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THE PSYCHOLOGY OF PERSONALITY DISORDERS
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Author Topic: What to look for in a therapist (qualifications, other)?  (Read 37281 times)
whiletheseasonspass
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« Reply #20 on: April 09, 2010, 08:01:58 PM »

Staff only

This thread about what we're looking for in a therapist is split off from another started by Randi Kreger about how therapists have helped/hurt: https://bpdfamily.com/message_board/index.php?topic=115997.40.

Without getting into details ( sorry I have not read all of the posts but some of them) I had the opportunity to speak to two T's recently that were my daughter's T's.  So the first one was phenomenal.  He was brilliant and perceptive and thought outside the box and was able to HEAR  and synthesize what H and I were telling him and he was able to see the possibility of BPD  in our D and then after talking to us ( h and me) HE felt validated by what we had told him.  He would have been the best T for our D.  But our D did not like that anyone was finding out what she was really like- being challenged so that was the end of him.  

Now- presently there is one who is exactly what I was afraid of- she is an enabler and to my D she is a keeper.  This is always the case- anyone who agrees is IN and if you see though her- and start to challenge you are out.  So I was telling T#2  the exact same things I told T # 1 (above) and #2  took it all differently and seemed to have a ONE TRACT MIND- and she used all of my very important information differently than #1 and kept defending our D as if I was TRYING  to use the information AGAINST  our D instead of informing the #2  of another side that my D is so good at hiding.  This T wasn't hearing a word I was saying.  She was like a broken record no matter what I said.  My aim was to help my D.  

It is about skills.  The ability to HEAR WITHOUT BIAS, SYNTHESIZE INFORMATION, THINK OUTSIDE THE BOX, UNDERSTANDING THAT THERE IS A GLOBAL PICTURE AND NOT JUST ONE SIDE...AND MORE!

Bleccchhh.  Speaking to this T#2 keeps me feeling so hopeless and my H too about our D.  I know it IS our D's own choice who she picked and I know what her schtick is all of the time- but besides what this thread is about I also wish there was a law that prevented BPD's to pick their own T's too.  That would be a miracle, eh?  Of course you need to have the diagnosis of BPD for that kind of magical thinking.  So many on these boards say uBPD...or they are too young for the psyche to "name" as BPD.  

Thanks

wtsp

oops- just saw that Randi had all of her answers necessary.  Well it felt good to vent anyway.  

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MaybeSo
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« Reply #21 on: April 10, 2010, 11:09:19 PM »

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Experience is not enough.  There is a way of thinking that's important. . . the science of mental health

?

there are therapists/psychologists/psychiatrsits that are skilled and talented and there are those who are not ...

the point I was trying to make, which I don't feel is especially unique or controversial, is that a clinician who has a lot of expeience with a particular type of problem or disorder, like BPD, will possess more  knowledge and more expertise concerning that disorder, and therefore will likely be able to offer more help or assistance to someone suffering from that disorder, ... than would another equally skilled clinician that has little or no knowledge or experience of that particular disorder or ailment.   

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« Reply #22 on: April 12, 2010, 01:33:00 PM »

"there are therapists/psychologists/psychiatrsits that are skilled and talented and there are those who are not ... "

agree. . . but, they aren't equivalent levels of care therapist does not equal psychologist does not equal psychiatrist.  They are supposed to target different things.  Granted, there is significant overlap these days with the expansion of scope of practice of midlevels, but, even when performing similar tasks, you're dealing with very different experience/training/thought process among professions. 

"the point I was trying to make, which I don't feel is especially unique or controversial, is that a clinician who has a lot of expeience with a particular type of problem or disorder, like BPD, will possess more  knowledge and more expertise concerning that disorder, and therefore will likely be able to offer more help or assistance to someone suffering from that disorder, ... than would another equally skilled clinician that has little or no knowledge or experience of that particular disorder or ailment.   

