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26 May 2007

What qualifies a mental health therapist? [More:]
I'm confused about qualifications. Is an LMFT qualified to give individual therapy? How about a LMHC? Does a LMFT have more education than a LMHC? There are plenty of PhD's in town that offer counseling. One is a neuropsychologist. Is she going to hook my head up to a machine? :) How about continuing education? Are therapists required to pursue continuing education credits?

I'm confused about qualifications and who I should choose. I don't have anyone to ask for a recommendation.

I'm feeling incredibly normal today, but come Monday I may feel crazy again. I'd like to know how to proceed.
In my case, it usually depends on how much my "patient" has had to drink.
posted by Eideteker 26 May | 14:01
Eideteker, are you a therapist? I didn't know that. So, the tipsier your clients, the more qualified you are? ;)

I have a weird feeling about making an appointment with a counselor that has a non-functional or outdated website.

This place looks like it's mainly for substance abuse. I don't have a substance abuse problem.

This place scares me for some reason

It's hard to make a choice. I may have to shop around.

I may take it to AskMe, or figure it out. This may not be a good question for MeCha.
posted by LoriFLA 26 May | 14:18
And eid, I think I just got your joke. I realize you may be playing the role of therapist. :)
posted by LoriFLA 26 May | 14:23
I understand. It can be a little overwhelming.

The most important qualification is how you feel with that particular therapist. It doesn't matter how many fancy degrees they have on the wall or how many write-ups they get in the national press. If you don't, on a gut level, feel comfortable with this person or think that this person can help you with your problems, it won't work.

The relationship between therapist and client is the source of the cure. And that's not something you can predict from the alphabet soup of degrees out there.

Be ready to interview a whole bunch of them. Tell them what you want to get out of therapy. Ask them how they work. If you find one you like, someone you think might be in a position to help you, try a trial run, of a month or so. See how you feel at the end of that month. If there are problems with the relationship, talk about them with the therapist. If it's not working, ask them for a referral to someone else. And if they're obnoxious or completely useless, don't be afraid to terminate it.

I'm not familiar with Florida at all. So I can't help you with specific recommendations. OmieWise is a shrink and he might know people down there. Or he might know people who know people. Why don't you e-mail him?

I hope this helps. And I hope you are feeling better.
posted by jason's_planet 26 May | 14:27
Lori, it tends to vary by state. I can give you the specifics for California (I actually just did a research project on this), but I suspect most of this is going to apply nationwide.

LMFTs are counselors with master's degrees who are qualified to do individual, family, and group counseling. Their background will probably be in "systems work," which means that even if they see you as an individual patient, they will likely be working to see you in the context of your family (maybe both your family of origin and your current family) and to work in ways that take those relationships into account. (Note: this may be less true of older LMFTs, which various surveys show tend to work from more psychodynamic or individualistic theoretical models.)

The description from the American Association of MFTs website:

Marriage and family therapists (MFTs) evaluate and treat mental and emotional disorders and other health and behavioral problems, and address a wide array of relationship issues within the context of the family system. MFTs believe that individuals and their problems must be seen in context, and that the most important context is the family

In my own MFT training, we're getting a lot of training on working with individual clients. Nationwide, the majority of MFTs' clients are individuals rather than families or couples (54% vs. 42% for families and 35% for couples).

LMHC are another master's level counselor. They don't exist right now in California, but they're trying to get a bill put through that would license them. From my research, the scope of practice for a LMHC:

Professional counseling is the application of mental health, psychological, or human development principles through cognitive, affective, behavioral, or systemic intervention strategies that address wellness, personal growth, or career development, as well as pathology. The primary purpose of counseling is to empower the client to deal adequately with life situations, reduce stress, experience personal growth, and make well-informed, rational decisions.

It's more of an individual focus, and apparently LMHCs can specialize more than MFTs (so, a LMHC can be accredited in career counseling, for example).

The other master's level counselors are LCSW (licensed clinical social workers), who can see individuals, families, or groups; their focus tends to be both on individuals and on community systems. The CA regulations:

a service in which a special knowledge of social resources, human capabilities, and the part that unconscious motivation plays in determining behavior, is directed at helping people to achieve more adequate, satisfying, and productive social adjustments. The application of social work principles and methods includes, but is not restricted to, counseling and using applied psychotherapy of a nonmedical nature with individuals, families, or groups; providing information and referral services; providing or arranging for the provision of social services; explaining or interpreting the psychosocial aspects in the situations of individuals, families, or groups; helping communities to organize, to provide, or to improve social or health services; or doing research related to social work

That covers the master's level. I have less knowledge of doctorate-level counselors; there are PsyDs and PhDs and MDs. They're obviously going to have more training (at least six years instead of two or three), but a lot of that training is going to be focused on research rather than counseling skills. (Which is not necessarily a bad thing, just that it's not like a psychiatrist gets eight years of learning to counsel patients and an MFT only gets two years of the same.)

