How Do I Know What Kind of Therapist to Choose?

by Annabelle Parr

Choosing a therapist can be overwhelming. If you search Google or Psychology Today, you will likely find a long list of different therapists including licensed marriage and family therapists, licensed professional clinical counselors, licensed clinical social workers, psychologists, and psychiatrists. How do you know what kind of therapist will be the best for you? And what is the difference between all those different licenses?

Licensed Marriage and Family Therapists (LMFT):

An LMFT holds a Master’s degree in counseling, which typically involves between two and three years of school. LMFTs are trained to view individuals from a family systems perspective, meaning that they learn to see individuals in the context of their relationships. Relationships include family, friends, significant others, and even your relationship to yourself. Despite what their license seems to imply, LMFTs also work with individual clients; they do not exclusively offer marriage and family therapy. Their license speaks to the lens through which they view clients and the various presenting problems they may bring into therapy. LMFT’s must complete at least 3,000 hours of supervised experience before becoming licensed, and this experience must include working with children, families, and/or couples.

An Associate Marriage and Family Therapist has completed their Master’s but is still working on their 3,000 hours of supervised experience.

Licensed Professional Clinical Counselors (LPCC):

An LPCC also holds a Master’s degree in counseling. Many Master’s programs qualify students to sit for both the LMFT and LPCC licensing exams. However, LPCCs tend to work more generally, with a focus on mental health issues as opposed to relational issues, and tend to focus on the individual rather than the individual in the context of their relationships. LPCCs also must complete 3,000 hours of supervised experience prior to licensure, and a portion of their experience must be in either a hospital or community based mental health setting.

An Associate Professional Clinical Counselor has completed the Master’s degree requirements but is still working toward the 3,000 hours of supervised experience.

Licensed Clinical Social Workers (LCSW):

An LCSW holds a Master’s degree in social work. Their training teaches them to help connect clients with resources, both externally (like community resources, support groups, etc.) and internally (like coping skills). An LCSW must complete 3,200 hours of supervised experience in order to get licensed, and they must be supervised specifically by another LCSW for a portion of their hours. They may also provide individual, family, or couples therapy, but the lens through which they have been trained focuses on ensuring clients have access to all the resources they need to thrive.

An Associate Clinical Social Worker has completed the Master’s degree requirements but is still working toward the 3,200 hours of supervised experience.

Psychologists:

A licensed psychologist holds a doctorate degree, either a Ph.D. (doctor of philosophy in psychology, focused on both research and clinical work) or a Psy.D. (doctor of psychology, more clinically focused than research focused), which can take between four and seven years to complete. Licensed psychologists also require 3,000 hours of supervised clinical experience for licensure. Psychologists typically have more training in psychometric assessment and test administration than an LMFT, LPCC, or LCSW. A psychologist with a Ph.D. is prepared to practice clinical work, conduct research, and/or teach, whereas a Psy.D. is typically primarily focused on clinical work.

Registered Psychological Assistant or Postdoctoral Fellow: A registered psych assistant is still working toward the doctoral degree and receiving supervised clinical experience. A postdoc has already completed the doctorate, but is completing the supervised clinical experience hours toward licensure.

Psychiatrists:

A psychiatrist holds a medical degree, and has completed a period of residency, and fellowship. Psychiatrists are medical doctors and are able to prescribe medications. A psychologist, LMFT, LPCC, and LCSW are not able to prescribe medication. Psychiatrists are also able to provide psychotherapy services, but their training is more medically focused.

What’s the takeaway?

Ultimately, there can be a lot of overlap in the services provided by the above practitioners. They are all qualified to assess, diagnose, and treat the full range of mental and emotional disorders found in the Diagnostic and Statistical Manual (DSM). The specific license under which a therapist operates speaks to the lens through which they have been educated, and the duration of education.

