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.

Let’s Talk About Anxiety

by Annabelle Parr

Anxiety is a hot topic these days. It’s all over the news, and apparently it is on the rise. In the age of information and technology, we are constantly bombarded with doom and gloom news alerts, including reminders that on top of everything else, we are plagued with increasing anxiety. Eventually, these reminders can get exhausting and may even contribute to the anxiety that is apparently so prevalent in the first place.

Image source: https://www.theodysseyonline.com/poems-read-anxiety

Of course, there are benefits to all this conversation around anxiety: we have a better understanding of what anxiety is and as a result we may be able to understand and empathize with those who are struggling better. But it’s important to be careful that we don’t pathologize all anxiety, and that we don’t lose sight of the strength that exists in those who truly do have anxiety disorders.

Anxiety: Natural Response to Stress or Disorder?

The way we talk about anxiety today, it is easy to believe that all anxiety is inherently bad and forget that it’s our natural response to threat or danger. We actually need anxiety to survive; it prepares our body to respond appropriately in the face of danger. However, our physiological experience of anxiety developed back when the regular dangers humans faced included running from large, sharp toothed predators. So when we are experiencing the fight-or-flight response before a big exam or presentation, it may not feel particularly adaptive. But despite the discomfort that comes with anxiety, it is natural when it is experienced as the result of a particular situation or problem, when it is proportional to the stressor, and when it only lasts until the situation is resolved (ULifeline, 2016). Anxiety, though often painful, is an important and adaptive part of the human experience.

Image source: aconsciouslifenow.com

Though originally an adaptive response, anxiety does have the potential to be harmful when it manifests as “constant, chronic and unsubstantiated worry that causes significant distress, disturbs your social life and interferes with classes and work” (Active Minds, 2016). In other words, anxiety is no longer helpful when it begins to appear when there is no actual threat present. When a person experiences anxiety but has no threat to respond to, what happens? They begin avoiding situations that are actually safe. Their mind and body are telling them that safe situations are threatening, which can have a debilitating effect. When anxiety becomes disordered, it arises unexpectedly, is overwhelming, and, rather than catalyzing adaptive behavior in the face of a threat, often fosters avoidance of everyday situations (Here to Help, 2016).

Image source: http://www.huffingtonpost.com/2015/05/18/anxiety-photos-katie-crawford_n_7292548.html

So what is the takeaway? Anxiety is uncomfortable, but it helps us respond to threat, uncertainty, trouble, or feelings of unpreparedness (Active Minds, 2016). Anxiety becomes a problem (and possibly a disorder) when it comes seemingly out of nowhere and in the absence of a stressor proportional to the response, and it interferes with functioning in some way.

Recognizing Strengths as well as Struggles

There is no denying that feeling anxious is not pleasant. It can range from uncomfortable to unbearable. For those with anxiety disorders, anxiety is unpleasant on a whole new level; it can be completely overwhelming and paralyzing. It is hard to describe how out of control one can feel in the middle of a panic attack, or how draining it is to go through the day (week, month, or year) flooded with anxiety.

But in the midst of this struggle, it’s important to remember that anxiety doesn’t own you. It may be a part of you, and it may influence your life in various and profound ways. But anxiety does not determine who you are. A diagnosis does not define you. You are not a disorder. You are not weak, powerless, or alone.

Image source: http://quotesgram.com/from-brene-brown-quotes/

Acknowledging the pain anxiety can bring is so important, but it can also be helpful to recognize that struggling with anxiety may also foster certain strengths. According to Dr. Tracy Foose (2013), trait anxiety is associated with being “highly conscientious, honest, detail oriented, performance driven, socially responsible, [and] self-controlled.” Furthermore, learning to cope with anxiety can push us towards an increased self-awareness and knowledge of ourselves. Because it is so uncomfortable, it can motivate us to grow and change parts of ourselves or our lives that may not be serving us. And once we learn that we can move through the discomfort of anxiety, we often feel stronger and more confident in ourselves knowing that we have the fortitude to move through something so profoundly difficult (Sutherland, 2011).

Finally, if you do feel like anxiety is controlling your life, you don’t have to stay stuck in this space. Not only can anxiety teach you to embrace vulnerability and reach out for support from loved ones, but therapy offers very effective treatment. Cognitive Behavioral Therapy and Acceptance and Commitment Therapy can teach valuable coping skills, and can help to change your relationship to anxiety. Nothing will ever take anxiety away completely, but we wouldn’t want that because without anxiety, we wouldn’t survive. But therapy can help us learn that even in the worst throws of anxiety, we will survive, and even thrive.