And all of those people are going to be required to take continuing education courses in order to get relicensed. (I think it's six credits every two years for MFTs in California.)

All that said -- go with your gut. The single most important element in getting good mental health care is a good relationship between the client and the therapist. The things that constitute a "good relationship" are so subjective that I think it's just important to go with what feels right.
posted by occhiblu 26 May | 14:28
Also, I meant to say, in CA at least, LMFTs and LCSWs are considered interchangeable for most jobs (not all of them; LCSWs are going to be more qualified for most institutional settings like hospitals), and the reason both groups are pushing back against licensing LMHCs is because it would be a third group qualified for most of the same jobs. I'd say in terms of training and qualifications, they're all at the same level.
posted by occhiblu 26 May | 14:32
Heh. On total non-preview: What jason's_planet said.
posted by occhiblu 26 May | 14:34
As for recommendations, have you checked out the Psychology Today Therapist Finder? I really like it.

(Also, I wouldn't worry too much about websites. I'm definitely, by far the geekiest member of my MFT class; it's a bunch of people who really like working with people and really don't like working with machines. Which is probably what you want in a counselor!)
posted by occhiblu 26 May | 14:37
Thanks so much jason and occhiblu. This makes me feel better. There are several therapists locally that have LMFTs. I'm glad to hear they are qualified to counsel individuals. I'm going to make an appointment. Just guessing, but their rates may be more affordable than a PhD. I have Blue Cross Blue Shield PPO. I don't think my plan covers counseling. Even if it does, I'd rather pay cash, since my deductible is kind of high anyway.

I have tried the Therapist finder on Psychology Today.

There's an LMFT locally that is a member of the AAMFT. I don't know if I should be impressed by this or not. I called her yesterday, and I liked the warmth in her voice. (Strange, I know) I'm going to call next week for an appointment. I totally agree that it is subjective. But since I've never done this before, I got hung up on credentials.
posted by LoriFLA 26 May | 14:46
There's an LMFT locally that is a member of the AAMFT. I don't know if I should be impressed by this or not.

No. Not at all.

I called her yesterday, and I liked the warmth in her voice. (Strange, I know)

No. NOT strange. This is great, actually. You're going with your initial gut feelings. I mean, you'd have to know more about her to decide whether you wanted to engage her as your therapist. But keep going with your gut feelings.

Be well.

posted by jason's_planet 26 May | 14:51
Yeah, AAMFT memberships just means that she's licensed and paid her membership dues. It's a good thing to be a member of a professional organization, but it's not really a separate qualification.

And yes! Liking her on the phone is good. I picked my last therapist because I liked the way she responded to my email. :)
posted by occhiblu 26 May | 14:56
Actually, the AAMFT site has a fair amount of good info, if you want to poke around further to learn more about MFTs.
posted by occhiblu 26 May | 14:58
Thank you again occhiblu and jason. I appreciate it very much.

Thanks for the well wishes Jason. Actually I feel good most of the time, and I feel my life runs well most of the time. I have a couple things that need work, that arise again and again. I've been wanting to see a therapist for a while. I need tools and insight.

Off to check out the AAMFT link.
posted by LoriFLA 26 May | 15:04
OmieWise is a shrink and he might know people down there. Or he might know people who know people. Why don't you e-mail him?

After seeing his picture, all I could bring myself to ask is, "Hey baby, is there a couch in your office?" ;)
posted by LoriFLA 26 May | 15:52
posted by LoriFLA 26 May | 15:55
For what it's worth (egad, I actually spelled that out rather than acronymize it -- wtf?), the best therapy I ever had was from a 20-something intern, working her way toward her MFT license. I almost bailed when I heard her very young and chipper voice on the phone.

Yet I found her absolutely engaged, passionate, and incredibly wise beyond her years. The therapy was very much a collaboration, rather than the more one-way kind of relationship I'd experienced in the past (e.g., me talking, the therapist listening, and that's about it).

So I guess I'm not saying to go with a young therapist so much as to not worry to much about labels, etc. Go with who you interact well with. If you're meaningfully engaged in the interaction you're having with your therapist, that's what really matters. If you're not, talk to him/her about it or move on.
posted by treepour 26 May | 16:41
treepour, it's worth a lot. Thank you.

I'm looking forward to it now. I've been apprehensive for so long.
posted by LoriFLA 26 May | 17:12
It can be so much fun, in a weird way. It's lovely to have a place in your life where your entire job is to process what's going on, and where you can talk about anything without feeling judged, or worrying that you're going to hurt someone's feelings.

Good for you for having the courage to do it.
posted by occhiblu 26 May | 18:21
This is the creepiest ytmnd I have ever seen || Tired, cold, wet, hungry ... and sad.