What to Expect in Psychotherapy

I am overwhelmed.  What can I do?  Do I need to be in therapy?  How can I find someone to help me?’  These are questions many people will ask themselves at least once in their lifetime.  Often more questions arise as you try to access mental health services.  What exactly is a psychologist? How can I find one? Does my insurance cover psychotherapy or testing?  What can I expect during a first session?  What exactly is psychotherapy?  Below are answers to some of the more common questions, in hopes of guiding you through the mental health maze.

What is psychotherapy?  

Psychotherapy depends on the type of psychotherapy approach utilized, the reasons someone is coming in for psychotherapy, and their needs.  Generally, speaking psychotherapy is treatment that relies on a highly individualized process using verbal communication with a patient. Some people think psychotherapy is a place to vent with someone who is a neutral party.  Although this one small aspect of psychotherapy, it involves much more than simply talking or venting.  The psychotherapy process includes assessing, diagnosing, sometimes testing, and providing scientifically validated treatment.  Patients are treated to help them develop healthier patterns of emotions and behavior.  The process is collaborative and requires patients to be engaged and active in the process.  How long people remain in psychotherapy depends on the needs of the person.  Some people obtain psychotherapy treatment once in their lives. Others may obtain psychotherapy treatment on and off over the course of their lives. Depending on the setting and needs of the patient, you may be seen for a brief behavioral health consult for 15 minutes a handful of times – or for psychotherapy 45 minutes once a week, for weeks or months.

Do I need to be in psychotherapy?

There are times when friends, family and community can be a powerful source of comfort and support.  However, when your support system is not enough, or you have tried to help yourself without finding relief, psychotherapy is a useful way to make effective and healthy changes in your life. People often assume that only people with serious mental illness obtain psychotherapy treatment.  However, the vast majority of people in psychotherapy do not have a serious mental illness.  In fact, during any given year, one in four adults suffer from a mental health issue. One in 17 have a serious and persistent mental health issue.  People seek out psychotherapy for many reasons including anxiety, academic or work issues, family conflicts, medical illnesses, substance use disorders, stress, depression, or trauma and relationship challenges.  Many people choose individual or group psychotherapy to help them deal with various stressors in their lives.  Additional options include couples and family therapy.

What exactly is psychology?

Simply put, psychology focuses on the scientific study of the mind especially as it relates to behavior. Psychologists study the relationship between behavior and the brain and body, and the environment. The field is grounded in vigorous scientific research methods. Psychology focuses on concepts including, but not limited to, brain functioning, perception, cognition, personality, emotions and relationships. The field focuses not only on people’s mental health and medical issues, but also global issues ranging from prejudice reduction to healthy communities and businesses to global climate change.

What is a psychologist?

This is a question I am often asked given the various types of mental health professionals.  Psychologist’s expertise includes human behavior, assessments, diagnoses and treatment in a variety of ways.  They have doctoral degrees and are licensed in the state or jurisdiction they work in.  Psychologists spend an average of seven years in graduate school, after obtaining their undergraduate degrees.  Their focus of study depends on their specialty including but not limited to: psychotherapy theories and interventions, individual differences and lifespan development, bases of behaviors including cognition, emotions, biology, and culture, assessments, diagnostics, neuropsychology, research design, statistics. Additionally, psychologists engage in research in order to complete their masters thesis and doctoral dissertation.  Psychologists are also required to have a minimum of one additional year of supervised training after graduating from their doctoral programs. 

In addition to psychotherapy, they provide additional services depending on their specialty. For example neuropsychologists conduct intelligence, personality or provide specialized neuropsychological testing. You will find psychologists consulting for athletes, businesses, or provide expert testimony in forensic settings. Health psychologists help prevent or mitigate medical conditions or are administrators in medical  settings. Some psychologists work to make complex machines more user friendly and others focus on research and teaching. Others specialize in working with children or adolescents or families, communities, rehabilitation or school psychology.

Is psychotherapy confidential?

Psychotherapy is largely confidential, however, there are some exceptions which will be explained to you.  For example, a psychologist must break confidentiality if they suspect their patient is in immediate risk of hurting themselves or someone else, by drawing on resources in the community to help that patient.  If abuse or neglect is suspected towards a minor, they must report this to the New York State Child Protective Services.  Should you decide to use health insurance, your insurance company does access your information and/or contact your psychologist for information anytime they want – just as they do with your medical records.  In the past few years, insurance companies have been asking for personal health information more frequently, and in more detail.  During treatment you may decide you want the psychologist to be able to speak with someone else such as a physician or family member to help coordinate care.  In that case, you would fill out a form giving permission to do so. More detailed information about the limits of confidentiality will be given to you during your first visit.  

How can I find a psychologist?                                                                                                                                      A good way to find a psychologist is through word of mouth.  Asking friends or family is a great way to find someone who may be a good fit for you.  Contact your primary care physician, or other medical providers, and ask for specific names of professionals she or he has worked with can also be helpful.  Calling your local or state psychological association can be another good resource.  The Hudson Valley Psychological Association is our local psychological association and their website lists names of some psychologists in the area, as well as their specialties (www.hvpa.org).  The New York State Psychological Association has a referral service as well (www.nyspa.org). You can also find names of psychologists, and other mental health professionals, through your insurance company.  Once you have names, call to see who is available, and find out if they work with people who are dealing with similar situations as yourself.

Will my insurance cover the services?

Many insurance plans provide mental health benefits but it is always good to call your insurance company to find out. Most plans cover individual, group and family psychotherapy. Couple’s therapy is rarely covered.  Note all insurance plans purchased through the New York State of Health have to include some mental health coverage.  A trend occurring around the country is that more psychologists, similar to medical providers, are not accepting insurance. Your psychologist may not be part of your insurance plan. If that is the case, some insurance companies provide out of network benefits and you may be reimbursed for part of your psychologist’s fee, once you pay the psychologist their full fee. Some people choose not to use their insurance due to confidentiality, and pay out of pocket.  Some psychologists may offer sliding scale fees if you are paying out of pocket. This is where they base their fee on your income and circumstances.

What can I expect during an initial psychotherapy session?

Psychotherapy is one service a psychologist can offer. Anticipating an initial session can create anxiety.  Your psychologist will have you fill out paperwork initially and the first few sessions in particular involves information gathering.  You will be asked why you decided to obtain treatment as well as background information.  Questions will include relationship and work history, medical history, assessment of your symptoms and other psychological history, previous psychotherapy experiences, and questions regarding your cultural background and family to name a few.  This process, depending on the psychologist and the needs of the patient, is done formally or informally.  You will be provided with initial impressions by the psychologist and an outline of your treatment plan, usually within the first one to three sessions.  You can ask the psychologist the same questions you would ask your medical providers regarding their professional background, experience working with your issues, and any questions you have regarding the psychotherapy process.  As treatment progresses, it will look different for each person depending on the psychologist’s training and your needs. One thing to keep in mind is that psychotherapy requires patient engagement. In order for treatment to work you have to be engaged, or involved, in your treatment. You and the psychologist are both active participants, as opposed to you being the passive recipient of treatment. The more engaged you are, the more you will get out of the process.

Psychotherapy can seem daunting initially, however, many patients feel more comfortable once they have had their first session.  You are there to be heard, assessed, provided feedback and treatment so that you can work on ways to help you feel healthier overall. 

One in 4 people deals with mental health issues impacting them emotionally, cognitively, their relationships – and also medically. ‘Mind your Health’ by keeping mental health in the forefront.