How to choose a Therapist or Life Coach?

It can be hard choosing.  LPCC?  Psychiatrist?  MFT?  Life Coach?  

Therapists:  First of all, the distinguishing feature of any licensed therapist is that they are legally allowed to diagnose and treat mental disorders, as defined by the Diagnostic and Statistical Manual (DSM).  Approaches to treatment vary a great deal, as there is no requirement for any therapist to work in any particular way, as long as they are working in a professionally recognized treatment method, but there are many.

Unfortunately, the license type does not tell you what method(s) the therapist works with, or how effective they are.  In general, however, here are some distinctions: MFT’s are trained as relationship specialists, LPCC’s counsel individuals, LCSW have training in social work, psychologists often do testing and frequently are involved in research, and psychiatrists (MD’s) are the only professional group in California who prescribe medication. Often, that's all they do.

What’s a Coach?  While many therapists include coaching (guidance and support in attaining future goals) as part of what they offer, coaches do not do therapy….that is, they do not (legally) treat mental disorders.  (One wonders, however, that since they are not trained to diagnose, how they know a person doesn't have a mental disorder?) While therapists can treat mental disorders as well as helping people with personal growth, or working toward excellence, coaches claim only to work with personal future growth. Life coaches often distinguish themselves as focused on the future, vs. healing the past.

What “consumer protection” is there?  The purpose of a license is consumer protection. Earning a license requires fulfilling many very specific educational requirements, qualified training, many supervised hours of pre-licensed practice, and on-going accredited continuing education, as defined by California legal code, all for the purpose of increasing the likelihood that therapists will be safe for people in a vulnerable position.  The law is not fool-proof. Unfortunately, some disturbed or manipulative or unscrupulous people occasionally get through the screening process. But, at least there is some training and screening to ensure that the overwhelming majority of therapists are trustworthy.

On the other hand, there is NO screening whatsoever, for Life Coaches and NO regulation. Try googling “Life Coach training” and you’ll get pages of training “institutes” who grant certificates. It is a huge business right now, and basically, anyone can get certified with no tested skill or knowledge. Some of these schools ("for profit" businesses) offer a certificate for as little as 3 on-line hours. Most importantly, there is NO “screening” for safety.

Safety  As a consumer of therapy or coaching, you are in a vulnerable position. You want to be sure the person you are working with has been trained not to take advantage of that, or make mistakes out of ignorance or self-interest.

So, how to choose? Carefully review your potential therapist’s or coach’s background, training and experience. Is he/she just a great salesperson (as many coaches are), or does his/her track record indicate he is both good at what he does and safe.

Most importantly, if after a few sessions, things don’t feel right, he/she should be willing to talk with you about what doesn’t feel right. If it feels like he/she is again trying to “sell” or pressure you, as opposed to addressing and making well your concerns, it might be time to move on.

A word about Insurance   Most insurance companies specify that their benefits are for “medically necessary” treatment, as defined by the DSM.  Therefore, if you want insurance coverage, you will receive a mental disorder diagnosis. This did not happen before the inception of “managed care” in the 1980’s, and is a huge factor in the misconception that therapists only work with mentally ill people.  The burgeoning growth of the Life Coaching industry, in large part, is due to their encouragement of this misconception. What is true, is that if you want to work with a licensed therapist who offers personal growth work, and you do not have a diagnosis, you will have to pay out-of-pocket (as you will with a coach).

I'm really excited about getting published in The Therapist next month, the bi-monthly magazine of the California Association of Marriage and Family Therapists. The article is entitled, "Build you Private Practice with Group Psychotherapy." I wrote it because I want to encourage more therapists to lead therapy groups. Group psychotherapy is the BEST theapy for many who want to improve relationships.

I wrote one article on this blog more than a year ago. Since then, I have completed my two year long study of the brain (At the Psychoanalytic Institute of Northern California) and I am now ending my year long training at the Sensorimotor Psychothotherapy Institute. I've been busy updating knowledge and skills! Now it is time to learn more about blogging and sharing some important things with you.

