therapy

Therapist, Counselor, Social Worker, Psychiatrist! What’s the Difference??

July 6, 2015 admin Leave a Comment

As a licensed Marriage and Family Therapist I often get asked questions or hear statements like this:

“So I saw a counselor last year, but you call yourself a therapist. What’s the difference?” Great question . . .

“Can you prescribe meds to me?” No

“Since you’re a Marriage and Family Therapist, you must not work with individuals.”
I do work with individuals!

“So are you, like, a social worker??” Nope

“Hi, Dr. Gores!” I am definitely not a doctor!

It can be confusing to navigate all the degrees, licenses, and titles that come with seeking therapy. So today, as simply as possible, I will try to break it down for you.

Marriage and Family Therapist – Let’s start with this one, since that’s what I am, so it’s my favorite! A marriage and family therapist does not just work with couples, and families. In fact, I would say that a majority of my clients are individuals, and we work on a variety of issues. The main distinction of a MFT is what I would call a “systems approach.” Our advanced degree, and training is centered around looking at how the system of that client’s life impacts them, and how they impact it. The system includes family, friends, work environment, culture, etc. So if you see a MFT for therapy, they will help you with your issues through a lens of looking at the big picture. Because MFT’s have been trained with this systems approach, they have a little more ethical latitude of who counts as the client than licensed counselors do. I have the ability to see an individual, and then switch to couples counseling with that individual if I think that it is ethically appropriate, and the clients give informed consent (meaning that I have explained the risks, benefits, and boundaries around our new therapeutic relationship). A counselor is more tied to the client they first started with.

Counselor – A counselor is someone who has a masters degree in counseling, or someone with a master’s in clinical psychology. A counselor’s training will center more around individual therapy modalities such as psychoanalysis (Freud), Adlerian, Client Centered (Rogers), etc. Counselors don’t just work with individuals. They may also work with couples, and families. So much of what types of clients you end up working with depends on the hands on training and work you do after you complete your degree instead of what degree you graduated with. Most people who call themselves counselors, have a license with the term “counselor” in the title.

Note: A counselor and a therapist are not that different. We like to think we’re different, and sadly there can sometimes be an attitude that one is better than the other within the field. Our training and license process looks a little different, but fundamentally we are both master’s degree level individuals who provide therapy to a wide range of clients.

Social Worker – A social worker is someone who has graduated with a degree in social work, and usually has a master’s degree. Social workers often work in environments that involve them providing support, and connection to people with resources that they need; be that in a hospital, for the state or county, child protective services, correctional facilities/jobs, and on and on. Social workers can also see clients for therapy. Those social workers usually focused on what is called “clinical social work” in their degree or license program.

Psychologist – You cannot call yourself a psychologist unless you have a doctoral degree. They may have a PhD, or a PsyD. PhD programs are more centered around research, and PsyD programs are more centered around learning how to do therapy. Psychologists have additional training that a masters level therapist, counselor, or social worker does not have in testing and assessments. There are certain assessments that I am ethically allowed to give clients, but most must be administered by a psychologist. Those include personality testing, IQ testing, and more complicated and thorough assessments than I have available to me. That is why a therapist, counselor, or social worker you are seeing for therapy may refer to you to psychologist for testing if they think it would be beneficial.

Psychiatrist – A psychiatrist is someone who has a medical degree (and therefore is a doctor) and has specialized in treating psychological disorders with medication. Despite what Hollywood would have you believe, a vast majority of psychiatrists do not perform therapy. Someone would need to get additional training above and beyond their medical degree to offer therapy to their patients, and that person would be VERY expensive. When you visit a psychiatrist you should think of it as any other doctor appointment. If it is an initial intake, it may be slightly longer, but most med check appointments will be 10-20 minutes long. I often have clients who are offended that the appointment was so short, but that is always because they misunderstand the role of a psychiatrist in their mental health care.
Note: Unless you have the simplest form of depression, post partum depression, ADHD, or anxiety, please don’t get your psychological medication from your primary care doctor. That would be like finding out that you have cancer, and continuing to only see your family doctor. Your family doctor plays such an important role in initially diagnosing a possible mental illness, but a psychiatrist has specialized in the types of medications used for treating mental health disorders, and it is complicated!! I heard a speaker at a training few years back say that the goal of any psych medication is HUGE results with little to no side effects. The number of different types of depression medications, anxiety medications, mood stabalizers, etc. is staggering. It can take 6-12 months for someone to find the correct medication and the correct dosage of that medication. For the most part a family doctor does not have the experience to deal with these complicated issues.

So there you have it. Those are the mental health professionals that I most often hear my clients get confused by when they are trying to figure out who they need to utilize to get the best results in their therapy or mental health treatment. I didn’t even cover specializations that therapists can have such as play therapists, EMDR therapists, substance abuse counselors (I bet you can guess what that one is all about), etc. Another post for another day!

If You Want to Grow, Take it Slow

June 29, 2015 admin Leave a Comment

I’ll let you in on a little secret.

