Depression and HIV

October 2003     View PDF     En español
Reprinted from www.aidsmeds.com, US

How do I choose a therapist?

It is difficult to give advice on how to find a therapist. The referral you get will depend on the point of view and experience of the person who gives you the referral. Obviously, you should seek a referral to psychotherapy from a person you trust. Good sources of referrals include your medical doctor, the psychiatry department of a well-respected hospital or medical school, or perhaps a local AIDS organization.

Anyone can call himself or herself a psychotherapist; there are no legal requirements to use this title. Many therapists practicing in the United States are either psychiatrists, social workers, or psychologists. All three do psychotherapy; only psychiatrists prescribe medication. Training within each of these groups varies widely; some clinicians in each category are highly trained while others have little specific training in the practice of psychotherapy. State licensing is required for each of these professions. This means that if you see a licensed psychiatrist, social worker, or psychologist, you have the reassurance of knowing that they have met some standard of education and ethical practice. However, the requirements are variable and merely being licensed is no proof of competence.

You are entitled to ask therapists about their training, credentials, experience, and therapeutic approach. You should not expect personal information or a long detailed discussion of therapeutic philosophy. This is generally seen as counterproductive for the therapy.

You may need to interview several therapists to find one with whom you feel comfortable. Following is a list of attributes to look for in a therapist:

• The therapist should seem reasonable, respectful, attentive, and understanding.
• The therapist should not be authoritarian.
• The therapist should explain in a clear-cut fashion all matters relating to cost of therapy and time and length of sessions.
• Generally speaking—but not always more training is better than less, and training at a recognized and respected training institution is desirable. If you are attending a clinic where someone in training is seeing you, this person should be supervised.
• Avoid therapists who make extravagant claims for fast cures.
• It is helpful if your therapist is somewhat knowledgeable about HIV disease and has some experience in treating patients who are HIV infected. You may be able to find such a therapist if you live in a large metropolitan area with a high incidence of HIV disease. If your therapist does not have experience in this area you may have to do some extra explaining in your therapy. Therapy can still be very helpful.
• The therapist should be sensitive to ethnic and cultural differences.
• If you have had problems with substance abuse, it is often helpful to find a therapist who specializes in this kind of problem. Generally, therapy in combination with some kind of “twelve step” program (on the model of Alcoholics Anonymous, or AA) is the treatment of choice.

You are entitled to total confidentiality from your therapist. This means that a therapist can never communicate any information about you to anyone without your explicit permission. This includes doctors, insurance companies, and family members. The only exception is if you are in danger of physically hurting yourself or someone else in which case your therapist is required by law to communicate this information in order to prevent this.

There should never be any sexual activity between therapist and patient. Frank discussion of sex is part of many therapies, but sexual activity in therapy is always inappropriate. If this occurs in your therapy, you should discontinue therapy and report your therapist’s behavior to the relevant professional organization.