Subject: Finding a therapist when you have HIV/AIDS
From: [email-masked]
Date: Fri, 5 Apr 1996 15:08:12 -0500

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

[email-masked]

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

A diagnosis of AIDS or HIV sero-positivity always precipates a strong emotional response.  For most people this information begins a period of emotional disorganization, where they can experience any combination of the following symptoms: depression, anxiety, crying, difficulty sleeping, nightmares, inability to concentrate on work or studies, overwhelming fear, feeling helpless, hopeless, powerless, despair or a preoccupation with dying.  Depending on the severity of the symptoms a full scale period of crisis may begin.  If you are acutely ill or hospitalized, the crisis of your medical condition itself can be cause for a variety of symptoms of mental 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 to the hospitalization call your therapist and ask him or her if they could come to the hospital in order for you to have therapy sessions during this very stressful period.  If this is not possible, discuss the possibility of arranging for telephone sessions.  Telephone sessions are scheduled for a fixed time when you are not scheduled for any medical tests or procedures.  Usually the client calls the therapist at an agreed upon telephone number. When contracting for telephone sessions there needs to be some discussion regarding the possible need for flexibility, as whenever someone is hospitalized he or she is not completely in control of their schedule, 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 professional.  Today, most nurses have undergone some training in counseling, and 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 talking about whatever you feel the need to discuss.
Another option is to ask to see a psychiatrist or social worker. All hospitals have these professionals on staff.  Most of the major hospitals that treat large numbers of persons with AIDS usually have speciifc psychiatrists and/or social workers who are specialists in working with persons with AIDS.  There may even be specific groups for inpatients with AIDS run at the hospital that you could attend.  

The hospital chaplain may be another possibility of a professional who can provide you with counseling.  While it is understandable to be skeptical of how useful priests, nuns, ministers or rabbis might be to persons with AIDS who are openly gay or who have been drug injectors, there is a growing number of gay sensitive and openly gay clergy who have been well trained in pastoral counseling.  Some hospitals like New York Hospital/Cornell Medical Center have even hired specific chaplains who are not homophobic, drug phobic, or AIDS phobic to provide an invaluable component to psycho-social and spiritual support tp people with AIDS.
GROUPS
One very effective and inexpensive way to bridge some of the isolation experienced upon diagnosis is to join a group.  Organizations like Body-Positive 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 conducted 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 groups for people with full blown AIDS.  These groups satisfy many important needs and are usually very helpful to the participants.  Many people choose 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 best 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 therapist who is experienced in working with persons living with AIDS is your physician.  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 growing 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 mental health professionals volunteer at AIDS service organizations it is common for the organization to have compiled a list of therapists it feels confident referrring people with HIV or AIDS to. 
DISCUSS MONEY
You will need to ask any persepctive therapist many questions before deciding 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 the correct therapist.  If the therapist does not state what his or her fee is during the first phone call then you should ask.  If you have medical 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 order for you to be reimbursed.  If you are on a fixed income then you will need to inquire about whether or not the therapist accepts medicaid, medicair or will accept assignement.  Asignment means that you sign a certain section on the health claim form indicating that you want the insurance 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 have 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 continue to pay the original fee that this therapist will not continue to work 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 state 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 HIV sero-postive), and ask him or her how they feel about this. Then ask how much experience he or she has had working with other people living with HIV or AIDS.  If coping with HIV concerns is only one of the reasons why 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 that you have, e.g. being in recovery; ACOA issues, lesbian or gay issues, sexual dysfunctions, etc.
You should also ask whether or not the person is licensed. (This is not to suggest that simply because a therapist has a graduate degree or is licensed by the state that he or she is a good therapist or the right one for you.  There are many excellent people practicing psychotherapy who do not have a PhD, MSW, MD or RN, and many incompetent therapists with degrees.)  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 most psychotherapy sessions run forty five, fifty or sixty minutes.)  You should also ask how frequently does the therapist expect to see you. Usually 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 from keeping your appointment, does he or she have the flexibility to reschedule your appointment?  What is the therapist's cancellation policy regarding 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 sessions?  I believe that these are all important concerns that need to be discussed before treatment begins so that you and the therapist can each decide 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 needs 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, then it is often a wise idea and prudent to schedule two or three initial appointments with different therapists and do some comparative shopping.  If you are planning on doing this it is important to let each of the perspective 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 evaluating 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 went on? Is he or she asking you the kinds of questions that indicate to you 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 therapist with the kinds of questions you asked?  Did he or she become defensive 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 following 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 intrinsically emotionally or mentally disturbed than heterosexuals, and has had extensive experience working with lesbians and gay men in a lesbian/gay affirmative manner.  You do have the right to question any perspective therapist about his or her views on homosexuality and lesbian/gay life-styles.
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 Course 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 necessarily always a fatal illness, and you have not had any medical crises for awhile, than it would probably not be a good idea to begin therapy with someone whose focus will be on death and dying as opposed to living with HIV/AIDS. 
Do you need to know the sero-status of your therapist?  Some people may not want to begin therapy with someone who is HIV sero-positive or has AIDS out of a fear that the therapist might become ill and die before the treatment is completed.  A therapist does not have to experience the identical 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 correct therapist for everyone.  Even the most skilled and empathic therapists have patients who stopped seeing them because the patient didn't feel that they were getting the kind of help they wanted, or that they were getting better.   
Starting therapy is in many ways like beginning any new intimate relationship.  There needs to be some initial excitement, trust and intuitive feeling 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 priority.  Don't be afraid to be a critical consumer of psychotherapy.  Especially at this time in your life, taking control of how therapy begins can be a beginning for taking increasing control throughout your life.

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