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What's the difference between an LCSW, a Social Worker, a psychologist and a psychiatrist?
While it can sound confusing, don't let this overwhelm you. There are a number of professionals who can legally provide clinical psychotherapy, three of which are the most common and the most highly monitored by state license. All three must maintain licenses and must stay clinically current (among other requirements) to do so. All three require advanced clinical training and are required to obtain continuing education.
- Licensed Clinical Social Worker (LCSW or LICSW)- The LCSW is the only type of social worker licensed to provide clinical psychotherapy. An LCSW has a Masters degree in Social Work and extensive post-masters training, including clinical practicum and internships emphasizing psychotherapy modalities and hands-on clinical work. They have at least two years of supervised post-graduate work before passing a state Board exam to obtain their license, which requires rigorous review for the 2-year renewal cycle. They are typically the least expensive of the three types of psychotherapist.
- Psychologists (Ph.D.) - The Ph.D. psychologist has about 4 years of graduate training in psychology. In order to obtain the license as a psychologist most states require 1 or 2 years of post-graduate supervised experience. Masters level psychologists (non-Ph.D.s) typically obtain 2 years of graduate training and are not licensed to provide independent clinical psychotherapy. When choosing a psychologist, you may want to ask whether your psychologist is a "clinical psychologist", specializing in clinical diagnosis and treatment to distinguish between research psychologists and clinical psychologists. Psychologists often specialize in psychological testing and diagnostic evaluation, often with children, as well as psychological research.
- Psychiatrists - are MDs/physicians. They have been to medical school and have done a residency like any kind of physician, however it is important to note that it is not required that the residency be in psychiatry, so you would want to inquire about this. They are the only psychotherapist that can write prescriptions for medication. They are, generally speaking, the most expensive psychotherapist and while psychiatrists sometimes provide therapy, since managed care and the high cost of health care, these days often the psychiatrist is most utilized for medication referrals from other practitioners (LCSWs and psychologists).
How will the therapy of these different types of professionals differ?
The type of clinician does not determine the type of therapy. There are several types of psychotherapies in the broad sense of the word, quite a few modalities and theoretical frameworks within them, and any one or more of these might be used at a given time by a clinician in order to be most beneficial to a client.
What's a psychopharmacologist? I've never even heard this word before!
A psychopharmacologist is a medical doctor (MD) specifically trained and expert in psychotropic (psychiatric) medications. While general practitioners are legally permitted to prescribe medications for mental health or psychiatric issues, it is strongly recommended that a psychopharmacologist or psychiatrist be consulted for these types of medications. The major benefit of obtaining medical consult from a psychopharmacologist is that they will be able to provide a much more in-depth explanation of medications that you may need, what the medication will do, side effects, and what symptoms to watch for as signs of a medication not working. The psychopharmacologist is versed in clinical trials and studies, drug interactions, overdose management, pharmacogenetics, pharmacokinetics, and even the psychiatric effects of non-psychiatric drugs in a more comprehensive way than your general practitioner will be.
How do I find a therapist??
The best way to find a therapist is to talk with people you know and trust. Get a referral from someone who has had a successful experience with his or her therapist. Looking in the phone book is not advised as anyone can advertise in the phone book, and remember that - like with every profession - there are excellent, ethical, professional psychotherapists and there are quacks and unprofessional, unethical folks out there as well. Ask around, ask your primary practice doctor for a referral, ask trusted friends and family members. You'd be surprised at how many people go to therapists and how happy they are to tell you of their good experiences with psychotherapy. You are not alone, so ask around and you will find someone.
Does everybody have to go on medication if they are in therapy?
Absolutely not. Many people who go to therapists find that they can go to therapy, find relief from their symptoms and get back to happy, healthy lives without any medication. Likewise, there are clients who need to be evaluated for medication to help them with their problems and who find great relief from the medication. Not all clients need medication and of those who do, it is often only for a temporary period of time. If your therapist believes that you might benefit from medication, you and she will discuss the pros and cons but the ultimate choice is always yours.
