Dear Michael,

A friend of mine told me that he was tired of hearing me bitch all the time about the same problems over and over and that I should see a therapist. I’ve never gone to a therapist. What exactly do they do? And what’s the difference between a therapist, counselor, shrink and psychiatrist?

Same old same old in National City

Dear Same Old,

Before I explain the difference between different kinds of therapists, let me address the question “under” your question: Do you need professional help? Just because your friend is tired of hearing you complain doesn’t mean you need a therapist’s help. Your friend could simply be intolerant or cranky.

I recommend that people consider therapists as personal trainers for your head. When you work out at the gym, hit a plateau and can’t progress any further, if you’re smart, you stop doing the same old unproductive routine and get a trainer to help you move to the next level. A therapist does similar work for your mental state: when you’re “stuck” and can’t progress mentally, you need some expert help. Friends, relatives and lovers can be helpful, but they have neither the training nor the objectivity and confidentiality that a good therapist does.

Therapists (psychotherapists, psychologists and psychiatrists) are regulated and licensed by the State of California. They have rigid continuing education requirements and can lose their licenses if they misbehave (e.g., have sex with a client; violate your rights to confidentiality, etc.).

If you have a problem that is not going away, for example, your self-esteem continues to be low after years of trying to feel better about yourself, or you can’t get over your ex, or you feel depressed or panicky and often anxious, a therapist may be helpful.

A psychotherapist is a Licensed Clinical Social Worker (LCSW) or a Licensed Marriage and Family Therapist (LMFT). These good people are specifically trained to do psychotherapy, that is, therapy for your psychological issues. They do not issue prescriptions for any medications and rarely do psychological testing. Psychologists are also licensed by the state to do talk therapy (like psychotherapists), but these days, they often do psychological testing as well. These folks often have the initials Ph.D. after their names. Psychiatrists are medical doctors (MDs) who specialize in mental health. Their primary focus is usually in doing psychological evaluations and dispensing medications (antidepressants, anti-anxiety medications, etc.).

You can go to any of these for therapy, but note that each has their own specialty. Psychiatrists are usually the most expensive, often charging upwards of $150 an hour. Psychologists and psychotherapists usually charge about $75-150 per hour, depending on their experience and specialized training.

How do you find a therapist that you like and is able to help you with your problem(s)? Well…how did you find your doctor, dentist, chiropractor or acupuncturist? Most of us ask our friends, family and co-workers for recommendations. If you are new to town, call The Center and ask them for recommendations (they have a list of GLBT-friendly therapists that they will be happy to share with you). You can also look in the Greater San Diego Business Association’s business directory.

Once you have some potential therapist candidates (sounds like “American Idol”, doesn’t it?) I recommend a swimsuit competition! Seriously, put together a list of questions to ask them before you call them up. Some therapists will speak with you on the telephone before your first appointment, others will not. If this is your first time in therapy, I recommend talking with a therapist on the phone before you make an appointment

Interview several therapists over the phone before you choose one to see in person. Remember, however, that this is how they make their living, so keep your telephone interviews as focused as possible...ask your questions but don’t waste their time.

Once you have done your telephone interviews, pick one or two therapists and schedule an appointment. Tell them during your appointment that you are looking for a therapist and may see another therapist (or two) in order to find a therapist that you really click with. Don’t feel guilty if you don’t click with the first (or second) therapist you meet. You may need to meet with two or three to find the right one. It’s your time and money, so make sure you feel comfortable with who you choose.