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1) How do I choose the right therapist for me? 

There are lots of factors to consider when choosing a therapist. To make an informed decision, it's important to understand the credentials that follow a therapist's name. What level of education does the therapist have? Is the therapist licensed? The "L" before other letters refers to this (LPC=Licensed Professional Counselor; LMFC= Licensed Marriage and Family Counselor; LCSW= Licensed Clinical Social Worker... you get picture). Most therapists with these credentials have earned a 60 credit Master's degree (these are the letters "M.A. or M.S" that directly follow the therapists name), from an accredited learning institution, that included 2-3 internships. Psychologists typically have earned a Doctorate degree (a "Ph.D or Psy.D), use "Doctor" before their name to designate this, and write out "Licensed Psychologist" once they have obtained their license. Licensure by any type of therapist/counselor/clinician (the labels are used interchangeably) means that the clinician has completed a rigorous process, put forth by the state in which they practice. Licenses must be renewed every 2 years and continuing education (including a course on Ethics every 2 years) is required to maintain a license. Clinicians may not present themselves as "Licensed" if they are not; additionally, they should position their credentials, including their license number, where they can be easily seen by clients.

That being said, credentials are something you should understand but are only one factor to consider. Are there licensed therapists who aren't effective and unlicensed or pre-licensed therapists who consistently have positive outcomes? Absolutely! What the therapist specializes in and the treatment approach he or she uses are also things to consider, as well as the client population he or she typically serves. In my "Learn More About Me" page, I refer to "good fit" and the client/therapist relationship as being the most important factor in experiencing a positive treatment outcome. If the therapist you are considering offers a consultation, you should take advantage of this option, to get a feel for the therapist's style and personality and how it relates to your needs. 


Of course, cost is another factor that must be considered. Psychologists typically charge more for their services than do licensed Master's level therapists, but fees can vary greatly among all types of clinicians, even in the same area. All clinicians should take the time to explain their fees to you, before you start treatment with them,  or should have these clearly delineated on their website. Some therapists accept insurance plans, others only accept private pay, and some offer both options. Understanding your insurance coverage is important if you are seeking treatment and hoping your therapy is covered or if you are seeking reimbursement for these services. Mental health coverage is significantly different than medical coverage and you may be surprised by the limitations offered by  your insurance plan. You should also be aware that most health insurance plans typically require a DSM-V mental health diagnosis for them to pay or reimburse for services (note: "experiencing stressors" is not a mental health diagnosis!); additionally, most will not cover services from a clinician who does not hold a license. Please refer to Question 5 for more information about using your health insurance policy to cover your treatment versus using private pay.

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2) How will therapy help me? I have friends and family who love and support me and I've obviously been able to handle everything on my own...

Having the support and understanding of friends and family is a wonderful gift and nothing can replace this. However, their support can only take you so far--either they don't have the skills to help you, or they are wary of telling what they really think, for fear of hurting the relationship. Therapists have been specially trained and have a multitude of interventions and strategies to help you; additionally, they should provide you with the constructive feedback that is necessary for your growth (please note that "constructive feedback" does not mean judgmental comments that are damaging or unnecessary).   

While it is true that most people handle their stressors or difficult life circumstances on their own, "handling" them and overcoming those challenges in a way that allows you to feel confident and empowered are two different things. Most people who struggle emotionally or relationally find that the same issues keep recurring in their life or that they have certain patterns of behavior that limit them from reaching their potential or experiencing the satisfaction and joy they crave and deserve.

Engaging in therapy increases your self-awareness and develops your insight so you can break those patterns and responses that have not served you well. The goal of therapy is to provide clients with the tools they need to live a happier life--chances are, you are lacking in some areas that you may never develop if you don't engage in therapy. 

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3) What can I expect from therapy?

What you share with your therapist is confidential and privileged information, although there are certain conditions when the therapist is required to share information, or when the therapist feels that sharing some information with someone in your life would be helpful to your progress (don't worry though!--if this is the case, your therapist will need your signed consent to do this). During your first session, your therapist will explain these conditions to you, as well as provide you with some other details about therapy, during what is called the "informed consent" process. Sometimes, you will already have been provided with these items on a written agreement that you signed, prior to arriving to your first visit, but the clinician should always take time to review this document with you and make sure you understand it. This is the time to for you to ask questions --don't be shy and make sure you understand everything. Therapists understand that those new to therapy may have a lot of questions and no question is "too dumb" to be asked. It would not be unusual for the therapist to periodically review the document with you, especially if you are in long-term treatment. 

Therapy typically occurs on a weekly basis, although more frequent contact may be beneficial during periods of significant distress, and less frequent contact may occur as you prepare to terminate the process. 

