Dear Therapist:

I'm looking for some direction about something that I've been thinking about for a while. Maybe you can help. Often, I struggle with thoughts and feelings that make it hard for me to get through my day and I think I have felt like this since I was a teen. Feeling this way has affected my relationships at work, with my kids and my siblings. My current state has even put pressure on my relationship with my husband. It’s getting hard to get through the day and I am worrying that I am messing up my life and going to affect my children. I realize that I need to see a therapist but the big question for me is how do I choose one?  Who would be the best type of therapist for me? How do you know which "kind" of therapist is "for you?"  How do I know if they are experienced, competent? Do the letters after their name tell me something? They must be important if they are always there, but I feel embarrassed to admit that it all looks like "alphabet soup" to me.  So, I think I have two questions: If I'd like to see someone to help me with my feelings, how do I choose the right person? And, what do all the letters after the names really mean and how do they make a difference to how I find the right person to help me? Thanks in advance for considering my question.  

Response:

I think that many people feel the way that you do. There are many therapists out there with various different letters after their names. For the most part, the letters simply refer to the particular licensing that the therapist has. For instance, a PhD is a doctorate of philosophy, a PsyD is a doctorate of psychology, and an LCSW is a licensed clinical social worker. There are other acronyms as well.

It is important to recognize that the particular schooling and licensing do not necessarily mean much. Although it is important to verify that any therapist that you see is licensed to practice psychotherapy, it is the therapist—not the letters—that will ostensibly be helping you. There are good therapists of all different stripes. There are also many different schools of thought, modalities, and techniques. Across each mental health field, you can find therapists who practice in very similar ways. Typically it is experience and training, rather than schooling, that makes up the vast majority of a therapist’s capabilities.

Each client—and each therapist—has a different personality, different needs, and different preferences. A therapist who has helped one person with a particular issue may not be the right fit for someone else with a similar issue. To some degree, the first couple of sessions help both the therapist and the client to determine whether they are properly matched. This comes down to personality, therapy style, and the ability of the therapist to connect to the client in a way that makes the client feel comfortable. This is the period during which the client can begin to determine whether the therapist’s style and techniques speak to them.

Naturally, you need somewhere to begin. Rather than simply pulling a name out of a hat, you can reach out to a referral agency (like Relief Resources, Sephardic Bikur Holim, or JBFCS), or speak with someone who is involved with mental health resources. The more information that they have about you, the better they can help you to find the right therapist.

Once you have identified a therapist who seems appropriate “on paper,” the first session or two should give you a pretty good idea of whether they can help you. Remember that the intake session does not only serve as the therapist’s means for information gathering. It is also your opportunity to interview the therapist. Don’t be afraid to ask questions, or to challenge things that don’t appear to make sense. If you cannot be open and honest in therapy, the process will suffer. If the two of you will have trouble getting along, this should be out in the open as early in the relationship as possible.

Some therapists focus almost exclusively on one treatment modality (cognitive therapy as an example). This may or may not work for you. Even if it does, at some point, you may feel the necessity to move into a different strategy. If your therapist uses many modalities, tailored to the client and the need, this can prevent the fitting of a square peg in a round hole, allowing you to address your issues in the ways that are best for you.

-Yehuda Lieberman, LCSW

 psychotherapist in private practice

 Brooklyn, NY

 author of Self-Esteem: A Primer

 www.ylcsw.com / 718-258-5317

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