Finding a therapist (or psychologist, or psychiatrist, or... Help!)

Finding a therapist can be a bit perplexing, especially given the various professions involved. Here are a few thoughts to guide you in your search.

Umm, what's a therapist?

Believe it or not, this isn't as easy (or uncommon) a question as you might think. Technically, it could mean a lot of things. There are occupational therapists, physical therapists, speech and language therapist, and on and on. When I use the word therapist I mean psychotherapist--a professional who helps people with emotional difficulties through the use of some form of talk therapy.

What's the difference between a psychotherapist and a psychologist (and everyone else)?

It really is complicated, but let me break down who most of the players are:

Psychotherapist:

Psychotherapist is a generic term for anyone who is licensed to provide, well, psychotherapy. Here's how New York State defines the matter:

The practice of [psychotherapy]... includes the diagnosis of mental, emotional, behavioral, addictive and developmental disorders and disabilities and of the psychosocial aspects of illness, injury, disability and impairment undertaken within a psychosocial framework; administration and interpretation of tests and measures of psychosocial functioning; development and implementation of appropriate assessment-based treatment plans; and the provision of crisis oriented psychotherapy and brief, short-term and long-term psychotherapy and psychotherapeutic treatment to individuals, couples, families and groups, habilitation, psychoanalysis and behavior therapy; all undertaken for the purpose of preventing, assessing, treating, ameliorating and resolving psychosocial dysfunction with the goal of maintaining and enhancing the mental, emotional, behavioral and social functioning and well-being of individuals, couples, families, small groups, organizations, communities and society.

You see what a hard time they have defining psychotherapy? That's because helping people with their emotional challenges is a fairly universal human activity, and therefore it's impossible to define as compared with what other "helpers" do. It's just not as straightforward as optometrist or plumber.

The really confusing part

"Psychotherapist" is kind of a made up word. As far as I'm aware, you can't actually go to school anywhere and get a degree in psychotherapy. In fact, in New York, there's no such thing as a licensed psychotherapist (though therapists refer to themselves this way all the time).

Confused?

While a history of psychotherapy training and licensing is definitely another blog post, there are a few things that might make this a bit easier to understand.

For one thing, it has to do with...

...what  all those letters after a therapist's name mean.

The activity of talking to people about their lives and their emotional problems and offering advice and support is a tricky thing to regulate. Lots of people do this for their friends. Lawyers, teachers, nurses and doctors do it all the time as part of their work. Ministers and priests "give counsel." Alternative health providers, yogis and nutritionists all do the same.

You get the idea.

Here's a bit of direction on who the various players are:

Psychologist

A psychologist is anyone with a graduate degree in psychology who practices in the field, which may mean they practice psychotherapy but could also include teaching, research, organizational consulting and/or psychological testing. In fact, while many refer to all psychotherapists as psychologists, it is both the case that the majority of psychotherapists are not psychologists, and the majority of psychologists are not psychotherapists.

The letters: PhD, PsyD, or (occasionally) EdD for doctoral level degress, MA, MS or MEd for Master's degrees

Important note: Only psychologists with a doctoral degree (PhD, PsyD, or EdD) can be called "doctor." This does not imply that they are medical doctors (they aren't) and generally they cannot prescribe medication (though this is changing in some states).

Psychiatrist

Psychiatrists are medical doctors, which means they went to medical school and completed a residency in psychiatry. While psychiatrists can practice therapy, most work in in-patient psychiatric hospitals or in outpatient settings (including private practice) where they prescribe and monitor psychiatric medications.

The letters: MD (just like your primary care doctor)

Social Worker

Social workers have completed a Masters degree in social work (or sometimes, "social service"). While social workers do all sorts of work (advocacy, case management, social-service administration), many pursue private-practice psychotherapy at some point in their careers. In fact, the majority of mental-health services in the United States are delivered by social workers and when shopping for a psychotherapist it's likely that most of the therapist available will be social workers.