You should also be aware that although most people who engage in therapy have very positive outcomes, the process itself can be distressing and painful, at times. This happens as you recollect and share painful memories and experiences from the past, or as you learn things about yourself you had not considered before. There may be times where you feel angry with your therapist, or times when you feel that you could never live without your therapist's support and insight. This is a normal part of the process because therapy is an active and dynamic process that changes over time. 

Lastly, you should understand that the therapeutic relationships is a very unique relationship. No matter how tightly you bond to your therapist--or he or she with you--this is not a friendship. Your therapist should not "friend" you on Face Book or accept invitations or gifts. This is because as soon as you become personal friends, your therapist loses the objectivity that is necessary for him or her to do the job. Don't be insulted. Don't be hurt. Don't take this personally--this is NOT a reflection of how much your therapist likes you--this IS a reflection of how much your therapist values you and your work together. Trust me, it can be just as difficult for your therapist to not cross that professional line, as it is for you!

Therapy should be a fulfilling and life-changing experience. If you find that you are not making the progress you would like or that you and your therapist aren't a good fit, you should consider a different clinician. We will not take this personally, either--what we all want is for you to live the life you want and deserve. Really.

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4) What can I expect if my adolescent child participates in therapy?

While most parents/guardians would love for therapists to tell them exactly what is going on with their child or what they are thinking and feeling, the truth is there are very strict parameters about this. In the state of PA, minors 14 years of age or older have the right to make their own mental health care decisions. This means that they can engage in therapy without their parents'/guardians' consent and the parent/guardian cannot revoke this privilege. It also means that 14+ year-old minors have the right to determine what and how much is shared with their parents/guardians (i.e., the level of confidentiality). Of course, this can be frustrating or distressing to parents/guardians, who are not only worried about their child but who also feel they have a right to know, as they are typically responsible for paying for the treatment. However, guarding this confidentiality is not only the law, it also has a very solid rationale. If adolescents thought that what they shared in therapy would be shared with the adult in their lives, how much would they actually share? This would present a barrier to the therapist and adolescent establishing the trust they need for therapy to be effective. To be clear, the therapist does have limits to confidentiality, as was explained above, and these will be discussed during the informed consent process. If your child was, or is, being hurt; if your child is hurting someone; or if your child is in danger of seriously hurting him or herself, this information would be disclosed to you. Some situations are clear-cut and some present a more murky picture (for example, self-harm without suicidal intent) and the therapist will use professional judgement in determining what is shared with you. In all cases, the therapist should be encouraging the adolescent to share information with their parents/guardians and to develop a deeper and more trusting relationship with them. When an adolescent participates in therapy, this often involves sessions with the parent/guardian (either alone, or with the adolescent).   

All of this can be challenging for the parents/guardians but please use the informed consent process to have all of your questions answered and please trust that the therapist has been trained, understands this age group, and has your child's mental health and best interest in mind.

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5) Why should I private pay if my therapist accepts my insurance? 

There are lots of good reasons to choose a therapist who accepts your insurance and pay for treatment this way. If you can't afford to pay for therapy out-of-pocket, you should absolutely find a therapist who accepts your insurance--especially if you are severely depressed or are having thoughts of self-harm. But there are some very good reasons to not use your insurance and privately  pay for therapy, instead. You can certainly Google this but I will summarize the best reasons, here: 

  • By using your health insurance, you will be limited to which therapist you can meet with and you may have to change therapists if your insurance changes.

  • As I've mentioned, insurance companies don't pay for therapy unless there is mental health diagnosis. Even if you don't meet "criteria" for a diagnosis, your therapist will have to give you one. And even though this is confidential information protected by HIPAA, it does become a permanent part of your private health record. Again, real life conditions such as life stress are typically not covered.

  • Mental health conditions (i.e., your diagnosis) are considered pre-existing conditions and may affect your ability to qualify for certain health plans, may increase your premiums, or limit your ability to qualify for some life insurance policies.

  • You will still be responsible for a copay, for meeting your deductible, and you are still ultimately responsible for the cost of your treatment. If you self-pay, you may use your HSA and have your treatment be tax deductible, and you may be able to submit your superbills/receipts as a medical deduction when you file your taxes.

  • In some cases, you will require a referral from your PCP for treatment and a coordination of care is required by some plans. You may not necessarily want your physician to know of your emotional or relational difficulties. 

  • Some insurance companies only provide coverage for certain types of encounters (as an example, they may not cover the therapist providing treatment outside of the office) and for specific types of interventions. Almost certainly, the number of sessions, the session frequency, and the duration of each session is mandated by the insurance plan. Most therapists who only accept private pay will work with you to meet your needs.

  • Therapists have much more time to devote to you and your process, when you private pay. Submitting claims can be a lengthy and tedious process (some things like treatment plans have to be created, updated  and provided, over and over) and still does not guarantee the therapist payment. 

  • And finally...research shows that clients who pay for their own treatment are more motivated and are more likely to have better treatment outcomes!

Question 5
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