Everything You've Always Wanted to Know About Therapy but Were Afraid to Ask

You’ve heard about the benefits of talk therapy and behavioral health services and have considered giving it a try, but you’re a little uncertain about how to get started. From finding the right therapist and arranging payment to ensuring that your privacy is protected, there’s a lot to think about before your first visit. To help ease you into the process, we asked some industry professionals to field some of the most common questions.

Does insurance cover therapy?

Generally speaking, most insurance policies do cover therapy – but the reality is, it depends. "Insurance plans are typically scaled at different levels," explains Julie Frischkorn, L.C.S.W., Spark360’s director of behavioral health and mindfulness. "Some levels cover mental health and some do not." 

Frischkorn says to always call the number on the back of your health insurance card before your first meeting with a therapist to check to see if your plan covers mental health, the person you are planning to meet with is "in-network" with your insurance plan and whether you are covered for only a certain number of sessions or for unlimited sessions.

Clinical psychologist Aviva Gaskill, Ph.D., points out that while therapy may be covered by insurance, people often have high deductibles for out-of-network or sometimes even in-network services. "You will need to meet your deductible before insurance payment covers the cost of these services," she notes.

What is the best way to find a good therapist?

Frischkorn recommends seeking word-of-mouth recommendations from friends or family members. Another option is to look for a provider on PsychologyToday.com. "This is an excellent list of therapists, psychiatrists and groups all over the U.S.," she says. "You can refine your search by location, gender, insurances accepted, presenting concern, modality of therapy and other factors."

Once you’ve chosen a potential provider, Gaskill suggests having an initial conversation to ensure that you feel relatively comfortable discussing your problems with the therapist and that you feel he or she can move you in the right direction toward improvement.

What should I expect from my first session?

According to marriage and family therapist Lisa Bahar, initial sessions are called assessments. These are devoted to building rapport, identifying goals and steps to meet those goals, and determining whether there is a need for an additional resource, such as a nutritionist, psychiatrist, 12-step meetings or recovery meetings, couples therapy or other approaches. From there, the therapist creates a treatment plan based on their style and approach. 
Other items reviewed during the assessment might include follow-up sessions, policies, mandated reporting, licenses and any clarification on paperwork.

"Don’t expect to have firm solutions or change in the first couple of sessions," notes Stephanie Wijkstrom, M.S., founder and psychotherapist at The Counseling and Wellness Center of Pittsburgh. "[Initial sessions] are really exploratory, as the counselor comes to understand what is happening for you and in your life."

Frischkorn points out that you can always ask a therapist before arriving at your first appointment, "What can I expect from our first session?" This is a common question and may calm any nerves you have about your initial meeting.

How do I know that a therapist can really help with my problem? 

Trusting someone that you have just met is a practice in courage, notes Frischkorn. "If you are feeling hesitant, it may be helpful to ask your therapist about their areas of expertise and how they practice," she says. Frischkorn recommends meeting with a therapist at least three times before deciding whether it is the right fit.

Wijkstrom says to regularly monitor whether you feel the therapist listens, makes you feel understood and challenges you after getting to know you. "Of course, it’s also important to look for someone who specializes in the kind of treatment you are seeking," she notes. "While depression and anxiety are generally well-managed by all therapists, other focuses such as OCD, marriage counseling or personality disorders often require a specialist."
How long does therapy last? How do I know when I’m "finished"?

There is no simple answer to how long therapy takes, notes Karen R. Koenig, M.Ed, L.C.S.W. "Some people have long-standing issues that can take months to years to resolve," she points out. "With more straightforward issues, they can take a few weeks to several months."

Koenig tells her clients to think about being finished "for now," and to be open to returning whenever they feel a need. Some of her clients leave therapy after a substantial period of time, and then return after a year or two.
"If you have had a lot of trauma, or a psychiatric or personality disorder, you should expect a longer duration of treatment," says Wijkstrom. "Brief, solution-focused counseling is typical if you are managing grief or a situational difficulty."

Frischkorn likens therapy to a gift of time that you give to yourself.  "Therapy is the mental and emotional equivalent of going to the gym to improve your physical body," she says. "The more you go, the stronger and healthier you will feel."

Can a therapist share what I say during our sessions?

Whatever you choose to share with your therapist is confidential, with a few major exceptions, notes Frischkorn. "Therapists are bound by law to disclose if you have an active plan to kill yourself, an active plan to take the life of another person or if a child is in danger," she explains. All of this should be covered in the initial paperwork.

Frischkorn adds that you should be given an initial HIPAA notification letting you know that your records in psychotherapy are protected, just as they would be with any other health professional. They will also let you know how and when they disclose your information for insurance purposes. 

What are the main differences between various types of therapists?

According to Gaskill, the differences are as follows:
  • A psychologist has either a doctorate of philosophy in psychology (Ph.D.) or a doctorate of psychology (Psy.D.). They have typically had at least five years of graduate-level training and hold the title of "doctor." In most states, they cannot prescribe medication, though some have prescription rights in certain states with additional training. 
  • A psychiatrist has a doctorate in medicine (M.D.) or a doctorate of osteopathy (D.O.). They can prescribe medications and some also provide talk therapy. They have at least four years of medical school training, plus at least four years of residency, depending on the type of psychiatry they practice and whether or not they are boarded in additional practices of medicine and are also considered doctors.
  • A licensed marriage and family therapist has two to three years of graduate training.
  • A master of social work (M.S.W.) has two years of graduate training, plus additional supervised training work with clients to become a C.S.W. or an L.C.S.W.
  • A licensed professional counselor (L.P.C.) receives one to two years of graduate training, as well as supervised clinical experience.
  • A doctor of social work has significantly more training than an M.S.W.

What can I do if my insurance doesn’t cover therapy and I can’t afford to pay?

Frischkorn suggests asking your therapist if they have sliding scale options. Another option is to visit a community mental health clinic that typically provides services free of cost, or to use a telehealth site like Talkspace that provides access to therapists online or over the phone at a reduced rate. Students can also make use of their local university counseling centers.