If you re looking to start therapy, you know that a psychiatrist (an M.D. who can prescribe medication) or a psychologist (typically a Ph.D.) has probably mastered his discipline. But with many other confusingly labeled providers, you can t be so sure.

The fact that licensing requirements for therapists vary by state doesn t help matters. In New York, for example, psychoanalysts and family and marriage counselors in training are required to practice under supervision and pass an examination before launching into the profession. Sounds about right. But since the state recently revamped its regulations, many experienced therapists who trained under lessstringent guidelines were grandfathered into certification, via submission of an application and without ever taking the exam, according to Ruth Ochroch, past president of the New York State Psychological Association. And still, she says, the current regulations are inadequate. Some of these people will be a danger to the public because they won t be trained enough, Ochroch says. The term therapist is no longer legitimate.

Before picking a therapist, investigate the credentials of any candidate. Get referrals from your primary-care doctor, visit the websites of the American Psychological Association (www.apa.org) and the American Association for Marriage and Family Therapy (www.aamft.org), or check with a district branch of the American Psychiatric Association (listed at www.psych.org). To learn your state s requirements or the status of individual therapists, try your state s licensing and medical boards.

2. My fees are negotiable.

The more education a therapist has, the more he usually charges. In a comparison of fees by industry newsletter Psychotherapy Finances, marriage and family therapists charge around $60 to $90 per session; psychologists, $70 to $100 per session; and psychiatrists, $90 to $150 per session. Rates run even higher in pricey areas such as New York City. If you have only partial insurance coverage or pay outof- pocket, your bill can run pretty high.

What you might not know is that you can request a reduction in the rate. In fact, some practitioners see it as, well, therapeutic. Christine Ryan, a San Francisco editor, was seeing a therapist who disclosed, two years into treatment, that she would be raising rates. The therapist asked Ryan to think about the increased charge and discuss it later. The upshot: Ryan, who was considering increasing the frequency of her sessions, negotiated a break in the price hike to offset the cost of the added sessions. She approached it as a learning opportunity, says Ryan. And it really underscored that this was the right therapist for me.

Another way to save money is to find a therapist who offers a sliding scale of fees based on need or who charges lower rates for hard-to-fill time slots, such as midmorning and midafternoon. And if you re willing to consider a therapist-in-training, you ll really save on sessions. In New York City, for example, training clinics, like those at the William Alanson White Institute (www.wawhite .org) and the National Institute for the Psychotherapies (www.nipinst.org), offer low-cost psychoanalysis. Universities that offer postdoctoral programs in psychoanalysis are often another good resource for reduced rates.

3. I don t know anything about your condition.

If you re suffering from a particular problem, say, anxiety attacks, you ll want to see someone who takes a special interest in treating the problem. A diabetic wouldn t sign on with a lung specialist, right? Unfortunately, some therapists will take on all comers. Not every therapist is well trained in every disorder, says Richard Dana, a psychologist in Newton, Mass. Someone who is referred with obsessive-compulsive disorder may find that his therapist was not really trained in that area. According to Herbert Klein, editor and publisher of Psychotherapy Finances, many therapists lost substantial income during the 1990s, when businesses shifted to managed-care insurance. As a result, some practitioners don t feel they can afford to turn away patients.

Talk with your prospective therapist. For confidentiality reasons, he can t provide the names of clients as references. But you can describe your issues or symptoms and ask whether he has worked with patients like you before.

Therapy comes in many flavors. Among the classic approaches, cognitivebehavioral focuses on changing the patient s thought and behavior habits, while psychodynamic stresses the role of early and current relationships, often with an emphasis on the one between patient and therapist. Then there are the newer, less mainstream approaches. For example, Emotional Freedom Techniques stimulate the body s meridian points, as in acupuncture, and Eye Movement Desensitization and Reprocessing, often used to treat victims of trauma, uses objects waved in front of the eye to reduce stress.

Different problems need different techniques, says Tina Tessina, a psychotherapist in Long Beach, Calif. Before starting therapy, ask your provider about his methodology. It s also possible to set up an initial trial period anywhere from one to several sessions to see if a given therapist s approach suits you.

5. I m just a pawn to your insurance company.

Managed-care companies have clamped down relentlessly on psychotherapy, requiring extensive reporting by practitioners and a lot of time devoted to paperwork justifying treatment, says Daphne Stevens, a clinical social worker in Macon, Ga. What s more, patients tapping their insurance to pay for treatment generally sign a release at the outset giving the managed-care company the right to see their records and discuss aspects of their treatment with the therapist.

Several years ago, Stevens says, she started seeing a suicidal patient who was in the throes of an emotional crisis. After six months of therapy, the managed-care company started asking when I was going to wrap it up, she says. When she insisted that the patient still required treatment, the insurer said okay as long as Stevens checked in after every session. Finally, Stevens worked out a fee agreement that allowed the patient to pay out-of-pocket. A less-charitable therapist might have let a patient go untreated.

