In this Ask Dr. Steve two-part series, we will cover when to contact a mental health therapist, how to select a therapist, what are the typical number of sessions needed per episode care and cost, what elements in mental health therapy affect positive change, symptom reduction, and return to “normal” functioning.

The opinions expressed in the answers provided are based on 30 years of experience and psychotherapy outcome research.

Q. How common is the need for mental health counseling or psychotherapy?

A. Over a lifetime, over 80% of the adult population will exhibit symptoms or problems that would benefit from mental health services. Only half of those in need will access mental health services.

Q. So, it’s normal to need mental health services?

A. That is correct. Think of mental health services as being similar to dental or primary care medical services. Eventually, almost everyone is in need.

Q. How do you know when to call and schedule for mental health services?

A. When you are “stuck”, it is the time for mental health services. You could be stuck in a negative emotional pattern, a negative relationship pattern, or a pattern of behavior (drinking, gambling, procrastination) that does not match your goals or values or your desire for satisfaction in your life.

Q. How do you locate or select a therapist?

A. To find a therapist, your primary care physician or clergy may have recommendations. Your health insurance company has a list of providers in your area. Google search engines like “Psychology Today” can provide you with options. Sometimes friends will have a recommendation.

Q. How do you choose from all of those options?

A. Therapists typically have credentials and licenses to practice. They usually list what conditions they are accustomed to treating. Honestly, the choices pretty much look similar “online.”

Q. What does a therapy session cost?

A. 2025 insurance discounted costs for therapy run between $90 to $120 per session. Private cash only providers may charge as much as $200 per session. Insurances cover most of this cost, if it is a covered benefit, and after deductibles are met.

Q. What is a deductible?

A. Health insurers sometimes require subscribers to pay for their own health care services for up to a certain limit, such as $500 or even as high as $3,000 as a deductible. All plans are different and can change every year. Please call your health insurer before you schedule with a mental health provider to find out about your co-pay and providers listed on your insurance.

Q. Should I pay attention to Google reviews?

A. No. Do not depend on Google reviews to select a therapist. Google reviews (mostly negative) are the ones posted and most are left by individuals who did not understand the cost or therapy process. Patients who are pleased with their therapy and their providers seldom leave google reviews.

Q. Does the number of years of experience of a therapist matter?

A. Research shows that less experienced therapists also get good results. Age and sex of the therapist is a preference, but not a requirement for effective therapy or counseling.

Q. How many sessions of therapy do most people participate in when obtaining good results?

A. Between eight and 12 sessions of therapy are needed to be effective for many if not most mental health problems. After that, follow up check ups are recommended. Frequently, other problems arise and people get back to therapy quicker and without hesitation.

Q. How do you know that the therapist you picked and are seeing is the right one?

A. You should like and respect your therapist. They should demonstrate good questions, compassion, professional demeanor, and ideas for you to explore.

Q. What are the ingredients to effective therapy or counseling?

A. These are a few key ingredients to effective therapy or therapists:

1. The therapy and client relationship needs to be positive and respectful. This is referred to by therapists as the “therapeutic alliance.” Research shows that this accounts for 60% of positive change, leaving 40% to other factors.
2. In most cases, the therapist should match the techniques with the problems and the client’s beliefs. There are many evidence-based therapies with a variety of techniques.
3. Continuous assessment and problem goal targeting. It is my opinion that every session, after small talk, should begin with “what do you want to accomplish in the 45-50 minutes that we have together today?” Also important is to ask the client if they experienced any upsetting events since the last session, including sleep deprivation, suicidal thoughts, uncontrollable anger or other emotions or life events like divorce, deaths, job trouble or loss, etc.

Q. What are some of the things that are associated with negative experiences in psychotherapy?

A. Boundary violations permitted by the therapist and dual relationships are ethical problems that lead to negative therapy experiences. Your therapist cares about you and your progress. However, they are not a friend, and certainly not a lover. They are a professionals providing a service. If that boundary is crossed there are potential big problems for both the therapist and client. Men and an approximately an equal number of women therapists are brought before the licensing board each year for having inappropriate, mostly sexual, relationships with clients.

Q. What are boundary violations?

A. Meeting for lunch or coffee with your therapist is likely a boundary violation. Texting, emailing, or calling your therapist at times other than therapy appointment times can be a boundary violation. I once had a therapist selling “healthy” water machines to their clients. This is a dual relationship that can cause problems. Don’t buy a machine and then you might get less focus and attention in the therapy.

Q. What are some other complaints that people have about their past therapists ?

A. Many people complain that their therapist talks too much about themselves, their life, and the therapist’s own problems. Many people also complain that their therapist, even though they like the therapist, did not offer any methods to address the problems, symptoms and negative patterns that they were seeing help for. They would lament: “The therapist just listened.”

Q. When should you stop going to therapy?

A. Some therapist schedule weekly sessions and do not identify specific goals to be achieved or a timeline. With this in mind, if your improvements have plateaued, it may be time to go into a follow up phase versus a weekly session phase of treatment.

For some individuals, the goal might be to help the person with serious mental illness from needing emergency hospital services, thus justifying once a week therapy or even more for longer.

For most people seeking outpatient counseling, eight to 12 sessions and some follow up is what is needed and is statistically reported. Like your dentist and primary care physician attendance, your mental health services participation will start and temporarily discontinue over the years.

In upcoming articles, Dr. Steve Szykula and colleague Jason Sadora, M.S. and licensed clinical mental health therapist, will detail accessing medication therapies and alternatives to traditional medications including direct brain interventions (Spravato therapy), neuro-feedback therapy, trans-cranial stimulation therapies and others. Also detailed will be the many of the available psychological and neuropsychological evaluation services which are helpful in determining diagnoses and the course of treatment.

Dr. Steve Szykula has provided psychotherapy services for four generations of family members, grandparent, adult child, adult child’s children, adult child’s grandchildren, most often with one or two episodes of care occurring each year for eight to 12 sessions. Much like patients who rely on a primary care medical doctor over many years, the effective therapist builds the same type of practice and trust.

Dr. Steve Szykula and his colleagues at Comprehensive Psychological Services (WeCanHelpOut.com) offer a variety of therapy and medication options at their clinics.