Month: May 2017
How to Find the Right Therapist

How to Find the Right Therapist

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First and foremost: congratulations! In therapist-speak, you have moved from the pre-contemplative stage of change to the contemplative stage of change and are making progress towards your goals already! Seriously though… good for you. It takes courage to look for and ask for help and this is an excellent first step. Secondly, take heart: the process of finding a therapist can be arduous and tricky at best, not to mention any lingering reservations you may have about the whole thing.

I hope to provide you with some information that can make it easier and help you get to the next step- whatever that may be for you! It can be as easy as picking up the phone, but sometimes the long can be the short. Putting in a little time to research and prepare could save you time, money, and opportunity. It’s complicated and there is misinformation out there. I’ll give you the inside scoop!

Where to start and a word about word of mouth:

Surprise! The yellow pages are not the place to look anymore! With the exception of word of mouth, the internet is your best friend here. Word of mouth can be extremely valuable, but needs to be taken with a grain of salt.

It can be tricky to try to assess how helpful and in line with what you are looking for, a word of mouth recommendation is. Consider a person lingering in therapy for many years who loves their therapist, but for who those close to the person continue to worry about their loved one’s high level of depressive symptoms. That would probably be a word of mouth recommendation that you don’t want to take!

Recommendations from primary care doctors and other therapists can be safer, however I myself actually once inadvertently recommended a terrible therapist to my best friend! You need to feel things out. And reach out, online and/or directly.

When you do find a good therapist, they may have a long wait list. Contact them anyway and ask who they recommend.

The internet however, can be overwhelming. Rather than wade through random websites, the easiest way to narrow your search is to use a website called psychologytoday.com. While not every therapist uses psychologytoday.com, it is widely used because of the low cost and ease of connecting with potential clients.

Front and center, in the middle of the homepage is a search field to enter your zip code. Entering your zip generates a list of nearby therapists. You can use the qualifiers on the left to further narrow your search, but use this feature with care. For example, if it is a priority to use your insurance, definitely select your company, however if you start selecting from the list of “issues” presented, you may weed out some therapists that would be a good fit.

For example, a therapist may not have selected “depression” as one of the top 3 issues that they work with, because they assume that all therapists are well versed in treating depressive symptoms and they have chosen to highlight other areas that they may have advanced training in and that are more specialized. They are likely more than qualified and open to referrals for people with depressive symptoms and should not be counted out.

Experiment with it, though and start reading some pages. The best part of this website is that you can read a bit about each therapist before emailing or calling them, including what they want you to know about their practice up front.

What about insurance?

Should you want to use insurance to pay for your therapy, calling your insurance company to ask for a list of providers that participate with your insurance is also a possible starting point.

Regardless, you will need to call your insurance company to verify that the provider you find participates with them and to determine your benefit information. Click here for a printable list of questions to ask your insurance company before your first appointment.

You can also google any relevant phrases like “treatment for depression” and your area code. Many therapists register on google with a list of relevant search terms that link to their contact information and website if they have one.

Keep in mind, though: having a fancy website can give you information, but does not necessarily correlate with the therapists’ level of skill. I for one have never had a website for my practice because I’ve never seen a need for one.

Understanding your options:

There is a myriad of different types of professionals who provide talk-therapy, also referred to as psychotherapy. Licensing differs from state to state, which means that some professionals are more common in some places than others and in some places, some professions have little to no representation.

I’ll put it out there up front: I’m going to give a very anecdotal, biased, non-scientific, but very finger on the pulse level of information regarding who is doing therapy and how to understand your options. I will also preface my thoughts by stating that while research has shown no correlation between outcomes in therapy and profession of therapist, it’s good to be informed of your choices.

The bad news first; one type of therapist to be careful about:

More education and authority is not always better. A Psychiatrist is a medical doctor who has specialized in psychiatry. They are qualified to provide therapy and to prescribe medication, which sets them apart from other professions.

In watching any amount of television one could surmise that medication easily and best treats any mental health concern. At the same time, in most areas there is a shortage of Psychiatrists, especially Child and Adolescent Psychiatrists, and not surprisingly a high need for prescribers. **Warning bells going off!**

However, a competent and ethical Psychiatrist will tell you that therapy is the first line of treatment for almost all issues that bring people to seek help. Ask about CBT. THEY should explain that Cognitive Behavioral Therapy is the gold standard for the vast majority of people seeking treatment. 

