Create the family you want to have

Who’s Who in the World of Mental Health

Mental Health Awareness Ribbon

Mental Health Awareness Ribbon (Photo credit: Wikipedia)

Written by, Kate Oliver, MSW, LCSW-C

In the field of mental health, you will come across many titles for professionals.  It can be confusing to understand what the differences are.  Here is a quick primer to walk you through the different types of helping professionals in the mental health field.

Social Workers- We typically have a Master’s Degree followed by a few years of supervision with a mandatory test to obtain a license.  Each state has different standards for Social Workers and it is a good idea to check what a license means in your state.  In my state, Maryland, in order to have my clinical license I needed to complete my Master’s in Social Work, then have a minimum of two years and 1500 hours of supervised work time.  After that I needed to pass my licensure exam.  In my state there are also Social Workers that have other certifications that mean they do not have as much training or experience, and or that they declined to take or did not pass the licensing exam meaning they still must be supervised by someone trained to supervise Social Workers. The lens Clinical social workers use when working with clients is typically to look at a person in the context of their environment to see what environmental stressors a client has and to work with a client to see how we can help them better manage within the system they live in.  Social Workers do not prescribe medication

Psychologists have a doctoral degree.  They also are required to take an exam following their degree and need to be supervised during and after school for a period of time before practicing without being supervised.  Psychologists tend to look at patients (Social Workers call them clients, psychologists call them patients) through more of a medical model i.e.- in what ways is this person not functioning?  What are the symptoms…let’s treat the symptoms.  Psychologists do not prescribe medication.

Professional Counselors have varying ways to describe themselves, Licensed Family Counselors, or Licensed Marriage and Family Counselors.  Like Social Workers, Professional Counselors have Master’s Degrees with supervision and testing following their Graduate Degrees, however their Master’s is in Counseling rather than Social Work and they are more likely to be trained in methods akin to a Psychologist, and/or have specific training for their license such as specialization in Marriage and Family work rather than working with individuals.  They do not prescribe medication.

Pastoral Counselors have a Master’s or Doctoral degree in Pastoral Counseling.  They come to counseling with a spiritual perspective often related to a specific religion and will bring in religious and mental health elements into their work with a client.  They do not prescribe medication.

Psychiatrists are trained medical doctors.  Psychiatrists have been through a full medical training with all the tests involved with becoming a doctor but, just as a Pediatrician specializes in working with children, Psychiatrists specialized in mental health.  They most definitely tend to see patients through the medical model and do prescribe medication.  Psychiatrists often meet with patients for about 30 minutes and do medication monitoring.  I would highly recommend that anyone seeing a Psychiatrist also see a Psychologist or Social Worker as it is unlikely you will be getting any talk therapy with a Psychiatrist.

Mental health providers may be found in many different places, schools, hospitals, and in private practice.  They may provide individual, group, couples or family therapy, or a combienation of all of those.  No one group of practitioners has been found to be more successful in treatment than any other group.  However, there is one factor that increases the effectiveness of treatment across mental health provider types.  It will probably come as no big surprise that regardless of training background or methodology, the strength of the relationship between a client/patient and the provider  is the number one predictor for success in treatment.  So, if you see someone a few times, and the chemistry is just not there, it is probably time to switch to another provider.

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May 25, 2012 Posted by | thinking about therapy? | , , , , , , , | 5 Comments

Finding a therapist for a traumatized and/or attachment disordered child

Some elementary school counselors use books an...

Some elementary school counselors use books and other media to help their counseling (Photo credit: Wikipedia)

As therapist who specializes in both trauma and attachment disorders, I can tell you it is important if you are searching for a therapist for one or both of these issues, that you find the right therapist for your child.  Doing so will save you a lot of money and aggravation and is more likely to speed the healing time for your child.  To start, look at my post on  finding the right therapist for you or your child (you can find the link at the bottom of this post).  With these particular children, and probably people with other specialized issues as well, there are further steps you would want to take to ensure that you have the right person.  I see the steps for this particular issue as follows:

1.  Figure out if your child has “only” trauma, or has trauma with attachment related issues.  Here is the distinction, a child with trauma without attachment disturbance usually experienced a one time occurence, or something that happened over a relatively short period of time and was quickly identified.  Trauma with attachment related issues is trauma that also impacts a child’s ability to bond with their caregivers in a healthy way, for example abuse or neglect by a primary caregiver or ongoing abuse or neglect that a child did not disclose.  If you feel as though your child’s trust in adults to provide care for them has been altered significantly, you will want to see someone with knowledge of attachment related issues.  To clarify this distinction, a teenager carrying on a short-term, secret relationship with a much older adult that they thought was younger or who was tricked into a situation where they kept a secret because they were breaking the rules when they were traumatized does not fall into this category of attachment disturbance.  It is within reason to anticipate that teenagers will try to stretch or break the rules and it does not signify a break in a child’s core ability to trust that their parents will care for them.  A teenager whose step sibling was abusing them for an extended period of time whenever their sibling came to stay at the home does fall under the category of possible attachment disturbance.  The difference is the primary caregivers were around at the time of the trauma and did not know to stop it, while in the first example, the teen was doing an activity it would be reasonable to assume is developmentally expected but someone took advantage of them inappropriately.  When in doubt, I would see someone who specializes in both trauma and attachment.   If you find that there is an attachment related issue for your child’s situation, I would always make sure to take the child to a therapist that understands attachment because in order to work on attachment disorders or disturbance, you must know about trauma since the two go hand in hand.

