Here are some
answers to questions people have about psychologists and psychological services. If you
have other questions of a general nature about psychology, please send them to us. If we
think they would interest others, we will add them to our site.
What is a clinical psychologist?
A clinical psychologist
is a professional who has rigorous training in psychological assessment, diagnosis, and
graduate school for about 5-7 years beyond college, leading to a Ph.D. or Psy.D. degree.
Clinical training begins in the first year, along with coursework on the theory and
practice of psychology, and continues through several years of supervised experience. In
addition, a year of full-time internship in psychology must be completed. Most
psychologists also receive at least one year of post-doctoral supervision.
An original research project also must be done, which promotes
psychologists as "scientist-practitioners." The result is a strong clinical
orientation tempered by a desire to use methods that are based on sound data and
Only psychologists receive extensive training in the full range of
psychological testing, including the assessment of intelligence, attention, learning
disabilities, memory, and personality. Also, no other profession requires the amount and
intensity of training in psychotherapy.
Psychologists use psychotherapy to help their clients understand their
problems and learn new ways of coping with them. The psychologist helps guide the client
in changing problematic behaviors and emotional reactions. The psychologist offers an
objective point of view, expertise in human well-being, knowledge of the process of
emotional/behavioral change, support, and encouragement. All these serve to foster the
difficult process of change and personal growth.
What is the
difference between a psychologist and a psychiatrist?
The main practical difference for most people is that psychologists do
not prescribe medications, while psychiatrists can. If one of our clients appears likely
to benefit from medications, we refer them to a psychiatrist or their physician.
Psychiatrists also can admit people to the hospital directly, while psychologists usually
Another key difference is the focus of our interventions. Psychiatrists
are trained to identify an illness and to control it, usually through the use of
medicines. Some also do psychotherapy. Psychologists also are trained to identify and
treat mental illness, but tend to look at treatment as a framework for teaching the client
ways to handle problems in a more effective way.
From the client's point of view, treatment with a psychiatrist often
means taking the medications that are prescribed, and might also include following
specific advice about how to handle a situation. Treatment with a psychologist involves a
more active exploration of the problem, learning different ways to deal with the problem,
and making specific efforts to change the way they think, feel, and act.
The training of psychologists and psychiatrists differs, as well. The
two different training models can both yield skilled practitioners, but tend to promote
somewhat different approaches to mental health care. Indeed, the two tend to complement
each other, and it is not unusual for skilled practitioners in each field to refer their
clients to the other.
The training of psychologists is described above under "What is a clinical psychologist?"
In contrast, psychiatrists attend medical school for 4 years, during which they are
exposed to mental health issues for approximately 1-2 months. They then complete one year
of a general medical internship, followed by three years of psychiatric residency. They
receive the bulk of their training in psychiatry during these three years. It is their
training in medicine that permits them to prescribe medications.
How long does it take
to get psychological testing completed?
Psychological testing usually involves 2-6 hours of face-to-face time
to do the testing itself. This is usually spread out over 1-3 sessions. We generally need
1-2 weeks more to interpret the test data and write a report. The report can be delayed if
the client does not return questionnaires or other information in a timely manner. Another
possible delay occurs when your insurance company requires you to get a preauthorization
number before testing can begin. If you choose to proceed without that number, you end up
paying the whole cost out-of-pocket.
The moral of the story is this: Plan ahead. Don't wait until the week
you need the test results to schedule an appointment. Although we try to respond to your
needs, you have to allow a realistic amount of time for us to do the work. The quality of
our testing is important to us, and quality takes time.
What is your perspective on
psychotherapy with adults?
We believe that you will get better when you can make conscious,
informed choices about your behaviors, thoughts, and emotions when you are aware of
your own predisposition toward certain reactions and interpretations of events and you are
empowered to challenge and change those patterns.
Because your efforts to change almost always affect your interactions
with others, an interpersonal focus sometimes can help identify potential pitfalls. It
also can increase the learning that occurs as you observe not only your own actions but
those of others.
In some cases, particularly when dealing with deep-seated issues based
on early abuse or dysfunctional family dynamics, we find that sustained progress is more
likely if we help you see the relationship between current behavior and earlier
For example, during treatment you might come to understand that you
have a pattern of difficult, unsatisfying relationships. As you explore further, you find
other patterns that contribute to your interpersonal problems, like pushing people away
when they get too close or choosing partners that are unreliable or abusive. It soon
becomes clear that you make choices and respond to intimacy in ways that are tainted by
difficult childhood experiences (like learning to see the people who are closest to you as
dangerous, unpredictable, or uncaring). With this insight, you can start to question (and
test) your tainted beliefs and expectations. Finally, you can practice acting in ways that
allow healthy relationships to flourish.
What is your perspective
on psychotherapy with children?
