Monday, May 6, 2019

What do psychologists do (and why would you go to see one)?


So, you have taken the leap and decided to see a therapist. Or your child might benefit from counseling. Either way, you are faced with a range of choices and decisions. What type of therapist should you see? What approach is best? How do you distinguish between the different mental health specialties, and why should it matter?


Information online may be even more confusing. Some therapists espouse amazing results. Testimonials from clients are not permitted by many licensing boards, yet are listed on some websites. Life coaches sometimes boast high rates of success, despite the absence of any licensing, certification, or regulatory board that monitors competence in coaching. And unfortunately, there are endless debates about what approach works best for different problems.


I often see questions and comments online that reflect understandable confusion about the differences between mental health professionals, particularly psychologists and psychiatrists. Psychological and intellectual testing are confusing as well, along with questions about who can administer and interpret evaluations. What exactly is involved in a gifted or ADHD evaluation? Are psychologists merely "testers," as some have labeled them?


Even more troubling, I recently stumbled across online comments  that characterized psychologists as less helpful than other mental health professionals. The author claimed that psychologists are more focused on psychopathology, and are less "strength-based" than members of other counseling professions.


Why is commentary like this a problem?

  • It is inaccurate and delivers misinformation to the public.
  • It contributes to unnecessary and arbitrary divisiveness among mental health specialties.
  • It creates divisions that have nothing to do with how therapy is implemented, or with the quality of services that are provided.
  • It perpetuates meaningless stereotypes about what "clinical" means, and when or how therapy is helpful.


I have worked as a clinical psychologist for over 30 years, and have had the privilege of collaborating with a range of mental health professionals. I have tremendous respect for the diversity of training and experience of psychotherapists in different fields. Since we all benefit from the variety of approaches, training and experience among mental health professionals, it is disheartening to witness divisiveness or stereotyping about different mental health professions in print or online.


In response to this confusion - and some misinformation out there - I felt prompted to write about the mental health specialty that I know best. And while any given psychologist is not necessarily a better psychotherapist or the right therapist for you, there is some basic information that needs clarification about the field:


1. Clinical psychologists have more years of training than any other mental health specialty. That's right - even more years of mental health training than psychiatrists. They receive a doctoral degree after approximately five or more years of post-graduate education and training, and then are required to earn post-doctoral hours before licensure. Much of their training involves supervised experienced within a range of internship settings. (Psychologists cannot prescribe medication, though, except for those with additional training who are granted prescription privileges within a few states in the U.S.)


2. Psychologists (including school psychologists and neuropsychologists) are the only mental health professionals with adequate training, and authorized by most states in the U.S., to administer and interpret intellectual and psychological testing. Along with psychiatrists, psychologists also are authorized to diagnose mental health disorders.


3. Psychologists receive training in research methods, and they use research-based strategies to inform their treatment decisions. Their research training helps them evaluate recent findings in the literature, and determine what is useful to include in their work.


Despite claims that psychologists are too "clinical," or too focused on psychopathology or "diagnosis," they still can be strength-based, compassionate, creative, and relational. These abilities are not mutually exclusive! In fact, training in diagnosis and the complexities of personality and psychological disorders is a good thing. Would you go to a primary care physician, a reading specialist, or even a car mechanic who was not trained to "diagnose" the problem? Understanding what causes distress informs treatment decisions. It does not detract from one's ability to empathize, relate and offer support in psychotherapy.


Does this mean you must see a psychologist for psychotherapy or parent coaching? Of course not! 


There are thousands of excellent, highly skilled psychotherapists who would be the right fit for you or your child. Make sure that any therapist you choose is licensed, has training and experience in the area which you are seeking to address in therapy, uses good boundaries (i.e., does not spend the session sharing his/her personal life with you), and is someone with whom you can achieve a good rapport. Coaching is an unlicensed and uncertified profession, so use even more caution with personal or parenting coaches.


If you need to find a psychotherapist, seek out referrals from respected sources, such as your physician, spiritual adviser (e.g., minister, rabbi, priest), or a school counselor. Trust your instincts. Get informed. Pay attention to what works for you. Don't just assume that your insurance company will provide a helpful referral. In fact, many therapists refuse to accept insurance because of meager reimbursement and possible breaches to confidentiality.


When you start therapy, come prepared to work hard and to collaborate with the therapist. Learn more about what to expect, and identify personal goals for yourself. You may feel uncomfortable at first, since speaking with a stranger can feel awkward, but give it a few sessions before making a decision. Of course, if you or your child feel extremely uncomfortable, or your gut instinct tells you that the therapist would not be a good fit for you or your child, then look elsewhere. All because your physician or neighbor recommended a particular therapist does not mean he or she is right for you.


In my opinion, a great match is a highly trained, experienced psychotherapist who is collaborative, empathetic, compassionate, curious about the human condition, and respectful of differences, individual values and boundaries. Your therapist is never going to be your friend; however, you must feel accepted, understood and valued. If you are seeking therapy for your child, find a therapist with child or adolescent training and experience, who engages easily with your child, and who readily includes you in the treatment. Although therapists guard children's privacy, helping you feel part of the therapy process and understanding how to better communicate with and help your child is essential. This might entail occasional or frequent meetings with you and the therapist, or meetings that include your child, or even the entire family.


Therapy is just a start. Ultimately, we all need to extend what we learn in therapy to the world at large. Improved self-esteem, communications skills, self-awareness, and the elimination of nagging symptoms can be a springboard for enhanced relationships with our children, family, friends, neighbors, and colleagues at work. It provides a unique opportunity for exploring long-standing concerns in greater depth and receiving useful, direct feedback. Therapy also encourages us to make healthy and meaningful decisions, enjoy the present moment, and feel better about ourselves.


The following are blog posts about psychotherapy for those who are gifted or who have gifted children:

When is it more than giftedness? A psychologist's perspective

A gifted person's guide to therapy

Five misconceptions about therapists

Gifted children and adults: When is therapy helpful?

Stress management toolbox: Nine tips for parents of gifted children

When does therapy benefit gifted adolescents?


2 comments:

  1. This is important information, Gail. Thanks for writing it. Here is my "two cents" on the topic. https://rainforestmind.wordpress.com/2017/12/28/psychotherapy-and-giftedness/

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    1. Thanks, Paula. You share a great list of resources about therapy for gifted people. Readers, please check it out!

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