Ask A Therapist: New to Therapy Q&A

In Ask a Therapist, our therapists answer questions about therapy, mental health, and healing practices. Today, Sam Allweiss, LCSW and Katie Tesensky Conn, LMFT go back to the basics to answer questions for anyone who might be new to therapy or interested in trying therapy for the first time. They answer first time therapy questions such as:

• How do you find a therapist?

• What do all those letters after a therapists’ name mean?

• How do I use insurance to go to therapy?

• What should I ask during a consultation?

• What are some different theoretical orientations or modalities therapists work with? How do I know which one to pick?

• Do I have to take medication if I’m in therapy?

• What does the therapeutic process look like?

Connect with Katie at Katie@RoomToBreatheChicago.Com.

Connect with Sam at Sam@RoomToBreatheChicago.Com.

Interested in having your question answered by our therapists? Submit your questions to us at yoga@roomtobreathechicago.com!

Interview transcript {edited for clarity}

Katie (she/her): Did we make it?

Sam (she/her): We made it!

Hi, Katie, it's good to see ya!

Katie: Hi, Samantha, good to see you as well!

Sam: So, we're here today to do a little bit of basic Q&A on what therapy is for folks who might be new to this process, because we recognize that there's a lot about this that can feel a bit daunting to get into, there's some different terminology that you might be seeing when you're looking up therapists on Psychology Today or other search sites, and so our aim today is to help make this feel as accessible as possible for folks.

So Katie, if you are open to doing a brief introduction about who you are in the Room to Breathe world…

Katie: Yeah.

Sam: And the type of work that you typically do, then we could jump into some questions I have for you.

Katie: Yes, absolutely. So, like Samantha said, my name is Katie. I am a therapist here at Room to Breathe. I have been here for many, many years, almost 10, which feels like I'm aging myself, but that is…that is very true.

I am a marriage and family therapist. So, the letters after my name are LMFT. We will get into that in a little bit, but…yeah, so I work with a lot of individuals, a lot of couples. And I supervise, uh, other clinicians, too, so I have been in the world of private practice for quite some time.

So, hopefully I can clear up, right, misconceptions and answer questions, and as you said, Samantha, make it a little bit easier for those who are new to the therapy world.

Sam: Fantastic, yeah.

Yeah, so I'll jump out some questions that I have, and then, you know, if folks who are listening to this, or listen to snippets of this, have any additional questions, we'll be sure to connect at the end with your email, my email as well, so folks could reach out to us, so we could always do a follow-up.

Katie: Yes, definitely.

Sam: The first question that I had for you, is where do therapists work? How do you…how do you find a therapist out in the world? And where do you go to look for someone if you're wanting to work with a therapist?

Katie: Yes, so there's a few different avenues that you can take. Obviously, Google searches are part of that process as well.

But I think for a lot of folks that we see that you can, um… and people want to go this route, like, go the insurance route, so they may look and may go to their insurance, ask for a referral that way, kind of look up online. There's also, though, different websites, like Psychology Today, that can be helpful in finding a therapist. Also, though, a lot of people can get referrals from other practitioners, like their primary care physician, different doctors that they work with, or just other people in kind of the wellness world, too. But I think there's a few different settings that you can go to to see a therapist. And I think that sometimes there can be, like, different understandings of what those settings are.

So, many outpatient therapists, outpatient meaning you're seeing a clinician, a therapist for the typical one-hour session each week, or every other week is typically in more of a private practice setting, or a group practice. Private practice is typically…one, maybe a couple clinicians, whereas a group practice is similar to what Room to Breathe is, where you have multiple clinicians that are working together.

Me being a couples therapist, I share a lot of clients with other people, too, which can be super helpful in taking more of a collaborative approach.

So that can be a good avenue to take if you are, again, just kind of looking for someone to meet with on a weekly basis.

Private practice also, too, a lot of folks will use insurance benefits to cover the cost for those services as well. For folks, though, that may not have insurance or don't want to use insurance, there's also, though, a community mental health setting can offer services, either, like, at a sliding scale rate, sometimes there are free services that are offered. It kind of just depends. But those can also be found, you know, through internet searches, Psychology Today. Things of that nature.

Hopefully that answered that question. Am I missing anything? I'm trying to…trying to think.

