There are many practitioners who offer mental health services and the choices are often confusing to the individual seeking therapy. Regardless of who you chose to work with, a good practitioner will first gather relevant background information about you and your current issues and will build a conceptual framework for understanding them, with an appropriate treatment plan that follows. Your chosen mental health professional should be able to articulate a logical and coherent plan of action that is designed to treat specific goals. As your therapy progresses, the focus and goals of the therapeutic process may change, but you and your therapist should both be clear about the goals you wish to achieve and the plan and process for achieving them. There should also be a mutually understood mechanism in place to evaluate your progress along the way as well, so that you and your therapist can determine if there needs to be a shift in your course of treatment.
There is copious literature that identifies empirically validated treatments for a wide variety of issues. For example, depression is best addressed with a combination of medical management and cognitive behavioral therapy; whereas a patient whose primary treatment focus is overcoming a specific trauma may seek to be treated with somatic experience therapy. A good practitioner will be aware of the best modality for your specific issue. Most therapists have preferred approaches, although they may have training in many different therapeutic approaches. It is important to ask how experienced the practitioner is with your condition and how confident they are, that their approach is the most appropriate plan of action for you.
When looking for the right provider, a patient will likely encounter some of the following terms (among others) as descriptions of the provider’s professional background: Psychologist, Social Worker, Counselor, and Therapist. The differences have to do with education programs, training, and philosophy, but there is little evidence that one is better than another. However, there are variables that help you, the therapy seeker, evaluate a provider’s education credentials, professional licensure, and years of experience. Each of these important pieces of information will help you evaluate whether a professional is the right match for you, at this particular moment in time.
With regard to educational credentials, the minimal terminal degree in most cases is either a master’s degree or a doctoral degree. While there are some counselors who work with a bachelor’s degree and additional professional training, their licenses are very limited to treating a specific issue, and usually in a specific treatment setting (e.g. licensed drug and alcohol counselors). It is probably important to know where the professional degree was earned and whether the program was an accredited program. Accredited programs are recognized by professional organizations as having the requisite course content, so that when a person graduates, they have had an appropriate educational pathway to allow them to work professionally and competently in their field. Some programs will have a better reputation than others, and some patients will want to obtain this information.
However, simply graduating from a program is not enough. Most developed countries and in the United States, all of the individual states, will have additional licensing requirements for various mental health professions. Licensure is very important as it sets a minimal standard of competency for professional work, and in this manner protects the public. In order to be licensed, a person (with the required educational credentials) will take written and oral exams. These exams are administered by local licensing boards, whose mandate to issue licenses is legally given at the state or national level. Once a person has shown the licensing board that they have the required educational background and have passed the requisite examinations, they receive a license to practice in their profession. In many locales this license is renewable on a yearly or biyearly basis. Renewal requires an affidavit that the practitioner is not, or has not been involved in legal proceedings, and has not had ethical complaints lodged against them with their local licensing board. In some locales, a specific amount of continuing education courses must be taken to maintain a license, and proof of professional malpractice insurance is usually required by the licensing board.
Licensure thus protects the public from charlatans who simply want to hang out their shingle and call themselves a “therapist.” The word “therapist” does not connote any kind of professional degree or training, and in most states there is no law that prevents someone without any qualifications from simply calling themselves a ‘therapist’ and charging clients. The word ‘therapy’ describes an activity that mental health professionals engage in, and is in fact, a term that any person can use freely. Therefore, if the professional you are working with has no license and simply identifies themselves as a ‘therapist’, without any other professional mental health credentials, you should be very wary of their ability to help you. A person without a license is not answerable for their ‘professional’ activities to any governing body and therefore, the patient has no place to lodge a complaint about a professional who behaves in an unbecoming manner or who offers a non-validated treatment protocol. On the other hand, licensed professionals can be held accountable for their professional activities. The public can access records of the various licensing bodies to see if a licensed professional has had complaints lodged against them, and can initiate a complaint if they feel that they have been treated inappropriately. Since there is a regulatory body issuing a license, that same body can remove the license from a person who is unsafe or reckless in the way they practice their profession. You wouldn’t seek medical treatment from someone without a medical license and you shouldn’t seek psychological treatment from someone without a professional mental health license.
