Looking for a Noodle Needle in the Haystack

(a.k.a. How to Find a Therapist)

With recent depictions of therapists in the media such as Good Will Hunting, The Sopranos and Analyze This, we've come a long way from the haunting images of a psychiatric ward in One Flew Over the Cuckoos Nest and the stereotypic silent psychoanalyst. Still, many of us continue to harbor the belief that seeking the help of a psychotherapist carries an element of shame and embarrassment, or that therapy for everyone else is okay, but an admission of weakness in ourselves. However, if you've been living in New York City for longer than six months, you've probably quickly assessed that having a shrink is as common place as having a hairdresser. In fact, in some circles, his/her location and fees may even be touted as a sign of status. Of course, there are more valuable reasons for seeking the expert help of a therapist, but even if you have thought about it, it can be even harder to find the appropriate one for you. Hence, the following information is intended as a quick "how-to" in therapist shopping, discussing when it's the right time to consider psychotherapy, the types of therapists available, considering insurance plans and payment options, and finally, identifying the right person.

But There's Nothing Wrong With Me!
People usually seek therapy when they discover a roadblock in their work or personal life that hasn't lifted after several months or years - not because they are inherently unstable or "screwed up." Having these roadblocks emerge is quite universal; if you've never experienced one, its likely that you may not have allowed yourself to recognize the roadblock as an emotional issue. Common reasons for seeking some type of counseling include longstanding feelings of mild depression or anxiety, patterns of disappointing or destructive relationships, and difficulty coping with everyday stressors (such as frequent conflicts with a boss or co-workers). Specific issues such as substance abuse, severe eating disorders, obsessive-compulsive disorders (hair-pulling, hand-washing), and difficulties in assessing reality can be more debilitating and dangerous, and thus, require a more tailored intervention. Regardless of the reason though, seeking professional help is an admirable act. "Outpatient" psychotherapy (seeing a professional in his/her office) will be the main focus of this article. "Inpatient Treatment" refers to problems requiring a safer environment, such as when the person is judged to be dangerous to themselves or others, or needs a secure setting for addiction treatment.

Are There Several Varieties?
After acknowledging the presence of the aforementioned roadblock, where to start? The term "psychotherapist" refers to anyone wishing to offer counseling, independent of background and training. It's very generic and doesn't necessarily tell you about the person's credentials. It's tantamount to calling someone an athlete without specifying whether he or she is a runner, rock-climber, or swimmer. Exercising with any of them would get you into good shape, but you might want to know beforehand so that you weren't hiring Lance Armstrong to train you for a marathon. Here is a short list differentiating the types of therapeutic athletes available:

Social Workers have a Masters degree in Social Work (MSW) from a two-year program and then earn state certification (CSW). Social Workers obtaining an "R" after their degree have completed several years of post-Masters supervised training and are recognized by insurance companies.

Psychologists have completed a four to six-year Doctoral degree (Ph.D., Psy.D., Ed.D.) in some sort of psychology program (e.g. Clinical, School, Counseling). Psychologists in private practice must be licensed by the state in which they work to legally use the title "Psychologist." There are other types of psychologists who study organizational and societal behavior, so the type of program completed is relevant. School psychologists often specialize in working with children and learning disorders.

Psychiatrists complete a four-year medical program and a three to four-year residency in Psychiatry. With the advent of a variety of safe medications, many new psychiatrists in the field specialize in pharmacological interventions. However, some psychiatrists provide psychotherapy to their patients as well, while others work in conjunction with the patient's chosen therapist, providing less frequent appointments for medication monitoring.

Psychoanalysts are mental health professionals who have completed a several-year post-doctoral training program including many hours of personal psychoanalysis and supervision. Psychoanalysts can be Psychiatrists, Psychologists, Social Workers, and at some training institutes other mental health professionals such as Psychiatric Nurses, and Art Therapists. Psychoanalysts receive the most extensive and intensive training in identifying and understanding longstanding personality issues that have interfered with one's present life.

Within all professions, clinicians can adhere to a variety of approaches as well. Some therapists focus primarily on changing dysfunctional behaviors or thoughts (Cognitive-Behavioral), while others focus on their patients' emotions within the context of their families and interpersonal contacts (Psychodynamic). Because no method is ever "pure," therapists may realistically practice some integration of approaches, but often professionals will identify themselves as working more closely from one particular framework than another.

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