The process of choosing a therapist is a personal one but it can be confusing with so many options. LPC, LMFT, LCSW...What is this alphabet soup? What's the difference between a counselor and a therapist? Do I need a psychologist or a psychiatrist?
A psychiatrist is a medical doctor who has received specific training in treating mental health disorders. Some provide counselin, however many psychiatrists manage their clients' medication needs while the client participates in counseling through another provider.
A psychologist has a doctoral degree in psychology. Psychologists are trained to provide therapy and administer psychological testing. Generally when a court orders that an evaluation be completed, it is performed by a psychologist. A psychologist does not prescribe medication.
Master's Level Counselor or Therapist
This is where things get confusing. Licensed Clinical Social Workers (LCSW), Licensed Professional Counselors (LPC), and Licensed Marriage and Family Therapists (LMFT) generally have similar roles. Each is licensed by the state board to provide mental health services and must abide by professional and ethical standards. However, each provider's unique education and experience shape the areas of expertise. For example, a Licensed Marriage and Family Therapist is likely to have experience working from a family systems model but may have unique expertise working individually with a specific population. A Licensed Clinical Social Worker may have additional training in client advocacy but can be an expert in providing family therapy. School counselors usually have a master's degree in counseling or education but may specialize in academic counseling rather than mental health. If you are seeking counseling from a school counselor, be sure to ask about areas of expertise and any limitations on the service that can be provided.
Counseling interns are professionals who have completed their master's degrees but have not yet met the requirements to become licensed. In order to provide services, they must be registered with the state board and receive ongoing supervision by a licensed professional. Although interns are generally less experienced than licensed professionals, they have to abide by the same professional and ethical standards. Sometimes interns are able to provide services at a lower fee than that of licensed professionals.
What is the difference between counseling and therapy?
Most of the time these terms are used interchangeably. Traditionally, counseling was considered short-term and advice-driven, while psychotherapy was more focused on analyzing thoughts and experiences. In reality, each counselor/therapist has his or her own approach to helping clients, which likely involves a combination of approaches.
Before scheduling the first session, many counselors will offer a brief consultation to gather identifying information and ask questions about your counseling needs. This is a good opportunity for you to have a conversation with the counselor to explore whether this person is a good fit for you. After all, you are not just hiring a professional to provide a service. You are also choosing whether to enter into an important therapeutic relationship.
As a parent, I hope my children don't grow up being afraid of the world. I do, however, know that there are frightening things my children need to be protected from. Providing our children with tools to keep them safe while preserving their childhood innocence sometimes feels like walking a tightrope, particularly when it comes to issues around sexual touching and personal boundaries.
How Early is Too Early?
Many parents have expressed to me that they want their children to understand the difference between good touch and bad touch, but they don't want to give young children too much information. My advice is to start early by teaching them about their anatomy. Even pre-verbal children can learn about their body parts. When bathing your toddler or changing a diaper, talk to your child about who is allowed to wipe or wash them. As they become aware of norms around getting dressed, talk to your child about who is allowed to see him or her undressed (a parent or a doctor, for example) and when it is appropriate to keep clothes on.
Give Your Children Language
Knowing the names of body parts is empowering to children. Learning that a penis or a vagina has a name removes some of the mystery of that body part. It's a body part, just as an elbow or a foot is a body part. It helps children feel a sense of ownership. This is MY vagina. This is MY penis. That sense of ownership is a protective factor against potential abuse. It also gives children the words they need to communicate if someone does try to touch them inappropriately.
Demonstrate That You Can Handle It
Teaching your kids about their bodies reassures them that YOU are comfortable talking about the subject. If your children know that you can comfortably talk to them about their bodies under normal circumstances, they are more likely to come to you if there's a problem such as a health concern or to report inappropriate touching. When children have the impression that parents are embarrassed by genitals or the words we use to describe them, they may worry that talking about it will be upsetting to adults. By leading the conversation, you are demonstrating that it is okay to come to you.
But What If I'm Not Comfortable?
