Talk Therapy Decoded
In Episode 7, my friend Dr. Lisa Rice asked me a question that I get often: “How do I find a therapist for my daughter?” First, I want to identify the types and credentials of the various professionals who provide talk therapy. Then, I will unpack the professions' distinctions and how to land on the one (or two or three) to call. Finally, I’ll describe how long therapy might take, how you know your daughter is feeling better, and some essential elements to keep at the forefront of your mind during the search process. Whew!
This information is not intended for addressing severe mental health needs such as active self-harm or life-threatening thoughts or behaviors. Please utilize local emergency resources or the 988 Lifeline to speak with trained crisis counselors. Multiple professional associations report that clients may wait 3-5 weeks before their first appointment, which is too long for a critical situation, so contact Lifeline to take a more aggressive advocacy role or seek emergency services. Additionally, I encourage you to try and call 988 for yourself. Say something like, “I’m a mom wondering what my daughter would experience if she were to text or call you.” Professionals are happy to answer questions about their services and getting familiar with this service will help ease use.
WHO PROVIDES TALK THERAPY?
Talk therapy assists a client (or patient) to alleviate emotional distress, improve functioning, and enhance well-being. The provider holds either a master's or doctoral degree in one of several fields. The person's degree is the first set of letters after the name. Several professions prepare folks to provide talk therapy, including social work (MSW or LCSW), counseling (MA, PhD), marriage and family therapy, nursing (MSN, DNP), medicine (MD), psychology (PhD), and professional psychology (PhD). Sometimes, professionals seek specialties within their given field, such as psychiatry in medicine, sports psychology, or career counseling. A doctoral degree or a PhD does not mean that the person is a better therapist. Medicine and psychology require a doctoral degree to become licensed to practice, whereas the other professions license practitioners at the master’s level with some years of post-degree practice under the supervision of a qualified professional. The doctoral degree usually indicates more research, teaching experience, and training in supervising practitioners. Psychiatric nurse practitioners and psychiatrists can prescribe medication and may collaborate with non-prescribing talk therapy providers to serve patients. Sometimes, you will find several of these different talk therapy providers practicing together under one roof!
The second set of letters after a professional’s name is the credential awarded (and usually overseen) by a state licensing board. You always want to seek help from someone with an active license because it means they have been vetted and given legal permission to practice by similar professionals presiding on a government board; licensure requires specific education and training standards, and practitioners must engage in ongoing training to maintain their license. If you don’t see a provider's license number prominently visible online, use the state board online license look-up feature to verify it. Certifications demonstrate voluntary training specialties. Non-governmental agencies award certifications and these certifications on their own are not a license to practice. National professional bodies that award certifications often have rigorous requirements to obtain and retain active certification.
The main point here is for you to be an informed consumer about the alphabet soup of letters that follow a name. I often encounter folks who do not know that several different professions provide talk therapy, and this is understandable! Additionally, please ensure any provider you consider seeing is licensed and free from complaints with their board. Lastly, if you’re looking for a specific therapy technique or method, try to find a therapist certified in that approach. For example, Eye Movement Desensitization and Reprocessing (EMDR) is helpful for treating trauma as well as many other disorders. This is a specialized skillset requiring 20 hours of training, 30 hours of practice, and then receiving approval by a board in order to identify as an EMDR Certified Therapist.
WHAT’S THE DIFFERENCE IN TALK THERAPY FROM DIFFERENT PROFESSIONS?
Professions vary in the way they view how human suffering/symptoms came to be and how to restore health and promote optimal living. A fairly universal understanding across professions is that talk therapy is not advice-giving. At times, a therapist may be directive, or follow a certain number of prescribed steps in a specific intervention. On the whole, however, you can get advice from friends, family, and self-help resources, so a therapist should be different from the support that you and your daughter already have. Advice-giving suggests one party knows better than the other, which can create dependency on the therapist and undermine autonomy. What a talk therapist does is create a place for self-discovery and self-exploration in a nonjudgemental, empathetic, client-centered relationship.
