Who does what
The titles are confusing, so here is the map. A psychiatrist is a medical doctor who diagnoses and prescribes. A psychologist holds a doctorate and provides therapy and formal testing. Licensed clinical social workers, professional counselors, and marriage and family therapists hold master's degrees and provide most of the talk therapy in the country.
Finding someone and paying
Begin with your insurer's directory, filtered for in-network providers, and expect to contact five or more before one has an opening. A federal parity law requires most health plans to cover mental health on terms no stricter than medical care, so copays should look similar. Without insurance, a session commonly costs one to two hundred dollars. The cheaper routes are real:
- Many therapists hold sliding-scale slots, and you have to ask for them.
- Community mental health centers and university training clinics charge by income.
- Campus counseling is usually free to students.
- An employee assistance program at work typically offers several free, confidential sessions.
If you are on a parent's plan, the statements may be mailed to the policyholder, and you can ask the insurer to send yours to you instead.
What to expect
The first session is an intake covering history, goals and logistics. Fit with the therapist predicts results better than the method does, so it is normal to switch after two or three sessions if it is not working. Cognitive behavioral therapy, the most studied approach for anxiety and depression, is structured and often runs twelve to twenty sessions. Antidepressants usually take four to six weeks to show their full effect, and they should never be stopped abruptly without the prescriber's guidance.
When to go
Seek help when low mood or loss of interest lasts most days for two weeks, when worry interferes with work, school or relationships, when sleep or appetite changes sharply, or when you are drinking to cope. Sleep, movement, daylight and time with people are the foundation, but they are not a substitute for treatment.
If you or someone near you is thinking about suicide, call or text 988, the Suicide and Crisis Lifeline, at any hour, and call 911 if the danger is immediate. Asking a friend directly whether they are considering suicide does not plant the idea.
Note Write down what you want to say before a first appointment, including symptoms, how long they have lasted and any family history, because minds go blank in waiting rooms.