However, the provider’s area of expertise and scope of practice tends to depend upon the clinical experience that they have gained. So when looking for a therapist, it can help to understand what their license means, but it is perhaps more important to understand the specific supervised and licensed experience that the therapist has. Do they have experience working with anxiety, panic, trauma/PTSD, depression, identity issues, couple’s therapy, child therapy, family therapy? What modalities are they trained in? Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, Psychodynamic Therapy, EMDR, Emotion Focused Therapy, Somatic Therapy? Do their areas of expertise and treatment modalities align with your needs and goals?

Research consistently shows that the therapeutic relationship is the most important factor in whether therapy is successful. So it’s key that the therapist you choose feels like the right fit for you personally. But it can be hard to try to figure out who might be a good match based on credentials and website information alone. A good place to start in narrowing your search is looking at the therapist’s areas of expertise and preferred treatment modalities. Once you have found someone whose specialties line up with your goals, you can reach out to the provider and ask any questions that may not have been addressed on the practice website. (If they won’t take the time to respond to your questions, they might not be the best fit!) If you feel comfortable with the therapist during the initial contact, you can schedule your first session. You will want to meet with the therapist 2-3 times to evaluate how safe and comfortable you feel working with this person. Choosing a therapist is a process, and it can feel overwhelming at first. But once you know how to narrow your search and find a provider that feels like a good fit, it can be incredibly rewarding.

How To Listen When Someone You Love Is Struggling

by Annabelle Parr

Life presents us each with challenges.  While it is often uncomfortable and painful to grapple with adversity, to experience this struggle and to feel pain is to be human.  At some point, we will all find ourselves in this place, as will those we love.  So how can we help each other?  How can we listen when someone we love is struggling, whether it is with a mental health condition or with a painful experience in his/her life?

 LET GO OF THE IMPULSE TO TRY TO FIX

Source URL: https://scott-williams.ca/2013/03/

It is painful to watch someone we care for struggle or hurt.  And it’s natural to want to take away her pain or try to fix the problem at hand.  However, despite our best intentions, trying to “fix” does not actually help.  It tends to make the person struggling feel as though she cannot share her pain, sadness, or anger.  Trying to “fix” sends this message: “I can’t handle seeing you in pain, so I have to make everything better.”  It also implies that it is not okay to feel sad or angry or anxious, and that these feelings should be avoided at all costs.

AVOID ADVICE

Just like our impulse to fix the pain, we also often believe that the best way to help is to offer advice.  But advice is usually not helpful for several reasons.

1. If we offer good advice, our loved one will think that anytime he is struggling, he needs our instruction.

2. If we offer bad advice or our advice doesn’t work as we hoped, our loved one can place the blame on us instead of owning responsibility.

3. Advice takes away the gift of helping our loved one to realize that she knows herself best, and ultimately she is capable of navigating difficult situations herself. (Though, of course, she will always have our love and support).

LIMIT SHARING YOUR OWN SIMILAR EXPERIENCES

Source URL: http://www.lifehack.org/articles/communication/the-biggest-communication-problem-not-listen-understand.html

If you have had a similar experience or believe that you have felt the same way, you can share this with your loved one.  But don’t make it all about you.  Keep your story brief, and make sure the purpose of the story is to let him know that he is not alone.  Also, be sure to include that you understand that your experience, while maybe parallel in some ways, is yours, and you are not claiming to have experienced the exact same situation or feelings.  This allows him to feel comfort in not being alone, but also gives him space to communicate how his experience may be different.

If we shouldn’t try to fix the pain or offer advice, and we should limit how much we share of our own experience, what can we do to help?

REFLECT OR PARAPHRASE BACK TO YOUR LOVED ONE WHAT YOU HEAR HIM/HER EXPRESSING

This shows that we are listening, and gives us the opportunity to clarify that which we don’t understand fully.  While it may sound too simple to just reflect what our loved one is saying, it actually makes the person feel heard and understood.  It also offers her the opportunity to hear what she is expressing, and to clarify how she feels or what she wants.

USE NONVERBAL SIGNALS TO SHOW YOU ARE ENGAGED

Nodding and using eye contact and engaged body language shows that we are interested and open to what our loved one is sharing.  It gives him the space to express himself, and makes him feel heard.