Children are brought to treatment for a variety of reasons, including
behavior problems, school problems, ADHD, learning disabilities, depression, anxiety, and
difficulties with peers. These children often need to learn specific skills for coping
with their problems. Often, parents need to learn to take a different perspective on the
child's behavior, along with parenting skills and ways of managing the behavior. With
learning difficulties, educational interventions are often needed, along with skills
training to make the most of the child's potential.
Sometimes, there are issues and problems troubling the child that
underlie the difficulties you see on the surface (like bad behavior in response to
parental separation). Psychotherapy can be used in these cases to resolve those underlying
problems and teach the child to cope with difficult circumstances.
For example, a child might be identified as being defiant and
oppositional to parents and teachers. Treatment might focus on teaching the parents how to
effectively set limits and respond to defiant behavior. Over the course of treatment, the
psychologist might find underlying factors such as depression, fears, or peer problems.
She would then help the child express and manage his feelings in a more appropriate way,
while also sensitizing the parents to the child's struggles.
How long does psychotherapy take?
does not occur overnight, particularly with long-standing problems. While we sometimes see
sufficient improvement after only one session, it is typical for additional sessions to be
Clients generally can expect to see some improvement after a few
sessions, and significant improvement after 10 to 20 therapy sessions. To put
that in perspective, you need to invest the equivalent of 1 to 3 work days in actual
treatment time to see substantive progress. Most of the time span of
psychotherapy is spent finding opportunities to practice new skills and try new ideas.
Our goal with each client is to work efficiently toward improvement of
the clients subjective well-being and objective level of functioning. Often, a focus
on specific problems and behaviors is sufficient to provide that improvement. In other
cases, longer-term treatment is needed because the issues causing the dysfunction are
deeply-ingrained and obscure. In these cases, we find that concrete attempts to change
often fail until the underlying issues are defined. Another situation when change can be
delayed occurs when the client simply needs more time to develop a sense of safety within
the therapeutic alliance before venturing into the process of change.
Do I have to be
"crazy" to see a psychologist?
Deciding to pursue psychotherapy often is a difficult decision. You
might think that seeking professional help is something only very sick people need to do.
Or is a sign of weakness. Or that you should be able to handle your problems on your own.
Or that you should only try harder.
In truth, we all have problems and, sometimes, we just do not know what
to do about them. Sometimes we lack the skills we need to handle a particular problem.
Sometimes we have the skills but we are overwhelmed by an accumulation of problems and
stressors hitting us all at once. And sometimes we are held back by erroneous messages and
beliefs we learned early in life about ourselves and ways to handle problems.
Look at it a different way. If you are missing out on much of the good
that life has to offer because you are sad, anxious, worried, full of self-doubt, racked
with feelings of guilt or shame, repeatedly having poor relationships, or not living up to
your potential, isn't it kind of wasteful to not seek help?
How effective is psychotherapy?
Overall, mental health
treatment is highly effective, especially when provided by well-trained, experienced
caregivers. In fact, the success rate for psychotherapy rivals or exceeds that for
treatment of most physical illnesses.
Researchers who have reviewed hundreds of psychotherapy outcome studies
report success rates of about 75% with children, adolescents, and adults. In one review
that looked at outcomes for 2400 clients, half the clients showed measurable improvement
after only 8 sessions. After 26 sessions, that number rose to 75%.
When treatment of depression has been studied, psychotherapy has proven
to be as effective as medications. And, while medications might work somewhat faster and
do not require much effort, psychotherapy offers the added benefit of teaching the client
new skills for managing their difficulties.
Psychotherapy also appears to have lasting benefits. In a study of
people who had suffered recurrent episodes of depression, 25% of clients who received
psychotherapy in addition to medications relapsed over a period of two years. That is much
lower than the 80% relapse rate of those who received medications alone.
Many types of problems are amenable to psychotherapy, including anxiety
disorders, behavior problems, school difficulties, adjustment disorders, life-stage
issues, relationship problems, and reactions to traumatic events. Attention Deficit
Hyperactivity Disorder often is best handled with a combination of medication and skill
development. Some problems, such as schizophrenia and mania, almost always need
medications to achieve symptom control, but psychotherapy can help clients adjust to the
illness and its effect on their lives.
Of course, any individual's treatment outcome depends on a number of
factors, including the severity of the problem, the personal resources of the client, the
client's motivation to change, the skill of the therapist, and the "fit" between
the client and therapist.
If psychotherapy is so effective, why does my
insurance company try to limit it so much?
"carve out" their mental health benefits, which means they shift those to a
company that provides only mental health services. That company has to pay for any
assessment or psychotherapy that is authorized, so they profit by refusing to authorize
care or by refusing to pay legitimate claims.
Since many people never appeal these denials, it is money in the bank
for the carve-out.
At the same time, those carve-outs often encourage people to take
medications instead of getting psychotherapy, because they do not have to pay for the
medications (those costs fall back on the primary insurer).