After one day of eating healthy, I have this very strongly held belief that I will step on the scale the next morning, and be 10 pounds lighter. Obviously this is completely irrational, and not surprisingly has never happened, but there is a part of me that is disappointed every time. There is a part of me that wants to just give up in that moment.

The truth is that any time I attempt a change in my life I want to put very little effort in, and see HUGE results, but that’s not the way the world works.

Photo credit

I see this in my therapy practice a lot. A couple will come in who has been having significant issues in their marriage for years. They are on the verge of divorce, and giving counseling a try as a last ditch effort to save their marriage.** Inevitably after about 2 sessions, they are disappointed that things are dramatically different. They want to lose 10 years of dysfunction in 2 weeks on a dysfunction “diet.” It’s not going to happen.

Someone wants to parent their kids more effectively and comes in for help. We go through really practical things they can start doing to change the behavior they are seeing at home. The next week they come back and declare that it didn’t work, so we need to figure someone else out.

We live in a society that gives us instant results at the tip of our fingers. Don’t know the answer to something? Google it on your phone! Don’t want to cook dinner? Order a pizza! Want to read the newest book that just came out? Buy with one-click for your kindle! You don’t even have to get off the couch! Now I do all of these things, and am thankful for the ability to look up the answers to things without driving to the library to find an encyclopedia, but this has also shifted our expectations to immediate gratification in all areas of our lives.

We want instant change, and that is not going to happen, so we give up before the real change has a chance to even get going!

Real change is slow. Really slow. But slow change is the most authentic, and likely to stick. That means that slow change is good!!

Let me repeat that: SLOW CHANGE IS GOOD!

In fact when I’m working with clients, slow change is my goal. I am extremely suspicious of fast change, because all too often fast change is formed out of shear will power. Using will power to change greatly increases your likelihood of falling back into old patterns, because will power fails. It is designed to help with short term temptations, but long term change. So I encourage slow change. Not only does that reset my clients’ expectations to a more realistic standard, but it greatly reduces the chance that they will give up when they don’t see realistic results.

So what changes are you trying to make in your life? Are you expecting change to quickly, and sabotaging yourself in the process?

**As a therapist I see couples enter therapy at all different points in their marital journey, and let me tell you this: DO NOT WAIT UNTIL YOU ARE ON THE VERGE OF DIVORCE TO GET COUNSELING. I have so many clients come to counseling that have already chosen divorce in their hearts. There have been so many years of hurts, anger, pain, and emotional distance building up that by the time they walk in my office they hate each other. That gives me almost nothing to work with! I can tell who those clients are within 20 minutes of them walking into my office, and it makes me sad. They have very little chance of making it. Sometimes they surprise me, and we all enter the trenches together and come out on the other side healed. But that is by far the exception. There are other couples that realize that they are not communicating well, not connecting well, or reeling from something like an affair, but who are “early” in the process of those pains. I can also tell who those clients are very quickly, because I can see that they still genuinely love each other. They are just stuck. Those clients are a delight to work with, because they are both still “all in.” When both people are still “all in” we can work through almost anything! So if you are struggling in your marriage, please don’t wait to long. Counseling can be expensive, but divorce is much more expensive – both financially, emotionally, and spiritually.

The Empty Fountain

April 13, 2015 admin Leave a Comment

This is the fountain at the front of our development. Now if you can look past the two adorable children – I know, it’s super hard, but try your best – you may be able to see that the water is green. Not just great looking water with a little tinge of green, but GREEN! Like, “Did they dye it green for St. Patrick’s Day and forget to change it back?”

My first thought when I noticed how gross it started looking is that they needed to just dump a bunch of chemicals into it until the water returned to a normal color. Well just two days after I thought that, this is what the fountain looks like.

Apparently no amount of dumping chemicals was going to help the mess that had developed in this fountain. It has been completely drained. It is completely empty.

This made me think about how often we approach problems or areas of unhealthiness in our lives in similar ways. We try to feel better, or fix those problems by dumping in temporary fixes. We dump in distractions like food, TV, spending money, relationships, and becoming more successful just to name a few. Those things feel better right away, but after the effects fade the issues are still there. Whatever is causing the green, funky water remains, and we are right back where we started again.

We even do this in therapy. If you have ever gone to therapy week after week, and simply “downloaded” the events of the week to your therapist who listened, cared, and showed you compassion, you probably felt better. You probably really liked your therapist. But you probably started to see the same problems, and patterns creep up after ending therapy. Someone who just listens and cares every week isn’t doing therapy. They are just being a really good listener.

Now before you get all defensive about your last therapist, who you loved, and who was a really good listener let me pause and say that listening is an integral part of therapy. You cannot be a good therapist, and not be a good listener. It is just not possible. But real healing, real growth needs more than listening. Real growth sometimes means emptying the fountain, and digging around in the plumping until you find the source of the problem. Real growth is messy, painful, uncomfortable . . . and so so worth it!

So what about you? Are you dumping chemicals, and hoping that this time it will stick, and the water of your life will stay clear? What would it look like to empty the fountain? In the coming months, I will be sharing some resources that I think can help empty, and clean out the pain, and the scar tissue that so often leads to the life issues we struggle with. It’s not easy, but it is worth it!