Dr. Frankie L. Preston, Psy. D., Inc.

Licensed Psychologist

Licensed Marriage and Family Therapist

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Things To Consider

Considerations When Choosing or Making Referrals

to Mental Health Professionals (MHPS)

By: Frankie L. Preston, Psy.D.

Licensed Psychologist

  

     INTRODUCTION: Generally when mental health problems present, the person, couple, or family is caught

    off-guard. Difficulties might occur as a consequence of situational circumstances such as sickness, death,

    divorce, affairs, job loss, legal charges, etc. or when symptoms intensify to a reaching intolerance: for example, 

panic disorder or depression. This can cause a person to become unable to function as they normally would,

perhaps thinking of hurting themselves, or feeling of harming others, which would typically be out of character. 

I often comment to clients:  “given certain circumstances, if you are not ‘depressed,’ ‘worried,’ ‘anxious,’ etc., then

perhaps you’re more unusual than those experiencing ‘nothing,’ ”which might also represent a problem.” The

point is: we have a determined amount of tolerance for stress, and although we might resist the notion of being

overtaken by what life deals, ultimately we cannot control other people, circumstances, or “happenings,” but

we can control our reaction to them, and we have our limits. This is why professionals become educated,

trained, experienced, and practice as mental health providers. Regardless of impressions you have about those

seeking mental health services or those who provide these services, many of us experience difficult people, places,

 and circumstances that will take us beyond the confidences we often take in our families, friends, churches,

 bartenders, hair-dressers, etc. While “good listeners,” and a relief to express ourselves life can become

 difficult - well beyond the scope of their good intentions and best advice they might offer.

Thus, a MHP is needed. 

 

The fact is mental and emotional problems are seldom anticipated, often catching people off-guard and unprepared.

These struggles are not any more “elective,” than physical illnesses, similar in manner to one who occasionally has

to face physical crises or emergencies. Both affect the other, emotional or physical, spilling into our personal,

marriage, family, work, financial, etc. lives. Emotional or physical illnesses are systemic processes, and cannot

 be “compartmentalized.” Seeking the assistance of a licensed mental health professional is the proper way to

deal with these inevitable challenges, crises, transitions, and dilemmas. 

 

Social stigma continues to exist, and some may view persons experiencing emotional difficulties as if they were

 “elective,” being something they’ve either chosen to experience, or the result of something they’ve failed to

do or mishandled. By saying: “keep your chin up,” “forget about it,” or any number of statements basically

 translating into “stop that,” our friends, families and even strangers are likely attempting to console or encourage,

 but the message one receives is: “your symptoms would go away if you quit or elected to do something.”

Therefore, the illogical conclusion is: “we must have made a choice to ‘create our problems,’ so we can make a

 choice to “make them go away.’” To various degrees, we do create our problems, and we have to change certain

choices, decisions, affiliations, etc. if these problems improve or “go away,” but few actually decide or elect to create

 these problems. This “feeling of being stuck,” being on that emotional “merry-go-round,” is one of many reasons

why people resist turning outside of themselves to seek a MHP for potential solutions. Apathy, “it won’t get any

better,” becomes the fuel keeping many “stuck.”

 

If we believe others think our emotional difficulties are “elective,” and somehow we can’t make them simply go

 away, or stop feeling as we do, self-critical thinking and shame might compound problems that “snow-ball,” or

gather mass and speed. What others might think, particularly family, significant others and employers,

 frequently influence us to postpone early intervention, even though society at large has made monumental

strides in becoming more accepting of emotional and mental illnesses in comparison to the prejudices of thirty

years ago. The fact is treatment approaches, both therapy and medications have tremendously evolved, and even

 the most serious illnesses, those more complex and chronic, once considered as untreatable, are much easier to

 manage with the proper treatment attitude and planning. Accordingly, my purpose in writing this article, is to

assist those facing their emotional crises, knowing help is available, understanding some options to consider, and

making a better-informed decisions when choosing or referring someone to a mental health professional (MHP).

Some of the most common questions I’ve received are: what are the differences in MHPs; what do the different

 degrees mean; and what do all those acronyms mean after the MHP’s name (are more letters better…

does that mean smarter)?