SHOW EMPATHY

Empathy is: “I see that you are struggling and hurting right now, and I am so sorry.  I can’t fix it for you or take it away, but I will sit here with you and listen to your story.  As much as this hurts, it is okay to feel this way.”

Check out Brene Brown’s brilliant short on empathy.

Sometimes, all our loved ones need when they are in pain is to be heard; to be given a space with someone they trust to express how they are feeling.  Sometimes, however, they may need some extra support or professional help.

CSAM IS HERE TO HELP

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

REFERENCES:
Brown, B.  (2013, Dec 10).  Brené Brown on empathy. Retrieved from https://www.youtube.com/watch?v=1Evwgu369Jw

Hypochondriasis is like OCD: Cognitive Behavioral Therapy Can Help

by Lucas Myers

You are patiently explaining to the third doctor that the bruising on your arm is a sure sign of leukemia. Once again, she tells you that the tests all came back negative. You’ve heard it all before. She explains that much like the parasites causing intense stomach pain were just some gas, and the terrible headache in June was not a brain tumor but most likely a sign of dehydration, this is just a normal bruise and should clear up in a few days. You attempt to cap your seething frustration as you push your doctor to try another test. As soon as you get home you make an appointment with another doctor - perhaps this one will help. Welcome to the challenging world of someone coping with Hypochondriasis, sometimes referred to as Health Anxiety or Illness Anxiety. 

Hypochondriasis, estimated to be affecting 1-7% of the population, causes a person to dread that she has, or is going to have, a terrible disease or physical ailment. This person may constantly monitor her vital signs, and see minor changes in her body as “symptoms” of something far more ominous. She may “hop” from doctor to doctor, reading obsessively online about disease and seeking validation and treatment by demanding unneeded tests. Negative tests may bring some temporary reassurance, but this typically wears off quickly, only to be replaced by more illness fears. 

Those suffering from Hypochondriasis may believe that their excessive worrying is protecting them. They may believe that any discomfort or imperfection of body functioning is a sign of serious illness. Perhaps they sense that any doubt or uncertainty demands thorough investigation. Often they may scour the Internet until they find “proof” that the symptom they are concerned about is associated with a debilitating or deadly disease, such as cancer.

While hypochondriasis might seem funny or eccentric at first, those who have had or known someone with hypochondriasis tell a different story. The obsessive check-ups, monitoring, research, and fear can demand an enormous time investment and stress academic, professional and social relationships to the breaking point. Hypochondriasis can cause a person to become so obsessive that it appears to share similarities with Obsessive Compulsive Disorder (OCD). In particular both diseases share the feature that the more an individual attempts to address their fears (by checking, washing, doctor hopping, etc.), the more intense those fears tend to become. An important difference that distinguishes the two is that while someone with OCD may live in terror of getting a disease, someone with Hypochondriasis lives with the fear that they already have it.

Recommendations to those with Hypochondriasis include sticking to one doctor, avoiding Internet searches about illnesses, keeping active, and stopping self-checks. Of course making these changes is often very difficult to do without help, especially because the very nature of Hypochondriasis is the lurking sense that diagnosis of disease is just one doctor away. The nightly news often offers headlines that read as confirmation of a new health threat and a bombardment of well-meaning public health messages could leave anyone on high alert. However, WebMD is not the answer so where else can someone turn who is struggling with hypochondriasis?

The first step is education about the condition. Understanding hypochondriasis is crucial to gaining the power to change and sticking with a treatment plan. Make sure that a licensed or supervised psychologist is part of the healthcare team. Not only do they have the expertise to diagnose Hypochondriasis, but research has equipped them to to treat it. Due to the many similarities between OCD and Hypochondriasis, strategies developed to treat OCD have been found to be highly effective when adapted to the treatment of Hypochondriasis. According to recent studies by Harvard University and the Mayo Clinic, the most effective treatment is Cognitive Behavioral Therapy (CBT). 