Sam: No, yeah, I don't think so. It's really helpful. Uh, another avenue I was thinking for folks is to ask if they're comfortable, people in their life.

Katie: Mm-hmm.

Sam: Who maybe have talked about going to therapy, because a lot of times those referrals can be really helpful if it's someone that, um, your friend has really benefited from working with. And then for group practices, too, what's helpful about that, maybe you don't want to see your friend's provider, but a lot of group practices have a certain model or ethos for practicing. At Room to Breathe, we have a lot of practitioners with a somatic focus lens.

Katie: Mm-hmm.

Sam: And so you could find a practitioner, likely, in that practice, or a therapist in that practice, who has a similar alignment to a therapist that your friend really benefits from working with.

Katie: Yes, definitely, definitely, because I think the word-of-mouth referral can be super helpful, and right, maybe you don't want to see the same person, or… or, you know, schedules don't align, things like that, but it can be nice to at least start off knowing, okay, this is a good, a good place to be, and then I can kind of find my fit that way. Because as you said, I mean, it's a daunting process, it's overwhelming. It… I mean, you wanna… make sure that you have the right, or find the right fit. And it sometimes takes a little bit of time and energy to do that, but obviously it's worthwhile… a worthwhile process to go through. So…

Sam: Yeah, absolutely. Yeah, thanks for answering that.

Along those lines, when looking for a therapist, I know a lot of times, uh, you can find a lot of letters next to a therapist's name. And I wonder if you could tell us - what do those mean? How can you figure out what the therapist's training or background is in if you're noticing a lot of those confusing acronyms.

Katie: Right, right, just basically an alphabet after their name.

Sam: Yes.

Katie: Yes, I mean, first and foremost, if you don't know, or if it looks like an un…I don't know, uncommon one, just ask. It is totally okay to ask, right? There are many different credentials and all types of things. So, right, first and foremost, just ask if you don't know.

But I will say, the main ones that are usually…that you're usually seeing are social work degree, um, counselor degree, doctoral-level clinician, and then marriage and family therapist.

So I will go through all those. So the social worker, fully licensed clinician, is going to be LCSW. Great, they have gone through a specific social work program. Um, they're fully licensed, so they have met certain clinical hours and have taken an exam. Great, okay.

Kind of same thing for each of these different licensure types. So, professional counselor, again, they have a background in counseling specifically, have gone… have sat through different, um…I think two exams, don't quote me on that. Um, but have passed certain markers so that they can, they can practice, too.

A doctoral, uh, level clinician, so that's typically your psychologist. That is going to be a… what, a PsyD, so P-S-Y-D, or a PhD. They have, again, gone through a doctoral-level program. If you need any type of testing done, those are the people that you want to go to, the psychologist.

And then..Who am I missing? Oh, the MFTs. Myself.

Sam: Yourself!

Katie: That is going to be LMFT, like I said earlier, so the licensed Marriage and Family Therapist. So that is going to be a clinician who has… who specializes in working with couples and families, also individuals too, but that licensure type tends to have, obviously, in the name, a much more focused, um, education and background on family systems, couple systems, things of that nature. Now, it doesn't mean that the other professions, other, um, licensure types can't work with couples and families, it's just kind of a different background.

So, I'm trying to think… there's also…so those are kind of the main…four, I guess you could say, of like, okay, if you were going to see a therapist, you want someone with those letters after their names. Or that, like, education.

And then, right, some of the other subsets of those things, specializations, I think that's where it can get a little confusing, quite honestly, because again, there's just lots of letters. Um, but like I said earlier, I mean ask the clinician if you don't know. Also, quick Google search can help, too. Um, particularly if you're looking for a specialization, say you want to, you know, work with someone who has a background in substance abuse or addictions, that's, again, a very specific certification. That one is CADC. Um, so you'd want someone who has that kind of certification.

But, again, it's…Those are the main four types of, um… licensure types that you would want to find, or want to have in a therapist.

Sam: Yeah, yeah, that's really helpful.

And the way I think about it is that oftentimes there's a little bit of a different orientation too, or, like, training, foundation of the training, but when folks are working in private practice, all of those who are licensed are trained to provide individual therapy. There are some folks who will provide group therapy and couples therapy in addition to the MFTs. But that's something that, an area of specialization, again, that they oftentimes get additional training and support in.

