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What is psychotherapy?
Psychotherapy can seem mysterious and frightening. However, therapy is really a special kind of conversation, the goal of which is to assist the client or clients in overcoming life's difficulties and expanding life's possibilities.
What are the different types of therapy that are available?
There are hundreds of different therapies available. You may have heard of some of them, such as cognitive-behavior therapy, gestalt therapy, psychoanalytic therapy, play therapy, etc. Each type has different goals, different techniques, and different ideas about how people change. In the real world, few therapists are purists; that is, most mix and match various approaches to suit the needs of a particular client or family.
With so many different types of therapy available, how can I know I'm getting the right one for my particular problem?
This is where your trust in your therapist becomes important (see below for information about what qualifications to look for). However, it might be reassuring to know that, most of the time, there are many approaches that can be effective for a particular situation. That is, there is rarely only one way to help with a particular problem.
However, while all types of therapy can be effective in resolving the problems that bring people to therapy (for example, anxiety, marital conflict, depression, acting-out in a child, addiction, etc.), therapies differ tremendously in their goals, and it is important to find a good fit between your goals and the type of treatment you seek. If you are seeking only to solve a specific problem as quickly as possible you will want to consider such therapies as cognitive-behavior therapy, EMDR, family therapy, or medication. If, in addition to symptom relief, you are seeking self-understanding, you will want to pursue an insight-oriented therapy such as intensive individual psychoanalytic psychotherapy.
What qualifications should I look for in a therapist?
Be very careful in Washington State. Be aware that licensing is voluntary in Washington and that anyone may offer counseling or psychotherapy in private practice, with no credentials whatsoever.
What you're looking for is a licensed independent clinical social worker (LICSW), a licensed clinical or counseling psychologist, a licensed marriage and family therapist (LMFT), a licensed psychiatric nurse practitioner, a licensed professional counselor (LPC), or a licensed psychiatrist. You can verify a practitioner's license status online. In Washington, click on this link.
Washington also has an 'associate' designation for professionals who have finished their degrees but haven't yet met the other requirements for full licensure. Their credentials will include the letter "A' at the end: LICSWA, LMFTA, LMHCA. Oregon has something similar, though they use the term 'intern' and the letter 'I': LCSWI, LPCI, LMFTI. This becomes important when it comes to insurance payment or reimbursement for therapy. Insurance will not pay for the services of therapists who are associates. This includes out-of-network coverage.
State licensing is not enough though. Therapists in independent practice should have substantial supervised experience in providing psychotherapy before practicing privately. How much experience? That depends on whom you ask. I would suggest four years as an absolute minimum. In many states there is no legal minimum requirement. Often, a therapist who has just finished graduate school can legally practice independently. Although this would be considered unwise, even unethical, it would be legal in many states.
You should also ask your therapist what specialized training he or she has received beyond graduate school. After completing their basic graduate degree in nursing, social work, medicine, marriage and family therapy, counseling, or medicine, mental health professionals who wish to practice psychotherapy in independent practice usually attend an institute to get further training in a particular type of therapy (for example, family therapy, group therapy, psychoanalytic therapy, behavior therapy, etc.), in treating a particular type of problem (for example, addictions), or in working with a particular group of people (for example, children and adolescents).
Is it necessary for my therapist to specialize in treating my particular problem?
The short answer is: sometimes. One reason why it's important to see an experienced therapist is that experienced, highly-trained therapists have a broad range of skills and knowledge, regardless of their specialty. A therapist who has been in practice for a while has probably helped clients with just about every conceivable kind of concern at one time or another. Furthermore, even though people tend to be focused on a specific issue that causes them to seek help, human beings are complex, and most of us have multiple challenges in our lives. So, a well-rounded therapist is probably the best kind. However, I would suggest that a specialist is preferable in the following situations. Keep in mind that plenty of excellent therapists would disagree with me about this list:
An addiction or eating problem
Couple or family therapy (see below for more information)
Is it important to like my therapist?
It's crucial to feel a sense of confidence in your therapist's skills, professional judgment, integrity, and common sense. It's also important to have a sense that you can trust your therapist to keep your confidences and to have your best interests at heart. Trust your instincts here.
Although feeling a 'chemistry' with your therapist is important, and probably necessary, it isn't enough. Be sure to ask about his/her training and experience as discussed above.
When is couple or family therapy a good choice?
Couple or family therapy is an obvious choice when marital or family relationships are the focus of concern. Given the fact that young children are extremely dependent on their environment, parental involvement in therapy also makes sense when the behavior or adjustment of a young child is at issue.
However, many people don't realize that couple or family therapy can also be very effective in resolving seemingly individual problems, such as depression, anxiety, and addiction in both adults and children.
Couple and family therapy are fundamentally different from individual therapy. It's not just a matter of putting more people in the room. In fact, family therapy can be conducted with only one person. Couple and family therapy are defined by the way the therapist thinks about and approaches issues. Couple and family therapy differ from individual therapy in their goals, their techniques, their understanding of why people get into difficulty and how they change. For additional explanation, click this link.
Because couple and family therapy are so different from individual therapy, it is important to make sure that your couple or family therapist has received specific training and supervised clinical practice in that method of therapy. Therapists who wish to specialize in this area usually acquire the relevant training in one of two ways. They either (1) have a Masters degree in Marriage and Family Therapy and are licensed as a marriage and family therapist (LMFT) or (2) are licensed in another mental health discipline and attend a family therapy institute for specialized training.
The best way to find a qualified couple/family therapist is to choose a clinical member of the American Association for Marriage and Family Therapy (AAMFT). AAMFT clinical members (but not associate or student members) have fulfilled a rigorous training and supervised practice requirement. Follow this link to access AAMFT's membership directory.
How private is the information I disclose to my therapist?
Effective psychotherapy requires that clients be able to communicate with their therapist freely and openly, secure in the knowledge that their communications will remain private. Therefore, unless the client permits it, therapists are prohibited, by professional ethics and by law, from disclosing client information (including the fact that someone is receiving psychotherapy services) to third parties, except in certain very specific circumstances. These exceptions include: statements of suicidal or homicidal intent; abuse or neglect of a child, elder, or vulnerable adult; information needed to facilitate treatment in a medical emergency; and court orders compelling the release of information.