Choosing a Counselor
Troy Todd, Ph.D., BCN
When deciding on the right counselor for you, the most basic thing to understand is their level of training. The better trained and/or the more appropriately trained they are, the more likely they are to be able to help you reach your goals. There are many degrees that can be used to provide counseling, here are the more common ones you will find:
BA or BS: Bachelor’s of Arts/Science in psychology: four years of undergraduate studies.
MA or MS: Masters of Arts/Science in counseling psychology, clinical psychology, educational psychology, etc.: two years of graduate studies after a Bachelor’s
MSC: Master of Science in Counseling
MSW: Masters degree in social work (required for advancement to an LCSW)
LCSW: Licensed Clinical Social Worker
MFT: Marriage and Family Therapist (study length typically that of a Masters degree)
LMFT: Licensed Marriage and Family Therapist
LMHC (LPC): Licensed Mental Health Counselor (Licensed Professional Counselor), typically requires a Masters degree
PsyD: a four-year doctor’s degree (a total of eight years of education, may have a Masters degree in addition) that may require the completion of a dissertation and focuses on clinical practice techniques.
Ph.D: a five-year doctor’s degree (a total of nine years of education, may have a Masters degree in addition) requiring the completion of a dissertation, focusing on the understanding and use of clinical theories and therapies, statistics, and research in helping people solve problems.
Psychiatrist: a medical doctor with additional training in psychotropic medications and the psychological disorders. Usually, they do not provide counseling.
Whatever the degree, a counselor is usually required to have a license to legally practice in a state. Licensing is a means by which the state attempts to protect the patient. Each state keeps record of the counselor’s license and any complaints filed by patients against them. You can verify a license and see actions taken by the state against the licensed counselor. To obtain a license, a counselor must have a degree that can be verified by the state and pass a test that asks questions about counseling to the level of their eduction. Often, licensing exams will have a section on the legal aspects of counseling (such as how to manage patients and records in a way commonly held to be correct). To maintain the license, the counselor must pay a fee every year and avoid having too many (the amount and type vary from state to state) complaints from patients. Since it requires some amount of discipline to obtain and maintain a license, the counselor with one in good standing shows some indication of professionalism.
As you consider which counselor to use, you should determine what insurance coverage you have for services. Every insurance policy is different, and it may provide different coverage based on the type of diagnosis being treated, or the method used to treat it. There will likely be a copay and/or limit to the number of sessions the policy will cover. The policy may also cover the treatment differently if you use an “in network” or “out of network” counselor. You will need to call your insurance company and ask them about these factors, and obtain a list of providers they will cover. Likely, these providers will be on the lower end of the education scale and they may be difficult to get into because they are being sent patients through your and other insurance companies. Some counselors work on a “fee-for-service” basis (meaning they do not take insurance, or they offer a “cash” rate). These counselors are trying to keep overhead low by not dealing with insurance companies (who often pay at a low rate and are unpredictable and slow to pay). Depending on your policy, you may be reimbursed for some or all of the expense of using one of these providers. This is another question to ask your insurance company.
There are several other factors you should consider to determine which will be the best value for your overall treatment. You can expect to pay anywhere from about $60 to $150 for a session depending on the cost of living where you live and the business model of the counselor. You might expect to pay less per session for counselors who have less years of education, but this is not always the case. Value is also determined by session length. Most counselors have sessions that last 45-50 minutes. Most will have a longer and more costly initial session. Although session cost and length are important factors to understand overall cost, the most important measure of value is how quickly your counselor can move towards your goals. Some goals, by their nature and severity, take more effort and time to achieve. Your forthcomingness and dedication to work are very significant factors in treatment length, and therefore, cost.
The competency of counselors vary greatly, which will likely require you to evaluate several of them. One excellent source of finding a good counselor is to ask your friends and other associates who they recommend. It is likely that some of them have used counselors for themselves or family members and do not typically bring this up in conversation. They will be able to help you understand the characteristics of the counselor they have used. Not every counselor is right for every person, so their experience may not directly relate to you, but they will at least have some good ideas of what to look for and what to look out for. When you are evaluating the counselor, call their office and, if possible, talk to the counselor directly. Assess them as if you are trying to hiring someone to perform critical work on something valuable to you and you want it done right in a reasonable amount of time. You will want to ask them basic questions such as, “do you treat (whatever problem you are trying to overcome)?” “Do you work with people (like me, e.g.: in the military, of a particular belief system, type of culture, age range, education level, etc.)?” “What are your rates?” and “What are your hours?” Although the answers to such questions are important, the way in which they answer them is more important. You will want to find someone who is confident and comfortable in working with people like you. As they provide these answers to you you will see that when a competent counselor talks about the characteristics of their patients that are similar to you, they will do so easily and be realistically confident regarding their success in treating them. You will also be able to notice the type of personality the counselor has, and be able to tell if their personality works well with yours.
When you think you have found a good match, schedule an appointment. Just the scheduling will provide an opportunity to assess how well the counselor is organized. If they can get you in quickly and are able to understand and accommodate your schedule, it may show they understand your lifestyle and have the means to meet your needs. When you meet with them, they will be trying to determine what resources you possess to achieve your goals. You should be doing the same. Notice if they are able to understand your situation readily (obviously, you have to be very honest with them: in counseling it is difficult for anyone to know what facts are necessary to solve the problem…do not hold information back from them or you will only delay your growth). Notice if they are flexible in their understanding of problems and are able to switch skillfully from one explanation to another as they determine what is applicable to you. Also notice how they are able to adjust to how you think and see the world. They should adjust their way of working to a way that makes you feel comfortable but challenged. They should also be very focused on achieving your goal, and able to keep your focused on the same. Early on, they should ask you what you want to achieve; watch for them to repeat it back to you, probably with their own insights. Expect them to accept you where you are; if you have an unusual way of looking at the world, expect them to accept that and not try to change your way of thinking (later, if they assess your “world view” keeps you from achieving your goals, they will respectfully challenge it). Also, notice how punctual they are for your appointment, and how organized they are as they treat you. Some counselors take longer than others to complete the initial assessment of you before beginning treatment. Some extend their initial session to accommodate all the information gathering they feel they need to do, others spread it across several sessions. The quicker they can gather what they need and provide you with useful intervention, the faster you can reach your goal. Their interaction with you should be comfortable and respectful, but driven towards achieving your goal; this may be experienced as “painful” or “difficult” but the pain or difficulty should be related to goal achievement. A good counselor is always asking questions or making comments for reasons related to your goal. If at any time you do not understand why a counselor said or asked something, ask them; a good counselor should accept your desire to understand and be able to explain what they are doing. If the counselor you are evaluating does not seem to be moving you to your goal or seems to lack understanding of your situation, you should seek another counselor immediately. Counselors understand that not every person they work with is a good match, and that these people will seek someone more appropriate for them. Stay focused on what you want to achieve and be willing to do what is necessary to meet your goals.