Katie: Mm-hmm. Mm-hmm, mm-hmm. Right, but typically any therapist that's gonna be, again, like, in an outpatient setting, to your point, has a background in working with individuals, right, in kind of, like I said, I mean, a therapeutic setting, but it's like, right, that's… that's the… bread and butter, if you will.

Sam: Yeah, yeah, absolutely. Thank you for that.

I know we touched on this question briefly, but I'd love to expand on it a little bit more. Can you tell me how I can use insurance to go to therapy? What happens if a therapist is out of network, and how much does therapy typically cost in each of these cases?

Katie: Yes, so… Therapy can be…again, for most people who have…health insurance, they do want to use those benefits to go see a therapist, and…majority of the time, therapy is a covered service by insurance. Obviously, you want to make sure, you know, talk to your insurance directly, you know, talk to the billing department of whatever practice you end up going with, just to double check everything. But…That is again, that's a way that people are using their health benefits to cover the cost. And a lot of times, insurance panels, insurance companies will have a network, what's called a network of providers that accept the insurance plan. Um, so that's kind of a first line of defense in, like, okay, I want to make sure that this practice that I'm interested in going to, and this provider that I want to see, this therapist I want to see, they are in network with my insurance, so I can use them, so I can see them and use my insurance benefits to cover the cost.

Because the cost of therapy can range, but typically if you're paying directly out of pocket, it can range from, like, 150 to 200-ish dollars per session. It can vary a little bit based on the clinician that you want to see, the therapist that you want to see, if you are going for couples or family therapy, group therapy is at a different cost too, but again…it's gonna be specific to what insurance plan you have. So, again, double check that, but… That is a way that people go to have the cost partially covered, and again, contact your insurance to get more information on what the specific benefits are.

Sam: Yeah, yeah. The one thing I'll add, too, is that folks who have HMO plans can have a harder time finding providers, so most private practices or group practices take PPO insurances, and most practices will do a free insurance verification for you as well, so if you submit your documentation, if you submit your insurance information, they should be able to run a verification uh, check as well, and then that will include what your copay is, which…would you say it's around, like, $20 to $30 on average for folks?

Katie: Yeah, I'd say maybe…yeah, maybe a little bit higher…I think…maybe, like, 40… it just, again, it just maybe depends…20, 40, somewhere around there, whatever… whatever, like, a typical copay would be that's, again, typically what it would be for an in-network therapist, too.

But to answer your question about the out-of-network therapist. And again, this is very plan-specific, um, but just because a therapist is out of network does not necessarily mean that you can't see them. You certainly can. Um, it just might be applied to then an out-of-network deductible, or you pay out-of-pocket up front, and then you can submit verification of, you know, that you saw that provider to the insurance company directly. It's a couple more steps, but my point is that there's still… again, if you find a therapist that you really click with, you really want to see, despite them being out of network, there's still ways to go about that too.

Sam: Beautiful, yeah, thank you for that.

I'm curious if your thoughts on how a client who's never been in therapy before should approach a consultation, to be clear, a consultation is what typically happens after you reach out to a clinician and say, hey, I'm interested in working with you. You'll typically get a free 10-15 minute phone consultation or Zoom consultation, so they get to know a little bit more about you. You can ask any questions of them.

What should I ask during a consultation?

Katie: Such a good question.

Sam: What should I be looking for if I've never done one before?

Katie: Yes, yes. I think…it's such a good question, because the fact of the matter is that shopping around for a therapist is a thing, and it's okay that it's a thing. It's, again, you want to make sure that you find someone that is a good fit, and that you feel comfortable talking to.

So I think a lot of times, these consultation calls are important because you want to kind of feel out how, again, what this person is like, how they communicate, but also if there are specific things that you want to talk about - hearing how they've worked with clients who are dealing with anxiety in the past, let's say, is helpful to know. Um…what, you know, how do they…how do they work with this? What are, kind of, perhaps some techniques that they use to help a person manage anxiety, cope with anxiety, um, if that's kind of part of the presenting issue.

I think it varies in terms of how…Um, it varies from person to person of…you know, if they want to know certain theoretical orientations and things like that, but certainly that's something to ask if that's important to you, if you want to know, okay, you come from a cognitive behavioral therapy lens, and that's what I want to help treat my anxiety. Okay, that would be something to…to ask about. I think trying to be, good general rule of thumb, trying to be a little prepared for these consultation calls with a couple questions is helpful, um, just to make sure that you're doing your own due diligence and getting what you want out of it.

