Potential clients reaching out to me and my fellow therapists have been wondering how to decide whether they need professional help. They also often ask what kind of help would be appropriate and where to find it, especially if they have limited resources. Here is some guidance.
How do I know if I need assistance?
Negative emotions are a natural part of human existence — during a pandemic or otherwise — and are best accepted as such. Social support, exercise, mindfulness and engaging in relaxing and pleasurable activities can sometimes help you maintain emotional balance. But if you have tried these measures and your anxiety, sadness or anger remain so high they affect important parts of your life, it might be time to turn to therapy or medication to help you cope.
You should consider professional help if you are: feeling anxious, tense or angry all the time; unable to relax or take your mind off your worries; experiencing panic attacks; or having difficulty sleeping, concentrating, interacting with others or getting things done.
If you can’t enjoy anything and are feeling depressed and tired most of the time, that could be a sign of clinical depression. Other signs include a change in sleeping and eating patterns; frequent crying; feelings of hopelessness, guilt and shame; difficulty making decisions and focusing; and self-harming or suicidal thoughts and behaviors. Depressed people often have a hard time accomplishing their work and socializing with others (given physical distancing, this might mean withdrawing from your household members or avoiding all virtual interactions).
Children, too, might need help coping given their dramatically changed schedules, increased isolation and home schooling. “It is natural for them to be more emotional, worried, sad or clingy,” said Sandra Pimentel, the chief of child and adolescent psychology at Montefiore Medical Center at the Albert Einstein College of Medicine. “Even more tantrums are completely normal.”
Red flags that parents should watch for include a significant change in behavior, severe sleep problems, complete social isolation, persistent separation fears or low mood, or preoccupation with death and dying, according to Pimentel. If you observe these issues in your child, reach out to a professional who can assess what is going on and decide whether therapy or medications are needed.
How can therapy or medication help?
Therapy offers a chance to speak confidentially to a professional about what you are dealing with and what you would like to get help for. Good therapists establish a collaborative, compassionate and authentic relationship with clients and make them feel heard and understood. They also “help clients step back and figure out why they are struggling and why their life is not working as well as it could be,” said Marvin Goldfried, a professor of clinical psychology at Stony Brook University.
Goldfried explained that, based on the understanding of your problems, you can learn to think, feel and behave differently, leading to a resolution of your psychological symptoms and an improvement in your personal and work life. This process takes time, because changing patterns that took years to establish requires motivation, dedication, honesty, and hard work in and out of therapy sessions.
Psychiatric medications can also be helpful with or without therapy. “There are both short-term and longer-term pharmacological solutions that can be beneficial for adults and children,” said Leslie Rokoske, a psychiatrist at Veritas Health in Washington, D.C., who is seeing an increase in patients looking for help with anxiety and depression.
What are the different types of therapists?
A wide variety of degrees can lead to a license to practice therapy, and it can be difficult to understand the differences. Here we will go over some of the more common types of therapists you are likely to come across.
A psychiatrist is someone who has obtained a medical degree (MD) and completed a four-year residency in psychiatry. They can prescribe medication and often work in conjunction with psychologists, social workers or counselors.
A psychologist has completed a doctoral program in clinical psychology, which lasts approximately five to six years and leads to a PhD or PsyD (Doctor of Psychology). PhD programs tend to place a strong emphasis on research in addition to training therapists, while PsyD programs are mostly focused on practice.
Social workers, clinical social workers, professional counselors, and marriage and family therapists obtain a master’s degree, which requires on average two years.
While fees generally go up in correspondence with a therapist’s education level, someone with a master’s degree could be as helpful as someone with an MD or PhD. It is important that a practitioner is licensed to practice therapy; most states have websites where you can verify this.
What about the different kinds of therapy?
There are many theoretical orientations or “schools” of psychotherapy. Two of the most influential are cognitive behavioral therapy (CBT) and psychodynamic psychotherapy (also called psychoanalytic). Many therapists integrate methods from these and other orientations.