The letters: MSW is the most common degree, but because licenses for social work are issued by individual states, the letters could include: LCSW, LMSW, LSW, CSW or LICSW; some social workers pursue a doctoral degree in social work, commonly a PhD (as with psychologists) but occasionally a DSW (Doctor of Social Work) is used

Marriage and Family Therapist

Marriage and Family Therapists are another Masters-level provider. Despite what their name implies, their work is NOT limited to marriage, couples, or family therapy. Marriage and Family Therapists may provide individual therapy including to children and adults, and may lead group therapy.

The letters: MFT

Counselor

While this is yet another generic term synonymous with therapist or psychotherapist, it also designates a kind of graduate-level training certifiable to provide psychotherapy in some states. Even if licensed, counselors may or may not be eligible for insurance reimbursement.

The letters: MS or MA

Psychiatric Nurse Practitioner

Nurse practitioners have a masters degree that includes academic and clinical training in a particular area of medicine. Psychiatric nurse practitioners are eligible to prescribe medication and provide psychotherapy.

The letters: NP or APRN (often accompanied by RN and MS or MSN)

Nurse, clergy and lawyer

Yes, I said lawyers. Because psychotherapy is so difficult to define, and because it incorporates activities (like helping people with problems related to healthy living), many states have found cause to list specific professions that are exempt from guidelines limiting the practice of psychotherapy. Technically, in New York, at least, anyone licensed in one of these professions can legally practice psychotherapy. While I have yet to come across a lawyer who's "hung out a shingle" to practice psychotherapy, I have come across several nurses (including those who are not psychiatric nurse practitioners) who have done so.

In their case, The letters are: RN

What does this have to do with finding a good therapist?

Both a lot and very little. Because the history of psychotherapy is complex, a search for a therapist can be a lot like swimming in alphabet soup.

Here are a few guidelines for finding your way through the fog:

If you're looking for medication, you'll need to find a psychiatrist or psychiatric nurse practitioner.
 

While your primary care doctor can prescribe psychiatric medication, a specialist is really best qualified, particularly if there are complicated issues related to the medication.

If you're looking for a therapist, ignore the letters.

Just because someone's spent more time in school doesn't mean they're better qualified to help you. In fact, a good deal of academic training isn't all that relevant to the practice of therapy. A few of the following might be relevant:

Post-graduate training Many therapists, regardless of graduate degree pursue post-graduate training, typically at a psychotherapy-training institute. It is often here where they hone their skills as practitioners. Where a therapist completed his or her post-graduate training is also often an excellent clue as to how they practice. Not sure where they did post-graduate training? Just ask. And most institutes have websites where you can get a flavor of the particular brand of therapy in which your therapist trained.

Recommendations from friends As with a dentist or a house painter, referrals from friends are a great way to go. Of course you'll have to let whomever you ask know that you're looking for a therapist, but that could be a great opportunity to share (and perhaps hear) some of what you're working on in your life. If they're not comfortable with you seeing their therapist (though this is common, and your sessions should be entirely confidential) you might ask them to get a referral for you through their therapist.

Spend some time on the internet Even as some therapists still prefer to keep information about them to a minimum, you'd be surprised at what you can find with a google search. An increasing number of therapists have websites (as I do), but you also might be surprised to find information about a therapist's training, as well as reviews from patients (on sites like yelp.com and local.google.com)

Do they seem established or busy in their practice A therapist who seems to have a full schedule (and therefore hard to book a time with) is likely pretty successful in his or her practice. While not a sure thing, it is an indication that they're established and in demand.

Shop around While it may seem a bit like finding the right used car, there's nothing wrong with setting up initial appointments with a few different therapists who've caught your eye. You may end up spending more money in the start, but it's well worth it when you find the right fit.

Unfortunately, all of the certifying and credentialing in the field has made the already-difficult challenge of finding the right therapist for you a bit more daunting. But finding a good therapist doesn't have to be so daunting. Ask around, do some research, and find the therapist who's right for you.