Posted by: counselorcarmella | August 2, 2012

Basics: Finding A Qualified Counselor

People often call our office and ask what kind of counselor they need.  They  see letters like LPC, LISW,  and LMFT and its just alphabet soup to them.  It is confusing.  They’re already feeling vulnerable and they want to  feel like they’ve chosen wisely in terms of  a therapist. Qualifications are important. A good match in terms of personality is also important.  The  gender of the counselor often matters.  Some people prefer to work with someone who’s cultural background is similar to theirs or who is  of a similar age. 
 
I can explain all the letters, but basically they all mean that the person has completed a graduate program and has  a license to practice  counseling/therapy.  Most programs are in counseling, social work, or marriage and family therapy. Some  masters level psychology programs  qualify graduates to  test to be a licensed counselor.  To be a licensed psychologist, the person has to have completed a PhD program. In terms of  finding a counselor,  the “L” in front of letters at the end of their name  is  even more important than letters like PhD. Counselors don’t have to have doctorates; they do have to have licenses.   Letters like “MA,” “MS,” or  “MSW” indicate the graduate training.  MD means the person has completed medical school.  As far as mental health providers,  someone with an MD is going to be a psychiatrist.  They specialize in medications  for mental health conditions.   They do not usually provide  talk therapy.  They let counselors do that.  Their job is to monitor meds.  There are also   nurse practitioners or clinical nurse specialists who   received specific training  and can prescribe some psychiatric medications. Psychologists may  provide talk therapy or  testing/evaluation services.  They  are often the PhDs and  they do not prescribe medications.
 
A good way to make sure someone is qualified is to  find out if they  accept health insurance.  Whether or not you have insurance or want to use it,  its important to know if they’re  listed with  insurance companies.   Insurance companies will only  add people to their  list  of providers if they’ve  met education and licensure  standards.  Some counselors choose not to  take health insurance and that’s just a matter of  how they  decide to operate, but  someone legit COULD be on insurance pannels if they wanted to be. If none of the insurance companies would take them, then  there’s a distinct possibility that something is amiss in terms of  their qualifications.
 
A word about priests,  ministers, rabbis, and other spiritual  leaders. Some people seek out “counseling” from a clergy person or other spiritual leader.   Seminary programs differ in terms of how much counseling training they provide their students.  I’m all about  appropriately involving clergy. What’s important to understand is that they are not  qualified to recognize or treat major mental health issues.  They may be able to  provide some ideas in terms of possible solutions to a problem or  simply help  someone talk through a concern with someone “safe.”  They  might  provide premarital or marital  education or a limitted amount of guidance for couples.  They’re obviously the “go to”  people for spiritual concerns and they can provide general  compassionate support during times of crisis or grief. Its very important that clergy have the  names and  contact info for local  counselors  to refer anything more major to folks who  can truly help with the more complicated psychological issues. They are  not  licensed therapists and should not be trying to diagnose or treat  major mental health problems.  They should not be providing hard core psychotherapy. 
 
Some clergy believe that  counseling and psychiatric medications are  unnecessary and that  all the  information we’ll ever need can be found in the Bible.  I do not agree and I think this  mindset is slowly changing.  If you’re sick, you go to a doctor.  If you’re having a mental health or  significant relationship problem, you seek out a trained professional in that field. 
 
 To be licensed, counseling professionals have to have had certain courses, passed a national exam, and  received at least two years of supervision under a more experienced clinician  with the same  license. Supervision involves discussing   cases in terms of diagnosis and  trreatment and it is the supervisor’s job to  make sure the supervisee is  making solid clinical decisions and   working at a certain level of skill.
 
Most graduate programs related to the field of counseling are at least 60  credit hours long and  take two to three years to complete. Anyone with any of the above letters after their name should have had a  course in recognizing and diagnosing mental health  problems, a course in  human development to know what is “normal” at various ages and life stages, and  at least one course in  family and couples work.  They’ve also had at least one course in   counseling theories, a course in ethics for helping professionals, a course in counseling techniques, and  a course in cultural sensitivity.  They’ve also completed  internships in order to graduate.  There are lots of other classes, as well.  Programs vary but  the  courses needed to qualify for the licensure test are required, and then there are certain courses based on each program’s particular emphasis.  Programs also allow  students to   take classes for  additional  specializations, as well.  My program was a counseling program, for example, but  we could  specialize in either school guidance or marriage and family therapy.  I  specialized in MFT and  was then qualified  for two different licensure tests because I had the basic counseling courses plus  specific classes related to working with  couples and  families.  I reently saw a degree program listed as “social work with an emphasis on mental health.”  Social work is a broad field, but this indicates the person  has  had classes concentrating on  skills needed to   work  with those experiencing  mental health conditions.    
 
