MENTAL HEALTH MATTERS: Seeking a therapist? Consider these professional credentials

It feels like fall outside today! The air has a crispness to it that is so refreshing and delightful. My air conditioner is not cycling on and off all the time. The seasons, they are a-changing!

Going to therapy is often about change as well. Most human beings do not change unless we are sick and tired of being … sick and tired! Change is hard. And that takes what I consider to be equal to all the planets lining up in just the right ways.

What do therapists do? How do they work? How are they trained and prepared to do their work? Mental health therapists generally help people understand and manage emotional, behavioral and relationship difficulties. There are some things you can expect from a good therapist who follows sound ethical principles and uses what we call evidence-based practices.

What exactly are evidence-based practices? Good question! These practices are methods backed by reliable and replicable scientific research and are shown to help with a particular problem. In mental health practice, this typically involves a combination of three components: Research evidence that it is effective, professional expertise from trained therapists and the client’s needs, preferences and circumstances.

Both the client and the therapist bring very important but different elements to the table. Therapists should be the experts on approaches to therapy, which interventions to use and when to use them.  Clients are the experts on themselves. Clients bring our knowledge of our history, how we think, what feelings we experience and both the joys and personal struggles we encounter.

What can you expect from therapy?

You should expect confidentiality. There are only two exceptions to this, which I will describe shortly.  What you share with your therapist should be held in confidence, which means that therapists are professionally and ethically obligated to keep private your information and the details of your discussions private. Your information should be kept safe and secure. Each therapist should be able to describe to you what their practices are to ensure that this is the case. And, you have the right as their client to ask how they keep your information safe.

There are two exceptions to maintaining confidentiality. Should any client express an intent to harm themselves and/or others, therapists have a legal obligation to report this to the proper authorities and resources. This is tied to therapists’ professional code of ethics, which should drive their professional practices.

Depending on the therapist’s professional training, each profession has a professional code of ethics, and you should be able to look them up. Social workers, licensed professional counselors, marriage and family therapists and addiction counselors each have their own codes that you can find online. They generally address the same responsibilities but may be worded slightly differently from one another. It can be helpful for clients to look at them and understand why therapists do some of the things they do.

You should not feel judged. Many people already judge themselves harshly.  You should not have to feel that coming from a therapist. Most of us are expert self-judgers all on our own. We are already accomplished “self-loathers!” There are also some folks who don’t know what it’s like to not be judged, and therefore, it may be difficult to figure out what meeting in a supportive and non-judgmental environment might even feel like. Non-judgment can also help build a feeling of safety between you and your therapist, and that takes time. It also takes a nonjudgmental therapist.

A good therapist should be able to assess areas of mental health concerns, including but not limited to your levels of anxiety, depression, trauma and stress. This is very important because it also indicates how much you are suffering from your current circumstances. Ideally, that assessment should also inform the therapist about which interventions will be useful to help them meet you where you are.  The assessment should also help them determine if they need to make any professional referrals to further assist you.

A well-trained therapist should be able to teach you various coping skills to help with the burdens of the difficulties you are experiencing. This may involve skills of emotional regulation, communication and problem-solving. You can expect to receive the tools you need to start to make changes in your life.

You can also expect that your therapist will likely use a structured, evidence-based approach as an intervention to help you solve your problem. One example of such an approach is cognitive behavioral therapy, also known as CBT. CBT operates on the idea that our thoughts are powerful drivers of our emotions and our actions.

A very simple example is our beliefs and thoughts about ourselves. Many adults carry the belief that they are “not good enough.” They may have developed these thoughts in response to messages they received as children from the adults in their lives. When we carry these thoughts into adulthood, we may sabotage opportunities that come our way. In fact, we may not even recognize opportunities and miss them altogether. CBT is helpful in uncovering those thoughts and helping you replace them with thoughts about how resourceful and able we are.

