A psychotherapist is someone you are going to trust to help you with your psychological and emotional well-being, and therefore, it is important to become an informed consumer of mental health services. Choosing a psychotherapist can be complicated for someone unfamiliar with the process, and therefore the following information can be used to help you feel more confident that you are choosing a qualified psychotherapist who best fits your needs and interests.
Once in therapy, allow yourself 2-3 sessions to determine whether the therapist you chose and the therapy techniques she uses are compatible with what you are looking for. Do not be afraid to ask the therapist questions that will help you feel more comfortable. Questions can include, "What do you see as my problems," "What do you think is going on," and "How is therapy going to help," "What are the goals for treatment and how might we get there?" This is your therapy, and you are in charge of getting the most out of it!
TYPES OF PSYCHOTHERAPISTS
Below I will describe the various mental health practitioners who provide psychotherapy, or counseling, and differences based on their degree and training. Keep in mind though that regardless of the degree, it will be important for you to find a “licensed” practitioner meaning they have met both national and state requirements for their field of study. Essentially anyone can call him or herself a “psychotherapist,” as this term refers to anyone who uses psychological techniques to assist in the changing of thoughts, feelings, and behaviors, and not all psychotherapists may have adequate education, training, and licensure.
Clinical/Counseling Psychologist: Clinical and counseling psychologists have academic doctorates (Ph.D. or Psy.D.) and, to officially use the term “psychologist,” must have a license to practice in the state. Clinical and counseling psychologists have expertise in psychological testing and in the assessment, diagnosis, treatment, and prevention of psychological disorders. Academic training is usually 5-7 years and includes clinical experiences ending with a full year at a pre-doctoral internship. In California, about one year pre-doctoral and one year post-doctoral experience and a passing score on a national examination are required for licensure. Licensure as a psychologist is denoted by the letters PSY followed by a series of numbers.
Counseling vs. Clinical: There does not seem to be much of a difference between clinical and counseling psychology programs, though clinical programs have traditionally included more training in the areas of more severe psychological disorders and counseling programs have focused more on delivering services in university settings. In addition, clinical psychologists have focused more on psychological or neurological assessments whereas counseling psychologist have focused more on vocational assessments. Both clinical and counseling psychologists can be seen in academia, community clinics, private practice, and college counseling centers, but in medical settings, it is more common to see clinical psychologists than counseling psychologists.
Ph.D. vs. Psy.D.: Many Ph.D. programs are based on a scientist-practitioner model that emphasizes the balance between clinical and research training whereas Psy.D. programs focus more on clinical training. The Ph.D. scientist-practitioner model emphasizes the importance of developing practitioners who can also evaluate or produce research on the causes and treatments of psychological disorders. Though clinical Ph.D. programs tend to have smaller class sizes and more rigorous admissions requirements, the quality of the practitioner seems to be more related to the individual practitioner’s own background education and experience.
Social Worker: A licensed clinical social worker (LCSW) holds a master’s degree in social work (2-3 years of academic training), has completed about 2 years of supervised post-degree clinical experience, and has passed a written examination. LCSWs have training in mental health and social welfare systems and are qualified to provide psychotherapy. For more information on California's requirements for social workers, click here.
Psychiatric/Mental Health Nurse: To be listed in the state of California as a psychiatric/mental health nurse, a California Registered Nurse must hold a master’s degree in psychiatric/mental health nursing and either two years of supervised clinical experience or credentialing by the American Nurses Association as a Clinical Specialist in Psychiatric/Mental Health Nursing. A psychiatric/mental health nurse often focuses on the treatment of psychiatric disorders and is qualified to provide psychotherapy and those with special training in psychopharmacology hold an advanced practice license that allows them to prescribe medication.
