Choosing a Therapist

I've heard that Maine has the largest number of therapists (and lawyers) per capita! So finding someone should be easy, right? Hopefully it will be. Here are some things to consider:

1. Be aware of the different types of therapists out there and what their credentials mean:

• licensed clinical counselors - LCPC - master's degree level clinicians who have completed a counseling internship and training/education in many facets of counseling theory and practice. Counseling uses the wellness model, which means that it is a collaborative process in which the emphasis is on the strengths already present within an individual--change occurs by helping a person build on the positive aspects of their life. This is in contrast to the medical/illness model, which views clients as having problems that need to be "fixed" by an "expert."

• licensed drug and alcohol counselors - LADC - master's degree level clinicians who have completed a counseling internship in a substance abuse recovery setting - LADCs typically focus on substance abuse issues, but are trained to handle other issues that come up in the course of recovery

• social workers - LCSW, possibly MSW - master's degree level - an LCSW has been trained specifically for clinical work, whereas an MSW may not have been. www.answers.com defines social work as "Organized work intended to advance the social conditions of a community, and especially of the disadvantaged, by providing psychological counseling, guidance, and assistance, especially in the form of social services." Social workers look at things from a systemic point of view (i.e. "what's going on in this person's community/culture/family/relationships/job/etc. that may be causing difficulty?") - they often work to connect people with appropriate resources in their community.

• psychiatrists - M.D. - medical doctors - they have gone through regular medical school to become a doctor, and have chosen to focus on mental health concerns. Psychiatrists are the only type of mental health professional who can prescribe psychotropic medications. (Other than psychiatric nurse practitioners. Your primary care physician can prescribe as well, but PCPs usually don't have the degree of knowledge and training about psychotropic meds that psychiatrists do.) Because psychiatrists are doctorate level professionals, and are in high demand for medication management, they will most likely be more expensive to see than a master's level clinician, without necessarily having the same degree of training for counseling as master's level clinicians do.

• psychologists - Ph.D.s or Psy.D. - doctorate level clinicians - There are many different types of psychologists; you're probably looking for a Clinical Psychologist or a Counseling Psychologist, who have been trained in assessing and treating mental health "disorders." Ph.D.s usually have an extensive background of doing research in graduate school, whereas Psy.D.s have more "hands-on" training in working with mental health consumers.

• school counselors - master's level clinicians who specialize in issues specific to school counselors. They usually have many jobs--in one day they could fix students' class schedules, run a group for kids with anger management issues, do crisis intervention, and talk to a class about applying for the SATs. (some school counselors will also have an LCPC, which means they took additional classes in counseling beyond the requirements for becoming a school counselor.

• pastoral counselors - state licensed pastoral counselors meet similar requirements to LCPCs and LADCs, master's degree level counselors - counseling tends to incorporate religious principles. Some religious organizations give certification for titles such as "Christian Counselor;" these types of counselors are unregulated by the state, and their training and qualifications vary.

• others - To my knowledge, anyone without a criminal history who is willing to pay the application fee can become a "registered counselor" (or LPC in Maine). Educational and training requirements are unclear, and can vary person to person. [personal opinion - if a person is claiming to be a "therapist" and does not have at least a master's degree from a reputable institution, I'd be wary of working with them.]

If there is a -c or -cc after a clinician's credentials, this stands for "conditional," which means they've probably received their license in the past few years and haven't yet completed the requirements of becoming fully licensed. (for example, an LCPC-c must complete 3000 hours of counseling-related work in order to receive full licensure)

    2.    It's ok to "shop around."

• There are a huge number of counseling theories that are very different from one another, and a wide variety of personality types in the counseling profession. So, if you end up seeing a therapist who never smiles and keeps making you move plastic dinosaurs around in a sand tray while s/he watches the clock, or makes you do "role plays" week after week even though you hate them, it's ok to try a different therapist. (Obviously, things aren't usually that extreme, but you get the idea.)

• It's ok to make appointments for consultations with several therapists to find out more about what they do and get a sense of whether he or she can provide what you're looking for. (Sometimes, therapists don't charge for an initial consultation appointment, but find out before you go!)

• If you leave your therapist--even if you've been seeing him or her for months--it doesn't mean that you did anything wrong (or that you think they've done something wrong)--sometimes people just don't work well together for any number of reasons. Remember, you are paying your therapist for his or her services. You are in charge; they are your "employee." If every time you went to McDonalds, they gave you a salad instead of the Happy Meal you ordered, you'd probably stop going, right? This is their job--they shouldn't be personally offended if you leave.  [Note from a certain counselor who has been "stood up" many a time: Having said that, it's really annoying when someone makes an appointment and then doesn't show up--unless an emergency is happening. If you're not going to go, whatever the reason may be, just cancel!]

    3.    It's ok to ask questions.

• If you ever get confused or don't understand something (from a technique a therapist is using to his or her billing plan), don't be afraid to ask! You have the right to understand what you're getting into. If you're taking about your huge fear of spiders one week, and the next week your therapist brings in a tank of big fury tarantulas, it'll probably be helpful to find out his or her reasoning behind that decision! You and your therapist should be partners in working towards your goals--if you often suspect that s/he is "hiding" things from you, or not letting you in on what s/he is doing, this is more like having a boss and lesser-ranked worker relationship. [Note: Counselors (and other types of therapists, I think) are required to have a "disclosure statement," which is a document explaining what their credentials are and how they do their work. It should also have information about payment and billing, and other info that would be good to know. If you have questions, and don't remember getting a disclosure statement, or have lost it, just ask for another one--it could be useful!]

• In therapy, confidentially is of utmost importance. If you ever feel like your therapist might be breaking confidentiality in any way, ask what's going on! Sometimes it's difficult to question people who seem like "experts." But remember, nothing will change unless you talk about it.