What is psychotherapy?

Psychotherapy is the treatment of mental and emotional disorders through the use of psychological techniques designed to encourage communication of conflicts and insight into problems, with the goal being relief of symptoms, changes in behavior leading to improved social and vocational functioning, and personality growth.

Is there a difference between therapy, counseling, and psychotherapy?

Psychotherapy is the most specific term referring to the process of therapy on psychological issues as defined above. Therapy is often used interchangeably but is the more general term referring to the treatment of any illness or disability, e.g., physical therapy, or any healing power, e.g., aromatherapy. Counseling is also a more generic term and is often used in describing an exchange of ideas or advice-giving, e.g., pastoral counseling, career counseling, or providing legal counsel.

Who provides psychotherapy?

There are four main types of licensed mental health practitioners providing psychotherapy:

• Psychologist (Ph.D. or Psy.D)
• Psychiatrist (M.D.)
• Licensed Clinical Social Worker
• Marriage and Family Therapist (MFT)

A licensed clinical psychologist has a doctorate in clinical psychology (Ph.D. or Psy.D.). Psychologists have completed the most rigorous training for providing psychotherapy, either a 4 or 5-year graduate program. Elements of this program include completing a dissertation (Ph.D.) or doctoral project (Psy.D.), a minimum of 1,500 hours of pre-doctoral supervised practiced in a formal training program, 1,500 hours of post-doctoral supervised practice, and passed the appropriate state licensing examinations. In California, psychologists are overseen by the Board of Psychology.

A psychiatrist (M.D.) is licensed as a physician and surgeon in California. It is important to know that any physician can call himself a psychiatrist although physicians get minimal training in psychiatry in medical school. If you consult a psychiatrist, check for proper training in the field of psychiatry, such as post-graduate residency training in psychiatry and board certification in psychiatry. In California, psychiatrists are overseen by the Medical Board of California.

A licensed clinical social worker (LCSW) possesses a master’s degree from an accredited school of social work, typically a 3-year program. LCSWs have obtained 3,200 hours of supervised experience and passed the appropriate state licensing examinations. In California, LCSWs are overseen by the Board of Behavioral Science.

A marriage and family therapist (MFT) has completed a masters program in psychology, typically a 2-year program obtained 3,000 hours of supervised experience and passed the appropriate state licensing examinations. In California, MFTs are overseen by the Board of Behavioral Science.

What about medication?

Medication is designed to balance brain chemistry which has been changed as a result of a mental condition, such as depression or anxiety. Used correctly, it is mind correcting, not mind-altering. Many medications are not addictive; in fact most of the medications used for depression, bipolar disorder and schizophrenia are not addictive.

The choice of whether or not to take medication is often dependent on one’s own values. Receiving proper education is essential in factoring your decision. Some conditions are more strongly biologically in nature and have poor prognosis without medication, e.g., schizophrenia, bipolar disorder. For other conditions such as depression, there is variability. Medication is strongly recommended for severe depression, while milder forms can be effectively treated without medication (although medication can still be helpful). Research indicates that the most effective treatment for depression is the combination of medication and psychotherapy. Generally, receiving medication without psychotherapy to address your problem is not recommended. Being active in your treatment, learning about your condition and the strategies to best cope with it are essential ingredients which are all a part of psychotherapy.

As medical doctors, psychiatrists are the only practitioners who can prescribe medication (although a growing number of states have granted psychologists the ability to provide this service). Many psychiatrists provided medication only, meaning they focus exclusively on your medication and do not provide psychotherapy. They meet with you once a month or less if you are medically stable.

Other types of therapists (psychologists, LCSWs, MFTs) often work in collaboration with a psychiatrist – the former providing the psychotherapy, the latter the medication. Often this combination provides a good foundation for your treatment team.

How do I choose a psychotherapist?

There is no one way to find the right psychotherapist. The most common method is word of mouth. Friends, family, clergy, or other trusted individuals often are the best referral source because they know you and/or the therapist personally. While there is much research about the best type of therapy, the most consistent finding is this: the relationship between therapist and client is the most important factor in determining outcome. Finding someone that you can trust, feel will be hopeful, and have hope in you is the best criteria to use.

It is encouraged that you phone a potential psychotherapist. Ask your questions and see if he/she is the right fit for you. It is also important to ask if he/she can work with the particular problem that you want addressed, e.g., couples therapy, coping with depression, etc. I welcome such phone calls in my practice.

How much does psychotherapy cost?

Fees for psychotherapy range broadly. Most psychologists in private practice in southern California will charge over $225 – $250 per 50-minute hour, although this figure can go higher (especially for MDs). Initial evaluations can sometimes be higher than the fee for ongoing sessions.

Insurance providers will cover varying portions of psychotherapy. HMOs have their own network of providers from which you must choose someone. Typically, you cannot get reimbursed for anyone outside the network and there is often a limited number of sessions, however, you are only required to pay your co-pay. PPOs offer more flexibility, allowing you to choose who you want to see (although you pay less if you choose someone in-network).

Low fee psychotherapy is available through community based counseling clinics. Typically, these services are provided by interns under the supervision of licensed psychotherapists. Clinics in the Los Angeles area include:

• Maple Center (Beverly Hills) – 310-271-9999
• Southern California Counseling Center (Los Angeles) – 323-937-1344
• Airport Marina (Westchester) – 310-670-1410
• Antioch (Cliver City) – 310-574-2813

Click on Services for more information about fees and insurance for Dr. DiPaolo.

How long does psychotherapy take?

This depends. Unlike many other health conditions, there is no one procedure that can be done to you to fix your problems. Psychotherapy is a collaborative process between you and your therapist. The initial consultation should help you to get a feel if this is the right person with whom to work. Over the first few months, one should not ask the question, “Am I fixed? ” Rather ask, “Am I moving in the right direction? ” Spinning off of the old adage, “Psychotherapy is a journey, not a destination. ”

Psychotherapy often requires a deeper examination of core issues, childhood events or past traumas. Akin to an archeological dig, this excavation of old material unsettles things which have been dormant for many years. When this happens, you may actually feel worse. Know that this too can be part of the process which will ultimately promote healing.