I am not versed in all the professions’ origins and models for understanding humans, but I can provide some high-level examples of a few for you to illustrate the point. Social workers consider individuals in context and the mutually influential relationship between persons and their physical and social environments. They focus on strengths, supports, resilience, and growth potential. Counselors, on the other hand, operate from a developmental perspective and employ a wellness paradigm where mental, social, occupational, spiritual, and physical well-being are on continuums. They focus on strengths, client autonomy, and living fully. Physicians and nurses practice from the medical model, meaning mental disorders are the result of a physical disorder in the brain, and treatment may be prescribed to treat the illness.
The lens through which the provider was trained to understand emotional and psychological distress informs their approach to understanding your daughter and directing her care. Licensed providers in all of these professions can diagnose and treat individuals, couples, and families. Professional identity may be less salient than other characteristics such as ethnicity, age, or gender. Your daughter’s buy-in and her opinion on who she might like to talk to is a significant driver.
Generally speaking, it is discouraged to have more than one talk therapist at the same time because different goals or approaches may be unproductive simultaneously. However, you may consider different modalities of therapy at the same time, such as individual therapy combined with family therapy or individual therapy alongside group therapy. As social beings, we learn different lessons in small groups than in a private dyad, and they can be powerful complements to one another.
WHEN IS IT TIME TO SEEK THERAPY?
No surprise here that the answer to this is, “It depends.” If your daughter is initiating the conversation about wanting to talk to someone, that’s a positive indicator to begin the process of finding a therapist as she’s ready for change. She has likely thought about it for some time and maybe done her own “research” by talking to friends or looking it up online. Maybe a trusted adult like a teacher or a school counselor suggested therapy, or maybe one of her friends talked about being in therapy. Be curious about your daughter’s “Why Now?”
On the other end of the continuum, it is generally not a good idea to “force” your daughter into therapy if she is highly resistant and not in imminent danger. Yes, you, as the parent, are in charge of her care and well-being, and talk therapy mandated by a parent could come at some cost to the parent-child relationship. Additionally, therapy requires some buy-in and willingness to engage in the process, so it may be unproductive if she is non-participatory. You can suggest that she seek a therapist and then give her some autonomy to decide which therapist she likes.
Sometimes our daughters experience a “big” thing and struggle to bounce back. Sometimes they have a series of things over time (sometimes things we don’t realize!) that “snowball,” and they just can’t get on their feet before the next life punch. Consider the severity of the changes in your daughter’s functioning across different settings including home, school, and socially. Is she having trouble doing activities of daily living (ADLs) like going to school, completing academic requirements, taking care of her body, or maintaining her living space? Have her struggles created such strain on the parent-child relationship that you’re stuck in a negative, unproductive cycle that seems to be creating more harm than good? Has your daughter tried and exhausted solutions that have been successful in the past, and she needs some new resources? If some of these indicators have been present for three to four months or you notice downward trends in her functioning, I encourage posing the question, “Would you like things to be different? We can find someone together who might be able to help you feel like yourself again.”
As a licensed professional counselor, I have had clients who came to therapy during a mental health crisis. This work first involved stabilization (sometimes for weeks), then building and practicing skills, and eventually naming indicators of when to seek help sooner in the future. Some clients have started therapy at a time of relative stability in order to revisit something in their past that they want to understand at a deeper level and to feel more resolved before possibly encountering a similar challenge again. Examples of this could be trauma or abuse in a previous relationship, a significant loss of a job or a loved one, changes in the family structure (divorce or remarriage), or a move to a new school, town, or country.
HOW LONG DOES THERAPY LAST?
Individual, couples, and family therapy typically begin with an initial session where the therapist gathers a lot of information about “the problem” as well as some background information and ideas about what the client wants to be different. Sometimes, this initial session is a little longer (60-75 minutes) and may cost more than a therapy session. I let clients know beforehand that this session is different than the rest because the purpose is to gather history, assess the current issue, and collaboratively shape the next steps. When seeing a kiddo, parents are active participants in this step. Each subsequent session lasts 45-60 minutes weekly or biweekly (or a schedule determined collaboratively), and the role of parents in their kid’s therapy sessions varies. The American Psychological Association reported that the average duration of therapy ranges from 12-20 weeks, depending on the client and the issues. Three-fourths of people who attended weekly therapy for 6 months reported significant improvement in their lives. Sometimes, folks prefer to remain in therapy for a year or more; after resolving what they first came for, they realize they have more work to do. The duration of therapy is always the client’s choice.
