How Do I refer someone for therapy?
Sometimes I am asked how people can recommend therapy to someone they care about who is in emotional pain. It may be uncomfortable to say, “I’m in therapy and finding great results”, or “You really ought to see a psychologist”. It may be easier to say, “I know of a therapist who specializes in treating _______” (anxiety, depression, relationship issues, addictions, etc.). Or, I have heard of a local therapist who has written about _______”. Just letting someone know where he or she can obtain more information about an emotional problem, can provide a step toward getting help.
You might also recommend looking at the increasing resources available on the Internet. On Dr. Nightingale’s website site there are anxiety and depression questionnaires for people wondering about their symptoms. This site also has free articles, including one on how to choose a therapist. Tell him or her that financial arrangements can be made by calling the therapist’s office. Often office staff will explain different payment methods, what the fees are for individual therapists, what if any discounts are available for paying at the time of visit, and may even check on insurance benefits for potential clients.
Therapy is about personal growth, exploration and finding coping skills to enjoy life again. Therapy is not a place of coercion, confrontation or where only seriously mentally ill people seek treatment. Therapy is more like having a coach for the most important sport you can play…your life.
Good results in therapy are best attained when a person has a good rapport with the therapist, is highly motivated to change painful aspects of life, and has specific treatment goals he or she wishes to attain.
© Lois V. Nightingale, Ph.D., 2018 Clinical Psychologist, (lic. #PSY9503), Marriage, Family and Child Therapist (lic # MA21027), director of the Nightingale Center, author, national speaker and mother 714-993-5343
8 Important Tips for Choosing a Therapist
In choosing a professional with whom you plan to discuss your most personal issues, one who you trust to give you direction and assistance, it is important to first spend some time considering what results you would like to see if therapy was successful from your own perspective. Remember no one can change someone else. We can only choose to help change ourselves, and a person has to first be uncomfortable with the way their life is going before they are open to alternative ways of doing things. There is, however, a very good chance that if one person changes what they contribute to a situation others around them will not only begin to respond differently but may also be motivated to have a different life for themselves.
After becoming clear about what you would like to obtain from therapy it is then important to consider what are the most important qualities you want in a therapist working with you or those you love. Educational qualifications are important to many people. The following is an outline of the most common types of psychological counselors and the academic and experiential qualifications of each:
Psychiatrist. A Psychiatrist is a Medical Doctor who after completing an M.D. has had 3 years of specialty training in mental disorders. A board-certified psychiatrist has, in addition, practiced for 2 years and passed the written and oral examinations of the American Board of Psychiatry and Neurology. Most Psychiatrists only handle medication prescriptions for patients. Some psychiatrists have taken further training to conduct psychotherapy, and of those, most have been trained in psychoanalysis, which is an analytical and individual process-focused therapy. Medical continuing education is required to maintain their licenses.
Clinical Psychologist. A Clinical Psychologist has a Ph.D. in psychology and has completed a doctoral dissertation, as a contribution to new research and information in the field of psychology. He or she has completed at least two years of working with clients under supervision. They then must pass written and oral examinations. Psychologists are also required to complete continuing education classes to renew their licenses. The license of Clinical Psychologist has the widest scope of practice for psychotherapists, including, prevention and treatment of emotional and mental disorders with individuals, children, adolescents, couples, families and groups with personal, social, emotional or behavioral problems. They are licensed to do assessments, psychological testing and interpretation and hypnosis. They may have hospital admitting privileges, do forensic evaluations and be expert witnesses in a court of law. Psychologists cannot prescribe medications.
Registered Psychological Assistant. A psychological Assistant is training to be a Clinical Psychologist. He or she has a Masters degree, is finishing or has finished their Ph.D. and is in the process of collecting the above mentioned 3000 hours. They are under the direct supervision of a Psychologist who has been licensed for at least two years.
Educational Psychologist. An Educational Psychologist has a Masters degree and an Ed.D., a doctorate in education. They also have completed 3000 hours under the supervision of a licensed supervisor and then passed a written and an oral test. Their training primarily focuses on learning and social problems in school-age children. A School Psychologist is recognized in many states and is a Masters level license.
Licensed Social Worker (LCSW). A Licensed Social Worker has a 2-year Masters Degree in Social Work plus 1,000 hours of clinical placement and 3200 hours of post Masters clinical supervision. They are then required to pass comprehensive written and oral examinations. Their training focuses on social work, such as family intervention and the welfare of children. They provide individual, group, family, child, marital, and adolescent therapy. They generally practice in family service agencies, HMO hospitals, employee assistance programs, mental health clinics, courts, and health center.