You may feel uncomfortable having conversations with your kids about their anatomy and the difference between appropriate touching and inappropriate touching. Perhaps this was a topic that your family didn't talk about. Maybe your personal history adds some extra challenges. Or maybe you just aren't sure how to start the discussion with your own children. That's okay! If you are feeling uncertain about how to talk to your kids or having difficulty with your own discomfort about words like penis and vagina, a counselor may be able to coach you through steps to increase your confidence and to practice having these conversations.
Adolescents are known for having quickly-changing moods. She's happy one minute, crying the next. He withdraws to his room at home, but seems to engage with friends. Adolescence can be a stressful time for young people and parents alike. You used to be able to predict what would set your child off, but now it may seem like a stranger is living under your roof. Does my child need counseling? Are these symptoms of a mental health issue?
Many of these changes are considered normal and developmentally appropriate. Adolescents are testing the boundaries of their emerging independence and often focus an increased amount of energy on their social relationships, not to mention the wave of hormonal changes they are going through. Although your adolescent may seem like a mystery to you, you actually have more knowledge and familiarity with your teen than anyone else. If your child begins to show signs of depression, anxiety or another mental health issue, you may be the first to see the signs.
Only a trained professional is qualified to make a diagnosis, however there are signs you might observe that could indicate a need for an evaluation by a professional. Some of these signs are normal to a certain degree. For example, who doesn't feel irritable sometimes or have a bad night of sleep now and then? When these problems interfere with an individual's ability to maintain relationships, perform academically, and attend to daily self-care needs, there may be cause for concern.
*If you learn that your child has expressed thoughts of harming him/herself, or has acted on these thoughts, it is important to seek intervention immediately, either through a mental health professional or emergency services such as a local crisis team or law enforcement, if the risk is imminent.
If you observe significant changes in your adolescent's mood or behavior, don't be afraid to . Let your child know that you are worried about him/her, and that you would like to communicate about what's going on. I suggest this, knowing that adolescents may not communicate as openly as we would like. However the most important part is that they know you are willing to listen, even if they don't immediately open up.
Family therapy can be a resource for increasing communication and increasing your knowledge of ways to support your adolescent. If you are concerned that your child may be experiencing depression, anxiety, or other emotional challenges, I suggest contacting a mental health professional to request an evaluation and recommendations.
Many health insurance policies include coverage for mental health therapy. While insurance is a cost-effective option, there are several advantages to paying out-of-pocket instead of using insurance benefits.
"I don't want anyone to know my personal business"
In order to submit an insurance claim, the therapist has to include, at a minimum, a mental health diagnosis. Sometimes the insurance company requires that the therapist provide more detailed information about the reason services are being requested. This information becomes part of your health record. As a client, you may prefer to pay out-of-pocket in order to avoid sharing your private information with your insurance company.
"Why do I need a diagnosis? I'm not sick"
As mentioned above, when an insurance claim is filed, it includes a diagnosis. While a diagnosis is helpful in determining the course of treatment of someone who experiences a mental health issue, not everyone meets the criteria for a qualifying diagnosis. You may be seeking therapy to improve a relationship, learn new skills, or to prevent a problem from getting worse. As mentioned above, even if you do meet criteria for diagnosis, you may not want a diagnosis to become a part of your health record. Paying out-of-pocket allows you to seek therapy on your own terms.
"I want to choose my own therapist"
Most insurance companies have contracts with healthcare providers who are called "preferred providers" or "network providers." Some insurance companies do not provide coverage for you to receive services from a provider who is not part of their network. Others will reimburse you at a lower rate if you choose to see an out-of-network provider, but only if you have met your annual deductible. If you pay out-of-pocket for therapy, you have a wider selection of therapists to choose from regardless of your insurance plan.
"I don't want a company to decide what services I can get."
Your insurance company may have restrictions on the type of therapy allowed under it's plan, or the length of therapy. Some policies limit the number of sessions allowed in a calendar year. Self-pay allows you to choose the type of treatment you want for the duration that you and your therapist determine is appropriate.
Deciding whether to use your insurance benefits is a personal decision that may depend on a number of personal factors. Before scheduling a therapy session, be sure to contact your insurance company to verify your coverage. The following questions may be helpful in determining whether to use your insurance or to pay-of-pocket:
Simone D'Amore is a Licensed Professional Counselor practicing in Beaverton, Oregon.