Licensed Therapists

Psychotherapists... counselors... therapists... these are all generic labels for someone in the business of helping others with their problems. Anyone can call themselves a "psychotherapist", "counselor" or "therapist". As a matter of fact, in most states, anyone can legally practice psychotherapy, regardless of their academic education or professional training...or the lack thereof. However, most states now requires that all practicing psychotherapists pay a fee to either be licensed or listed in a state database kept by the Department of Regulatory Agencies. Unfortunately, there is no easy way to know who is competent, ethical or effective in helping others. However, you can learn how to interview a prospective therapist and assess whether that person matches your personal needs and concerns.

With so many different therapists practicing such a wide variety of styles of therapy, where does one begin? It may be helpful to start by getting a few names from different sources. Do not rely upon the first recommendation you get. There are other considerations you may want to be aware of that might help you to make a better, more informed choice about who to work with.

Talk with other people who have been in therapy. Get names recommended from family, neighbors or friends. Also talk with other professionals who may have contact with therapists in the community. Doctors or clergy may also know of a particularly effective and experienced therapist that they refer to. Another good source for referrals may be other mental health professionals you may know socially, who are familiar with psychotherapists in the community and would have nothing personally to gain by referring you to someone.

Some caution is advised however when receiving referrals from personal recommendations. Take into account who you are receiving the referrals from. Friends, relatives or neighbors may not necessarily be the best judge of competence or be able to determine the right match according to your needs. Selecting a friend's therapist could also raise concerns of loyalty, competitiveness or confidentiality. Doctors or clergy may not necessarily know very much about psychotherapy or the different approaches and practitioners. You might wind up being referred to a doctor's colleague or friend, who is biased towards a particular treatment approach accepted among their limited professional circle only. The same holds true for referring mental health professionals. Evaluate for yourself how well the person you are receiving referrals from understands your needs and how knowledgeable they are about varying styles and approaches that differ from their own. Also, do not choose a therapist who you may already know socially. It is unethical for a therapist to work with someone with whom he or she may have a dual relationship.

Other sources for referrals can be found by ads in the yellow pages, local newspapers, and other free community magazines and directories available at restaurants and shops around town. Keep in mind that these advertisements are designed to catch your attention and do not necessarily provide any assurance that the person is qualified, experienced or reputable. Attending public presentations or workshops by therapists is another way to get introduced and learn about one's personality or practice style.

Psychotherapy referral services may appear to be a good way to get referrals, but they typically only give out names of therapists who have paid a marketing fee to the company or get a commission for making the referral. If you call an agency or large group practice for a referral, you may be assigned to a therapist solely on the basis of who has an opening in their schedule. If you have selected a health insurance plan which limits you to seeking treatment only from an "in network" provider, you may get referred to a therapist selected solely because their zip code location is nearest to yours. You may also find that that therapist in the provider network is severely restricted to the kind and amount of therapy covered under your insurance policy.

After asking around, you may find that the same person is recommended from several different sources of referrals. That may be a good sign that you have found someone competent. But, are they compatible? Regardless of which method you ultimately use to get a particular therapist's name, it is essential to follow up with a personal interview. Only then can you better assess for yourself if working with this person is right for you.

Even though a therapist may come highly recommended and has many years of experience helping countless others, he or she still may not be the right match for you or your needs. It is essential that you feel comfortable with the person whom you will inevitably entrust with your deepest secrets and fears. Take some time to interview a few different therapists. You have a right to ask questions and make an informed choice.

Be prepared to interview a therapist by phone and in their own office. Most therapists will talk to you briefly over the phone when they call you back. As you may know, therapists are difficult to reach directly, so be prepared to leave a detailed message, giving them alternative times and phone numbers where you can be reached day and evening. Tell them how your were referred, and explain your intention in wanting further information from them. When asking about an initial interview, ask whether you will be charged and how much. Some therapists charge full fee, while others will waive their fee entirely. Some will meet with you for a few minutes, while others will set an entire hour with you.

-Do you have openings? How soon can you get me in? How long is the wait?
-Are you available for appointments on weekends? Evenings?
-Do you charge for an initial appointment? How much?
-What is your fee? Do you take reduced sliding fee clients? Is there a cash discount? Do you take credit cards? PayPal? Must I pay in full at the time of service, or can I make partial payments?
-How long are your sessions? 45, 50, 55, 60, 90 minutes?
-Are you in my insurance plan's mental/behavioral health network? Do you file my insurance claims for me? Can I just pay my insurance co-payment?
-What is your theoretical orientation for doing therapy? Freudian? Psychodynamic? Behavioral? Cognitive? Systemic? Humanistic? Existential? Transpersonal? Ask them to explain the difference. A combination can sometimes be best.
-How long have you been practicing psychotherapy? Are you licensed? Do you have a consulting supervisor? What is your experience working with others who may have similar issues?
-What's the expected time frame in order to treat my kind of problem? Is it a long term or short term course of treatement? What results could I expect?
-What's your preferred style for doing therapy? Individual? Group? Family? Weekly? Monthly?
-Where do you practice? Private office, hospital, clinic, agency, group practice? Is there free parking? Near a bus route?
-Are you available for emergencies by phone? Do you charge for phone calls? Reading emails?
-What is your policy for cancellations, rescheduling or missed appointments?