Marriage and Family Therapist (MFT): Psychiatrists, psychologists, social workers, and psychiatric nurses are the four nationally recognized mental health providers, but some states also provide licenses to practice psychotherapy to master’s level counselors. In the state of California, a Marriage and Family Therapist holds a master’s degree in a relevant field, has about 2 years of supervised post-degree clinical experience, and has passed the California licensing exam. While their training is in marriage and family therapy, they may also be qualified to treat individuals. Click here for more information regarding MFTs and LCSWs in California.
Psychiatrist: Psychiatrists are physicians with medical degrees (M.D.s) who specialize in the diagnosis, treatment, and prevention of psychological disorders. It would be important to find a psychiatrist who has had post-graduate residency training in psychiatry (usually 3-4 years) and has passed a national examination to become board certified by the American Board of Psychiatry and Neurology. In the state of California, only psychiatrists and other licensed physicians are approved to prescribe medications, electroconvulsive therapy, or other medical procedures. Regarding psychotherapy, not all psychiatrists have had extensive training in psychotherapy, and therefore, it would be important to inquire about training and experience in psychotherapy if you are considering engaging in psychotherapy with a psychiatrist.
Important Factors to Consider: Having a license to practice psychology does not necessarily mean that the psychologist’s doctoral training was in clinical psychology. Those with Ph.D.s in cognitive, social, organizational, and developmental psychology can feasibly sit for the exam and become licensed as long as they have met the other requirements for licensure. In addition, some practitioners have a Ph.D. after their name but have a license to practice under an MFT license. This can be misleading as the PhD may or may not be in the field of psychology and the individual may not have fulfilled the requirements described above. Therefore, it is in your best interest to look beyond the license and look also at the practitioner’s education and background to fully understand his or her competencies.
Most mental health practitioners would agree that more important than specific educational background would be amount of experience, range of experience, and quality of experience in determining the therapist’s competence. In addition, a strong therapeutic relationship and a culturally competent therapist may also be important components of effective therapy.
Quality of experience: To become a professional dancer, one can read a book on dancing or practice dancing at home in front of a mirror, but to become the most proficient dancer often requires training with a competent instructor. In the same way, it is certainly possible to become a good therapist by reading about therapeutic techniques, being supervised by anyone who is licensed, or by getting a lot of experience (see below), but I have found it invaluable to have learned from experts in the field who have been practicing, learning, teaching, and developing for many years. I do feel that for the cognitive behavioral treatment of anxiety disorders, it is important to find a therapist who has had quality training and supervision.
Amount of experience: Reading from a text, learning in a classroom, or seeing one client with one particular problem can all be great learning experiences but most professionals really begin to develop their skills with repeated, hands-on clinical experience. With each new client a therapist sees, she reevaluates what she has read and learned and reevaluates her treatment approach allowing her to continuously develop and hone her skills.
In most established PhD programs, students begin to see clients by their second year, then spend the next two years working 20 hours a week at approved local institutions (and often also work extra hours at other community organizations for more variety of experience), and then spend their last year working full-time at competitive APA-accredited* institutions. Most psychologists, therefore, graduate with a tremendous amount of experience. In addition to graduation requirements, psychologists in California must also have 3,000 hours of clinical experience to obtain state licensure.
* Definition of APA-accredited: The American Psychological Association (APA) accredits professional training programs in psychology based on whether the programs meet the standards and guidelines set forth by the APA. Accreditation requires the training program to undergo regular reviews to ensure the quality and integrity of a training program.
Range of experience: Is it necessary to see a therapist who has had a wide range of clinical experiences? Most problems do not occur in a vacuum but are rather part of a
complex network of emotions, life experiences, and relationships. Having seen a wide range of clients in a wide range of settings may allow the therapist to see problems with sufficient depth and
clarity to put them into perspective. In addition, many people’s lives are touched by issues that they may not struggle with themselves. For example, clients may be overwhelmed by having to care for
a family member with a serious mental or physical illness or they may come from a family where substance abuse was common. A therapist with some experiences in these areas may be better able to
provide direction for the struggling client.
