Choosing a Mental Health Professional

Archived Q&A and Reviews

September 2003

Many subscribers use this parent community to find recommendations for a therapist. Sometimes it's hard to know what to look for. By all means, recommendations are an excellent way to start. Here's some other information to help you make an important decision. (I intend to use as little 'jargon' as possible.)

There are so many different kinds of mental health providers in the Bay Area. Licensed professionals, trained in both mental health theory and practice, tend to be one of the following :

M.D. - Medical doctor with medical training and possibly additional clinical training;
Ph.D. - Psychologist with doctoral level training (usually 4-5 yrs minimum before licensure) ;
Psy.D. - Psychologist with doctoral level training (same as above);
LCSW - Licensed Clinical Social Worker with masters level training (usually 2-3 yrstraining before licensure);
MFT - Marriage Family Therapist with masters level training (same as above)
Psychoanalyst - Can be any licensed mental health professional who has completed additional training- in what might be known as 'depth-oriented' treatment- from a psychoanalytic training institute.

There are also interns, individuals who are in training, but are not yet licensed who provide services. For example, an MFTI is a Marriage, Family Therapist Intern. While interns have less experience in the field, they are often very energetic and excited to be learning. If you have financial concerns and are open to working with someone with less experience, an intern can be a good choice.

Interns, as is true for all mental health professionals, must represent their level of training accurately. Interns are not supposed to call themselves therapists, can not present themselves as having their own office or business, and must make clear that they work under the supervision of a licensed therapist. These ethical guidelines are intended to help with informed consumer choice.

Here's the confusing part- while different degrees and different degree-granting programs may vary quite a bit, it is also possible that providers with different degrees or licenses might actually practice somewhat similarly! So the letters after the name will tell you something about how much pre-license training the person had in clinical theory and clinical practice. That may be it.

Another potentially confusing piece- there really are no set questions you should ask a therapist to assess their competence, empathic capacity, intelligence, or best-fit for you. Some potential consumers like to 'shop' around to meet a few providers before they make their choice. Other people are just as happy to get one recommendation and hope that person seems like someone they can work with.

If you are looking, here are some guidelines I would offer:

1) Think about your budget beforehand. Therapy can be a big financial commitment and when it's a 'good' treatment it can be priceless. Try to afford the most you can in order to widen your options of potential providers (i.e. people with more expertise and experience). However, be realistic about what you can afford so that you don't have to prematurely end what you worked so hard to get going.

2) Think about what's important to you in a therapy experience and don't hesitate to discuss it with any potential provider. A 'good' therapist may not say, 'Oh, sure I can offer you just that.' A good therapist will be responsive to you and will let you know that s/he can think respectfully and creatively about your concerns.

3) Even when you feel an immediate rapport with a therapist, remember that it takes time to be known, to know someone else, and to develop a relationship. This is true in therapy, too. Most people come to therapy looking for some answers to important life questions. Since therapy is also about self-discovery, you may find you have more questions before you have any answers. Don't worry if you feel lost or confused at times.

I know this outline covers just some of the variables in getting started in therapy. I hope it's a useful start.

Melissa Holub, Ph.D.

July 2008

I am a licensed psychoanalyst and I wanted to add and respond to Dr. Holub\x92s very thoughtful and useful post on choosing a therapist.

Research Psychoanalysts:

There is a relatively rare licensing category in California Dr. Holub left out of her otherwise very complete list of licensed mental health professionals: research psychoanalysts.

Research psychoanalysts are academics from non-therapeutic fields (in my case, I have a Ph.D. in English) who train at state-accredited psychoanalytic institutes after several years of internship training, and who have done significant research on psychoanalysis in their research field.

Nancy Chodorow, a well-known feminist scholar who was at Berkeley for years, author of _Feminism and Psychoanalysis_, is an example of a research psychoanalyst. California Research psychoanalysts are licensed through the California Medical Board.

Psychoanalytic training:

Psychoanalytic training is very intensive, and is done after a PhD, or after being licensed as an MFT, MD, or social worker. All California accredited psychoanalytic institutes use a tripartite approach to training, including at least four years of course work, hundreds of hours of supervised analyses, and hundreds of hours of their own training analyses.

A \x93training analysis\x94 is when the psychoanalytic candidate goes through her or his own psychoanalysis, which usually means four sessions per week for several years. The idea here is that the candidate can best learn about how the unconscious psychology works through an intense exploration of her or his own unconscious processes. No other form of mental health training requires a training analysis.

Another very demanding aspect of psychoanalytic training is the supervised analyses. The requirements here are to be supervised by a senior analyst during an analysis conducted by the \x93candidate\x94 in training with one patient (four sessions per week for years). This is usually the training requirement that makes psychoanalytic training last at least five or six years since it is difficult to find a patient who can manage and sustain such an intense treatment.

Treatment options with psychoanalytic candidates:

If you are looking for intensive therapy, one treatment option to consider is to work with a psychoanalytic candidate at one of the local psychoanalytic institutes. The benefits of such a treatment option is its depth, and you will be working with an experienced mental health professional who is being supervised by a very experienced psychoanalyst. The fee will be even more negotiable since the candidate needs the training. Four sessions per week can be daunting for most people, but that frequency has many benefits besides the depth and what I would say is the seriousness of the work. It can also be a more gentle approach to therapy since it should give more time to broach and explore sensitive and complex aspects of our psychologies. This is true for both adults and children.

You can call the bay area psychoanalytic institutes directly to inquire about the availability of \x93control cases\x94 (the term for candidates\x92 supervised treatments), or you can simply call them for a referral:

Institute of Contemporary Psychoanalysis, Northern California
The Institute for Psychoanalytic Studies
San Francisco Center for Psychoanalysis
The Psychoanalytic Institute of Northern California


Dr. Holub\x92s description of interns fits best those interns who are in a private practice internship working under a licensed mental health professional. The majority of interns work in training agencies and are supervised by the particular agency\x92s faculty of supervisors.

Contacting these training agencies or institutes directly is a great way to find an intern therapist for low-fee therapy. Often you can find licensed therapists at these agencies too. Here are some east bay agencies to start your search:

Women\x92s Therapy Center, El Cerrito (510) 524-4822
Pacific Center (LGBT), Berkeley (510) 548-8283
The Psychotherapy Institute, Berkeley (510) 548-2250
Ann Martin Center (Children), Oakland (510) 655-7880
Jewish Family and Children\x92s Service, Berkeley (510) 704-7475

These agencies can also refer you to agencies that may be closer to where you live or work, or a better fit for your particular needs.

Good luck with your search!
Dr. Eric W. Anders, Ph.D., Psy.D., Rockridge and Walnut Creek