In the coming weeks and months I intend to write about anxiety, panic and trauma (my practice focus) and answer questions that might come my way about these things.

I also intend to write about the incredible benefits of group psycotherapy, for those who want to feel more confident with people and have better relationships. By that, I mean closer, more intimate personal relationships and more effective and productive relationships at work. More soon!

The High Cost of Therapy

I got a fascinating question from someone on my answering machine recently: Can you refer me to a therapist in a "lower income bracket"? The question erroneously assumes I am in a high income bracket! This led to some thoughts that I'd like to share with you about a common misconception that therapists make a lot of money. I know first-hand about this misconception, because I once had it, as a young person in therapy, unaware of all the “behind-the-scenes” work involved.

Many would be shocked to know that for every 45 – 50 minute clinical hour, I need to spend about up to two (sixty minute) unpaid hours (sometimes more) on related tasks. And, expenses run 40 to 50 cents for every dollar received!

Consultation
So what does all this time consist of? Good, effective and ethical therapists rarely work in isolation. When a therapist consults with others, a patient/client’s case benefits from the professional input of a number of perspectives. I have one senior therapist I consult with bi-weekly, and three other peer therapists I meet with on alternative weeks. This consumes 2 - 3 hours per week, and costs about $225 per month.

Education and Training
Here’s an example of on-going training expenses: I just returned from a trip to Washington DC where I attended the American Group Psychotherapy Association’s annual conference. That ran just under $2,000 total, but my group therapy clients benefit from all that I learned. I’ll also be attending the annual 3 day Northern California Group Psychotherapy Conference at Assilomar soon.

Then there’s the semester long PINC (Psychoanalytic Institute of Northern California) Neuroscience class I’m taking. The fee was $600 and requires me to travel back and forth to the UC Berkeley campus, adding another $10 per trip for gas, parking and bridge fare. But, what I’m learning about recent discoveries on how the brain works is an invaluable biological foundation for both the psychodynamic and cognitive-behavioral work I do with patient/clients.

What other activities take up my time?
In addition to consultation and training, I spend hours on case management, writing clinical notes and case formulations, filling out insurance forms, trying to get through to insurance companies on the phone for checks that never come, looking up information for, and talking to clients on the phone, reading, writing and studying, volunteer activities (like mentoring junior therapists and serving on the boards of my professional associations) bookkeeping and marketing, including keeping up a web site (www.sanfranciscotherapist.info) and this blog.

What are the other expenses?
Everyone knows the high cost of living in San Francisco. Office rental, utilities and services are no exception. Therapists also have to pay fees for their license, liability insurance, professional memberships, books, supplies, on-line services, furniture, electronic equipment and more.

Another huge expense is the discount I am obligated to take (up to 50%) whenever I accept a managed care insurance case. And often, I reduce my fee for those who pay directly and can not afford to pay my full fee.

It’s worth it!
Now you know a bit about the background work and how relatively little many therapists in private practice “take home.” In fact, most therapists I know, can’t really make it in San Francisco without a second source of income, such as from a spouse, a second job, a pension, or some other additional source.

But you should also know, not for a moment am I complaining. I am reminded of how lucky I am to be doing rewarding work every time I see a client move through their difficulties and discover how to live without debilitating depression or anxiety. I feel honored to be sharing in a process that helps a young person begin to find their genuine self and feel their aliveness. I feel deep gratitude for my profession, whenever I see people in group therapy learning new and effective ways of relating and learning to appreciate themselves. As far as I’m concerned, all these things are worth the high cost (to me, as well as to you) of therapy!

Barbara Elbl, MFT, CGP (Licensed Marriage and Family Therapist & Certified Group Psychotherapist) provides individual and group psychotherapy in San Francisco for anxiety, panic, depression and relationship problems.