Choosing an effective mental health and/or addictions counselor is a lot like choosing a good undertaker: nobody wants to need one and by the time you do; you’re probably in no shape to go shopping for one.
The process can be confusing. There are a lot of options and simply navigating the alphabet soup of professional credentials can be overwhelming. It’s helpful to understand the different types of addiction professionals, your options for types of treatment, and strategies to ensure that the clinician you’ve chosen is a good fit for you.
Types of Professionals
Psychiatrists prescribe medications and it’s rare for these folks to spend any significant time face to face with clients.
Psychologists are considered experts in human behavior and cognition (thought processes). They provide testing for any number of conditions (processing challenges, learning disabilities and extensive psychological assessments). Most provide counseling services that tend to focus primarily on changing behavior without a lot of emphasis on emotion.
Therapists are an eclectic group of professionals who take a holistic view to treatment. They have earned a masters degree in a variety of studies (psychology, social work, counseling). There are slight variations from state to state but they’re usually either a Licensed Clinical Social Worker (LCSW), Licensed Clinical Professional Counselor (LCPC) or Licensed Marriage and Family Therapist (LMFT).
Substance abuse counselors (CADC, LADC) also come from very eclectic backgrounds. They most often have either an associate’s degree or bachelor’s degree, though in many states it’s possible to attain licensure with no post-secondary education at all. The majority of substance abuse counselors are recovering addicts and alcoholics.
Counseling vs. Therapy
Unfortunately, these terms are often used interchangeably. Counseling is best understood as focusing on change from today forward; whereas therapy incorporates examining how past experiences continue to affect current perspective and behavior.
In the context of addiction recovery, I urge folks to avoid looking at the past unless there is a compelling reason to go there (example – chronic PTSD). I strongly suggest that stability and sobriety have to come long before mental health concerns. This is especially true because attaining sobriety almost always has a huge impact on mental health.
How Do We Know Who Gets It & Who’s a Quack?
Quite often folks choose counselors by the same means that they locate a plumber. They find us by through internet searches. They look for who’s in their neighborhood or close by to work. Some get referred by their primary care physician and others by their health insurance provider.
My experience is that the very best recommendations come from friends, family, coworkers or from self-help groups like AA or NA. These folks can share their suggestions of local resources based on personal experiences. They know which providers “get it” and which ones are nice people who just aren’t effective.
Two suggestions:
1. The more you know about what you need and what works for you, the easier it will be to ensure that your clinician will work for you.
2. Interview the professional. Clinicians are like shoes – sometimes you have to try on a few to find a good fit. Please keep in mind that your clinician’s job is to be of service to you.I very much appreciate it when potential clients interview me. They don’t want to waste their time or mine. The types of questions they ask usually go to the heart of the matter:
Are you a recovering addict or alcoholic?
Did you grow up in a family of addiction?
How much experience do you have in working with PTSD/Depression/other conditions
Do you judge people based on how they deal with the hell they’ve been through?
Are you comfortable incorporating my spiritual (and/or) religious beliefs in counseling?
These are standard and straightforward questions that any clinician should be willing to answer. I encourage folks to ask what they really want to know and those types of questions usually show past negative experiences in counseling.
Will you change the subject if I talk about really bad things that happened to me?
Will you give me direct feedback and not just say things like, “Uh huh, Hmm, and I see”?
Will you answer my questions with questions?
If you think I’m kidding myself will you tell me?
Will you tell me how I should feel or how I should live my life?
Can we just talk sometimes or do I have to stay with what you think is important?
Listen to your intuition. If you feel uncomfortable with the clinician you’re seeing, tell them. If something can be changed, great! If not, consider asking them to recommend someone who has the style/attributes you’re looking for. Meeting with someone you know you can’t be open with doesn’t make sense. Please remember that we work for you.
Jim LaPierre LCSW CCS is the Executive Director of Higher Ground Services in Brewer, Maine. He is a Recovery Ally, mental health therapist and addictions counselor. He specializes in facilitating recovery (whether from addiction, trauma, depression, anxiety, or past abuse) overcome obstacles, and improve their quality of life. Jim offers a limited amount of online therapy to those with very flexible schedules.counseling@roadrunner.com