Wednesday, February 11, 2015

What is my therapist?

On any given day, the annuncitator panel (that sign with lights you click to tell your therapist you've arrived) is filled with incomprehensible acronyms. How can there be this many kinds of therapists and what does it mean?

I'm sporting a Psy.D. after my name. That's a Doctorate in Clinical Psychology. This kind of doctorate is awarded after completion of a dissertation that was a case study of a patient seen while working in a training clinic. The focus of the dissertation is an exploration of current clinical theories integrated and explained in the process with a patient in treatment. It's then reviewed by teachers/ defended by the author and accepted or rejected. My dissertation was about an adult child of holocaust survivors, and in a more subtle sense, non-verbal trans-generational transmission of trauma, and the theoretical-process in the room with the patient. It demonstrated an understanding of clinical process, theory, practice, and critical thinking.  In simple terms a Psy.D. is a doctorate in clinical practice. It does not make me a specialists in holocaust survivor children, rather it demonstrates a competency in clinical thinking.

In order to have a docotorate, you also have to complete a Masters Degree (MA). So, when you see a Psy.D after a therapist's name it means they have a doctorate of clinical psychology built on top of a masters degree, and have finished school. Same with Ph.D.

A Ph.D is a Doctorate of Philosophy. The difference between this doctorate and a Psy.D. is the Ph.D's additional emphasis on research. Ph.D' s spend time conducting research along their degree path. Psy.D's study research concepts in order to understand research, but do not conduct research. In simple terms a Ph.D is a doctorate in clinical practice and research. The dissertation is generally a piece of research done by the practitioner.

The post grad clinical training for therapists with PsyD's and PhD's is the same. It's the focus of document that is approved at school that is the essential difference. The differences between the 2 degrees are subtle and minimal. Both degrees are doctorates, and in practice both are referred to as psychologists.

MFT is a Marriage and Family Therapist.The degree has a lot in common with Psy.D and Ph.D but is completed at the masters level. In a general sense it's a 2 year degree versus a 4 or 5 year degree. It's not by defnition a lesser clinician (MFT's are psychotherapists but not psychologists), rather a background with less depth of study. They also have several thousand hours of post grad work and are highly trained.

An LCSW is a Licensed Clinical Social Worker.  This is a masters degree in social work. They also share an overlap of thought and study with MFT, Psy.D, and Ph.D, with a different focus (they are also called psychotherapists).

An MA denotes a Masters in counseling en route to but not yet awarded a doctorate.

A psychiatrist is a Medical Doctor. They're the ones working from a medical model and writing prescritpions. Some psychiatrists also practice psychology in addition to the medical process. They are skilled diagnostitions, and have a deeper understanding of nuerobiology, medicine, and science.

To make this really confusing. The degree is not the caregiver. There are excellent, average, transcendent, gifted, and awful at every degree level. It's important to pick your caregiver based on who they are and how they practice more than the degree itself.

Personal opinion is that sometimes there are situations that require a skilled hand with regards to diagnosis and pathology that do well to see someone with a more advanced degree. In practice, I've seen sometimes diagnostic opportunities missed (a mixed episode overlooked, a personality disorder diagnosis thrust upon someone for the wrong reasons, etc). But these are rare exceptions. I refer to clincians who's work I believe in, and who are ethical and talented... and these traits have little to do with their acronyms. One of the therapists I look up to and hold in the highest regard has an LCSW degree.

Writing this gave me a headache, I can only imagine what its like for the unitiatied and seeking relief. I like the ten-thousand hour rule... I tend to think folks doing things with ten thousand hours between them and the task... allows a deeper  more excellent process (that or it's an invitation to laziness). Headache indeed.

Monday, February 2, 2015

The beginning, the middle, and where is the end?

People tend to start therapy in some sort of crisis of feelings, loss/anxiety,  change in relationship, or when their coping mechanisms start to wobble. A sense of relief from the presenting-issues generally happens within a few sessions if not immediately after the first session. Research tells us that one of the most powerful tangible experiences in therapy comes from experiencing a sense of hope. Talking to someone with basic skills and a grounded, focused empathy should give the client that sense of hope and a sense that their feelings are contained, the crisis will pass, time will do the work, and perhaps a new narrative is formed that one uses to find higher ground under their own power.

The question that immediately comes up.... Is it time to stop therapy or is this just the beginning?  To simplify... Are you here to seek relief or to try and manufacture a deeper change? Both are valid, both are connected by soft tissue, and both can be foreward and reversed engineered into the clinical process. The thing is, you're here, the hood is up, the engine is right there... so why not?

This tends to be an ambigious endeavor for the patient (it should be crystal clear to the psychologist) and is all grist for the mill. That being said, there's nothing wrong with a quick few months or few sessions of talking. The take-home should be a sense of relief, and a language for what is there but not necessarliy on the table.