After the decision to seek therapy has been made, an individual may feel unsure about how to choose a therapist. People seeking therapy often find that they have no standards to use in evaluating potential therapists. There are many competent therapists practicing therapy using different approaches.
The purpose of this guide is to provide you with information that might be useful in selecting a cognitive-behavior therapist. No guideline can provide strict rules for selecting the best therapist for a particular individual. We can, however, suggest questions you might ask and areas of information you might want to cover with a cognitive-behavior therapist you are considering seeing before you make a final decision.
What Is Cognitive-Behavior Therapy
There is no single definition of cognitive-behavior therapy. Although some common points of view are shared by most cognitive-behavior therapists, there is wide diversity among those people who call themselves cognitive therapists, behavior therapists, or cognitive-behavior therapists. The therapists themselves may say they practice cognitive therapy, or behavior therapy, or cognitive-behavior therapy, or some other approach, all of which fall under the umbrella of CBT. The definition that follows is meant to give you a general idea of what cognitive-behavior therapy is. It is not, however, an absolute definition.
CBT is typically a short-term, problem-focused therapy that relies of scientific research. The focus is on the difficulties in the present, although in understanding these difficulties occasionally early life experiences are discussed. The goal of therapy is to teach the individuals to be their own therapists by providing strategies to evaluate their thinking and manage problematic behaviors. The emphasis is on providing you with the tools you need to make progress towards the goals you set.
Qualifications and Training Necessary for Particular Mental Health Professionals
Cognitive-behavior therapy can be done by a number of different mental health professionals. Competent cognitive-behavior therapists are trained in many different disciplines, and the distinction between different types of mental health professionals can sometimes be confusing. Therefore, we have listed below a brief description of the training received by different types of professionals who offer cognitive behavior therapy. Keep in mind that the emphasis on CBT during training will vary between the disciplines listed below.
Psychologists have doctoral degrees (Ph.D., Ed.D., Psy.D.) from graduate programs approved by the American Psychological Association and, soon, the Canadian Psychological Association. Clinical psychologists also have a one-year clinical internship, and one to two years of supervised postdoctoral experience is generally required to receive a license. Licensing or certification procedures vary and are the responsibility of state or provincial governing bodies.
Clinical Social Workers
A clinical social worker must have a college degree plus at least two years of graduate training in a program accredited by the Council on Social Work Education.
Certified social workers have a master's or doctoral degree in Social Work (MSW, DSW, or Ph.D.) from a program approved by the Council on Social Work Education, have had two years of post-degree experience in the practice of social work, and must have passed an examination given by the Academy of Certified Social Workers (ACSW). Licensing procedures vary from state to state and province to province.
A Psychiatrist must have a medical degree. Although, technically, an individual can practice psychiatry having had four years of medical school and a one-year medical internship, most psychiatrists continue their training in a five-year residency program in psychiatry. Psychiatrists who have Board certification have had two years of post-residency experience practicing psychiatry and must have passed an examination given by the American Board of Psychiatry and Neurology. But please note that the board certification for psychiatrists does not include any specifics about their training in or knowledge of CBT.
Professional counselors usually have master's (M.E.D., M.A.E., M.A., or M.S.), specialist (Ed.S.), or doctoral (Ph.D. or Ed.D.) degrees from an accredited university. Certified counselors typically have graduate training in counseling, and must have passed an examination given by the National Board of Certified Counselors. Licensing procedures vary from state to state and province to province.
Practical Information About the Training
The degrees and training described above give some sense of what is required to get that degree, but no information at all about how the therapists approach their clients or treat their clients' problems. That is covered a little below, but, it bears repeating: ask questions.
Practical Information About Therapists
You have the right to obtain the following information about any potential therapist. This information may be obtained from the referral person, over the phone with the therapist, or at your first visit with the therapist. Although you may not feel that all this information is relevant, you will need a substantial amount of it to evaluate whether a particular therapist would be good for you.
Your first session with a cognitive-behavioral therapist should always be a consultation. This session does not commit you to working with the therapist. The therapist will likely ask a number of questions to get a clear idea of the problem. The goals in the first session should be to find out whether this particular therapist is likely to be helpful to you and if you feel comfortable and confident with the therapist. During this session you may want to discuss the therapist's approach to treating you, your goals for treatment, possible timetables, and potential pitfalls to these goals.
Questions to Ask When Deciding on a Therapist
A cognitive-behavior therapist will devote the first few sessions to assessing the extent and causes of the concerns you have. Generally, your therapist will be asking quite specific questions about the concerns or problems causing you distress and about when and where these occur. As the assessment progresses, you can expect that you and your therapist will arrive at mutually agreeable goals for how you want to change. If you can't agree on the goals of therapy, you should consider finding another therapist.
The following are things you need to know about a prospective therapist:
Training and Qualifications
You should find out whether the individual therapist is licensed or certified by your state. If the person is not licensed or certified by your state or province, you may want to ask whether the person is being supervised by another mental health professional. Some clinicians will be certified in cognitive behavior therapy.