Sam: Mhmm.

Katie: Because it is, you know, your time. You want to make sure it's worthwhile.

Sam: Yeah, yeah. I think you brought up something that we talk about a lot, but maybe isn't as… it doesn't make as much sense to other folks in terms of theoretical orientations.

Katie: Yes.

Sam: Can you talk a little bit what you mean by that, and maybe how folks could do their research when they're thinking about what theoretical orientations might be helpful for them.

Katie: Yes, definitely. So, theoretical orientation, it's kind of…it is when a therapist, like, kind of what frame of reference the therapist works from, I suppose is the best way to put it.

Sam: Yeah.

Katie: Um, there are lots of different schools of thought in terms of, right, again, how to treat anxiety, depression, things like that. I think a lot of people will, right, do a little bit of, like, research on their own to see, okay, right, what are some ways to treat anxiety? And things like that. So, they'll, they might have a little bit of knowledge going into a call, but might not know exactly how a therapist would, um, use different cognitive behavioral CBT tools.

So I… but again, it's gonna be different, as we were talking about the different licensure types, like, there are different…just different approaches to things. So, if you're wanting to know a little bit more of, again, I think a…the easier way to think about it is, like, what is a therapist's frame of reference? Like, that's a similar way of getting more information about their theoretical approach. Um, so that, again, might be a little bit more helpful to think about. Again, if you have a specific area that you want to focus on in your life, or what you want to get out of therapy.

But again, it's - a lot of therapists are…they pull from a few different theoretical approaches, or they have a few different frames of reference that they will use working with people. But again, that's part of why the consult calls are important, to see if you…if you like what they, you know, their approach, if it's gonna work for you or not. Hopefully that answers that question.

Sam: Yeah. Yeah, yeah, it's kind of hard to ground it, because it's something we talk about so much as therapists. Um, I tend to think about theoretical frameworks as, um, yeah, like you said, these specific ways of treating different conditions should be research… grounded in research and evidence-based. And the research tends to show us what sort of treatment modalities or theoretical frameworks will be helpful for certain conditions.

Katie: Yes.

Sam: Uh, there are certain frameworks that are helpful for people who have PTSD, post-traumatic stress disorder. So you want to make sure that a therapist is grounded in one of those to help you with moving forward, or pulls from a couple different modalities.

Katie: Mm-hmm.

Sam: I would say the main ones are, you know, and folks can do their own research on this, CBT, which you named, cognitive behavioral therapy, DBT, dialectical behavioral therapy, ACT, acceptance and commitment therapy, EMDR, I always mess up what the acronym stands for…

Katie: Eye movement, desensitization, and then repetition? E-M-D-R? I think…oh god, forgive us, I don't… I think that's what it is.

Sam: I know. I said it, and I was like, I actually don't know this one. Um, but it's about stimulating left brain, right brain connection for developing new neural pathways around trauma.

And then there's IFS internal family systems. So you could do your own research on these different frameworks, and see which one you tend to gravitate towards, or seem really…seems really interesting to you, because some of it is just working with what is interesting to you. They're all just different lenses into understanding human, humans and human psychology.

Katie: Absolutely. Right.

Sam: Um, yeah, yeah, so I have some clients who say, like, hey, I want to work specifically with this sort of therapist who specializes in this, because this, I really gravitate towards it. Another one is somatics, or folks who have specific SE or somatic experiencing training.

Katie: Right.

Sam: Um, and so you could get someone who specializes in that, in addition to the letters after their name, standing for the license that they have.

Katie: Yes, right, right.

Sam: So, there's a lot of different ways we can get into the weeds here, but hopefully that's some helpful background information that helps…

Katie: Yes. Yes. And again, like, tips to ask during a consultation call, too. I mean, I think the…ask as many questions as you can, and I mean it's true in that there's, you know, no silly question, because, right, you don't… you don't know, and you're trying to figure it out and explore, so, right, ask away.

