Who does what
Psychologists, who hold a PhD or PsyD, licensed clinical social workers, licensed professional counselors and marriage and family therapists all provide talk therapy, and all are licensed by the state. Psychiatrists and psychiatric nurse practitioners are medical providers who prescribe medication and usually offer brief visits, not weekly therapy. Your primary care doctor can also prescribe the common medications for depression and anxiety.
Running the search
Start with your insurer's online directory and filter by location and specialty. Directories are notoriously out of date, so expect to contact eight or ten names in order to reach three with openings. Other good routes are a referral from your doctor, your employer's assistance program, and, for students, campus counseling. On a consultation call, cover the following.
- Ask whether they have experience with your particular problem and what approach they use for it.
- Ask whether they are in your network, what the fee per session is, and what they charge for a cancellation.
- Ask when they have a regular weekly opening, and whether sessions are in person or by video.
A therapist seen by video must generally be licensed in the state where you are physically sitting during the session.
What it costs
In network, you pay your plan's copay or coinsurance, often after the deductible. Federal parity law requires most plans to cover mental health care on terms comparable to medical care. Private-pay sessions commonly run from one hundred to two hundred fifty dollars. If your plan has out-of-network benefits, ask the therapist for a monthly itemized receipt, called a superbill, and submit it for partial reimbursement. If money is tight, ask about a sliding scale, and look at university training clinics and community mental health centers, where fees are low.
The first sessions
The first appointment is an intake: paperwork, your history, what brought you in and what you want to change. Sessions run about fifty minutes, usually weekly at the start. What you say is confidential, with narrow legal exceptions for imminent danger to yourself or someone else, abuse of a child or a vulnerable adult, and a court order. The quality of the working relationship is among the best predictors of whether therapy helps, so if you do not feel understood after three or so sessions, say so, and move on if nothing changes.
Note A waiting list is no place to sit out a crisis. If you are having thoughts of suicide while you search, call or text 988 at any hour.