"

I agree, with the caveat that experience without proper frame of reference is nearly useless.  Meaning, I would tend to prefer a less experienced (with BPD) doctoral level practitioner than a masters practitioner who has lots of exposure to BPD because in my view treating BPD should be outside of the scope of practice of a masters level therapist. 


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MaybeSo
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« Reply #23 on: April 12, 2010, 10:11:13 PM »

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I agree, with the caveat that experience without proper frame of reference is nearly useless.  Meaning, I would tend to prefer a less experienced (with BPD) doctoral level practitioner than a masters practitioner who has lots of exposure to BPD because in my view treating BPD should be outside of the scope of practice of a masters level therapist.

 

I see it differently.  I would rather work with a skilled and talented cinician(s) who has expertise in a specialized area if I were dealing with a difficult and specialized disorder such as BPD, regardless of the PhD v. Masters level of education. I've seen way too many genuinely talent people from the 'lower eschelons' of life work wonders and way way too much inflated pseudo brilliance from supposedly 'higher degreed' individuals... to assume or expect the degree or even the school (Harvard v. a State School) necessarily means squat

A psychiatrist is of course a medical doctor and therefore can treat medical issues and perscribe medication, whereas a psychologist and MFT or other master's level clinican cannot.   A psychologist can administer and interpret a variety of psych tests.  Someone w/ a PhD level education may also be invovled in teaching/research endeavors.  While perscribing drugs and administering (certain) psych tests are beyond the scope of practice of a master's level clinican...Neither of those targeted skills, nor teaching or research endeavors, necessarily make an individual a better therapist.  I've worked with way too many physicians and other 'supremely degreed' individuals whose people skills and common sense were absolutly atrocious and whom caused many more problems than they ever helped.  I am not personally automatically enamoured of  or even trusting of a professional based on the degree.

I would never personally choose to do ‘therapy’ with a psychiatrist.  This is an individual who has focused most his/her adult life on the study and application of a classic medical model, and gaining expertise in prescribing drugs for specific mental health issues.  They are usually over extended and stressed-out and typically  have way too large a patient load.   They can barely keep up with seeing their patients 1x every 2 weeks to check on how the medication is doing and are of course immersed in all sorts of insurance issues and hospital paperwork.  This is the person I want to see for medication, this is  NOT the person I want to see for ongoing  ‘therapy’.   

In any event, what I've seen in practice are 'treatment teams' with a psychiatrist taking the lead on dx and medication even though they have the least 'face time' with the patient...and maybe a psychologist for testing...but the people working daily in the trenches in group and individual therapy, including DBT therapy targeted for BPD symptoms, are mft's and/or lcsw's.  Further rounding out the team are psych. nurses and in some cases even case managers.   

I don't see too many psychiatrist's or psychologists leading dbt therapy groups or any kind of therapy groups w/ significantly mentally ill individuals. In fact I've never seen that.  Ever.  At least not in out-patient or partial hospitalization programs and / clinic programs that I've been exposed to. Not even once.  Maybe that's just the case in  my state or my area, but that's what I see.  In support of family members of those who suffer w/ BPD, it is my understanding that some Family Connections type support groups are led by lay people; family members who have lived with this disorder and gone through their own skills training and are trained to help lead groups of family members who are eager to learn similar skills, with positive results.

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« Reply #24 on: April 12, 2010, 11:25:39 PM »

continued...

The overlap is that all three are involved in psychiatric patient care to one degree or another.  But there is less and less overlap, and more specialization in each role, specifically…

Psychiatrists are medical doctors and their expertise usually lies in hospitalization and medication issues of patients with acute mental health problems.

Psychologists are relied on by schools, hospitals and other social institutions to administer and interpret psychological tests, and some also perform  therapy.  Many psychologist programs can be entered from directly after the undergrad level of study has been completed…meaning you do not have to move from undergrad to masters to PhD level study.  Indeed,  if you want to ultimately become a psychologist, it is recommended that you not take a  masters course of study such as an MFT undergoes, because you will have to start from scratch and go through many of the same hours of onsite training that you did while getting your MFT.  