 

Before addressing these very relevant questions, I must first stress, that time is of the essence! If someone

 is experiencing a mental health crisis; if they seem unable to control themselves, if they are a danger to

themselves or others do not hesitate, call 911, get emergency personnel involved immediately, seconds do count.

Later, you can entertain alternatives, and make more informed choices about choosing a MHP, but failure to

respond to the crisis can easily result more complicated situations with more challenging and possibly

irreversible consequences. Most outpatient MHPs are not equipped to handle “out of control,” “harm to self,” or

“harm to others”- type emergencies and many will say this on their telephone message systems (“if this is an

emergency, call 911”). Even though seemingly ridiculous to a casual caller, especially if you are in ongoing therapy

 with someone, simply wanting to leave a message while this diatribe plays, the “call 911” message might appear

 pointless, but the same message is recorded by so many MHPs it indicates general agreement - when

emergencies present, callers must contact local sources with authority, facilities, and the professional diversity

required to promptly and properly deal with that emergency. All emergencies are not equal, so don’t wait.

 As for situations not as “life-threatening,” or not indicative of damage-proneness, you can be more proactive

than reactive, and take ample time to consider options, being better enlightened, research, and being more

informed about some of the intricacies associated with selecting a licensed MHP.

 

There are a number of well-qualified MHPs in the North Alabama area, and the task of making this choice can be

 difficult. Considering the types of degrees, the kinds of licensure, the “certifications” listed, their advertisements,

the acronyms following their names, and their areas of “specialization,” can be an awesome task, especially due

to not anticipating the crisis that prompts your decision. Plus, are they are listed on your “insurance provider panel”

 were they recommended by someone who knows them as a MHP or otherwise (friend, neighbor, speaker at the

Rotary Club, etc.), and what about other practical factors (i.e. travel distance, office times, solo or group practice, etc.)?

 All of these questions are worthy as you arrive at an informed decision for you, your family, friends, etc. Much of

 the information presented below can assist you in better knowing how to decide.

 

IN BRIEF, AND IF YOU ONLY READ ONE THING, READ THIS: Anyone seeking a MHP for a personal

therapist, a referral source, or as a consultant seeking another point of view from one with whom they have been

 working would be well-advised to do the following (bullets):

·        Request a curriculum vitae (resume, which should address most bullets);

·        Check their type of licensure (regulated by state law) to practice;

·        Inquire about highest level of degree attainment (masters, doctoral, etc.);

·        Establish what area their degree is in (counseling, psychology, education, religion, etc.);

·        Review professional experiences (i.e., places employed, the duration {local versus

 numerous transitions}, part-time or full-time, types of clinical experiences versus work

 in administrative or as a teacher, etc.);

·        Check their prior training (practicums, internships, supervision, specialization

{by what criteria and how achieved}, etc.);

·        Request their continuing education documents (minimal requirements versus

maximum opportunities, focus consistency, local or travel, workshop providers

{Google the providers and/or sponsoring organizations});

·        Inquire from several sources (i.e. doctors, judges, attorneys, ministers, persons who

 have prior worked with the MHP);

·        Determine if MHP is covered by your insurance’s provider panel. This is a

 convenience  for you, but might have no relevance about whether the MHP is best qualified

to serve your interests and mental health needs. If a pre-determined and “approved provider

 panel” exists, review the MHPs who are covered, and apply (if possible) the same bullets

prior noted above. “Apply” is underlined for a reason…specifically because your

 insurance company’s criteria might be different in terms of who they rather than you might

 choose. Yet, you still have a right to inquire about the bulleted items and information.