Marriage, Family and Child Counselor (MFCC). A Marriage Family and Child Counselor or Therapist, as they are most often referred to, holds a Masters degree in counseling and has completed 3000 hours of supervised counseling. They must also pass a written and an oral examination. Their license allows them to counsel individuals, couples, children, adolescents and groups with relationship problems. They are also required to attend continuing education classes for license renewal.
Registered Intern. An MFCC Intern is working on or has finished a Masters degree in counseling and is working toward licensure by collecting the 3000 hours to be eligible to sit for the licensing exams for Marriage, Family and Child Counselor. They are practicing under the direct supervision of a licensed therapist and treat relationship issues.
Psychiatric Nurse. Psychiatric-mental health nurses are registered professional nurses who have specialized training at the Masters level or above. They conduct individual, family and group consultation and education. A few are in private practice, but most practice in hospitals, community mental health centers and other agencies.
Pastoral Counseling. These are members of the clergy, some have specialized training in psychology, counseling or social work. They provide inexpensive counseling but it is important to evaluate psychological counseling from anyone with little or no training in psychotherapy.
Lay Counselor. A Lay counselor is an unlicensed person who offers counseling through an organization such as a church, temple, nutritional program, self-help group, school, etc., or just on their own. Anyone can call themselves a counselor or therapist, so be sure to ask about training, credentials, certificates, internships, qualifying exams, liability carriers, insurance reimbursement, length of experience and their “scope of practice”. Don’t be afraid to ask what their intended outcome is for treatment and how many people they have treated with your particular concern.
Remember all licensed therapists are ethically required to list their license numbers in advertising. For instance: Licensed Clinical Psychologists’ numbers start with PSY…, licensed Social Workers’ license numbers start with LCS…, and MFCCs’ license numbers start with MFC…
Finding a therapist with whom you feel comfortable is very important. Sometimes this may mean asking a potential therapist about their views on topics of importance to you. Most therapists have been trained to be as objective and accepting as possible, but they are still human. You may want to know how long they have been in practice, do they have any specialties that they write or speak about. You may want to know if a therapist has experience raising children of their own or if they use scientifically based treatments. Just taking the time to have a brief conversation over the phone with a potential therapist can give you a great deal of information about your comfort level in working with him or her.
Knowing the background and specialties of a therapist can help you make your decision. A therapist should be able to provide you with an outline or brief summery of their experience. Look to see how long he or she has been treating people with your specific concern. Look for community service and other indications that he or she is genuinely concerned about people. If you have a preference for a particular type of therapy, look to see if he or she has had personal training and experience in that therapeutic intervention.
A therapist should also be willing to tell you his or her fees up-front. You may be responsible for looking into your own insurance or HMO to see if or how much is covered by your carrier, but the therapist should let you know what his or her customary fee is, and on what terms that fee is expected. Do they bill insurance for you? Are all fees due at time of service? Is there a discount if you bill your own insurance? Can you put the fee on a credit card or pay it off over time? Don’t be afraid to ask the financial questions, you are hiring this professional to help you.
Most therapists are very conscientious when it comes to client confidentiality, but some policies differ from office to office. If you are in a special circumstance such as, a divorced parent or the parent of an adolescent in therapy, you may want to ask the therapist what his or her policy is regarding disclosure to family members in these situations. You may want to know how your records are kept after termination of therapy and for how long. Some therapists must disclose client conversations with case managers if they are reimbursed by an HMO or third party insurance. If you have concerns about your privacy and confidentiality be sure to ask the questions you need answered up-front.
Phone policies differ between therapists. Many times the first contact you will have with a therapist is by phone, and during the course of therapy there are often phone contacts made between therapist and client. An initial call to a therapist’s office should be returned within twenty-four hours during business days or the following business day if placed during a weekend. Ask up-front what the therapist’s policies are regarding phone calls. Does he or she return your calls in a timely manner? Does he or she carry a pager in case of emergency? Are there hours when a live person answers the phone? Does the therapist charge for phone calls during non-business hours or for calls over a certain length of time? Who covers for them when they are on vacation?
Trust your intuition. If you feel uncomfortable with a therapist after a couple sessions don’t keep hoping it will change. Talk about it with the therapist and if you still do not feel rapport and a sense of trust, try another therapist. One of the reasons psychotherapy is successful is the relationship between the therapist and client, if this relationship is not good, therapy has little chance of working.
