comfort in obtaining appropriate services. While different therapists have their own style and training, there are some factors likely common to most therapeutic relationships.
Do I want a therapist, counselor, psychologist, psychiatrist, or something else?
It can be confusing to navigate the sea of terms for providers of mental health support: psychiatrist, psychologist, therapist, psychotherapist, counselor, coach, social worker, mental health counselor, etc. They all seem to offer therapy but it is not easy to understand the differences. Let me offer my thoughts about some of the differences among these professionals.
Psychiatrist
A psychiatrist is a medical doctor and may therefore prescribe medication; some also offer “talk therapy”. Medical doctors such as psychiatrists have undergraduate degrees, four years of medical school, plus four years of a psychiatry residency training. Medical doctors must also pass a state exam and meet additional requirements to be licensed to practice.
Psychologist
A psychologist is a another health care professional with a doctorate degree such as a PhD or PsyD degree. Because psychologists don’t have to go to medical/nursing school, they do not prescribe medications, and must also take a state-level exam to be licensed to practice. There are Master’s level professionals in Psychology but, technically, they are not considered psychologists unless they continue on to complete the doctorate degree. While some psychologists conduct research, work in commercial settings, or have expertise in administering psychological testing/assessments, many psychologists offer “talk therapy”.
Therapist/Mental health counselor/Psychotherapist/Social worker
I imagine that some people will take issue with my description here but, largely, these titles are just about the same thing. These professionals have Master’s degrees in their respective fields but they all focus on mental health. Some might consider that a psychotherapist works with clients on deeper or more complex issues versus a counselor or therapist, who focus more on more transitory or less complex problems but that is just opinion. My master’s degree was from a mental health counseling program but I can still legitimately call myself a counselor, therapist or psychotherapist. A Master’s level social worker can also offer “talk therapy”, same as therapists, psychotherapists, and counselors, however, some social workers focus more on higher-level advocacy for societal problems such as poverty, racism, violence, child protection, etc. and work in government, agencies and hospitals. All of these professionals must pass state-level exams and meet other requirements to be licensed to offer therapy services.
Coaching
There are also individuals who offer support and advice on life problems, career work, financial issues or any other subject, who serve as coaches. Coaching is not a regulated industry, so there are no licenses with mandated education, training or licensing required, although there are many (optional) programs available. I am not saying that coaches are necessarily any less capable or effective than other professionals but they are subjected to less scrutiny in this sense. In the mental health world, some coaches specialize in life coaching, trauma coaching, stress coaching (you get the picture) but practitioners must be careful to ensure that they are not at risk of practicing counseling/therapy without a license.
Getting started
Well, let’s assume that, with the help of my blog about how to find a therapist, you have in fact found one. You should expect to fill out a fair bit of paperwork. A lot of the paperwork is similar to what you
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have to complete when you start with a new primary care doctor; you are asked to provide an extensive background of your health and the issue(s) that brought you for treatment, as well as giving your written informed consent to begin services. Most of the time, this informed consent form is likely pretty long because the document is supposed to fill you in on the therapist, their background, practices, information about all fees, reasons for services to be terminated, etc. While some of this information might seem boring, I suggest that a new client spend the time to review. It explains things like cancelation and missed session policies and what happens in the event of a failure to make timely payment. When I meet a new client, I review these issues verbally in the first session, as misunderstandings over these issues can damage the trust between therapist and client and is a big reason that therapy ends before goals are met.
As you read through this paperwork, take note of any questions or concerns. Perhaps you can address them in advance of the appointment or, if you prefer, you can ask the question during the first appointment itself. If you don’t like the answers, it makes it easier to move on to a new therapist. If you do decide that you do not want to continue working with this new therapist, it is completely your prerogative and you should feel no guilt about it. I would ask that you not set up an appointment and then ghost them, as many therapists do not get paid when you do that. You may, in fact, feel comfortable asking for a referral to another therapist who might be a better fit. It may seem awkward but therapists are obligated to offer referrals as appropriate.