Given enough time and therapy, clients will see changes in how they look at the world around them. Hopefully, they feel more confident and try to take on a challenge they could not even see before. There are numerous other interventions that therapists use in helping clients, including but not limited to therapies of mindfulness, psychoeducation, trauma-focused approaches and supportive therapy.

Early on in therapy, a therapist will help you set goals, even as simple as “I want to feel less depressed.” Your goals may become more specific over time, but the general idea here is that you want to change something about your life, and having a goal helps you measure your progress.

At the very heart of your work with a therapist, you should feel support and understanding. These are the minimum expectations, and given the experiences and training of the therapist you work with, that will only be the beginning.

What is the duration of time you will spend in therapy? This depends completely upon you and the therapist as you measure your progress together as you work together. When clients have a really good therapy experience, they may decide to continue to work with their therapist to solve or manage other problems they have uncovered. Others are satisfied with their experience, and they and their therapist agree on a time to terminate the working relationship.

What credentials should a therapist have?

Therapists come into the work through several avenues. Their formal training comes from one of several academic avenues. You will see credentials in their promotional material. This can be confusing for someone new to the therapy experience. I am going to briefly describe what you may find as you look for a good fit.

You will find psychiatrists whose credentials will appear as “M.D.” or “D.O.” They are licensed at the state level. They will have a medical degree with specific training in psychiatry, and they provide critical medical oversight of your treatment if it includes medication. Today’s psychiatrists generally do not do therapy, although you may find some exceptions. Their credentials may appear like this: Dr. Seuss, D.O./M.D.

You may also find board-certified psychiatric mental health nurse practitioners, or PMHNPs. They are also licensed at the state level. These professionals began their training by going to nursing school and go on to obtain their master’s and/or doctoral degrees. Mental health nurse practitioners are trained to provide medication like a psychiatrist, as well as therapy. Their credentials will appear as such: Shelly Seuss, PMHNP.

You will likely find practitioners who are licensed clinical social workers. They provide therapy and have completed their master’s degrees in social work, with potential further training as well. They have had supervised clinical practice and are also licensed at the state level. Those with a designation as an LCSW are likely to be found in agency settings, practicing under the direct supervision of a more experienced social worker. Their credentials will appear as such: Donald Seuss, LCSW or LMSW.

Other social workers are licensed as an LISW, or a licensed independent social worker. This means they have been supervised by a social work supervisor for a minimum of two years, have passed an exam and are licensed to practice independently.  Their credentials may appear in several ways, such as: Shelly Seuss, MSW, LISW.

You will find professionals who are licensed professional counselors. They usually have a relevant master’s degree, supervised practice and a state license. They provide therapy, and their credentials will appear as: Donald Suess, LPC/LMCH.

Marriage and family therapists have specialized training in therapy regarding relationships and family systems.  They have also had supervised practice and state licensing as well. Their credentials will appear like this: Shelly Seuss, LMFS.

You may also find interns or associates who are in training at the graduate or postgraduate clinical level. Depending on the specific programs of study, their requirements vary, as do their credentials.

Peer support specialists also play an important role in the mental health system.  These are people who have lived experience with their own mental health diagnoses. In addition, they have specialized training and certification(s). Their role is to provide critical support for others who often have been newly diagnosed. 

There are also professionals who specialize in alcohol and drug counseling.  Depending on the level of training and expertise they have, their credentials will appear as such: Shelley Seuss, ADC (alcohol and drug counselor). A certified addictions counselor will have the credentials CAC I or II (certified addictions counselor), each with varying degrees of training and experience.

In sum, there are numerous professionals who provide excellent therapy in our mental health systems. There isn’t really a “wrong” choice about who you work with. Your choice is often driven by your specific problem, such as your need for medication, specific therapies, who is available in your community and your personal preference regarding personalities and approaches.

Many people have had wonderful results from working with a therapist, often finding relief for symptoms they have suffered from for a long time. There are also those who have had less than wonderful experiences. If this is you, I encourage you to look for recommendations from others who have had good results and try someone new.

Until next time, I hope you are enjoying football season, cooler temps and the anticipation of the holiday season right around the corner!