What Steps Should You Take When Choosing a Therapist?
People are always asking me how to choose a therapist that’s right for them. There is a confusing array of titles, backgrounds, and technical jargon that make it really hard to know who is going to be able to help you, and, even more importantly, who might do you harm. In this post, I am going to give you the skinny on how to find the right treatment for you or your child.
Types of Mental Health Professionals
A Psychiatrist has a medical degree, and is the only person in the mental health field who can prescribe. Although some psychiatrists do therapy, their primary training is in medicine. This is who you see if you need a prescription. Although there are exceptions to the rule, most of them have around 10 years of training in medicine, and some therapy training that they got during residency and/or fellowship. Some call themselves psycho-pharmacologists instead of psychiatrists. This mostly seems to be a fancy title indicating that they really really understand the medicine they prescribe – it is not a regulated or licensed term.
Clinical Psychologists have graduated from 5 or 6 year graduate schools where they receive PhDs in psychology. Some receive PsyDs, which is a similar degree, with the difference being a reduced focus on research. The term Clinical Psychologist is a licensed and regulated term, similar to a medical degree, in that the state has set standards for who can call themselves a psychologist. Most clinical psychologists have had training in therapy for all five years of graduate school, followed by a year of supervised work or post-doctoral fellowship. Like a medical doctor, psychologists are addressed by the title “doctor” though they do not prescribe medicine.
Social workers went to graduate school to get a masters in social work, or an MSW. This is a two year degree. After getting their MSW there are other layers of training they may have received, and additional letters to acquire. A Licensed Clinical Social Worker, or L-CSW has to have passed the licensing exam and had three years of supervised clinical work. An L-MSW has passed the licensing exam but not yet attained all of the necessary years of supervised experience. Since so much of their training happens after their initial degree, quality of treatment by social workers varies widely based on where they got their supervision after grad school. Most are caring individuals (otherwise why do social work?), and some are people I would absolutely trust with myself or my children. Others have not had anywhere near the level of training and experience I would require in my own treatment provider. Then again, there are psychologists I would say that about too….see below for more tips on how to differentiate between therapists.
Mental Health Counselor
Mental Health Counselors have two years of training in mental health. This is a relatively new title, and training programs do not yet have to have accreditation by any larger body.
Other Steps You Can Take
Ask around. Your friends may have someone they love, and this can be a great way to figure out who is fabulous and who’s a fraud.
Understand what type of treatment you are looking for
Are you looking for CBT? Medication? Play therapy? What is the difference between these things? Well, cognitive behavioral therapy, which is also known as evidence based practice, is a research tested approach to mental health treatment. The mode of change is generally understood to be via the learning of new skills to change thoughts, feelings, and behaviors. Psychodynamic therapy, play therapy, and integrative approaches have an underlying premise that the mode of change is the relationship with the therapist, which leads to insight and eventually change. There is evidence that having a good, caring, empathic relationship with someone is helpful, however, there is stronger research showing that having a good, caring, empathic relationship with someone who ALSO teaches you CBT skills will produce greater and faster change.
Don’t be afraid to ask questions
This is a big one. I always try to remind people that they are consumers, and that if a mental health practitioner is unwilling to spend a few minutes on the phone talking, he or she will probably be unwilling to give in other ways as well. Be respectful, of course, but don’t be afraid to ask questions. Share what you are looking for and see if the person on the other end of the line gives you a response that makes sense. If you like how they sound, set up a consultation. You can always set up a few consultations and then stick with whoever feels like the right match for you and your needs.