CBT is designed to help identify and change the behaviors that maintain and worsen anxiety and other symptoms of hypochondriasis. Sometimes it may include exposure therapy-- confronting fears little by little until they lose their power. For example, if someone is terrified that they have cancer, they may visit a cancer hospital. Another technique, cognitive restructuring, teaches clients to challenge the validity of their health related fears. An approach that borrows from Mindfulness-Based CBT, is to learn non-judgmental acceptance of unpleasant thoughts. From a mindfulness perspective this discomfort is normal, and distress arises from the persistent attempts to control or escape discomfort.

Over the course of therapy, which is often as short as 16-20 sessions, clients learn to use these tools to challenge their health related anxiety as well as the behaviors that they have been using to cope with those fears. If you would like more information on Hypochondriasis or Cognitive Behavioral Therapy, click here to contact us.

References:

Leahy, Robert L. “Are You a Hypochondriac?” Retrieved October 9th 2013 from:

http://www.psychologytoday.com/blog/anxiety-files/201009/are-you-hypochondriac

Haupt, Andrea. “How to Cope with Hypochondria” Retrieved October 9th 2013 from:

http://health.usnews.com/health-news/articles/2012/07/10/how-to-cope-with-hypochondria

Hypochondria / Health Anxiety |Symptoms and Treatment. Retrieved October 9th 2013 from:

http://www.ocdla.com/HYPOCHONDRIASIS.html

America's Suicide Problem Pt. 2: Getting Help

by Lucas Myers

In our last blog, we discussed what suicide is and the high rates of suicide impacting many of us nationwide. Now it is time to talk about solutions. If you or someone you care about is thinking about suicide, stop and think for a moment about who you could go to for help. Regardless of your age, think about who the trusted adults and friends are in your life. It isn't an easy conversation to have, so if you or someone you know is struggling, it can be really helpful to have a caring person in your corner. If a person is in need, she may be working hard to hide how she feels, but hoping desperately that someone notices how much she is hurting. If you need someone to talk to and you don't have the words to ask, start with “I need help”.

If someone comes to you for help, the first thing you should do is stay with the person in need. Don’t leave her alone. Unless there is a threat of harm to you, stay with her even if it’s just on the phone. Even if you’re going to be late for work, or school, or dinner at Mom's, stay with her, others will understand.. 

Next, listen; really listen. There is an old saying that we were given 2 ears and 1 mouth so we could listen twice as much as we speak. This is too important to make a joke or dismiss the person’s concerns. Be supportive. There are some tough questions you can ask that will show you care. “Are you ok? Are you thinking of hurting yourself? Will you go with me to get help? Who would you like to talk to?” These questions are about getting the help needed to survive this crisis. 

The most important thing you can do is to get help. Chances are, you aren’t a trained counselor. Getting help is essential because this isn’t a simple situation you can handle on your own. Even though I’ve received training in crisis counseling and suicide assessment, the first thing I do with a person in crisis is to notify my supervisor for backup. It’s always OK to ask for help. It is ALWAYS OK to ask for help. This problem is bigger than one person, so ask “Are you getting help? Can I help you get help?” There are two numbers that you can use to get help. 1-888-724-7240 is a local San Diego crisis line available 24-7. The other number is a national number you can use if the crisis is out of the area and that is 1-800-273-TALK. These numbers are both nation-wide and toll free 24-7. You can call and speak to a professional for immediate help. Also, don’t be afraid to call 911. This is an emergency. 

Your friend may ask you to keep what he’s told you a secret. Don’t do it. This is too important. You are not a friend if you’re letting the person you care about keep all that pain to himself instead of getting help. This secret is not worth dying for.