I am not just someone with an axe to grind with some wacky Psychiatrist(s), although there may be some of those in the back of my closet somewhere… axes, not Psychiatrists!!!! But I digress. The Adolescent Psychiatrist who gave the most recent psychopharmacology training that I attended (2016) stated that with the exception of ADHD (which I take issue with, but that’s beyond the scope of this post), he will not prescribe to people who have not first tried talk-therapy for a minimum of 3 months.

He was extremely cautionary about people even referring clients to Psychiatrists at all, and remember this is coming from an actual Psychiatrist! He recommended Psychiatric Nurse Practitioners when medication is needed (a widely held position of those working in this field).

Shhh, what’s that noise? Did I just hear a Psychiatrist sharpening an axe somewhere? Don’t’ get me wrong, there are some great Psychiatrists out there. Unfortunately however, the field of psychiatry has shifted almost 100% away from providing therapy and towards prescribing medication. Of course, there are circumstances when medication is necessary and important. Research consistently shows though, that the right type of talk therapy produces better outcomes for the vast majority of people.

Furthermore, in my own experience, over the years there have been very few people that I have needed to refer for a psychiatric evaluation at all. I could count on one hand the number that I have needed to refer immediately.

Moving on…

Since 2004 I have worked for 3 large, non-profit, mental health/behavioral health organizations in 2 states: Maine and New York. I have also spent the last 8 years building a private practice in New York. In private practice, I’ve come across all types of therapists, but primarily Clinical Social Workers, Psychologists, and Marriage and Family Therapists.

In Maine, though I worked in the field there for over 5 years, I never heard of any Marriage and Family Therapists! Doesn’t mean they don’t exist there, but I never came across one.

What I did hear of in Maine, albeit rarely, were LCPC’s (Licensed Clinical Professional Counselors). I have never come across this term in New York, but I believe Marriage and Family Therapists and Mental Health Counselors may be types of LCPC’s? Not sure.

No wonder there is so much misinformation out there, online and in general regarding who provides what type of therapy and to whom. Even WebMD gets it wrong in their description of therapists who are social workers.

In my experience working with people from all different backgrounds, in all different levels of care, social workers are more widely providing therapy than any other type of clinician. Why is this? It’s impossible to nail that down, but what we do know:

The differences between the types of professionals providing therapy are vast and complicated, but the main difference between social workers and the others is that the field of social work is based on a set of values. These values are service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence. While of course not every social worker lives up to these values, it is notable that they are at the core of our profession. They are also the values that one should look for in a therapist, regardless of the credentials after their name or their level of education or experience. These are values that lend themselves to good outcomes. It’s no surprise- insurance companies want to pay us (though, not nearly enough!) and clients want to see us.

 

Bottom line:

When looking for a therapist, ask yourself if the person seems non-judgmental, caring, sensitive, and if they will meet you where you are at. If they are a social worker, bonus! 😊 Ask if they are experienced and trained to do CBT and if it is an integral part of most of their work (it should be!).

Use the internet and those around you, feel things out armed with information, and call your insurance company (if using). Click here for an easily printable list of questions to ask your insurance company before scheduling at appointment.

Hint: If your nerves or procrastination are getting the better of you, a helpful mantra might be “just do it”. You’ll be glad you did.

 

Alisa Reed, LCSW-R

 

 

-The opinions presented in this post are just that: solely opinions of this writer, and not professional recommendations. Statements are to be taken at your own discretion and resulting choices, at your own risk. Please seek the assistance of a licensed therapist of any kind if you would like help understanding any of the ideas presented here.    

 

 

 

 
Should I Start a Private Therapy Practice

Should I Start a Private Therapy Practice

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This is a question that more and more therapists have been asking themselves and earlier and earlier in their careers. Sure, there are some people who know that private practice is where they want to end up and sometimes they are looking to get there as quickly as possible. There may be nothing wrong with that, but there are external pressures that are currently pushing more and more therapists to go this route before they are ready or otherwise would. The reason for this situation is economic and systemic and it may come as no surprise that the system is being exploited by insurance companies and a government that just doesn’t work. Though the need for therapists has increased, by and large gone are the days (at least for now!) that one could obtain a full-time job as a clinician with benefits, especially right out of graduate school. If you are a new grad., someone at the beginning of their career, or a therapist at any point in your career: having been in your shoes, I’ll give you some inside info that can help you decide if private practice is right for you and if so, when.

The first thing to ask yourself and to answer honestly: have I had enough high quality supervision, training, and experience doing the type of therapy that I will be doing in private practice? If you read the above paragraph and your thoughts went to, wow this is a terrible situation for clients too! Your heart is definitely in the right place. And if it was the first thought that came to mind, bless you, social worker! But what about you? If you enter private practice without having put in some solid time working for an agency with excellent training and supervision, and doing the work! you and your career are also at risk.

