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A Psychologist, a Counselor, and a Social Worker Walk into a Bar...

4/3/2014

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A question I'm often asked is, "What are the differences between all the different mental health professions?" There are therapists, psychotherapists, counselors, psychologists, clinical social workers, psychiatrists, LMFTs, LPCs, LCSWs, PhDs, PsyDs, MDs.... it's incredibly confusing! Allow me to break down the most common mental health professions for the state of Oregon.

Some of these titles are general and can refer to practitioners of all backgrounds. They include therapist, psychotherapist, and counselor. You may have also heard the term QMHP, which stands for Qualified Mental Health Professional, and encompasses several degrees and competencies. See the full list of requirements to be a QMHP in 
OAR 309-039-0510,

Licensed Clinical Social Worker (LCSW)
Known for: Using a person-in-environment perspective, which means addressing both internal (thoughts, emotions) and external (environment - social, political, familial, economic, etc.) influences that affect a client's condition. Social workers often also have an interest in social justice and helping more vulnerable populations.
Education: Master of Social Work, which includes two years interning under supervision.
Clinical training: 3500 work hours, 2000 direct client hours, 100 hours meeting with clinical supervisor, then pass two exams
Ongoing requirements: 40 hours of continuing education courses reported every two years
Licensing board: Board of Licensed Social Workers

Licensed Marriage and Family Counselor (LMFT)
Known for: Specializing in working with couples and families using a systemic approach.
Education: Graduate degree with specific amounts of coursework related to marriage and family counseling as well as an internship. Several master of art, master of science, and master of education degrees meet the education criteria.
Clinical training: 2000 direct client hours, 2-3 hours/month meeting with clinical supervisor, then pass two exams.
Ongoing requirements: 20 hours of continuing education courses every year.
Licensing board: Board of Licensed Professional Counselors and Therapists

Licensed Professional Counselor (LPC)
Known for: Using recognized counseling techniques with individuals, couples, groups, organizations, career counseling, and school counseling.
Education: Graduate degree with coursework related to counseling and career development. Several master of art, master of science, and master of education degrees meet the education criteria.
Clinical training: 2000 direct client hours, 2-3 hours/month meeting with clinical supervisor, then pass two exams.
Ongoing requirements: 20 hours of continuing education courses every year.
Licensing board: Board of Licensed Professional Counselors and Therapists

Licensed Psychologist
Known for: Psychological testing and diagnosing complicated cases.
Education: Doctoral degree in psychology (PhD or PsyD).
Clinical training: 1500 hours of residency providing psychological services, 2 hours meeting with a clinical supervisor for every 40 hours of psychological services, 2 hours of learning activities (case conferences, seminars, etc.) for every 40 hours of psychological services, then pass two exams.
Ongoing requirements: 50 hours of continuing education courses every two years.
Licensing board: Board of Psychologist Examiners

Psychiatrist 
Known for: Prescribing mental health medication, especially for complicated cases. 
Education: Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO).
Clinical training: Minimum three years post-graduate residency in psychiatry, then pass a minimum of three exams (several exam combinations are accepted). 
Ongoing requirements: 60 hours of continuing medical education courses every two years.
Licensing board: Oregon Medical Board
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How to Choose a Therapist

3/27/2014

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Finding the right therapist is a difficult endeavor. It's not like finding a good mechanic or Cuban restaurant, which people are happy to tell you about and recommend their favorites. Therapy is different. It's a very personal and vulnerable part of a person's life that is often not talked about. If you have friends and family that are open about their own therapy, ask them what they like about their therapist, and perhaps for a list of referrals from that therapist. Therapists know therapists. However, if you are like most people and do not know (of) anyone in therapy that you're comfortable asking, here's what I recommend:

1.  Shop online. 
This is how most people find a therapist. Many therapists elect to be listed in Psychology Today's online directory.  At this writing, a quick search in Portland, Oregon pulls up 977 therapist profiles. From there you can whittle it down by gender, zip code, age, insurance accepted, and even issues treated. When reviewing profiles, look for therapists that give you a sense of what it is like to sit across from them in a session. If they link to a website in their profile, visit the website. Listen to your intuition here and narrow your search down to a handful to call and interview.

2. Call your insurance company.
Insurance companies have directories of "in-network" providers, or providers whose services are covered by your insurance plan. When you call, they may ask you for your preferences and give you a list of names. Again, make sure to get a few names to call and interview.

3. Call your company's human resources department.
Many companies offer an employee assistance program (EAP) as part of their benefit package. Employee assistance programs often cover a wide range of services, including psychotherapy. Furthermore, they usually offer several sessions per year at no cost. Employee assistance programs are usually administered through a third party vendor and you can get the phone number from your human resources department. Much like an insurance company, you may be asked for your preferences and given several names of therapists.

4. Contact at least three therapists. 
Before you make an appointment with anyone, contact at least three therapists, and preferably not just by email. You want to get a sense of what it's like to talk to them, not reveal your deepest darkest secrets over the phone. Do they make you feel at ease? Is their style a fit for you? Do you feel like they're genuinely interested in you? Consider asking how they structure their sessions, how they believe change happens, if they've worked with anyone with your issue, and of course, any logistical questions such as office hours. If they are difficult to reach, they may not be responsive while working with you either. Always trust your gut if you have doubts. If you've contacted three and all three had red flags, contact three more. This work on the front end will increase your likelihood of finding someone whom you trust and respect. No one wants to bare their soul to therapist after therapist.

5. Check their license.
I highly recommend finding a therapist who is licensed, and most reputable therapists in private practice are licensed. Licensed therapists are required to complete thousands of post-graduate therapy hours prior to licensure, receive consultation and guidance from a licensed supervisor, pass licensing exams, adhere to statutes, administrative rules, and a code of ethics, complete and report continuing education hours, and are overseen by a licensing board. Looking up a therapist on a licensing board's website can verify that they are indeed licensed and give you any information about past disciplinary actions. 

6. Attend at least two sessions.
Most people are wrought with anxiety and emotions going into their very first session. I have had many clients that started crying from the moment they sat down, often saying, "I don't know why I'm crying!" It's because the lead-up of life prior to that first session is often heady, you're nervous about sharing with a person you've just met, and you are feeling vulnerable and maybe even overwhelmed. That first session is often not representative of what sessions will be like with a therapist, so I encourage you to commit to at least two sessions before evaluating your experience. That said, even after doing your best footwork on the front end to select a therapist, you may find they're not actually a fit. Don't feel bad about switching to a new therapist. It is your life! And, speaking as a therapist, we are most interested in you finding the best fit to improve your emotional health and well-being.

Happy hunting!
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    Sarah Zuber, LCSW is a behavioral and mental health therapist serving the Portland, Oregon community.

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