- What is the best type of therapy?
- How do I go about choosing a therapist?
- What is the difference between a Psychiatrist, Psychologist, Clinical Social Worker, and a Marriage & Family Counselor?
- Will I have to take medication--even if I don't want to?
- How long will my therapy take?
- What if I feel my therapy isn't "working?"
- What if my partner (or child) refuses to go to therapy with me, and we both need help?
- I'm seeing a therapist individually. My partner (or other family member) wants to join me for couples (or family) therapy, but my therapist won't see us both together. My therapist wants to refer us to another therapist for couples (or family) therapy. I have a friend whose therapist sees them as a couple while also seeing one of them for individual therapy. Why doesn't my therapist practice the same way?
A. This is a complicated question; unfortunately, there is no easy answer. There are many different types of therapy, and some conditions seem to be more effectively treated by particular therapeutic approaches. For example, cognitive therapy has been demonstrated to be effective in treating phobias. You must first have an accurate diagnosis and a knowledgeable therapist who can discuss with you which approach may be helpful.
A. Choosing a therapist can take some time, but it doesn't have to be a daunting experience. Selecting a name at random from an impersonal insurance list may not be very reassuring, but a personal referral from a friend or family member can be helpful.
It is common practice to inquire about a therapist's level of experience (number of years in practice), areas of specialty and any specific certifications, and professional organizations (s)he belongs to. Some additional considerations to keep in mind:
- would you prefer working with a male or female therapist?
- would you prefer working with a gay or straight therapist?
- do you have a preference for a particular theoretical orientation?
- does the therapist have training/experience working with your issues?
- does the therapist seem to understand your concerns and relate to your feelings?
The latter consideration can usually only be determined by meeting with the therapist personally. Of course, some verbal clues may be obtained on the telephone, but initial phone calls are typically brief, with only a limited exchange of information.
If you have difficulty making decisions generally, and/or several names have been suggested to you, it is preferable to make an appointment with only one therapist in the beginning. If the connection is a good one, and you think you might like to work with that therapist, then continue with that person and don't make other (initial) appointments to compare other therapists: too many choices can become very confusing, and a decision will be even harder to make!
Q. What is the difference between a Psychiatrist, Psychologist, Clinical Social Worker, and a Marriage & Family Counselor?
A. All four of these mental health disciplines are recognized and licensed to practice in the state of California. A licensed mental health clinician must obtain a professional degree, have graduate clinical training, and complete an internship after obtaining his/her degree. The total number of required intern hours varies for each particular license. All licensed mental health professionals are able to practice psychotherapy. Most provide individual psychotherapy; many offer couples/conjoint and/or family therapy. A smaller number also offer group therapy.
Because a psychiatrist is a medical doctor (M.D.), he or she is able to prescribe medication. Although trained in psychotherapy, some psychiatrists limit their practice to prescribing and monitoring medications. A psychologist (Ph.D.) is also licensed to practice psychotherapy and has special training in psychological testing. Even though a psychiatrist and a psychologist are both called "doctor," it is important to remember the differences. A Licensed Clinical Social Worker (L.C.S.W.) and a licensed Marriage & Family Counselor (M.F.T.) both have master's degrees and can provide psychotherapy, but they cannot conduct psychological testing or prescribe medication.
A. Effective psychotherapy depends on your full consent for treatment, and this is equally true when considering medication. It can be helpful to discuss medication with your therapist and consider a referral for an initial evaluation with a psychiatrist (if you are seeing a non-medical clinician) when depression, anxiety, or confusing or irrational thoughts disrupt your daily activities or significantly impacts the general quality of your life. The choice to take medication is yours, and you can decline medication even after an initial evaluation. However, some managed care companies may, at some point, refuse additional authorizations for psychotherapy if the patient declines to take medication.
Some people are inquiring about herbal medicines, such as St. John's Wort. As with any medication, it is important to discuss these alternatives with a psychiatrist as well, as they may have uncomfortable side effects or be taken inappropriately.
Note: Once any medication is started, be sure to discuss changing the dose or discontinuing the medication with the prescribing psychiatrist before you try to do it on your own.
A. There is no prescribed time to "successfully" complete therapy. It is a personal decision, best determined jointly by you and your therapist, and based on various considerations, including the initial reason for seeking therapy. Managed care companies focus on the severity and duration of symptoms to establish "medical necessity,"according to their proprietary criteria (which can vary from company to company). Only a certain number of consultations are authorized to reduce the symptoms or resolve the immediate crisis. Often, an individual may want to make lasting changes in his/her life, after the crisis has eased or beyond immediate symptom relief. It is important to discuss all considerations and options with your therapist, and make a decision according to your individual needs.
A. It is important to discuss with your therapist any concern you may be having about your therapy. It may simply be a feeling of being "stuck," or the perception that "nothing has changed." Addressing your concerns in an open and frank manner can be productive and often empowering. Once you have shared your concern, if the matter isn't resolved, you may want to consider a second opinion: a one-time consultation with another therapist specifically for the purpose of identifying issues, and with your own therapist's knowledge of the consultation and its purpose. Afterward, you can discuss the results with your therapist and determine the best way to proceed.
A. It would still be important to consider therapy for yourself, which often results in major shifts in the family dynamics. Although couples or family therapy may be desirable for relationship issues, a safe environment to discuss one's concerns and feelings, to get objective feedback, and to develop more functional coping strategies, can be productive in any stressful emotional situation. This is also true for workplace issues, when it is not possible or appropriate for co-workers or supervisors to join you in your treatment.
Q. I'm seeing a therapist individually. My partner (or other family member) wants to join me for couples (or family) therapy, but my therapist won't see us both together. My therapist wants to refer us to another therapist for couples (or family) therapy. I have a friend whose therapist sees them as a couple while also seeing one of them for individual therapy. Why doesn't my therapist practice the same way?
A. For many therapists, seeing an individual while also seeing the partner/family member in couples/family therapy, represents a conflict of interests. The emotional boundaries for the couple can become confused while both have access to the same therapist. It is extremely important that one feels safe within the therapeutic environment and is free to disclose any thoughts or feelings, without fears of betrayal or competition for the allegiance of the therapist.