After all, you want to do this work for 30+ years possibly, not burn out after 5, right? Of course, you want to avoid miss-steps and lawsuits! Who likes lawsuits? And I know, especially because you are reading this- you want to be a great therapist! Finally, if wanting to help people the best you can does not factor in, please go no further. I say this because some do. If it’s you, please don’t, this does nobody any good, you included! But I’ve seen well-meaning and skilled therapists struggle after jumping into private practice too soon and I’ve thanked my lucky stars countless times for my past supervisors and training, and some still current mentors and continuing ed..

Next, here’s a somewhat scary thought, but just like you help your clients to do, it’s one you must face: you will make mistakes. Are you ready to make mistakes when it’s all on your shoulders? The types of mistakes that even seasoned clinicians inevitably make, being human? Or are you at a point when you want the support of an organization that is set up in a way to safely enable therapists to learn and grow with an understanding that mistakes do happen?

Some less obvious, and just a few more fair questions that you may not have considered, but the type to think through: Are you prepared to properly assess and relatively quickly, the appropriateness of scheduling an evaluation with a potential client over the phone? Also, can you typically smell a subpoena a mile away? Like, in the first 10 minutes of an initial session? Or better yet, over the phone? If this question confuses you, you are not ready! If you get it, but haven’t developed this skill yet, you’re getting there… while some hopefully rare circumstances make this unavoidable, a courtroom is absolutely no place for a therapist. We do therapy! Not court! If you like a courtroom that’s fine- get advanced training as a forensic social worker (or the equivalent in your field) and add this to your practice, you will make a boatload of money and all joking aside provide an important service. But your average therapist- court- avoid!!! and refer to more appropriate resources.

If you are not stressed yet, you might be ready! If you are feeling discouraged or daunted, don’t worry, you will get there! Hopefully the information I’m presenting will help you figure out your next step- whether that’s reaching out to a therapist who can act as mentor, looking for work at an organization that provides better supervision and training, or calling on that ad for office space that you saw the other day. Things will click if you go about them in a mindful way. And some people are always more comfortable working for someone else and there’s nothing wrong with that! What matters is the same thing we tell our clients: that you trust yourself and access that voice deep down that knows what’s right for you.

The things that in my experience, were my biggest fears and ended up not mattering at all: how will I get referrals? How will I get in network with insurance companies? How will this all work? Will I feel too isolated? What if this doesn’t make financial sense? All of these questions are easily answered as you put one foot in front of the other. One route that makes sense for many: rent an office space for one day a week and start gradually. If you can’t find an office space for rent like this, call therapists in your area who may be willing to sublet an evening a week to you. A good therapist is not generally afraid of competition and might perk up at an opportunity for connection. A call from someone wanting to rent my office one day a week is a call I want to get!

Lastly, here’s a little secret that as a therapist, you probably already know but bears repeating now: everyone, even highly successful CEO’s, and the like, are afraid, at least a teeny bit, that everyone is going to find out they are incompetent. This is normal and healthy and part of why you are not a narcissist. But keep it in check. In considering going into private practice, keep your stress at a eu-stress level (admitted therapist nerd here) and let it motivate you to take the steps to make a well-informed and excellent decision.

If you are already in private practice and struggling, it’s ok! Use that struggle as a springboard for growth and rather than trigger shame or a shutting down, let it motivate you to figure out what to do next. And keep in mind: supervision and peer consultation should not go by the wayside just because you legally don’t need to have them anymore. A therapist in their late 70’s was a member of a private practice peer consultation group I used to attend! And while I provide supervision to others, I still seek it out myself and probably always will. Consider calling a sought-after therapist in your area who has a long wait list. They may welcome the opportunity to provide you supervision for payment, though they are short on space for clients. What a great opportunity! And at the very least an insurance policy against burn-out and the pitfalls of the work.

Bottom Line: Filter out the normal, healthy worries and hone in on what your gut is telling you. Have you had enough training and supervision and have things really clicked yet?

Helpful mantras: “Don’t let the perfect be the enemy of the good.” “One foot in front of the other.”

 

Alisa Reed, LCSW-R

 

 

-The opinions presented in this post are just that: solely opinions of this writer, and not professional recommendations. Statements are to be taken at your own discretion and resulting choices, at your own risk. Please seek the assistance of a licensed therapist of any kind if you would like help understanding any of the ideas presented here.   