The fact that psychotherapy is equally effective, can result in fewer
relapses, and has no side-effects is irrelevant because medications do not affect their
bottom line, but psychotherapy does.
This practice of limiting psychotherapy might also reflect some
continuing bias toward mental illness, and the belief by some that these disorders are not
legitimate or serious. However, managing mental illness is not about willpower or being
tough, it is about recognizing a treatable condition and learning how to control it.
Another factor that allows this inequity to continue is that people
with psychological problems may be more reluctant to complain about their coverage (to
their employer, the media, etc.), since that would mean revealing that they had sought
psychological services. However, this keeps the employer's benefits manager in the dark
and allows the carve-out to get away with shoddy coverage.
providing mental health care cost-effective?
Serious mental illness
(excluding alcohol/drug abuse) affects about 1 out of 10 Americans and costs $100-200
billion a year in lost productivity, absenteeism, and health care expenses.
Much of this cost
reflects the increased use of routine medical services by people who do not receive
treatment for mental illness. Indeed, one study found that people with untreated mental
disorders increased utilization of medical services at a rate six times greater than those
who did receive treatment. (But, like with medications, the mental health carve-out does
not have to pay for these medical services; those costs get passed on to the primary
insurer, employer, and individual.)
services not only reduces the use of general medical services, it can cost less in the
long run than long-term treatment with medications for mental problems. One study found
that a popular medication for treating depression would cost a third more over a period of
two years than a reasonable course of psychotherapy (and, remember, the effectiveness is
The bottom line, though,
is that psychological problems can rob someone of much that makes life meaningful and
worthwhile. We do not know how to put a price on that. We do know that psychological
treatment works with most people, can restore productivity, and can help the person feel
happier, more satisfied, and more at ease.
Aren't mental health benefits abused?
There are historical
factors that left many people with the idea that mental health benefits are abused.
Indeed, they were, some of the time, by certain parties.
Much of the abuse was
perpetrated by private psychiatric hospitals that hospitalized people unnecessarily, and
for weeks at a time. Often, the criterion for hospitalization and discharge seemed to be
the amount of insurance the person had, not the clinical needs of the person. This cost
employers huge sums of money in rising premiums.
mental health care got tarnished, even though the cost of outpatient psychotherapy is a
fraction of the cost of inpatient treatment. In fact, using a conservative estimate of
$800 per day for hospitalization and a standard yearly allotment of 30 days of inpatient
treatment, someone could be in weekly psychotherapy for 6-9 years for the cost of
one hospital stay.
Furthermore, a typical
client is actually in psychotherapy for less than 6 months. When someone is in treatment
longer, there is usually a legitimate clinical reason.
Why do you charge so much?
Because our fees look high, people often think we make extravagant
amounts of money. In reality, we know skilled tradespeople who earn more than we do. By
the time we pay our office overhead, absorb unpaid bills, and cover the costs associated
with being a psychologist (licenses, insurance, mandatory continuing education, etc.),
there is not as much slack as you might think.
In addition to being clinicians, we also are in a business where our
livelihood depends on getting paid for our time and expertise. Since we dedicate large
blocks of time to each individual client, the amount of time we have is limited.
Furthermore, the expertise comes to us at a high price, with many years of study,
sacrifice, and poverty. We also face the constant need to keep up to date and further our
training, and we carry a large amount of responsibility as health care providers.
Nonetheless, our fees are much lower than other professionals who also
sell their expertise. Lawyers, for example, often charge two to two-and-a-half times as
much as we do. Physicians often charge less than we do per contact, but you only get a few
minutes of their time. If you look at the hourly rate, theirs is much greater than ours.
Frankly, we value what we do, and we hope our clients do, too. If you
are going to pursue psychotherapy, you need to think of it as an investment -- an
investment in your life. For less than what you might pay to put new carpet in your home,
you can improve the quality of your life, have better relationships, and feel more at ease
What if I can't afford to pay?
We occasionally reduce our fees for highly motivated clients in great
need who cannot afford to pay our full fees. However, we must limit these opportunities,
for the reasons cited above. Also, the need for reduced fees must be disclosed up front.
Once you begin treatment, you are responsible for the fees that are agreed upon at the
outset, although we might negotiate some adjustment if your circumstances change
The following are some additional resources in our area where you might
get services for lower fees:
- The Psychology Clinic at the University of Alabama (348-5000)
- Indian Rivers Mental Health Center (345-1600)
- The Family Counseling Service of Tuscaloosa County (752-2504)
You should be aware that there are other mental health providers, with
far less rigorous training, who might charge lower fees than psychologists. However, since
insurance rarely covers them, you might actually pay more out-of-pocket to see one of them
than if you saw a fully-qualified, licensed psychologist. It pays to check it out.