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 Benefits of Group Therapy

Written by Lauren Helm

The Benefits of Group Therapy

Image source: www.mental-illness-resources.com

Though it may be intimidating to envision sharing your path of recovery and well-being with a group of others (who are admittedly, at least initially, strangers), group therapy may be a worthwhile alternative to pursuing individual psychotherapy. It is often more cost-effective than individual therapy, and yet can be just as efficacious as therapy provided one-on-one.

 At CSAM, we offer evidence-based group therapy treatments that are structured in approach, but also allow you to connect with others while you learn more effective ways of responding to anxiety or other related disorders. The therapist both teaches and guides group members through exercises geared towards helping each person make significant changes in their lives.

 Our CSAM therapist, Dr. Michelle Lopez, regularly leads a cutting-edge cognitive behavioral group, called the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders. The group helps you to understand the nature of our thoughts, emotions, and behaviors, the role they play in the development and maintenance of anxiety disorders and depression, and how to begin reclaiming your life. If you’d like to learn more about these groups, feel free to reach out to us!

Above and beyond the useful informational content that the group offers, there are added benefits to receiving therapy in a group setting. Here we briefly review a few (though not all) of Yalom’s therapeutic factors that may occur in group therapy: 

Universality

When you participate in a group and share your experiences with others, you may become more and more aware of the shared nature of human experiencing (including pain and joy), thus creating a sense of universality, and reducing feelings of isolation or aloneness. FYI, a sense of common humanity is connected to self-compassion and optimal well-being!

Altruism

Group therapy offers opportunities to practice compassion and other altruistic behaviors towards one another, enhancing a sense of connection to others as well as your connection to yourself. You can also be a role model for others: Studies find that kindness breeds kindness.

Instillation of hope

Each of us is resilient in our own way, and we can share with others how we have persevered despite extreme difficulty, offering hope and inspiration to one another.

Imparting information

Often, we have learned very practical information about how to navigate various aspects of life that others may benefit from. Imparting information is also a form of social support, which can positively impact our physical and emotional health.

Development of socializing techniques & Interpersonal learning

A group setting may allow members to practice new social and communication skills in a safe environment with the support of the therapist. This may lead to more satisfying interpersonal relationships.

These are but a few of the benefits that may be experienced as a result of participating in group therapy. If you’d like to learn more about the group therapy that CSAM offers, click here. You can also call our clinic to see if any groups will be offered in the near future so that you can experience the benefits of group therapy for yourself!

If you'd like to speak with a professional at the Center for Stress and Anxiety Management for help with anxiety, please click here.

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References

Barlow, D. H., Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Allen, L. B., & May, J. T. E. (2010). Unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide. Oxford University Press.

Ellard, K. K., Fairholme, C. P., Boisseau, C. L., Farchione, T. J., & Barlow, D. H. (2010). Unified protocol for the transdiagnostic treatment of emotional disorders: Protocol development and initial outcome data. Cognitive and Behavioral Practice, 17(1), 88-101.

Ellis, A. (1992). Group rational-emotive and cognitive-behavioral therapy.International journal of group psychotherapy.

Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Thompson-Hollands, J., Carl, J. R., ... & Barlow, D. H. (2012). Unified protocol for transdiagnostic treatment of emotional disorders: a randomized controlled trial.Behavior therapy, 43(3), 666-678.

Yalom and Leszcz (2005) The Theory and Practice of Group Psychotherapy, 5th edition, Basic Books p. 272