Being a good therapist goes beyond being a good listener. Be attentive to how the therapist may relate to you and treat you during the interview. Ideally, an experienced practitioner will convey warmth, genuineness and respectful interest for you and your concerns. Was he/she empathetic, dynamic and alive? Were they able to give you specific insightful feedback, even during the initial interview? A good therapist may also convey mutual trust and not be afraid to confront or challenge you and your beliefs. Pay close attention to your gut reactions.

Above all, a competent therapist should leave you with feeling of comfort and confidence in them as a human being and their therapeutic skills and abilities. Most importantly, you may begin to feel uplifted and hopeful about your future, by the time the interview is over.

The relationship between you and your therapist is of primary importance. A therapist's personal qualities, attitudes, expectations, beliefs, and values matters as much as their particular technique, approach or theoretical orientation in making therapy work. The following are questions you may ask yourself to determine how compatible you felt during and after your interview:

-Did the therapist convey personal warmth and concern for you?
-Were they genuinely interested in you and your welfare in a supportive manner?
-Were they sensitive to your feelings? Were you treated with courtesy and respect?
-Did the therapist make eye contact?
-Was there an atmosphere of mutual trust?
-Did you believe they were listening to you and could understand you?
-Were you able to talk easily and honestly with them? Could you be yourself?
-Were they accepting and affirming of your individuality?
-Did the therapist give you adequate feedback?
- Were you comfortable questioning or disagreeing with them?
-Were they insightful, being able to sense things beyond your present awareness?
-Did they have a touch of human wisdom, a sense of understanding that goes beyond technique and theory?
-Did you like them? Did you find their values and attitudes compatible with yours?
-Were you comfortable with the decor and physical set up of the waiting room and office setting?

There is no simple formula to determine whether a therapist is competent in what they do. Credentials, diplomas, certifications and licenses may be impressive, but still may not indicate or guarantee that a therapist is competent or ethical when helping people. At best, credentials only inform you of the extent to which the therapist has pursued his or her academic education and training in their profession.

Membership in a recognized professional organization, like the American Association of Marriage & Family Therapists, National Association of Social Workers or the American Psychological Association for example, may be important. Associations like these hold the practitioner accountable for following their organization's professional code of ethics.

The following questions may further help you to determine the level of competence of the therapist you are interviewing by assessing their professional training, credentials, licenses, organizational affiliations and history of experiences in clinical practice:

-What diploma and graduate degree did they receive? From which school? What year?
-Did they graduate from a specific clinical training program from their university? What was their major? Where did they do their clinical internship or post graduate work?
-How many years have they been practicing therapy? How long have they been practicing independently in private practice? Have they always been a therapist?
-What was their previous employment prior to private practice? Did they work as a therapist in an agency? Which ones?
-Do they currently have a clinical supervisor who reviews their work? For how many years? If not, why not?
-Are they licensed to practice psychotherapy with their state's Department of Regulatory Agencies? What year did they receive their license or register to become licensed?
-What professional organizations are they a member of? What are the criteria for membership?
-How much and what kind of specific experience have they had treating any particular problem you may be concerned about?
-What specific personal experiences or training programs qualifies them to practice their style of therapy?

Have they been in therapy themselves?
-Do they carry liability (malpractice) insurance?
-Have they ever had any formal complaints filed against them? What was the outcome?

There are a wide variety of master's and doctoral programs available to someone who seeks to become a therapist. After graduating with one or more degrees, one can qualify to become licensed by the state in which they reside. In addition, after completing certain post-graduate training programs or meeting specific criteria established by state or national professional organizations, one can obtain an ever widening variety of certifications which may indicate additional achievement in a particular area of practice.

Unfortunately, there are also an increasing number of "degree mills" and self serving training programs which enable anyone to obtain an official looking graduate "Diploma" or framed "Training Certificate" for the right price. It is often difficult to discriminate between the legitimately recognized universities and organizations from the meaningless ones.

To emphasize the point, psychologist Steve K. D. Eichel, Ph.D.'s article, "Credentialing: It May Not Be the Cat's Meow" describes how he successfully received credentials for his cat named "Dr. Zoe D. Katze, Ph.D., C.Ht., DAPA", by three major hypnotherapy associations, having met their "strict training requirements" and having had the cat's background thoroughly reviewed!