HOW DO I FIND A THERAPIST?
It can be intimidating and overwhelming to move from “I’m interested” in therapy to having that first appointment. Finding a provider who is taking new clients and who is also a potential “fit” can take a week or two. It’s a process of generating a pool of potential providers, making contact with several candidates, and then having the initial appointment.
There are sites like Psychology Today, Good Therapy, and Therapy Den where therapists pay to advertise their services. This can be a good way to generate a list of potential providers based on your preferences for specialty areas, therapist demographics, location, and other criteria. Therapists maintain their individual pages, so I encourage you to use these sites as a starting point. If you want to get the most up-to-date providers in your insurance network, call your insurance company or use their online tools to generate a list of potential providers. Then, you can cross-reference these two lists to narrow down possible providers. Next, investigate their business websites and social media pages.
I suggest seeking personal recommendations if you feel comfortable doing so among people you trust. Note that because the client-therapist relationship will be unique, and each client is unique, your daughter’s friend’s therapist may or may not be a fit for your daughter. Engage your daughter in the search process as much as she is able and willing. Maybe you generate a list of accessible therapists, and she selects her top three to five choices based on internet research. Set up free, brief consultations with several therapists - many offer this online or will accommodate a request for such. This way, you and your daughter can experience their voice and energy, the business environment, and ask questions about how they might go about helping your daughter. Book an initial intake appointment, and don’t be afraid to book two. It’s not unusual to have to wait a couple of weeks for an appointment. You can always cancel one of them, or maybe the first one is not the match you’d hoped!
WHAT CAN I EXPECT RIGHT AWAY?
Some people feel better initially because they no longer feel alone and trust that symptom relief is possible. Other times, folks feel a little worse before feeling better. With kids, it may take a little longer for parents to observe measurable changes; your daughter has to learn new insights and thoughts before trying new behaviors. Therapy can also be tiring for kids. You may want to know what happened in sessions, and it is your legal right to know. However, I encourage parents to allow trust and rapport to build independently of you. Speak to the therapist directly instead of asking your daughter about her sessions.
Since the pandemic, telemental health has become more commonplace. So far, research does not show any significant differences in outcomes for telehealth versus in-person therapy for mental health support. As long as the relationship between the client and therapist develops, virtual or online therapy is just as efficacious (helpful) as in-person therapy. Some therapists may prefer to practice one way or the other or specify issues as best suited for in-person sessions.
HOW DO I KNOW IF THERAPY IS WORKING?
Once your daughter begins therapy, it may take several sessions for your daughter to form an opinion about the therapist. I liken it to the toddler days of trying a new food several times before forming an opinion. Unless there are strong indicators otherwise (DO listen to your daughter’s gut since she is the client!), I encourage a 4-6 session trial period before moving to a different therapist or quitting altogether. Be mindful of how you discuss your daughter’s therapist and her therapy experience with her. You are a significant, research-supported influence in the outcome of your daughter’s therapy; your comfort level and conveying hope and belief that therapy will help her impacts her treatment outcomes!
Collaborate with your daughter’s provider to create observable indicators to mark change at home and school. Examples could be healthier sleep hygiene, more time engaging in age-appropriate social activities, or overall improved emotional regulation (or less reactivity) in the face of everyday stressors. What would it look like for your daughter to be “back” to herself? Consider how you experienced changes in your relationship with her, and how you observed changes in her relationships with family members and friends during her period of distress. A therapist may ask you and your daughter to consider completing assessments, or standardized measures, on paper or online, for the purpose of providing data to inform the “problem definition” and prioritizing therapy goals.
LISTEN FOR MORE
Figuring out when therapy could be helpful and finding a therapist can certainly be daunting. This blog includes an overview of the similarities and differences among professionals who provide talk therapy, when to consider therapy, the steps to begin the process, and what you can expect at the beginning. Listen as Lisa and Margaux explore this process in the Be On Her Side Podcast Episode 007 Therapy 101.