I'm not sure if I need therapy. I know I'm not "crazy" or anything, but I'm just not really happy. Could therapy help me?
Yes, therapy might be very beneficial to you. Many clients come to therapy for exactly that reason: that they have a generalized feeling of dissatisfaction with their life, feel "stuck", and "semi-unhappy" - but don't really know why, or what to do about it. This is a perfect reason to look into therapy. Afterall, life is too short to feel only semi-happy and therapy can definitely help.
I went to a therapist who gave me advice that doesn't feel right. What should I do?
If a therapist gives you advice or tells you what you should do, you should find a new therapist. Advice-giving is not what a therapist's job is. The therapist is there to work with you and to assist you in looking at what is and is not working for you in life and what brings you to therapy. It is your journey; the therapist simply works with you to assist you in the discovery and healing process.
Kathy, I heard you on the radio. You were giving advice to callers to the radio show on how to deal with their problems. I thought you said a therapist should never give advice. I'm confused…
The one time when you may hear a therapist give advice is on a radio or television show, with someone like Dr. Phil, Dr. Joy Browne or, yes, even Kathy Norwine. Regardless of the credentials of being a psychotherapist, when on the radio or television and responding to callers, we are in the roll of subject matter expert, advice-givers, and in a forum of media education and/or entertainment. Psychotherapy is not entertainment and entertainment is not psychotherapy and there is a distinct difference. When I practice therapy and work with clients in my private practice, I am in a completely different role than any time I may provide expert guidance or advice on the radio. Think about it - on the radio, I cannot possibly get to know someone, their personality, or to know what their long term and short term issues are like I do in the therapy process. Therefore, the advice I might give on the radio is based on a 1-minute overview of an everyday issue, and would never be something I would say or do in the psychotherapy office. Again, advice-giving has nothing to do with therapy and it is very important to distinguish between entertainment and psychotherapy.
So…if I'm one of your psychotherapy clients, does that mean you might talk about me on the air?
No. Never. Everything that goes on in the psychotherapy office is protected by the client/therapist confidentiality agreement. Your privacy, personal information and experience is completely protected and will never be divulged (except in the extreme instance where a client might cause harm to themselves or another, but that is all discussed and understood prior by client and therapist and of course has nothing to do with any radio issue!)
"You won't be able to hypnotize me or read my mind, will you?"
No. A therapist is not there to read your mind - no one could even if they wanted to. Regarding hypnosis, the only therapists who should be doing hypnosis are those clinically trained to do so - and - only with your absolute and complete consent. Typically a client who might need hypnosis to address a specific issue (attempting to stop smoking, for example) will typically request that and will typically be referred to a hypnotherapist. Further, a hypnotherapist can only hypnotize someone who specifically asks to be hypnotized. To be hypnotized, you must be ready, able and willing. No one can hypnotize someone who is unwilling - it literally will NOT work. The very first part of the hypnosis process is relaxation, and therefore, if you are afraid of someone hypnotizing you against your will - you'll be happy to know - it will not work! J No, we cannot read minds or hypnotize you against your will.
"How long will it take to fix me?!"
Now there's a question I get asked of all the time! First of all, you are probably not "broken" and probably don't need to be "fixed". Therapy is about looking at patterns and relationships and what is - and is not - working for you. It's about the everyday challenges that you face and the ways in which you approach them, as well as the long term behavior and thought patterns you've held that are not working for you and the journey of exploring those together to find better ways of relating and experiencing your life.
That said, sometimes clients come in feeling emotionally "broken", but we soon find that there are many strengths to draw on and that there are ways to feel much better and make life better through the process. Doing the work of therapy can really help the "broken," "lost," and/or "stuck" feeling that many clients describe experiencing when they first start therapy.
How long and how frequent are sessions?