2.  Once you have determined whether you are looking for a therapist with trauma training or whether you need someone with an attachment and trauma focus, follow the steps from my first post on finding a therapist and ask these additional questions.

  • What is your training in attachment and trauma?
  • What recent trainings have you attended or conducted that relate to attachment and/or trauma?
  • How do you conduct your sessions?

The answers to these questions, if you are talking to the correct therapist, should indicate that the person stays actively engaged in seeking training for attachment and trauma related issues.  Additionally, an attachment specialist will indicate to you that you will be in the room for most, if not all, of the time that your child is in therapy with them.  Attachment oriented therapy is significantly different in that a therapist focuses much more on your relationship with your child rather than their relationship with your child.  In traditional therapy including therapy for singular trauma, you would take your child to see the therapist, you might check in with the therapist at the beginning or the end, then your child would see the therapist alone for the majority of the session.

While traditional therapy is effective with many children, for children with attachment disturbance, it can actually damage a child’s relationship with their parent.  I have seen this happen, since a child with attachment disturbance has a tendency to reject caregivers, and, while they are alone with a therapist they may talk to their therapist about how terrible and difficult their parents are.  The therapist and child will bond over this and the therapist shakes their head in disbelief, meanwhile they may be overlooking a parent who is really trying their hardest to meet the child’s needs while reinforcing for the child that the caregivers in their lives are, in fact, inadequate.  Remember, children with attachment disturbance see adults as unsafe on some level and tend to fit them into these categories.  A skilled attachment therapist will spot when a child is doing this and help them to retrain their system of trust by teaching them how to find trustworthy adults and by training the adults in their lives to be trustworthy in the way the child needs them to be.  To learn more about attachment disturbance you can see my post linked below “What is attachment disorder?”

**A note to providers- I understand that you have seen parents who are, in fact, inadequate.  For this post, I am assuming that a parent who cares enough to read this post is adequate because they are involved and caring enough to research this issue.

Stay tuned for my post on getting specialized treatment for your child- the things insurance companies won’t tell you that can help you get your child’s treatment paid for.

April 16, 2012 Posted by | attachment, attachment disorder, health insurance, help for parents, thinking about therapy? | , , , , , , | 8 Comments

Two things your kids tell their therapists about you

Peers become important in middle childhood and...

Before I tell you what your children are telling me, let me say, I’m a child therapist and what your children are telling me about you might surprise you.  Keep in mind that I work mainly with children who have a history of trauma and/or attachment issues.  I see children with depression and anxiety too.   Your kids with attachment issues don’t tell me these things with words, but if you have a child like that, you know, they tell you things with actions.   You know your kids that you send to me?  The ones you would do anything for?  The ones you are so worried about?  I’m going to tell you two things they all tell me about you:

  1.  You need to take better care of yourself.  Now, if I had titled this blog “self-care for parents” you probably wouldn’t have read it, right?  But now you are, so please take a moment to remember your own childhood and ask yourself the following questions:
    1. What did you want from your parents that you didn’t get?
    2. Would you have been more likely to have gotten that from your parents had they taken more time for themselves that involved introspection and self-care?

If your answer is yes to either question, then guess what?  It’s true for your children also.  If you happen to be the parent of a child with attachment issues, you have to know self-care is of the utmost importance for you since those children tend to be, shall we say…very unrewarding.  I know, I know, you are one of those parents that is going to tell me you will take care of yourself when the kids are okay, right?  I have news.  There is this thing called attunement that makes it so that whole idea doesn’t fly.  Basically, when you are not okay, neither are your kids.  You know this is true if you were ever a kid with parents who were not okay.  Your attachment disordered children, if you have them, do not say these words out loud, instead, they tell you with their behavior by being even more miserable to you when you are not okay as a way to show that they are worried about you.  Every parent I have ever worked with who has a child with attachment issues finds that when they are doing better, so are their children.  Coincidence?  I think not.  Interested in learning more about actual ways to feel like you are taking care of yourself?  Stay tuned for more blogs about parental self-care and please- don’t skip them…do it for the kids.

  1. Another surprising one to many parents is this… kids want you to set limits.  I know!  The whining, negotiating, rule breaking and arguments threw you off, didn’t it?  Here’s what kids say behind your back- they know you do it because you love them.  If you didn’t set a limit, they will just keep testing to see when your love for them will kick in.  Here is a quick way to set limits that eliminates some of the arguments…”As your parent, I love you too much to let you do that.  You deserve better.”   This works when you are on the phone and they keep talking to you while you are trying to get self-care by checking in with your friend.  See how I put those together?  It sounds like this “I want to hear what you have to say.  Give me 5 minutes on the phone then you will get my full attention, like you deserve.”  Another example is, “You deserve to be in a safe environment, I love you too much to let you go to a party if I haven’t made sure responsible adults will be present.”  Sure you’ll get eye rolls.  You just blocked what they thought they wanted to do!  You also reinforced your love for them and that’s pretty hard to argue with – even though they will try.

Ultimately, what your children want is what we all know to be true in our hearts, when one person in a family is not doing well it is not just that child that has a problem, it is the entire system and the best way we can heal a hurting system is to heal the parts we can control the best- ourselves.  So, your work in helping your children, your most important work, is to care for yourself and your boundaries with love.  If you find it hard to do that, then it is not just your child that could use help from a therapist.

April 2, 2012 Posted by | help for parents | , , , , , , , , , | 8 Comments


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