The emphasis on cognitive-behavior therapy varies within each discipline. As such, the amount of training or type of professional discipline will not provide information on the therapist's familiarity and experience with CBT. Therapists with a strong foundation in CBT will not mind being asked questions about their qualifications and will freely give you any professional information that you request. If a therapist does not answer your questions to your satisfaction, or refuses to answer your questions, you should consult another therapist.
Many people feel uncomfortable asking about fees. However, it is important information that a good therapist will be willing to give a potential client. The following are financial questions you may want to cover with a therapist. This information may be obtained over the phone or during your first visit. You will want to know:
- How much does the therapist charge per session?
- Does the therapist charge according to income (sliding scale)?
- Does the therapist charge for the initial session? (Since many therapists do charge for the initial session, you should get this information before your first visit.)
- Is there a policy concerning vacations and missed or canceled sessions? Is there a charge?
- Will your health insurance cover you if you see this therapist?
- Will the therapist want you to pay after each session, or will you be billed periodically?
The following are other questions you may want to ask a therapist:
- How many times a week will the therapist want to see you?
- How long will each session last?
- How long does the therapist expect treatment to last? (Some therapists only do time-limited therapy, whereas others set no such limits.)
- What are some of the treatment approaches likely to be used?
- Does the therapist accept phone calls at the office or at home?
- When your therapist is out of town or otherwise unavailable, is there someone else you can call if an emergency arises?
- Are there any limitations on confidentiality?
As Therapy Proceeds
Once the initial goals are decided upon, you can expect the therapist to discuss with you one or more approaches for helping you reach your goals. Central to cognitive behavior therapy is home-based work. Many other forms of therapy do not involve exercises between sessions but it is an important part of CBT. As CBT is a skills-based therapy, people will be required to practice these skills. This practice occurs at a pace that is individual to you. As you continue therapy, you can expect your therapist to consistently evaluate your progress toward the previously established goals. If you are not progressing, or if progress is too slow, your therapist will most likely suggest modifying or changing the treatment approach. At each of these points you may want to ask yourself the following questions:
- Do you understand what the therapist has asked you to do?
- Do the therapist's instructions seem relevant to your objectives?
- Do you believe that following these instructions is likely to help you make significant progress?
- Has the therapist given you a choice of alternative therapy approaches?
- Has the therapist explained possible side effects of the therapy?
What to Do If You Are Dissatisfied With Your Therapist
Talk With Your Therapist
People can feel angry or frustrated at times about their therapy. If you do, you should discuss these concerns, dissatisfactions, and questions with the therapist. A good therapist will be open to hearing them and discuss your dissatisfaction with you.
Get a Second Opinion
If you feel that the issues and problems you have raised with your therapist are not being resolved, you may want to consider asking for a consultation with another professional. Usually the therapist you are seeing can suggest someone you can consult. If your therapist objects to your consulting another professional, you should change to another therapist who will not object.
Consider Changing Therapists
Many people feel that it is never acceptable to change therapists once therapy has begun. This is simply not true. Good therapists realize that they might not be appropriate for every person.
The most important thing you need to ask yourself when deciding to continue with a particular therapist is, "Am I changing in the direction I want to change?" If you do not feel that you are improving, and if, after discussing this with your therapist, it does not appear likely to you that you will improve with this therapist, you should consult another therapist.
How to Get the Names of Cognitive-Behavior Therapists
If you don't already have the name of a therapist, you might try some of the following suggestions:
- Call us, the Association for Cognitive and Behavioral Therapies. ABCT is not a certifying organization, but ABCT provides lists of all full members by state and, in Canada, by province, including information on specialties and populations served. You might call persons listed to ask for a referral. Our referral is found at www.abct.org.
- Each state or province will have a list of mental health providers separated by discipline (e.g., social workers, clinical counselors, psychiatrists and psychologists). Many of these professional organizations have a referral service.
- Call the university psychology, social work, or medical school psychiatry departments in your area and ask for a referral. Ask to speak with someone in clinical or counseling psychology, or the chairperson of the department of psychiatry.
- Call your local community mental health clinic. The clinic may have a cognitive-behavior therapist on the staff or be able to give you a referral.
- Look in the National Register of Health Service Providers in Psychology, published by the Council of National Health Service Providers in Psychology, 1120 "G" Street, NW, Suite 330, Washington, DC 20005. Persons listed might be able to give you a referral.
- Look in the National Association of Social Workers Register of Clinical Social Workers published by the National Association of Social Workers, 750 1st Street, NE, Suite 700, Washington, DC 20002. Persons listed might be able to give you a referral.
- Ask for recommendations from your family physician, friends, and relatives.
- Look at the American Board of Professional Psychology (click on Cognitive and Behavioral Psychology). This can be found at www.abpp.org.
- Look at the Academy of Cognitive Therapy, which can be found at www.academyofct.org.
The Association for Behavioral and Cognitive Therapies is a professional, interdisciplinary organization concerned with enhancing the human condition through the scientific investigation and application of the principles of human behavior.
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