FAQs

Many professionals serve as psychotherapists, and it can be confusing to understand how their training and services differ. A clinical psychologist has a Ph.D. from a clinical psychology program, generally considered to be a strongly research-oriented program. This person will have conducted specialized research, produced a doctoral dissertation, and will also have a great deal of training in psychotherapy and psychological assessments. Other psychologists have Ph.D.’s awarded from counseling psychology programs or school psychology programs; in many cases these are quite similar to clinical psychology programs but they tend not to focus as strongly on research or on psychological testing and assessment. Still others have a Psy.D. degree, which is granted by a specialized psychological training institute (i.e., not a university) and focuses on clinical work to the near exclusion of research.

A psychiatrist, in contrast, becomes trained by going to medical school and therefore has an M.D. degree. In Texas, only an M.D. can prescribe medication. Some psychiatrists do conduct psychotherapy, but more and more, given the exploding array of pharmaceutical medications, many psychiatrists focus on medication prescription and management. It can often be very helpful for a client to work with both a psychologist (for therapy) and a psychiatrist (for medication).

Still other professionals provide psychotherapy. For example, a master’s degree in education, social work, or family therapy can provide the necessary training to become a licensed therapist (e.g., a Licensed Clinical Social Worker [LCSW] or Licensed Professional counselor [LPC]). Unlike psychologists, these professionals cannot do psychological testing and, unlike psychiatrists or other medical doctors, they cannot prescribe medications.

There is a great deal of research on this question, and the short answer is “yes”. According to the American Psychological Association (APA), psychotherapy has been shown to effectively decrease symptoms of depression and anxiety, as well as to reduce related symptoms such as pain and fatigue. In 1995 Consumer Reports conducted a large-scale survey to examine the effectiveness of psychotherapy as actually used in the real world. The results were striking: of the approximately 4,000 people who reported having seen a mental health professional (such as a psychologist), nearly all of them said they had gotten a lot better as a result. The study also showed that people improved more the longer they were able to remain in therapy, with improvement scores increasingly steadily from 1 month to 2 years. For more information, see the Surgeon General’s report on mental health.

There are many different therapeutic models and theories. One way of organizing all the diversity is to divide them into two main groups: the psychodynamic approaches and the cognitive-behavioral approaches (please note this is a very crude classification, and many approaches won’t fit neatly into either group). The earliest psychodynamic approach was that of Freud, but much has changed in more recent approaches (e.g., self psychology, Accelerated Experiential-Dynamic Psychotherapy). In general, psychodynamic therapies help by working through thoughts and feelings about the client’s relationships and experiences in life. A strong working alliance between therapist and client is considered to be critically important. In contrast, cognitive-behavioral approaches work by targeting ongoing symptoms, using a variety of techniques to develop more flexible and satisfying solutions. Here again, the alliance between therapist and client is very important, but less to mediate the working through of problems than to enhance client motivation and treatment success. Both types of approaches are valuable, and being able to use both allows great flexibility in the treatment process.

Part of your choice may depend on your preference for a particular therapeutic approach or for a professional with a particular set of training experiences and/or degree(s). Other concerns that may be important in making your choice include the degree of experience the therapist has with your particular concerns, the length of time they typically see their clients, and whether they have ever been reprimanded by their licensing board. Practical considerations are also very important, including scheduling availability, location, and fees. All that said, probably the most important thing is that you sense you can establish a strong working alliance with your therapist. Usually it is possible to get a feel for this fairly quickly by talking with and/or meeting the therapist face-to-face.

Usually therapists meet with their clients once a week. Depending on the intensity of a client’s symptoms and distress, it may make sense to meet more frequently for a period of time. Meeting less than once a week is usually not recommended except when the therapeutic work is winding down. The reason for this is that meeting less can make it very difficult to establish momentum and create a strong therapeutic alliance. That said, however, in some circumstances it may work just fine to meet less often; this is a decision best made on a case-by-case basis.

Many insurance plans do provide coverage for a limited number of psychotherapy sessions (20/year is a common limit) and some psychological testing. You should know, however, that to do so they require the disclosure of personal information about you (e.g., your diagnosis). Although they claim to keep this information confidential, it becomes part of the insurance company files and is probably stored in a computer. Mental health professionals have no control over this information once it is provided to the company. I am not currently on any insurance panels, but you may be able to recoup some of the costs of therapy by using your out-of-network benefits. Of course, by paying for your services privately, you avoid all difficulties associated with insurance plans.