Senior Mental Health: How To Choose a Therapist or Psychiatric Prescriber

As a geropsychologist, I specialize in the behavioral and mental health of older adults. Given my background, I’m often asked by friends and family how to choose a therapist or psychiatric prescriber (one who can prescribe medication). Here is my guide describing the different types of health professionals and how to get started!

Overview

Deciding to connect with a therapist or psychiatric prescriber is an important step that, for many, can feel empowering. Others may find the decision difficult, and choosing who to see with all of the different titles and degrees you’ll see listed may make the decision even more confusing and cumbersome. More specifically, for therapists, there are psychologists (PhDs, PsyDs), social workers, and mental health counselors. For psychiatric prescribers, there are psychiatrists (MD or DO), psychiatric nurse practitioners, and psychiatric physician assistants. Sometimes psychiatrists will also offer therapy with or without medication management sessions, and your primary care physician or geriatrician may be options for psychiatric medication management as well. Given this, it may be useful to consider a few key factors and remain flexible while reminding yourself that you will have the final say in who you work with.

Frequently Asked Questions

What help can my insurance provider give me to find a provider? Can I also consider an out of network provider or private pay provider?

Your insurance company is an excellent resource for finding in-network therapists and psychiatric prescribers covered by your plan, and they should also be able to indicate the specialties of those providers. While some therapists and psychiatric prescribers accept insurance plans, and some do not, this is not a reliable indicator of quality. However, out-of-pocket expenses and the availability of existing coverage benefits are significant factors to consider. Many providers that do not accept insurance will still provide a superbill you can use to submit an insurance claim for reimbursement. Whether or not you have a specific provider in mind, your insurance company should be able to tell you what is eligible for reimbursement for out of network mental health claims.

Does the provider have specific training in geriatrics? Do they specialize in geriatrics?

Although providers may have the same degree or perform similar work, the clinical training behind the degree can look very different.  While it’s not necessary to choose a geriatric specialist, someone with specific training in geriatrics may be beneficial. Generally speaking, it’s less about the degree they hold and more about the training and experience they have that’s relevant to your treatment goals and medical needs.

Those 65 and older often have unique contextual, medical, and cognitive considerations that play a role in deciding the most helpful and appropriate care. As a geropsychologist, I have been trained to adapt evidence-based therapeutic approaches and psychiatric care to medical conditions that impact cognition such as dementia, multiple sclerosis, and post-stroke recovery. I have also trained and worked in nursing homes and assisted living facilities, and worked with individuals managing caregiving, grief, and loss. In general, a geriatric-trained provider may be more equipped to integrate and understand the biopsychosocial aspects of mental health and medical conditions in late life and manage these factors across a variety of settings and life events.

Sometimes the location in which you live may limit your access to or the availability of specialty providers in geriatrics. Often clinicians will consult with other clinicians as needed (i.e., when the clinical or medical concerns of patients are outside of their specialty), and this may help you in working with a local provider lacking training in a specific specialty area.

Also, given the current coronavirus pandemic, many providers are offering telehealth sessions, which may give you more options and access to providers outside your area, possibly even out of state. You should consult your insurance company to learn more about your options.

Often I recommend that individuals reach out to the clinicians they find and ask specific questions about their training in geriatrics. Consider asking how they might approach your current diagnoses or struggles. That answer may provide some clarity on their comfort and level of expertise in geriatrics, in addition to how they will attempt to manage your needs. Finding a good fit and someone you feel comfortable talking to is important!

How do I find a provider? Are those listed online the only options?

There are many ways to find behavioral health clinicians and prescribers.

As previously noted, your insurance company likely has a list of therapists and psychiatric prescribers that are in-network and covered by your insurance.

I also usually recommend asking your primary care physician for a referral. Your doctor may know of a way to connect you to a local institution or hospital, or your PCP may be embedded in such an institution. They would know your history, as well as the specialties available at the institution. They may also refer you to a gerontologist capable of managing psychiatric prescribing and with knowledge of all of the medical factors and contexts unique to those 65+. As noted above, your primary care doctor may also feel comfortable prescribing psychiatric medication.

Also, if you feel comfortable, I would suggest asking close friends or family members for recommendations of local therapists or psychiatry prescribers. I have generally found that people love sharing these recommendations in the hopes of helping connect others to effective providers. Similarly, asking the administrators of groups and senior centers you attend may provide you with a couple of names as well.

Additionally, I encourage people to do some of their own research and investigation through online databases. Psychology Today maintains a list of therapists and psychiatry prescribers, and on this site, you can refine your search by selecting the type of therapy (e.g., cognitive behavioral therapy, psychodynamic), insurance networks accepted, specialties (e.g., depression, anxiety, grief), age group or community specialization (e.g., older adults), and languages spoken.  The site also provides information on the clinician’s background and training, years in practice, and session costs. In addition to this site, APA’s psychologist locator and the National Register of Health Service Psychologists lists providers by location and specialty. There are also specific websites devoted to practitioners who follow specific modalities of therapy (e.g., Association of Behavioral and Cognitive Therapies). One thing worth noting is that to be listed on these websites, people usually need to be members of the organization or pay a fee.

Reaching out to a Professional

After receiving a few referrals and recommendations, consider reaching out to one or more of them. It’s not uncommon to find that some may not be accepting new patients, so do not be discouraged if you find this to be the case. Also, many clinicians offer free consultations to see if you’re a good match for each other.

To find the best match for you, consider speaking to the therapist and asking if they are familiar with and have practiced evidence-based treatment for your diagnosis or treatment goals. You can find the type of therapy (e.g., short term or long term therapy, group therapy) or theoretical orientations of therapy (e.g., cognitive behavioral therapy, psychodynamic) they offer, and see if what is described appeals to you and how you’d prefer addressing your concerns.

If you meet with someone and decide that it’s not a good fit, it’s perfectly fine to meet with someone else and consider other options. Shop around for fit! Being comfortable and your authentic self is essential in any relationship with behavioral health and medical professionals. Also, please know that clinicians are OK with this too.

Good luck in your efforts to support your health-related goals!

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Dr. Abby Altman is a geropsychologist and a consultant for SeniorLiving.org on the subjects of senior mental health and healthy aging. As a daughter of an occupational therapist working in nursing homes, Abby Altman, Ph.D., learned from a young age to appreciate… Learn More About Abby Altman

Since graduating from Harvard with an honors degree in Statistics, Jeff has been creating content in print, online, and on television. Much of his work has been dedicated to informing seniors on how to live better lives. As Editor-in-Chief of the personal… Learn More About Jeff Hoyt