MFTs are Marriage and Family Therapists, they are trained and licensed exclusively for the purpose of performing therapy with men, women, children and families regardless of the diagnosis.  They work either in private practice or in mental health agency’s and clinics and/or hospitals in tandem with a ‘treatment team’ that will include consultation with and referral to a psychiatrist if medication or medical issues are assessed.  They undergo a total of 7 years of total undergrad/post grad schooling and another 3000 hours of supervised onsite training as a therapist intern doing one on one, group, family and couples therapy supervised by a licensed MFT or clinical psychologist before they can sit for the state board and become a licensed therapist in private practice.  MFT’s along with LCSWs are relied upon almost exclusively in hospital settings by psychiatrists to perform hours of client individual and group ‘therapy’ , they are relied upon to peform assessment, diagnosis and treatment planning, and their scope of practice is NOT limited by law or ethics to any particular type of client or diagnosis.  Meaning…it is fully within the scope of practice for MFT’s to be working with individuals with BPD or any other diagnosis.  As with any clinician, if they feel they do not possess the knowledge or expertise to address a client’s presenting problem, they are legally and ethically mandated to refer the client to a practitioner who can and they most cetainly cannot perscribe medicine though they monitor and consult with a psychiatrist and other team members regarding medication issues.

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« Reply #25 on: April 13, 2010, 06:48:08 AM »

Quote
I see it differently.  I would rather work with a skilled and talented cinician(s) who has expertise in a specialized area if I were dealing with a difficult and specialized disorder such as BPD, regardless of the PhD v. Masters level of education. I've seen way too many genuinely talent people from the 'lower eschelons' of life work wonders and way way too much inflated pseudo brilliance from supposedly 'higher degreed' individuals... to assume or expect the degree or even the school (Harvard v. a State School) necessarily means squat. 



Beyond the scope of this thread, though I suppose it's tenuously relevant.  While I agree there are talented people in the "lower echelons" (though, I don't see them as lower echelons, I see them as designed for different purposes), part of skill and "talent" with respect to being a clinician, part of "expertise" is the training form.  Mental health is a strange field.  You wouldn't see a nurse as a "clinician" and talk about their talent, while arguing that the MD/DO doesn't mean squat.  The gulf between masters level and doctoral level in mental health is as wide.  It's not about talent per se, it's about roles.  It's just been blurred by politics and a lack of understanding. 
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Unreal
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« Reply #26 on: April 13, 2010, 06:55:13 AM »

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A psychologist can administer and interpret a variety of psych tests.  Someone w/ a PhD level education may also be invovled in teaching/research endeavors.  While perscribing drugs and administering (certain) psych tests are beyond the scope of practice of a master's level clinican...Neither of those targeted skills, nor teaching or research endeavors, necessarily make an individual a better therapist. 



That isn't the only difference between the fields (psychiatry, social work, psychology).  A PhD/PsyD cannot be looked at as teaching/research/assessment added on to therapy training (masters).  This is partially why you see so much pseudoscience in the field (e.g., EMDR, shaman healing, etc...).  Most doctoral level practitioners do zero research or teaching.   

Quote
I've worked with way too many physicians and other 'supremely degreed' individuals whose people skills and common sense were absolutly atrocious and whom caused many more problems than they ever helped.  I am not personally automatically enamoured of  or even trusting of a professional based on the degree.

Okay, but these are not correlated, and the answer isn't go to someone who is inadequately/inappropriately trained for the task; the answer is to find another physician or doctoral level provider with appropriate background that has good people skills.  It's not about being "supremely degreed," it's about meeting a minimum bar of entry.  I understand that legally LCSWs can do therapy.  But, that's more of a failure of the APA than a stamp of approval of social work for these roles.   

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« Reply #27 on: April 13, 2010, 07:00:06 AM »

  

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I would never personally choose to do ‘therapy’ with a psychiatrist.  