You can t do much about your managed-care company s access to your files, but you can discuss your concerns with your therapist and ask to see any correspondence he has with your care manager. At least you ll be able to know what s being said about you.

6. Our conversations aren t necessarily confidential.

If you think conversations between therapists and patients are always private, they re not. Court decisions have found that the confidentiality of records should be determined on a case-by-case basis. Should you end up in a court case in which you ve raised the issue of emotional health, your records can be subpoenaed by the other side. It s common in child-custody suits, for example. Those records can become part of the legal fodder if parents are divorcing, says Leah Klungness, a psychologist in Locust Valley, N.Y.

In addition, the federal Health Insurance Portability and Accountability Act, which was originally meant to safeguard patient privacy, was amended in April 2003 to remove a patient s right to give consent before certain covered entities i.e., providers, insurers, and health-information clearinghouses could access his medical records. As a result, confidential information about you can easily be disseminated without your ever knowing.

What to do? Ask to see what s in your records so you know what information could be passed on. While your therapist can t change what he has written, you can ask that he put in positive factors as well, such as your efforts to change.

Therapists generally receive some form of therapy themselves before treating patients. It is a requirement for becoming a practicing psychoanalyst, for instance. But that doesn t mean the person you see is necessarily a beacon of mental health. Some therapists may have their own set of emotional problems, which, in some cases, could interfere with successful therapy, says Los Angeles psychologist Yvonne Thomas. The real problems arise when a therapist has unresolved emotional issues and takes them out on you. One writer in Santa Fe, N.M., for example, recently saw a psychologist who, she says, came late to every session. When the patient finally called her on it, she says the therapist responded by angrily lashing out. She told me this is an issue she was trying to work on, and I had no right to criticize her for it, the writer says.

If you feel your therapist is behaving inappropriately, bring it up. Bottom line: A person should feel comfortable confronting the therapist and trying to have the problem improved, Dana says. If that can t happen, move on.

8. I m a drug pusher . . . and it pays.

Antidepressants and other psychotropic drugs have helped millions of people. But they re not right for everyone. Managedcare companies, however, encourage psychiatric consultations, in which patients are routinely prescribed drugs, in part because it s often cheaper than long-term therapy. Meanwhile, more psychologists are moving toward practicing psychiatry, in part because it s so profitable, says George Goldman, a psychologist in New York City. A psychiatrist can see a patient for 15 minutes, for what s essentially medication management, and get the same fee as a therapist that spends 50 minutes with a patient, Goldman says.

Your best move: Before you start working with a psychiatrist or psychopharmacologist, ask him to describe his philosophy about prescribing medication. If he suggests that you go on drugs, ask what the rationale is for the recommendation, how the two of you can monitor the treatment, and whether he has been pressured by insurers. If you don t feel comfortable with his answers, consider getting a second opinion.

9. I ll exaggerate your diagnosis to get you covered.

To qualify for insurance coverage, patients must be given a specific diagnosis, drawn from the Diagnostic and Statistical Manual of Mental Disorders, known as the DSM, published by the American Psychiatric Association. And since the level of coverage may depend on the diagnosis, therapists will sometimes assign a more serious condition when given two similar options because then there s the need for more therapy, Goldman says. Indeed, some states, such as California and Massachusetts, allow certain psychiatric disorders to receive a higher benefit level, which is generally assigned to medical visits. So [therapists] might give someone the diagnosis of panic disorder when the milder adjustment disorder with anxiety may also be appropriate, says Steven Sultanoff, a psychologist in Irvine, Calif.

But an exaggerated diagnosis can have negative implications as well. A diagnosis of depression, for example, could make it difficult to get disability insurance. To avoid diagnosis backlash, discuss the options before you begin therapy. Many practitioners are not inclined to put labels on their patients for a variety of therapeutic reasons but are forced to provide one before insurance companies will cover their services. Pay for your treatment out-of-pocket, and the need for any diagnosis and certainly for an inflated diagnosis may disappear.

10. I m going to drag this out as long as possible.

If your health plan doesn t impose treatment limits, you have more freedom to resolve your problems at your own pace. But you might also find your therapy goes on too long. Unless you have a serious problem, you should see some improvement within a few weeks and considerable headway in a couple of months, says psychotherapist Tina Tessina. At the same time, don t delude yourself that your last visit signals a cure for whatever sent you there. These tend to be chronic relapsing conditions, says Darrel Regier, executive director of the American Psychiatric Institute for Research and Education.

Discuss with your therapist how long your treatment is estimated to last. Then set up a schedule for evaluating your progress to determine if it should continue. If you feel things are dragging on without much progress, discuss your concerns with your therapist, and if you don t get a satisfactory answer, consider moving on.