Therapy can be a life-changing experience or an exercise in frustration. As with any professional service, care must be taken in choosing the professional you trust. Talk to friends about things they found valuable in their therapists. Spend time reading about the kind of therapy you would like to receive. Be an educated consumer. This is your life and you deserve to have a great one!
© 2014, Lois V. Nightingale, Ph.D., Clinical Psychologist, (lic.#PSY9503) director of the Nightingale Center in Yorba Linda. For more information call 714-993-5343
What is Cognitive Behavior Therapy?
Anxiety by Dr. Lois Nightingale on April 8, 2016
What is Cognitive Behavior Therapy?
Cognitive Behavior Therapy is an action-focused psychotherapy that focuses on addressing thought patterns (cognitions) that lead to disruptive behaviors and uncomfortable emotions. It is a relatively short-term form of therapy based on the concept that the way we think about things affects how we feel emotionally. CBT focuses on changing current mal-adaptive thought patterns, behaviors and communication rather than on past experiences. It is oriented toward current problem solving.
CBT is based on extensive empirical research. It is the primary psychological treatment being studied in research today. CBT has been shown to be as useful as antidepressant medication for individuals with depression and is superior in preventing relapse. Studies indicate that patients who receive CBT in addition to medication have better outcomes than patients who do not receive CBT as an added treatment.
While CBT acknowledges many of the core beliefs contributing to “automatic thoughts” in response to life situations, may have been developed in childhood or during times of crisis, the predominant focus is on helping clients feel better and behave better their current lives.
CBT clients need to be motivated, as CBT can be hard work. Clients may feel uncomfortable at times as they practice new behavioral habits. Clients are expected to do work outside of therapy. Homework assignments, journaling, role-playing, cognitive rehearsal, relaxation techniques, systematic desensitization, deep breathing exercises, reinforcement strategies, and validity testing, are all techniques used in CBT. Clients who seek CBT can expect their therapist to be active, problem-solving and goal-directed.
The harder clients work, the better their chances of recovery.
Cognitive therapy is not about “positive thinking” in the sense that you must always think happy thoughts. Rather, it is a way to gain control over racing, repetitive thoughts which often feed or trigger anxiety or depression. In CBT people learn how to change their behavior and their feelings to live more fulfilled lives.
Dr. Lois Nightingale, Psychologist PSY9503 714-993-5343
Self-improvement Step By Step
Starting any significant life changes can begin with choosing a small behavior change. Choose something you believe you can accomplish to begin with.
Physical Self-improvement
Write exercise time in calendar
Ask a friend to go with you
Add 2 more servings of produce a day
Work on an addiction
Drink 2 more glasses of water a day
Go to bed 1/2 hour earlier
Buy a Group-on activity
Share fitness tracker info with an encouraging friend
Emotional Health
Keep a gratitude list
Meditate 10 min. a day
Listen to motivational CDs in car
Compliment yourself
Join a group of positive people
Write a list of interesting volunteer opportunities
Make a therapy appointment
Education
Read a Parks and Rec guide
Find Meet-ups in your area
Read admitting requirements to a school of interest
Browse Amazon.com for info
Hire a tutor
Watch a YouTube video on the subject
Family
Schedule individual outings with each member
Put a family activity in the calendar
Celebrate birthdays and accomplishments
Send E-cards
Hug and kiss
Laugh
Make eye contact
Compliment out loud
Turn off electronics and talk
Tell family stories of courage
Financial Health
Track and categorize what you spend
Have savings auto-deducted
Look at monthly income and spending (share if in partnership)
Balance statements monthly
Take a personal finance class
Primary Relationship
Forgive quickly
Send a card
Recall how you met
Plan a date
Share a book
Tell about something in your day that made you grateful for them
Touch
Tell them you’re proud of them
Attend a marriage seminar
Remember life is short
Accept “no” for an answer without forcing your perspective.
Work
Bring mindfulness and staying present to your job
Remember why your work is important
Do your best work to be in your own integrity
Compliment yourself on the way home
Commit to bringing joy to coworkers
Celebrate yourself and others
If dissatisfied explore options
Spiritual Well-being
Read a daily inspiration
Notice where you are rejuvenated
Spend time weekly with like-mined people
Visit places that inspire awe and community
Pray or meditate
Do the things that remind you you’re not alone
Reach out to someone you view as spiritually centered
Pull out old art supplies
Tune up an old instrument
Take a class
Reinvent an ancestor’s talent
Follow along with a YouTube instruction
Keep a journal of your ideas
Have lunch with another artist
Go to an art walk
Working with a therapist has helped many people attain their self-improvement goals.
Call 714-993-5343 for an appointment.