From: MShernoff@aol.com
Date: Fri, 5 Apr 1996 15:08:12 -0500
Subject: Finding a therapist when you have HIV/AIDS

Attached is a file (in ASCII) that I'd appreciate your posting to the QRD's
AIDS resource library and anywhere else you feel it is appropriate.

Thanks

Mshernoff@AOL.COM


	Choosing a Therapist When You have AIDS/HIV
	Michael Shernoff, CSW, ACSW
Private Practice, NYC, NY
=0D

A diagnosis of AIDS or HIV sero-positivity always precipates a strong emo=
tional response.  For most people this information begins a period of emo=
tional disorganization, where they can experience any combination of the =
following symptoms: depression, anxiety, crying, difficulty sleeping, nig=
htmares, inability to concentrate on work or studies, overwhelming fear, =
feeling helpless, hopeless, powerless, despair or a preoccupation with dy=
ing.  Depending on the severity of the symptoms a full scale period of cr=
isis may begin.  If you are acutely ill or hospitalized, the crisis of yo=
ur medical condition itself can be cause for a variety of symptoms of men=
tal or emotional distress.
IF YOU'RE IN THE HOSPITAL
Noone should have to go through the adjustment to AIDS or sero-positivity=
 alone.  If an acute medical condition results in your being hospitalized=
, and you feel that talking to a professional would be useful, there are =
several options that can be persued.  If you have been in therapy prior t=
o the hospitalization call your therapist and ask him or her if they coul=
d come to the hospital in order for you to have therapy sessions during t=
his very stressful period.  If this is not possible, discuss the possibil=
ity of arranging for telephone sessions.  Telephone sessions are schedule=
d for a fixed time when you are not scheduled for any medical tests or pr=
ocedures.  Usually the client calls the therapist at an agreed upon telep=
hone number. When contracting for telephone sessions there needs to be so=
me discussion regarding the possible need for flexibility, as whenever so=
meone is hospitalized he or she is not completely in control of their sch=
edule, or unexpected medical emergencies.  =

If you are hospitallized and do not have a therapist tell your physician =
or one of the nurses that you'd like to speak with a mental health profes=
sional.  Today, most nurses have undergone some training in counseling, a=
nd many have gone on to receive post-graduate training in counseling and/=
or therapy.  Thus one of the nurses who is already involved in your care =
may be skilled in counseling, and willing to spend some time with you tal=
king about whatever you feel the need to discuss.
Another option is to ask to see a psychiatrist or social worker. All hosp=
itals have these professionals on staff.  Most of the major hospitals tha=
t treat large numbers of persons with AIDS usually have speciifc psychiat=
rists and/or social workers who are specialists in working with persons w=
ith AIDS.  There may even be specific groups for inpatients with AIDS run=
 at the hospital that you could attend.  =

=0D
The hospital chaplain may be another possibility of a professional who ca=
n provide you with counseling.  While it is understandable to be skeptica=
l of how useful priests, nuns, ministers or rabbis might be to persons wi=
th AIDS who are openly gay or who have been drug injectors, there is a gr=
owing number of gay sensitive and openly gay clergy who have been well tr=
ained in pastoral counseling.  Some hospitals like New York Hospital/Corn=
ell Medical Center have even hired specific chaplains who are not homopho=
bic, drug phobic, or AIDS phobic to provide an invaluable component to ps=
ycho-social and spiritual support tp people with AIDS.
GROUPS
One very effective and inexpensive way to bridge some of the isolation ex=
perienced upon diagnosis is to join a group.  Organizations like Body-Pos=
itive and Positive-Action have time limited support groups for people who=
 are usually asymptomatic or mildly symptomatic with early indications of=
 HIV illness.  These are not therapy groups, even though they may be cond=
ucted by a mental health professional.  They are self-help counseling and=
 support groups to help people adjust to living with HIV infection.  AIDS=
 service organizations all over the United States have ongoing support gr=
oups for people with full blown AIDS.  These groups satisfy many importan=
t needs and are usually very helpful to the participants.  Many people ch=
oose to either begin or continue their own individual therapy in addition=
 to attending a group.
Finding the correct therapist can be confusing and daunting even when the=
 issues are not as urgent and crucial as living with AIDS or HIV.  The be=
st place to begin is to ask someone whom you trust if they can suggest a =
therapist for you.  One logical person to ask for a referral to a therapi=
st who is experienced in working with persons living with AIDS is your ph=
ysician.  A friend or member of your support group who is in therapy and =
who talks highly about his or her therapist, or who you have observed gro=
wing and adjusting to their condition in ways that you feel are positive,=
 is another good source to ask for the name of a therapist.  Since many m=
ental health professionals volunteer at AIDS service organizations it is =
common for the organization to have compiled a list of therapists it feel=
s confident referrring people with HIV or AIDS to. =

