Choosing a mental health counselor or psychotherapist

The River Reporter
April 11, 1991

By THOMAS RUE

People from all walks of life and ages can benefit from mental health counseling. Some folks function just fine day by day, but seek counseling for personal growth or to find new insights. Others are burdened with serious or disabling emotional difficulties, perhaps the effect of abuse or trauma, that get in the way of a productive lifestyle. People seek counseling to ease their burdens and lead a more satisfying life. Counseling can be either voluntary, or court ordered if problems have led to significant legal involvements.

Adjustment to major life changes and normal processes -- such as school problems, a new romantic partner, birth of a child, marital communication problems, divorce, disease, or death of a loved one -- can all be easier to deal with if there is someone to talk to. Feelings of depression, anxiety, fear or rage may be uncomfortable, but it can be reassuring to discover such feelings are normal reactions to abnormal situations. Often, antidepressants or other medications are unnecessary, or even lead to further problems. Counseling may be sufficient.

Being a wise consumer
Choosing a professional counselor is not quite the same as buying an automobile or even selecting a dentist, but using wise consumer practices is sensible. Asking the right questions before you start counseling can save money, time, and pain.
In a 1985 survey of psychotherapists, Henry Grunenbaum, MD, a professor of psychiatry at Harvard Medical School, asked a group of psychiatrists, psychologists, counselors and social workers what they would look for in a therapist for themselves. The results reflect the preferences of a group of informed consumers. They wanted someone warm and sympathetic, who would talk instead of remaining silent. They looked for a therapist who would immediately respond to them as persons and sympathize with their problems, rather than make premature interpretations or draw attention to minor issues. Most respondents were willing to shop around for a therapist, but the more stress a person was under, the more likely she or he was to remain with the first therapist chosen even when that no longer seemed the best choice. Counseling services are provided by a variety of professional disciplines; most often by a person who has a masters degree or doctorate in counseling, psychology, social work, or a related field. A psychiatrist is a medical doctor with additional training in psychology. Only a physician can prescribe psychotropic medication. Some mental health services are covered by insurance companies. But in order to claim payment for such treatment, the professional will need to make a psychiatric diagnosis. Diagnostic categories are coded in a reference book published by the American Psychiatric Association, entitled Diagnostic and Statistical Manual of Mental Disorders. Very few insurance policies will pay for family therapy or counseling for "marital problems," "childhood or adolescent antisocial behavior" or similar non-medical descriptions. Too often, unscrupulous practitioners do not discuss the economic factors involved in diagnosis, in violation of the legal and ethical principle of informed consent, and a client's civil rights. If you are concerned about being given an inappropriate or damaging mental diagnosis, it may be advisable to pay for counseling without relying on third-party reimbursement. Another option would be to discuss with the counselor, what an agreeable diagnosis would be -- its precise clinical meaning, and how the proper treatment will help the condition -- prior to submitting an insurance claim.