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:

Active Minds. (2016). NSOD: Difference between normal anxiety and an anxiety disorder.  Retrieved from: http://www.activeminds.org/component/content/article/512-nsod-difference-between-normal-anxiety-and-an-anxiety-disorder

Foose, T. (2013, Feb. 19). Positive traits seen in anxiety disorders. SF Gate. Retrieved from: http://www.sfgate.com/health/article/Positive-traits-seen-in-anxiety-disorders-4291474.php

Here to Help. (2016). What’s the difference between anxiety and an anxiety disorder?  Retrieved from: http://www.heretohelp.bc.ca/ask-us/whats-the-difference-between-anxiety-and-an-anxiety-disorder

Sutherland, M. (2011). The Benefits of Anxiety. Retrieved from: https://willowtreecounselling.ca/articles/the-benefits-of-anxiety/

ULifeline. (2016). Anxiety vs. anxiety disorders. Retrieved from: http://www.ulifeline.org/articles/439-anxiety-vs-anxiety-disorders

THE POWER OF BREATHING

by Annabelle Parr

Whether or not you struggle with an anxiety disorder, we have all found ourselves overwhelmed by stress or anxiety at some point.  We each have slightly different stressors that trigger our body’s natural stress response, but we all know what the response feels like: sweaty palms, racing heart, tense muscles.  This bodily reaction can feel overwhelming, as if it controls us.  It is easy to feel powerless to our biological response to stress, but we have more control than we think.

THE STRESS RESPONSE

Source URL: http://www.gestaltreality.com/2012/07/11/metabolic-diet-supplements-an-exploration/

Before we deem our biological reaction to stress bad, let’s talk about what happens and what purpose it serves.  When we get stressed out or anxious, our body begins preparing us to face threat.  Stress activates our sympathetic nervous system, triggering the fight-flight-or-freeze response.  This causes the sweaty palms, racing heart, panicky breathing and muscle tension (McGonigal, 2013).  We often look at the stress response as inherently bad, because it is not healthy to be in the fight-flight-or-freeze mode chronically (McGonigal, 2013).  However, it’s important to remember that when your heart starts racing or your palms get sweaty, your body is just trying to help prepare you.  Nevertheless, these sensations can feel overwhelming, and perpetuate our experience of anxiety.  So how can we calm ourselves down once this cycle is in motion?

DEEP BELLY BREATHING

Using our breath, we actually have the power to activate our parasympathetic nervous system.  The parasympathetic nervous system allows our body to “rest and digest” as opposed to the sympathetic nervous system’s fight or flight response (Hunt, 2016).  While “take a deep breath” is common advice, how we actually take that breath is important.  This is how to use the breath to calm down:

Source URL: http://goodrelaxation.com/2015/05/deep-breathing-for-headaches/

1. Find a comfortable, relaxed seated position with your feet planted on the ground; alternatively, you can try breathing laying down.  Now begin to bring your focus to your breath.
2. With each breath, your belly should rise as you inhale and fall as you exhale. 
3. Your shoulders and chest should remain still.  If you notice your shoulders rise, or your chest move, drop the breath down to the belly.  Breathing into your chest is reminiscent of hyperventilating, which will only further activate your sympathetic nervous system (Hunt, 2016).
4. Now focus on breathing into your belly for four counts.  Hold your breath for a second or two.  Now exhale for five counts and relax (Hunt, 2016).  Repeat this process, focusing on your inhalations and exhalations, and making your belly rise and fall.
5. You may notice that your heart rate speeds up at first.  Don’t panic or give up.  Your body is not used to calming itself down, and is simply adjusting.  After a few cycles of inhaling and exhaling, you should notice your heart rate begin to relax. 
6. If you begin to get distracted or thoughts pop into your mind, simply notice they are there and then come back to focus on the breath. 

Source URL: http://goodrelaxation.com/2015/05/deep-breathing-for-headaches/

See if you can practice doing four or five deep belly breaths a day.  Then see if you can work your way up to thirty seconds at a time.  Then maybe a minute.  Eventually, you will be able to sit in this space with your breath for a long period of time.

Being able to tap into your breath to find a calm, centered space, no matter where you are, is an invaluable resource.  This diaphragmatic breathing essentially turns off your sympathetic nervous system and turns on your parasympathetic nervous system (Hunt, 2016). 

This is not to say that you will never feel stressed again, or that you will never experience the fight-flight-or-freeze response.  But using deep belly breathing can help you to calm your body down and lessen the biological reaction to a stressful situation.

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:

Hunt, M. G. (2016). Reclaim your life from IBS: A scientifically proven plan for relief without restrictive diets. Toronto, ON: Sterling Publishing Co., Inc.

McGonigal, K. (2013, June). Kelly McGonigal: How to make stress your friend [Video File].  Retrieved from: https://www.ted.com/talks/kelly_mcgonigal_how_to_make_stress_your_friend?language=e

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