How do we know if someone needs help? The major warning signs are actually pretty obvious. If you hear someone is threatening to kill himself, looking for ways to kill himself, or talking or writing about suicide or death you need to find help immediately. We can’t afford to ignore statements like “I wish I was dead. I never should have been born. You would be better off without me.” These are cries for help. A person who is contemplating suicide may feel hopeless, angry, or vengeful, and act recklessly without thinking. If something seems wrong and you are worried, get help immediately. For someone in a suicidal crisis, help can’t wait. What happens if your friend was just being dramatic and you called 911? He might be pretty embarrassed, he might have some explaining to do. What if he wasn’t being dramatic? Boom. Embarrassment just became the best-case scenario. Better to lose a friendship than to lose a friend.

Pay attention if your friend suddenly starts using more drugs and alcohol. 50% of those that attempt suicide are under the influence, most frequently alcohol. People who feel suicidal might seem moody, anxious, agitated or sleep all the time or not at all. Often, suicidal people give away their favorite things to their favorite people, or stop participating in their favorite sports and activities. Adults may pay off all the bills or update their will. If a teen quits the team or tries to give away her iPod, surfboard, Xbox, or favorite boots to her best friends, she might be saying goodbye. This is a big one because the adults in a teen's life probably won’t know about it if friends don’t speak up. If someone suddenly doesn’t want to hang out with her friends or avoids talking to her family, she may be withdrawing in preparation for life to end. This is when your friend needs you the most. Take her out to do something she might enjoy, or if she won’t go out, then go to her. Don’t put it off. Spending time with someone who cares is especially important because people who are depressed or suicidal often feel an intense sense of loneliness and worthlessness. 

In addition to warning signs, we can also look at risk factors. Breakups, divorces, major life transitions like changing schools, jobs, or moving away from friends, trauma or loss such as death of loved ones, abuse, or bullying are all potential risk factors for depression or suicide. If you or someone you know is being abused, tell a trusted friend or adult. Nobody should have to put up with physical, sexual, or emotional abuse. These days bullies are on Facebook, in school hallways, at work, and even texting on your cellphone, and it's hard to get away. Many adults and teens don't know that lesbian, gay, bi-sexual, transgender and questioning youth are 4x more likely to attempt suicide than their heterosexual peers because of the way they are treated in their homes, schools, communities, and religious institutions. If you see someone who can’t stand up for himself then stand up for him. We don’t have to tolerate hate. No one should suffer alone.

We’ve got to take care of ourselves too. Everyone feels overwhelmed sometimes, but there are some really simple things we can do to cope. Two of the best things we can do are exercise and eat healthfully. In fact, since the early 1980's, research has shown that regular exercise may be as effective as antidepressant medication for combating depression. Also I highly recommend dark chocolate. Very helpful tool, boosts serotonin, a happy chemical in your brain. Add it to the grocery list. Laughter and keeping your sense of humor is another way to cope. Keeping busy with activities or working with others as a volunteer to make a difference in your community is a great way to feel good about your life. These are good supplements to professional treatment and are good coping strategies even for people who aren’t feeling depressed to decrease overall stress. 

If you would like to speak with a professional at The Center for Stress and Anxiety Management, you may contact us at 858-354-4077 or csamsandiego@gmail.com. To see a list of other mental health conditions that we specialize in, click here.

References: 

American Association of Suicidology from: 

http://www.suicidology.org/stats-and-tools/suicide-fact-sheets

San Diego Unified School District Youth Risk Behavior Survey from: 

http://www.cdc.gov/healthyyouth/states/locals/ca-sandiego.htm

American Foundation for Suicide Prevention from: 

http://www.afsp.org/understanding-suicide/facts-and-figures

Walcutt, D. (2009). Chocolate and Mood Disorders. Psych Central. Retrieved on September 14, 2013, from http://psychcentral.com/blog/archives/2009/04/27/chocolate-and-mood- disorders/

Pedersen, T. (2013). New Guidelines for Using Exercise as an Antidepressant. Psych Central. 

Retrieved on September 14, 2013 from: http://psychcentral.com/news/2013/05/11/new-guidelines-for-using- exercise-as-an-antidepressant/54728.html

Tags: anxiety, therapy, mental health treatment, San Diego, support, depression, suicide, stigma