Selecting A Therapist

If you or a loved one are looking for a therapist, take the time you need to make an informed decision. Because therapy involves a commitment of time, money, and energy, it is essential that you feel confident about the therapist you select. Ask friends, relatives, or your primary care doctor for recommendations. Once with a professional, be sure to have all of your questions answered before entering a therapeutic relationship. As in any profession, there is a wide range of psychotherapists in practice. While most are competent and ethical, some are not.

Types of Therapists:
There are a variety of professionals who offer psychotherapy with varying levels of training. Marriage and Family Therapists (M.F.T.) and Clinical Social Workers (C.S.W.) have Master’s degrees and a more restricted range of practice than psychologists, who have doctoral degrees (Ph.D., Psy.D, or Ed.D). Psychiatrists (M.D.) are trained to prescribe medication. All therapists practicing independently should be licensed. You can verify licenses at the following agencies:

  • Board of Psychology: www.psychboard.ca.gov or call (916) 263-2382 to verify a license of a professional with a Ph.D., Psy.D., or Ed.D.
  • Medical Board: www.medbd.ca.gov or call (916) 263-2382 to verify a license of a professional with an M.D.
  • Board of Behavioral Sciences: www.bbs.ca.gov or call (916) 445-4933 to verify the license of an MFT, CSW, MSW.

Characteristics Most People Look For When Selecting a Therapist:

  1. Seems warm and accepting, but maintains clear and healthy boundaries.
  2. Is emotionally healthy; does not seem anxious, depressed, or arrogant.
  3. Is respectful and not condescending, belittling, or demeaning.
  4. Seems professional, competent, and knowledgeable.
  5. Accepts that clients are entitled to shop around for a therapist before they commit.
  6. Is willing to talk to you on the phone so you can interview them, and talks to you on the phone between sessions if necessary.
  7. Accepts that consultations or second opinions may be helpful during the course of therapy.
  8. Lets you explain your problems and does not try to prematurely fit you into a particular diagnostic box.
  9. Is active and engaged, answers most questions, does not avoid discussion, and can engage in ongoing dialogue and an authentic relationship.
  10. Is open to discussing progress and treatment plans. Listens to your assessment of what is helpful and what is not in the course of therapy and remains flexible.
  11. Has more than one clinical orientation and can fit his/her approach to your specific problems and does not impose only one approach on all clients.
  12. Presents you with clear office policies, including limits of confidentiality, client rights, etc. Read the informed consent contract carefully and ask any questions you may have before you sign.
  13. When therapy has not yielded significant results for a long time, neither blames you nor continues to take your money.

Managed care or fee-for-service?
When seeking psychotherapy, many people are confronted with the decision of whether to go through their insurance company to seek reimbursement for fees.

It is my general practice not to work directly with insurance companies. To protect my clients’ privacy, I do not submit insurance claims for my services and I do not belong to any insurance panels. The main reason why I decline insurance in my practice involves my commitment to keeping session content completely confidential. In order for my clients to benefit fully from therapy, I believe they must feel secure in knowing that what is revealed in session is held in strict confidence in perpetuity. However, managed care companies require their contracted therapists to disclose personal and sensitive client information to insurance personnel, most of whom are not medically qualified, to get authorization for sessions.

Going through managed care poses constraints on psychotherapy in that the length, type, and quality of treatment are compromised. By offering client-driven services on a fee-for-service basis, treatment in my practice remains in the control of the professional and the client, and it allows the freedom for me to work according to your actual needs. Self-pay gives you more control over your therapy without concern about limits of treatment or the need for authorizations for treatment.

Ideologically, my focus in my work is in stark contrast to the philosophy of managed care. Insurance companies require an overemphasis on pathology and diagnosis rather than a focus on health and connection. Managed care obligates clinicians to label everyone who walks in the office with a diagnosis in order to get reimbursed. This is not the way I choose to conceptualize clients or view treatment needs.

Furthermore, insurance panels are formed based on selecting providers who are willing to accept lower fees and not because they provide the highest level of care or possess a certain level of skill. You have less control in selecting a psychologist who would best meet your needs.

However, not all managed care companies are the same. Find out the facts and make an informed decision. Consider paying out of pocket for your psychotherapy as this option best assures that what you discuss in therapy remains private and keeps you and your doctor in control of your treatment. If you would like your insurance company to partly pay for a therapist, I recommend that you inquire whether you would be able to submit claims to your insurance company yourself using the statements I provide to you. However, this would only be possible if you have a PPO plan rather than an HMO.

Questions to ask your insurance provider:

  1. What is my coverage for mental health services, specifically CPT code 90806 (Outpatient Individual Psychotherapy)?
  2. What is the difference in reimbursement for mental health services from an in-network provider vs. an out-of-network provider?
  3. How would I look up a list of the in-network providers on my panel should I need to see a contracted provider?
  4. Will a percentage of the fee be reimbursed OR do I have a set co-pay OR is there a contracted dollar amount that is covered by insurance such that I am responsible for the remainder the fee regardless of how much it is?
  5. How many sessions are covered?

Be sure to calculate whether it would be more economical to see a therapist in-network or out-of-network. Considering the benefits of private treatment, it may be worth it to you to pay more out of pocket. Sometimes it can even cost less to see a therapist privately on a sliding scale than to go through insurance.

Whatever your decision, I would be happy to help you in whatever way I can, whether this be by providing therapy on a fee-for-service basis, providing you with monthly statements to submit to your insurance company, or by helping you find a preferred provider within your insurance plan.

For more information on managed care abuses, visit the National Coalition of Mental Health Providers and Consumers at www.thenationalcoalition.org or feel free to ask me for additional information.