 

 

 

 

 

 
Mom-Guilt vs. Mom-Shame: Why Mom-Guilt isn’t as Bad as we Thought

Mom-Guilt vs. Mom-Shame: Why Mom-Guilt isn’t as Bad as we Thought

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We hear the term “mom-guilt” all the time and always with a negative connotation. In fact, it’s a pretty widespread cultural belief, (even among some therapists!) that guilt in general- is a bad thing. The guilt associated with motherhood can be so particularly intense. It’s pervasive, widespread, and it can be an overwhelming topic to examine. It’s often in direct proportion to our love for our kid(s). But fear not, and don’t pick on guilt! It’s shame that is guilt’s single white female-esque mom-friend and she’s stalking us all. I’ll tell you how to kick her out… for good!

Instead of remaining mindful and accepting of one’s feelings, often women- overwhelmed- shut down, and end up burying guilt. Sometimes it’s as seemingly benign as noticing the feeling and with a roll of the eyes, dismissing it- ugh, mom-guilt… move on!  Be careful though; cigarettes are not bad sitting on the table, but when you actually smoke enough of them, chances are you will get cancer, and if untreated – it will metastasize and you will die. You need to toss the cigarettes and with them that bad mom-friend too!

Ok, so I might be thinking about cigarettes because I may have wiped my 3-year-old’s bum while nursing her newborn sister more than once today, but really – shame is an emotional cancer that stems from unchecked guilt. The goal is not to get rid of guilt, however. We can observe the cigarettes on the table (though harder for some than others), it’s what we do with them that matters.

Guilt is a normal and healthy emotion and one of the things that keeps levels of narcissism in check. Having a healthy relationship with our feelings of guilt should be the goal. Here’s how to do it:

First, notice your guilt. While some events trigger feelings, feelings generally come from and/or go along with, thoughts. Feelings generally lead to behaviors/actions (shutting down included). Try to notice how guilt works in you. Can you catch it at the thought stage? Wherever you catch it, ask yourself the following:

-Do I need to apologize for something?

-Do I need to make amends?

-Do I need to do different moving forward?

If you answer “no” to these 3 questions- poof! it’s gone! Allow yourself to let that guilt float away, it’s useless.

If instead, you answer yes to any of the 3, good thing you asked yourself! Push yourself to apologize, make amends, do different- whatever is needed for that guilt to float away; far, far away from you and your wonderful life.

Here’s an example to illustrate the process:

Throughout the day, little guilt molehills can build up to a treacherous gorge of shame. Perhaps you can relate: I need to use the bathroom, baby cries; I need to put on a shirt, baby cries; I need to drive to pick up my older child, baby cries; I need to quickly return a call, baby cries; I need to eat!!!, baby cries. The thoughts that go through our head at these times are sometimes conscious and sometimes subconscious.

We might be surprised how guilt inducing these thoughts are when we set out to notice them. Maybe it’s a tiny molehill: hurry! Or maybe big and heavy: I’m so bad at this… I’m a terrible mother. Regardless, having a healthy relationship with our thoughts in these circumstances might look like replacing guilt inducing thoughts with thoughts that are based on what we can conclude when we are mindful and connected to the moment.

Mindfully consider: do I need to adjust? Am I doing something wrong? The plane analogy (put the oxygen mask on yourself first, then the child) comes into play often when answering these question for ourselves. In this example, one can conclude- baby does not need a hangry, naked mother who needs a diaper herself!!! Replacement thoughts then might look something like, “(insert child’s name) is ok, this cry is not a cry of chronic, toxic stress- that’s something different. Let it go!”. Notice then, how the feeling changes and guilt releases.

Enjoy! And see what happens.

Being human puts that guilt on the table, but does shame still stalk you, waiting to pounce on your guilt and exploit it? If so, it can be helpful to reflect on where that shame comes from. Is it from shameful messages that our culture sends, that we can think critically about and reject? Does it stem from experiences that we have had that have been shaming of us?

If so, processing related grief and loss in order to chip away at negative core beliefs is a key step. Many of these patterns are deeply imbedded in our subconscious and take repeatedly coaching ourselves in this way, over time, to make new patterns more automatic. Regardless, mindfully examining guilt as described above can free us to engage more fully in the present moment, even if it’s wiping a bum! in order to experience the love- and that, my friends, is what it’s all about.

Bottom Line:

-Work towards having a healthy relationship with your thoughts and feelings connected to guilt.

-Ask yourself if you need to apologize, make amends, or do different. If you do, take the action needed and let guilt float away. If you don’t, a helpful mantra is “let it go”.

-Reflect on the roots of guilt and shame and coach yourself on establishing new beliefs, patterns of thinking and thus feeling and acting.

 

Alisa Reed, LCSW-R