Licensed Psychotherapists
Having a license to practice in one of the mental health specialties indicates that the therapist has met minimum qualifications for academic knowledge and clinical training as indicated by having a master's degree from an accredited graduate school, passing a qualifying exam, and having completed two years (or about 2000 hours) approved supervised experience in the field.
In most states, there are five kinds of licensed psychotherapists:

• Licensed Marriage and Family Therapists (LMFT)
• Licensed Psychologists (Ph.D., PsyD.)
• Licensed Social Workers (LCSW, LSW)
• Licensed Professional Counselors (LPC)
• Licensed Psychiatrists

By considering a prospective therapist's credentials along with the particular license they possess, you may be able to determine the amount and kind of academic training and experience they have had.

Doctors of Philosophy (Ph.D.), Psychology (Psy.D.), or Education (Ed.D.) have usually completed four or more years of graduate school and are all eligible for licensing. However, only those who have been licensed can call themselves psychologists. There are many Ph.D.'s from other related or unrelated academic fields who still practice therapy without being licensed or clinically trained. Psychologists can also specialize in a wide variety of non-clinical practice areas, including statistical research, industrial psychology, diagnostic testing and evaluations.

Licensed Social Workers (LCSW), Marriage and Family Therapists (LMFT), and Professional Counselors (LPC) usually have at least two years of graduate school and have earned a Masters' Degree (some may have doctoral degrees).

Licensed Social Workers often have other credentials: B.S.W. (Bachelor's of Social Work), M.S.W. (Master's of Social Work), A.C.S.W. (Academy of Certified Social Workers; a 2 yr post graduate national credential), BCD (Board Certified Diplomate; 5 yr post graduate credential) or DCSW (Diplomate of Clinical Social Work; 5 yr post graduate credential). Social workers are also trained to specialize in a variety of areas in addition to clinical practice including community organization and development, and administrative management.

Licensed Marriage and Family Therapists and Professional Counselors have other Master's degrees such as: M.A. (Master of Arts), M.S. (Master of Science) or M.Ed. (Master of Education). Marriage and Family Therapists have specialized training in the area of family systems while Professional Counselors may have a variety of more generalized training in the area of psychology and counseling.

There are many other professionals who may practice forms of psychotherapy. The list includes: Pastoral Counselors: M.Div. (Master of Divinity), or Th.D. (Doctor of Theology); Psychiatric Nurses: R.N. (Registered Nurse) or M.S.N. (Masters of Science in Nursing); and Alcohol Counselors: C.A.C. I, II, or III (Certified Addiction Counselors). Psychiatrists: M.D. (Medical Doctors); Psychoanalysts: (anyone trained or practicing Freudian or analytic styled psychodynamic approach); Hypnotherapists: anyone trained or practicing hypnosis); Sex Therapists: (anyone trained or practicing sex therapy).

A highly recommended, experienced and licensed therapist may have the right credentials, with a wall covered with prestigious diplomas and certificates, and still not be very effective in helping you. As ironic, an unknown unlicensed therapist with a limited amount of experience may be just the right match for you. Some people have a natural ability to listen and communicate well with others. This factor alone can sometimes make all the difference in being helped. In the long run, the theoretical practice style or technique one uses may not make much difference at all. Most likely, the ideal therapist for you has a healthy balance of:

• Professional credentials and training
• A natural ability to communicate
• A long history of having helped many others effectively with caring and respect

Recent economic and political priorities towards national health care reform, demand that psychotherapy be brief, symptom relieving and cost effective. Health Maintenance Organizations (HMO's) and managed health care organizations that regulate and limit the practice of health care in a competitive market may eliminate the affordability of mental health care for many people. Most health insurance companies that provide mental health benefits for "mental and nervous disorders" now contract with independent managed health care organizations to allocate, monitor and regulate mental health care treatment and insurance benefits.

What this means is that a managed health care organization could limit and control the amount and kind of therapy treatment seemingly available to you in your health benefits plan. It is important to understand that while you may be going to a competent therapist, your insurance company, as regulated through managed health care, may not cover the style and length of treatment that you or your therapist feel is warranted. You may be forced to make a decision about whether you and your therapist are willing to continue ongoing treatment even when your insurance benefits are discontinued. You may therefore want to ask your therapist how they would handle your fees, should you find that your therapy is no longer covered by your insurance plan.

I hope this article has been helpful in giving you a better understanding about what it takes to find a good therapist. You deserve to have caring, effective, professional help that is also affordable. Everyone does. You also have a right to be satisfied with the service you receive. You are ultimately responsible for the direction your life takes. The decisions you make today, influences where your life leads into tomorrow. Selecting a therapist who can guide you along the way for a part of your journey, may insure that you arrive safely at your chosen destination. Good luck in your life's journey! May you find the help you are seeking and continue to live your life with health and well being.

Sincerely,
Barry Erdman
be@nilenet.com