Is it necessary to see a therapist who has research experience and assessment experience? Every year, there are new medications and treatments that flood that market. In addition, existing therapies are also being constantly reevaluated and improved upon. Therefore, it can be important to have a therapist who has been trained to evaluate research on the effectiveness of psychotherapy techniques and will only utilize those therapies that have been “clinically proven” through scientifically valid research trials. An interest in research shows a therapist’s commitment to providing the most up to date and effective treatments available.
As for assessment experience, quality therapy begins with quality assessment. Though comprehensive psychological assessments are not a standard part of psychotherapy, experience in assessment can give the therapist a trained eye to quickly identify issues of concern and can also assist in the development of the most effective treatment plans. If further assessments are necessary, clinicians who themselves have had training in assessment, may be better able to make the appropriate referrals for more comprehensive assessment.
General therapist qualities: In a survey by Consumer Reports, readers indicated that a caring attitude, ability to listen empathically, genuine commitment to client’s welfare, sincerity, warmth, and responsiveness were all important therapist characteristics. These factors are thought to be important for promoting a positive therapeutic relationship which is characterized by feelings of mutual respect, trust, and hope. The most successful outcome in psychotherapy occurs when there is a good match between the therapist, the client, and the treatment method. For example, research evidence has consistently shown that cognitive-behavioral therapy is the most effective treatment method for obsessive-compulsive disorder, but if you do not feel comfortable with the therapist or do not have trust in her abilities, the treatment method will have limited effectiveness.
Cultural sensitivity: More recently, cultural sensitivity has also been identified as an important factor that promotes the effectiveness of psychotherapy. The American Psychological Association has focused on developing culturally component therapists over the last decade, and training in cultural sensitivity has become an important component of all established training programs. A culturally competent therapist:
TYPES OF PSYCHOTHERAPIES:
INDIVIDUAL PSYCHOTHERAPY: Research evidence has not found any consistent evidence showing superiority of one type of psychotherapy over another except for certain specific psychological issues. There has been overwhelming evidence supported by both the National Institute of Mental Health and the American Psychological Association that indicates that cognitive-behavioral therapy is more effective than other therapies for specific problems and symptoms such as seen in anxiety disorders, depression, weight management, body image disturbance/eating disorders, and habit and stress-related disorders. Therefore, though some may argue that all therapists are essentially the same, this may be true for more general issues. For those seeking specific treatment for specific issues, then it may be more important to find a mental health professional with specialized training for these particular issues.
GROUP THERAPY: Group therapy involves meeting with a therapist along with several other people and has several advantages. Clients often benefit from the support of other people having similar struggles. Group members can motivate each other to change. Group members can provide each other with practical advice. Groups allow clients to learn how to give and receive social support and clients can also practice new social behaviors, such as through role-playing, in a safe environment. Group therapy is also more cost effective with therapists charging less for group than individual sessions.
FAMILY/COUPLE THERAPY: Family therapy assumes that psychological distress, even of an individual, is part of a complex interacting system. To just treat an individual may not be sufficient. Through family therapy, each part of the interdependent system can be addressed. Family therapy can be for families that are having difficulties as a unit, or even when one family member seems to be experiencing much of the distress. Couple therapy or marital therapy often focuses on improving communication, reestablishing intimacy, and increasing problem-solving skills.
MEDICATIONS: A medical evaluation is important to rule out any medical issues that may be contributing to psychological symptoms. A medical evaluation with a physician or a psychiatrist is also important for those with a complicated medical history, neurological problems, or an acute medical illness. Consultation with a physician or psychiatrist may also help you decide whether medications would be helpful. Medications have been shown to be an important part of treatment for severe mental health problems such as schizophrenia, bipolar disorder, and psychosis, but other problems such as anxiety or depression may be effectively treated with or without medications. Therefore, consultation with a medical or mental health professional who can discuss with you the costs and benefits of specific medications may help you decide whether medication is the right choice for you. A psychiatrist or physician will be the provider who ultimately decides whether a prescription is warranted.