CBT has been extensively tested and proven to work for most psychological disorders. It is a relatively structured, shorter-term approach, with explicit goals and techniques, focused on building specific skills to help clients overcome their difficulties. For example, an anxious client might master relaxation methods or learn ways to tolerate anxious sensations as they approach what they fear. CBT therapists tend to be active in sessions and work with their clients on setting therapeutic “homework” to be completed between appointments.
“For children, evidence-based therapy like CBT teaches coping strategies and builds resilience,” Pimentel said.
Although psychodynamic psychotherapy has its origins in Freudian psychoanalysis, it has dramatically evolved. “Current psychodynamic therapy relies on the therapeutic relationship to help you explore how early attachments have led to current patterns in your life. It is also sensitive to how your subconscious is influencing your thoughts, feelings and behaviors,” said Marc Diener, an associate professor of psychology at Long Island University Post. Psychodynamic therapy tends to be less structured and more open-ended and to have fewer directives. Research suggests that it is effective for many psychological problems.
How do I find the right therapist?
When looking for a therapist who could be a good fit for you or your family member, consider asking your primary-care physician or pediatrician for recommendations. Searching on the Internet for therapists in your area and reading their websites — almost all therapists have one — can also be quite helpful.
After you narrow down your search, ask each potential therapist if you could have a free consultation to assess whether there is a good fit. This is your opportunity to ask how they approach their work and what the therapy process might look like. Research suggests that “active shoppers” do better in therapy than those who take a more passive approach.
But how can I see a therapist during the pandemic?
Most therapists have transitioned to teletherapy because of the coronavirus lockdown. While phone appointments are available, they typically provide videoconferencing therapy via one of the secure, HIPAA-compliant platforms that use end-to-end encryption and disallow recording. (HIPAA stands for Health Insurance Portability and Accountability Act.) To ensure the success of teletherapy, you need to have a private space and, in the case of video therapy, a decent Internet connection.
Research during the past three decades has found that video-enabled teletherapy is as effective as in-person therapy, and that the therapeutic relationship and satisfaction with therapy do not suffer. It is important, however, to distinguish between teletherapy conducted in a live 45-to-50-minute session with a therapist and the many mental health apps and “online therapy” applications that have proliferated in the past few years. These applications typically do not provide traditional therapy in real time with a licensed therapist.
If you would like to try medications for your psychological problems, talking with your doctor would be a good place to start. Primary-care physicians can prescribe some, but not all, psychiatric medications. If they refer you to a psychiatrist (or you decide to go directly to one), you can conduct those appointments, too, over telephone or video during the coronavirus crisis.
“Patients can then use a pharmacy benefits manager to get a 90-day supply of the medications delivered to their home,” Rokoske said.
What if I don't have insurance or much money?
Don’t let a lack of resources hold you back from seeking help. There are many options for low-cost or no-cost treatment, such as:
- Training clinics at doctoral clinical psychology programs, which often offer very low-cost and high-quality therapy.
- Private group practices with externs, who are trainees in doctoral clinical psychology programs, supervised by licensed psychologists.
- Local community mental health centers, often tied to counties, which treat people regardless of their ability to pay.
- Open Path Collective, a national nonprofit network of therapists who provide sessions at a very reduced rate.
- Project Parachute, which uses telehealth to match pro bono therapists with front-line health-care workers affected by covid-19.
- Give an Hour, which serves military families and victims of natural or man-made traumas. It also has a special program in Washington, D.C., that covers more issues.
- Actress Taraji P. Henson’s Boris L. Henson Foundation, which is offering five free individual therapy sessions until funds are exhausted.
- NY COVID-19 Emotional Support Hotline, which is only for residents of New York. You can make a free phone appointment at 844-863-9314.
Free hotlines, which can also help connect you to therapeutic care.
Department of Health and Human Services National Helpline: 800-662-4357.
Integral Care (15 languages): 512-472-HELP (4357)
National Suicide Prevention Lifeline: 800-273-TALK (8255)
Crisis Text Line: text HOME to 741-741
Jelena Kecmanovic is a founding director of the Arlington/DC Behavior Therapy Institute and an adjunct professor of psychology at Georgetown University. Find her @DrKpsychologist.