DISCUSS MONEY
You will need to ask any persepctive therapist many questions before deci=
ding whether or not you want to set up an initial appointment with him or=
 her. Affordability is one of the very important components of choosing t=
he correct therapist.  If the therapist does not state what his or her fe=
e is during the first phone call then you should ask.  If you have medica=
l insurance that reimburses you for part of the cost of therapy you will =
want to ask the therapist if he or she has the necessary credentials in o=
rder for you to be reimbursed.  If you are on a fixed income then you wil=
l need to inquire about whether or not the therapist accepts medicaid, me=
dicair or will accept assignement.  Asignment means that you sign a certa=
in section on the health claim form indicating that you want the insuranc=
e company to pay the therapist directly.
In addition, if you are seeking therapy while you are still employed and =
can afford a particular fee, how negotiable will the fee be if you ever h=
ave to go on disability or public assistance?  It would certainly not be =
in your best interest to begin therapy, feel that you are doing important=
 work in your treatment only to find out if and when you are unable to co=
ntinue to pay the original fee that this therapist will not continue to w=
ork with you at a reduced fee.  This is very important to discuss during =
the intial phone call or initial visit.  If you are not comfortable with =
how the therapist responds to your questions, or if he or she does not st=
ate very categorically that there is the potential for flexibility in the=
 event of an emergency situation, then you may not wish to even schedule =
an initial appointment with this person. =

ASK LOTS OF QUESTIONS
Be certain to tell any perspective therapist that you have AIDS, or are H=
IV sero-postive), and ask him or her how they feel about this. Then ask h=
ow much experience he or she has had working with other people living wit=
h HIV or AIDS.  If coping with HIV concerns is only one of the reasons wh=
y you are seeking therapy then you should ask the therapist about his or =
her experience in working with people with what ever the concerns are tha=
t you have, e.g. being in recovery; ACOA issues, lesbian or gay issues, s=
exual dysfunctions, etc.
You should also ask whether or not the person is licensed. (This is not t=
o suggest that simply because a therapist has a graduate degree or is lic=
ensed by the state that he or she is a good therapist or the right one fo=
r you.  There are many excellent people practicing psychotherapy who do n=
ot have a PhD, MSW, MD or RN, and many incompetent therapists with degree=
s.)  Be prepared that a professional who is licensed will usually charge =
a higher fee than one who is not licensed.
You will want to inquire about how long the sessions are.  (Currently mos=
t psychotherapy sessions run forty five, fifty or sixty minutes.)  You sh=
ould also ask how frequently does the therapist expect to see you. Usuall=
y therapy begins with once a week sessions, but in crisis situations more=
 frequent sessions can be useful and appropriate.  Will the therapist be =
available to you by phone if there is a crisis?  Will he or she have some=
 flexibility in their scheducle so if you need an additional session they=
 can schedule it?  Also if a medical emergency arises that prevents you f=
rom keeping your appointment, does he or she have the flexibility to resc=
hedule your appointment?  What is the therapist's cancellation policy reg=
arding payment for missed appointments?  Also if you are unable to get to=
 his or her office will they do hospital or home visits or telephone sess=
ions?  I believe that these are all important concerns that need to be di=
scussed before treatment begins so that you and the therapist can each de=
cide if the fit or chemistry is correct between you.   =