Beyond that,  we all have to  get continuing education units to maintain our licenses.  This means counselors can  take additional training in areas of interest.  We all gravitate towards some populations more than others.  This can be for all kinds of reasons.  Many clinicians go on to become certified  in certain types of treatment.  For example,  someone might decide to receive additional  training and  supervision to  become certified as an addictions counselor, a sex therapist, to work with young children, or  to  assist those having problems at work (employee assistance counseling).  Some certifications indicate training in a particular type of counseling, such as  cognitive behavioral therapy or  EMDR, which is  a way to treat  trauma.    Counselors usually join organizations and  subscribe to professional publications that reflect their primary areas of interest. 
 
No one can know how to do everything.   Many counselors don’t work with  young  children.  Others don’t provide  alcohol and drug  treatment or anger management programs or work  with people with severe eating disorders. Many choose not to  work with  court referred clients or  those dealing with   certain sexual issues.  If a counselor says they don’t  work with  a certain issue  or type of person, that’s  most likely because they don’t have the specialized training that is required to do that sort of work.  They  can provide  a referral to someone who  does.  It is unethical for someone to   try and  help with  problems  that are “beyond scope of practice” and we have to know when to  pass a case  along to a  colleague who can  help  in that situation  more effectively. 
 
Most counselors work for an agency or are in a group or private practice.   Sessions last  about an hour and they typically meet with clients once  every one to two weeks.  They may schedule someone more often for a brief period of time if the person is in  crisis.  The counselor should make sure you understand rules about  privacy and situations where they might have to share something you tell them.  A legit counselor should have  procedures in place for after hours emergencies and  should know how to  judge whether someone needs more intensive treatment like  hospitalization or an outpatient based hospital program. Some counselors  base  what you pay on your financial situation while others have flat rates.  Full fee here in  SC right now is about  $80 to $100 a session.  Like I said above, though, most  counselors work with major  insurance companies.  Medicaid and Medicare are a little trickier so many private agencies do not accept those  insurances. Many counselors offer evening hours for those who need to come in  after school or work.  Some even work on Saturdays.  Many agencies have cancelation policies where you’ll be charged if  you  don’t show up or if you don’t cancel an appointment  within a certain time frame.      
 
When deciding about a counselor, its important to ask them to explain a little about how they might approach  the concerns you’re presenting with. Do they  have experience working with  it?  Even if you don’t talk with the counselor directly, the office staff can tell you who specializes in what and who is “good” with what.  They know the counselors in their office and   what they do and  the issues and clients they’re best with. If a counselor does their own intakes and  answers their own phone, they should be able to elaborate and maybe give examples of how they work with  what you’re concerned about, if they do.
 
A counselor can be both skilled and technically qualified and still not be the right “fit” for you for some reason.  Sometimes, things just don’t “click.” You should feel  like the counselor  is interested in you, that  they’re listening to what you’re saying and thinking about  the information you’re providing them, and that they’re asking questions that show they’re  following what you’re saying.  They should  seem  to want to help and  show concern for  what’s troubling you.  They should not be  sitting behind a desk, taking calls while you’re talking with them, or   seem  focussed on  anything else.  Your time with them is yours and  that’s where their attention should be. They should seem professional and  confident. 
 
You should feel as though you and your counselor are working together to figure things out. Your counselor can’t “fix” things for you, but they can  help you determine what might   improve your situation.  Some counselors are more talkative during sessions and   share their thoughts and impressions.  Others are quieter and listen a lot. Some suggest homework assignments as far as   things to try or  materials to read. A good counselor should not  start  telling you what you “should” do or lecturing you.  You should not have a sense that you’re being judged, preached at,  or  that the counselor  expects you to  agree with   everything they say. Counselors make suggestions and  present thoughts or feedback, but we don’t boss people around.  Your counselor should be respectful of what you are saying and that you are  sharing personal information with them.
 
You might feel nervous, and you might not like something the counselor says, but  you shouldn’t feel   strange or  uneasy about how the counselor is relating to you.  If you get a “bad vibe” but you’re not sure why, trust your instinct.  Right, wrong, or indifferent, you need to feel  able to relax and be open and honest with  your counselor for them to be able to help you.   If you’re not comfortable, or if you  always leave their office feeling worse or as though  you’re not  “getting somewhere,” its okay to  talk with the counselor about this.  Just because you start seeing one person  also doesn’t mean you  can’t  decide you’d like to  try  someone else.  “Counselor hopping” to try and find someone who agrees with you and says  what you want to hear isn’t going to help much, but  its okay to  give someone else a try if the counselor you originally  pick  doesn’t seem to be working out for whatever reason.  There are lots of counselors  out there. 
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