That said – it’s too broad of an assumption to state that all unlicensed clinicians are unqualified or incompetent. Some therapists work without a license because no license is available for their discipline in the state / country in which they practice. Other unlicensed therapists are experienced professionals who work in settings in which licensure is not required. Before you consider whether to work with an unlicensed therapist, you should ask serious questions about the person’s education, experience, and background, and be aware that you have no meaningful legal recourse against an unlicensed therapist if you feel you’ve been injured or mistreated.
Psychologists, clinical social workers, licensed counselors, and marriage and family therapists are the main mental health professions that have licensing bodies. A safe recommendation is to only ever seek treatment from a licensed professional. Assuming that you follow this advice, how are you to choose from the many licensed professionals that offer mental health services? All of the professions mentioned include individuals who have either terminal master’s degrees or doctoral degrees. Among psychologists, the main categories of psychologists offering therapeutic services are clinical, counseling, educational, and developmental psychologists. Many psychologists will also seek post-doctoral training and board certification from a recognized professional organization. In general across all of the mental health professions, a doctoral level practitioner has deeper and broader experience than a master’s level practitioner simply because of the nature and length of their training programs.
However, years of experience and sub-specialization are also important considerations. Most mental health professionals have developed an area of sub-specialty, a special interest population or disorder(s) within their professional work. Others will choose to remain generalists. The best analogy is medicine. While you might go to your general practitioner for general every day concerns, if you had a cardiac problem, you’d seek a cardiac specialist. The same is true of mental health professionals. When a licensed practitioner has built up years of experience treating a specific disorder, their terminal degree is probably less important than their cumulative professional experience. So if your specific mental health issue is clearly identified, you’ll be best served in seeking out a professional who specializes in that particular area. While this may
cost more per session, you are likely to get to the heart of your issue more quickly, and your treatment will be more focused and efficient, often saving your mental health dollars in the long run. It is often false economy to seek a practitioner according to a budget, as you may end up with someone with significantly less experience, and thus need more meetings to address the
issue at hand.
Many people want to know how to find these highly specialized well trained professionals. The best advice is word of mouth referrals. Social networking has made it much easier to crowd
source this kind of information. Ask around and look for names of professionals that come from more than one source. Once you have a short list of options, you should consider meeting with more than one professional initially in order to see who you feel most comfortable with. Because at the end of the day, when you compare any number of professionals, with the same training, same license and equal years of experience, there will be one ,who for you stands out as a better match. The reasons for this are unmeasurable and have to do with personal chemistry, an elusive part of the therapeutic relationship that is difficult to measure.
Even when you have found the right person, you have to be ready for the journey of therapy. It is important to know that there are a number of potential risks as well as benefits involved in psychotherapy. Risks sometimes include experiencing uncomfortable feelings (e.g. frustration, anger, sadness, anxiety, guilt, loneliness, helplessness, or other difficult emotions). Therapy often requires discussing difficult and unpleasant aspects of your life. However, psychotherapy has been shown to have benefits for people who undertake it seriously. Therapy often leads to a significant reduction in negative feelings, better relationships with significant others, improved ability to cope with stressful feelings and difficult situations, and resolutions of specific problems. Psychotherapy requires substantial active effort on your part. In order for therapy to be successful, you will have to work on things discussed both during your sessions and at home. Psychotherapy works best when clients are willing to take risks in the form of trying new solutions to old problems and/or are actively willing to make changes. Therapy can be a highly effective tool for changing one’s own behavior and/or thought processes, but is generally not helpful in changing thoughts and behaviors of other people. However, changing one’s own behavior and attitudes frequently can lead to changes in significant others. Since you will be committing time, money, and energy to the therapeutic process, you are most likely to be best served by selecting a licensed professional with whom you feel comfortable, and at ease.
Alyson Aviv, Ph.D, ABPdN
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