{46} Although an M.D. may call herself or himself a psychiatrist, most psychiatrists have had specialized advanced training in psychiatry. Full qualifications involve completion of a residency in psychiatry, full membership in the American Psychiatric Association, completion of a program of study at an institute of psychotherapy, and board certification. Many psychiatrists who practice are eligible for board certification but simply have not yet taken the national examinations that are required in order to be certified by a national examining board. Although apparently many of us need to be reassured of this, you need not feel that there is anything wrong or embarrassing about asking a prospective psychiatrist, or his or her secretary, to describe the doctor's background and training. FEES At the time of this writing, the fees of psychiatrists in private practice range approximately from $75 up to $100 and occasionally more per session. Private psychiatric assistance is therefore largely reserved for the fairly well-to-do or for those who have health insurance with substantial psychiatric benefits. Fortunately, psychiatric care is available through many agencies; those that are run by counties and states normally have sliding scales (some private agencies will also take an individual's finances into account when setting fees). Rates for consultation with a psychiatrist at a public agency can be very reasonable (as little as a few dollars per visit, depending on the patient's income). This makes the services of psychiatrists available to those with modest or low incomes. DURATION OF TREATMENT If a psychiatrist finds that an emotional problem has a physical basis, or that it is due to biochemical depletion or imbalance in the body, successful treatment may be relatively short, sometimes a matter of a few months. If you choose to enter psychoanalysis, then the duration of treatment generally will be longer, often lasting a year and more; during this time, psychoanalysts may expect you to come for two or three sessions each week. Shorter-term therapies, such as cognitive therapy, are--in part because of the normal long duration required by psychoanalysis--increasingly advocated by psychiatrists. Biofeedback and relaxation training (see Chapter 5) are also among these shorter-term approaches. They may be effective within a period of several months. In this chapter, we have discussed the professions that make up the mainstream of professional practice in counseling and psychotherapy. However, beyond the established and more closely regulated professions of social worker, psychologist, and psychiatrist, there are a number of other kinds of therapists who offer services that are sufficiently different in nature that they deserve to be treated in a separate chapter. The next chapter describes their contributions to therapy. {48} 5 THE THERAPEUTIC JUNGLE, PART II Outside the Mainstream