10 Things Your Therapist Won't Tell You

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.

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.

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.