 BEING AN INFORMED CONSUMER OF PSYCHOTHERAPY
I am a firm believer that the individual seeking psychotherapy services n=
eeds to be an educated and sophisticated consumer.  It is largely through=
 asking the kinds of questions mentioned above that perspective patients =
are able to educate themselves.  If there is not an immediate crisis, the=
n it is often a wise idea and prudent to schedule two or three initial ap=
pointments with different therapists and do some comparative shopping.  I=
f you are planning on doing this it is important to let each of the persp=
ective therapists know that you are shopping around.  =

Once you feel satisfied over the phone then you will need to schedule an =
initial appointment.  During the initial session it is useful to be evalu=
ating what goes on.  Do you feel comfortable with this person?  Is he or =
she someone that you feel you would grow to increasingly trust as time we=
nt on? Is he or she asking you the kinds of questions that indicate to yo=
u that they understand what is going on with you, and will be able to be =
useful to you during this period of your life?  How comfortable was the t=
herapist with the kinds of questions you asked?  Did he or she become def=
ensive or welcome and value your inquiries about how the business aspects=
 of therapy will be conducted?   In other words did he or she communicate=
 to you that the two of you would need to become partners in the process =
of helping you?
When beginning therapy it is a good idea to ask the therapist what his or=
 her vacation schedule is. You may or may not want to begin therapy with =
someone who is planning to be away for several weeks immediately followin=
g the start of treatment.
PERSONAL INFORMATION ABOUT YOUR THERAPIST
The issue of how much personal information you have a right to know about=
 your therapist is controversial.  If you are lesbian or gay do you need =
to have a lesbian or gay therapist in order to receive good treatment?  I=
 don't believe that sexual orientation is as important as whether or not =
the therapist believes that lesbians and gay men are no more or less intr=
insically emotionally or mentally disturbed than heterosexuals, and has h=
ad extensive experience working with lesbians and gay men in a lesbian/ga=
y affirmative manner.  You do have the right to question any perspective =
therapist about his or her views on homosexuality and lesbian/gay life-st=
yles.
Similarly you may wish to question any perspective therapist about his or=
 her views on HIV or AIDS.  If you are a disciple of Louise Hay, the Cour=
se in Miracles or other New Age philosophies than it will be important to=
 you to begin work with someone who is at least familiar with this way of=
 thinking and supportive of it.  If you believe that AIDS is not necessar=
ily always a fatal illness, and you have not had any medical crises for a=
while, than it would probably not be a good idea to begin therapy with so=
meone whose focus will be on death and dying as opposed to living with HI=
V/AIDS. =

Do you need to know the sero-status of your therapist?  Some people may n=
ot want to begin therapy with someone who is HIV sero-positive or has AID=
S out of a fear that the therapist might become ill and die before the tr=
eatment is completed.  A therapist does not have to experience the identi=
cal issues as his or her patients in order to be helpful to them.
     It is also very important to remember that no therapist is the corre=
ct therapist for everyone.  Even the most skilled and empathic therapists=
 have patients who stopped seeing them because the patient didn't feel th=
at they were getting the kind of help they wanted, or that they were gett=
ing better.   =

Starting therapy is in many ways like beginning any new intimate relation=
ship.  There needs to be some initial excitement, trust and intuitive fee=
ling that this is a safe and nurturing place for you to be.  As time goes=
 on there should be an increasing number of tangeable examples of why you=
 trust this person and that he or she has your best interests as their pr=
iority.  Don't be afraid to be a critical consumer of psychotherapy.  Esp=
ecially at this time in your life, taking control of how therapy begins c=
an be a beginning for taking increasing control throughout your life.

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