Sam: Yeah, and I always say, working with a therapist is being in a relationship with another person, so also, do you like being in space with them? Do you like the way that they explain things? Does it make sense to you? Do they listen in a way that feels affirming to you? Are they interactive in a way that feels good? Do you want someone who's more, uh, active in a session, or someone who's a little more passive. So, it's also about, like, do you like their whole, uh, orientation to being a therapist? Do you like how they are in the session?

Katie: Right. I also think, too, just because… so say you have a good consultation call with them, you meet a couple times, and then you figure out, like, oh, I don't think this person is right for me. That is okay, too. That is information that, I mean, there's still other, again, right, therapists, orientations, like, there's other people that you can still, you know, talk to and move forward with. Just maybe it's not that one person, and that's okay.

Sam: Yeah. Awesome.

After someone goes through the consultation, say, I meet with you, we have a phone call, I really want to move forward to working with you, what happens next, and what sort of information do I have to give in order to start therapy?

Katie: Yeah, that's a good question. Because there is some paperwork, like typically intake forms that are required. Um, just as both from a, okay, what's your background, but also to - demographic information, and as we said, like, insurance information, and things like that.

So yeah, I mean, we… there’re forms that, right, you will need to complete prior to starting, um, but I think the biggest one is that intake form, um, where you are going into some additional detail about your background and why you want to go to therapy, why you want to start. But it's a form in which you can fill out, you know, to your comfort level too. You know, obviously, it is different talking to someone face-to-face versus just, you know, typing some… or, you know putting something into a form. But usually that…I mean it does help the therapist kind of get a good understanding of where you're coming from, what you would like to work on, certain goals that you may have for sessions too. Also okay if you don't know what goals you have, too. That's something that you can figure out with your therapist as well. So those first… I like to think of those first few sessions as part of the intake process and getting to know one another, um, so that, you know, you get a feel of who they are, and then, again, can kind of figure out what some of those treatment goals are moving forward.

Sam: Beautiful, yeah.

Do I have to take medication when I'm in therapy?

Katie: No. You don't. Some do, but also some don't. Also, therapists and psychologists cannot prescribe medication. So, I think just by nature of… of our work, we may have more anecdotal knowledge about medication, but we are not doctors, we don't have a background from the medication and, like, the medical standpoint. So, if medication… if a person wants to explore medication, they will need to see a psychiatrist or an advanced nurse practitioner, which… more letters after the name, unfortunately, but either an MD or someone with a…I think it's APRN. But someone who is qualified to prescribe medication, but lots of people take the medication, but also lots of people don't take medication. Just kind of depends on what works for each human.

Sam: Yeah, awesome.

Uh, the last question I have for you, I think, um, is a good way to wrap this up, um, wondering if you could talk a little bit about like, what progress in therapy looks like? Like, what should I expect when I go into therapy?

Katie: Yes, yes. Well, and I'm gonna give a little bit of a very therapist answer, progress can look different for every person. Um, but again, I think that's where the treatment goals that you kind of set with your therapist can be super helpful and be a good gauge of, okay, am I working towards these things? Am I seeing… am I seeing some change towards those? Or, I think this sometimes happens, that I'm realizing what brought me to therapy, like, got my foot in the door, but, oh, there are some other things that I also want to work on too. So it's not meant to be a moving goalpost, per se, but…um, progress, again, is going to look different for every person, but if you are feeling or seeing changes in your, you know, how you're thinking about things, certainly how you're feeling about, I don't know, certain situations, relationships, I don't know, interactions at work, things like that, I think that is a good gauge of, like, okay. Something's… something's shifting internally.

Also, though, if you aren't experiencing those things, too, it's not to say that therapy isn't working, maybe we just need… you need to talk to your therapist directly about it. And that's certainly okay to bring up, too, of, like, I don't know if I'm making the progress that I want to be making, because that at least gives the therapist an opportunity, and you an opportunity to reset, and maybe change things up and figure out where you need to go.

Sam: Well, Katie, thank you so much. If folks have any additional questions for you, how can they reach you?

Katie: Email would probably be the best, um, so it's Katie@RoomToBreatheChicago.Com and yeah, happy to help in any way that I can, even if it's finding a therapist or any of the…if people want more information about some of these questions, too. Happy to answer in a more thorough way.

Sam: Beautiful. Uh, and y'all can reach me at Samantha@RoomToBreatheChicago.Com.

Thanks, everyone. Thank you again, Katie. Have a great day.

Katie: Thank you, you too.