Depends on the psychiatrist and the problem at hand.  

Quote
They are usually over extended and stressed-out and typically  have way too large a patient load.   They can barely keep up with seeing their patients 1x every 2 weeks to check on how the medication is doing and are of course immersed in all sorts of insurance issues and hospital paperwork.  This is the person I want to see for medication, this is  NOT the person I want to see for ongoing  ‘therapy’.    



Too much of a generalization.  

Quote
In any event, what I've seen in practice are 'treatment teams' with a psychiatrist taking the lead on dx and medication even though they have the least 'face time' with the patient...and maybe a psychologist for testing...but the people working daily in the trenches in group and individual therapy, including DBT therapy targeted for BPD symptoms, are mft's and/or lcsw's.  Further rounding out the team are psych. nurses and in some cases even case managers.  I don't see too many psychiatrist's or psychologists leading dbt therapy groups or any kind of therapy groups w/ significantly mentally ill individuals.  



It depends on where you are.  Regarding Dx, psychology is generally the gold standard (assessment and Dx is how clinical psychology started), not psychiatry.  Masters level practioners are out there in large numbers, no doubt.  But, I'd use them differently.  I'd setup my team like this:

psychiatrist - med management

internist - rule out other conditions affecting emotional regulation (e.g., thyroid disease)

psychologist - dx and psychotherapy

social worker - supportive therapy and case management (visiting home, checking on children).  (your lay people role is traditional social work)            
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« Reply #28 on: April 13, 2010, 07:09:30 AM »

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Psychologists are relied on by schools, hospitals and other social institutions to administer and interpret psychological tests, and some also perform  therapy.  Many psychologist programs can be entered from directly after the undergrad level of study has been completed…meaning you do not have to move from undergrad to masters to PhD level study.  Indeed,  if you want to ultimately become a psychologist, it is recommended that you not take a  masters course of study such as an MFT undergoes, because you will have to start from scratch and go through many of the same hours of onsite training that you did while getting your MFT.  



Every doctoral level psychology program that I'm aware of awards a masters degree in the course of completing the doctorate.  What you're touching upon here is exactly the point I was making earlier.  There is a substantial difference in the masters degree that is completed on route to the phd/psyd and that that is completed as an MFT.  They are not the same course of study.  Further, psychology is an extremely vast field.  There are psychologists that never do any clinic work at all and there are psychologist who do therapy all day long.  I know psychologists that work for the NSA, for banks, in psychiatry depts, in neurology depts, in psychology depts, in private practice, for the department of corrections, for NFL teams, etc. . .   There are even psychologists, in a few states, that do med management along with providing assessment and therapy services (though I don't agree with the expansion of psychology into medication prescription; it is the same issue I have with the expansion of MFT and LCSW into doing psychotherapy, Dx, assessment). 

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« Reply #29 on: April 13, 2010, 07:17:49 AM »

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MFTs are Marriage and Family Therapists, they are trained and licensed exclusively for the purpose of performing therapy with men, women, children and families regardless of the diagnosis. 



MFT was never intended to be a generalist psychotherapy degree (nor was social work).  This is the scope of practice expansion that I'm talking about.  The MFT, as named, was designed to train people to do couples therapy, deal with child rearing issues, not deal with significant mental health issues. 


Quote
They undergo a total of 7 years of total undergrad/post grad schooling



Shouldn't be counting undergrad.  They are 2 - 3 year programs.  Otherwise, you're looking at 12-13 years of training for physicians and psychologists.  I don't think anyone looks at it that way.   

Quote
As with any clinician, if they feel they do not possess the knowledge or expertise to address a client’s presenting problem, they are legally and ethically mandated to refer the client to a practitioner who can and they most cetainly cannot perscribe medicine though they monitor and consult with a psychiatrist and other team members regarding medication issues.




Knowing what you don't know is a difficult thing. 

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