Sessions for individual psychotherapy are typically 50 minutes long. Most clients come to sessions once per week, but particular personal and/or clinical circumstances or courses of treatment might require more - or less - sessions per week.
Group psychotherapy typically is 90 minutes long, once per week.
How much does it cost?
The fee for services charged for clinical professions can vary due to a number of factors, for example: by geographic location, type of therapist (LCSW, PhD, MD) and type of therapy. Generally speaking individual psychotherapy sessions range from about $90 (and up) per session in the DC Metropolitan area. Where the cost of living might be less, so probably, is the cost of therapy. When you call a therapist that you are considering, be sure to ask up front what their fees are. You have a right to know. You wouldn't buy a gallon of milk without knowing what it would cost, nor should you hesitate to ask your therapist what her fees are. If you get a wishy-washy answer or the therapist seems to be avoiding the issue, move on to a new therapist.
Does insurance cover psychotherapy?
Generally speaking, insurance does cover most forms of psychotherapy - if the therapy is provided by a licensed (LCSW, Ph.D. or MD) clinician. Many insurance companies, however, only cover a limited number of visits and require the therapist to discuss your visits with them. Because of this and other factors, many therapists are now turning to "insurance free" practices in order to protect their client's confidentiality, among other reasons. Clients are increasingly content with this practice and pay the cost up front and then submit their claims to their insurance for "out-of-network" coverage, where they might receive slightly lower reimbursement rates, but their privacy is completely maintained.
I don't know where to start or how to talk about it.
Worry not. The therapist is very aware of how anxiety-provoking it can be for some people to begin therapy. If you feel that you want to see a therapist, but don't know where to start or what to say, simply make an appointment and say just that: that you don't know where to start or how to talk about it! I can assure you that this is not the first time the therapist has heard this, and they will happily help you get started. There is no right way to do therapy, so together with your therapist, you will find the way to communicate that works best for you. This is all part of the process and sometimes that first step is the hardest, but if you can overcome that anxiety, you might find that it is the best step you could ever take toward feeling better.
I'm trying to forget about it all and move on. Won't this dredge up old memories that I can just ignore?
This is a complicated question. Many people definitely try to "forget about it all and move on" but unfortunately our emotions really don't work that way, and what you really are talking about is pushing difficult thoughts and feelings back down, inside. But remember that those feelings aren't really gone. They will most likely impact your life, your decisions, your relationships as you may be unconsciously driven by this un-worked "stuff." It is true, that therapy can bring up feelings and memories that we'd rather put aside, but it is in the dredging up and talking about it that we will be able to process it through and really, genuinely move forward.
I don't get the whole "group therapy" thing. Why would I want to share my problems with other people? And - if I'm part of a group - does that mean I'm nuts?
Group psychotherapy is an interesting process and one that often creates great anxiety in clients prior to their first group session, where they ask exactly the question you have asked. This issue of sharing problems with others, while it might feel uncomfortable at first, typically becomes a very calming thing to do as we realize that we are not alone, that everyone struggles with things and that in a group setting, as we listen to others stories, we often benefit greatly in working out our own issues. In addition, clients often report learning so much about themselves; frequently about behaviors and attitudes that they were completely unaware of. Most clients find that group therapy provides a chance to talk with others who are experiencing similar problems in a confidential space, which can be particularly comforting.
There are several different types of groups: process groups, support groups, 12-step groups, self-help groups, etc. The people in groups are specifically not "nuts", and you and your therapist should discuss what type of group will work best for you.
If someone is in a group, do they also need individual therapy?
It depends. Sometimes people only go to individual therapy. Sometimes they only are in a group. Sometimes the two treatment modalities are used simultaneously, which can really be beneficial as the growth in individual and group are different and work well together. Sometimes one therapist might be both your individual therapist and your group therapist and sometimes you may have two different therapists for individual and group. If that is the case, you will need to sign confidentiality releases so that the two therapists can communicate together to best benefit your progress in treatment. |