 

Specialization and experience are among the most important areas to consider when selecting a MHP. One

obviously cannot begin their professional careers as a “specialist;” achievement requires the MHP acquire a

focus, faithfully direct their efforts to achieve area/s of expertise; and persistently seek educational and

supervisory experiences to hone the skills required to acquire knowledge and involvement to be genuinely referred

 to as a ‘specialist.” In the field of mental health, one cannot achieve specialization in all areas (over 50

specialty designations are noted by the American Psychological Association). Once specialization is achieved,

 consider this accomplishment is not static, meaning that once a MHP has acquired the necessary education,

 training, supervision, and licensure to hold themselves out as such, specialization has to be maintained…it is

 ever-evolving. Therefore, the shopping consumer might look at the consistency (versus variations, changes,

 inconsistencies, etc.) of the prospective MHPs path.

 

While reviewing their “knowledge and skills base,” level of education attained, the specific area of concentration

 listed on their degree/s are imperative for consumer selection. If you enjoy detail, research the practitioner’s

degree attainment and the primary area of study. If in “psychology” variations like: “clinical, educational,

experimental, developmental, industrial,” can appear and the same is true about practitioners whose educational

 focus was “religion and theology,” or “social science,” etc.  Where, what type, and duration of internship; what

type/s, if any, supervision (beyond that required) attained; specific licensure type/s (and what the law defines

them as being able to do/not to do); emphasis on the educational area (whether   involvement has focused on

 clinical or academics, etc.);  if employment has been consistent or spent in other fields, etc.; if continuing

 education choices have been relatively consistent, or is there an appearance of acquiring minimal hours to

simply maintain licensure can easily reflect if a practitioner is truly seeking evolving education or getting hours

required to practice are distinguishing factors; what, if any, certifications have been obtained; and what is

reflected during the total employment record and tenure while working areas of psychology, counseling, social

work, marriage and family therapy, or psychiatry? Once you’ve answered these questions, you should have an

extremely good idea about “qualifications,” and know if your selection is suited for a consultation.

 

The five disciplines immediately noted above are regulated by law in most states to include Alabama.

“Boards of Examiners” in Psychology, Counseling, Social Work, Marriage and Family Therapy, and Psychiatry

 have been legislatively recognized  by the State of Alabama, specifically for the purpose of regulating those

who hold themselves out to public consumers to privately engage in these MHP practices. Unlicensed practitioners

exist, and typically practice under the auspices of a non-profit umbrella-organization (i.e. mental health centers,

 family service centers, rape crisis organizations, inpatient treatment facilities, church-based counseling centers,

 and other religiously-acknowledged organizations, etc.). Many unlicensed practitioners are well-qualified and

require less payment, if any. The potential “down-side” is: if an issue of “malpractice,” use of unorthodox

 techniques, or insurance or legal matters arise, unlicensed practitioners are not subject to or regulated by State

Licensure Boards – no license – no regulation. This absence of regulatory-legal recognition, might invite one to

practice as a “MHP,” sanctioned by an agency under which they are affiliated, but they as individual MHPs are

 not legally recognized by the state (sometimes greatly lacking in the above “bullet listing”). If “malpractice” is

suspected, other than appealing to the umbrella agency, the consumer has little, if any, recourse through legally

 recognized licensure boards. Reporting to the Alabama Attorney General might prove an effective alternative,

and civil suits can be initiated by disfranchised consumers, but all-too-often little is gained financially (typically

one must possess a valid license to acquire malpractice insurance) and much can be lost, emotionally

(compounding problems, struggles, etc.).

 

To assure that the MHP you select is licensed to provide mental health services, the following licensure types

 can be confirmed by  legislatively designated boards (call, Google, etc.). Definitions of titles (what an MHP is called),

and in some cases, “practices” (what one may or may not do within the scope of their license) and are regulated by

 many of the “bulleted items” below noted (Google the various boards for details):

 

COMMON TYPES OF MHP LICENSURE IN ALABAMA:

 

Licensed Certified Social Worker (L.C.S.W.)

Licensed Marriage and Family Therapist (L.M.F.T.)

Licensed Psychiatrist (Alabama Board of Medicine, physician specializing in psychiatry)

Licensed Psychologist (requiring doctoral degree, an internship, passing national exam, etc.)

Psychological Technician (application approved, master’s degree minimal, passing a national exam at 60%

level, allowed to interview, and test under direct supervision by a licensed psychologist, but cannot

 engage in psychotherapy)    

    

Licensed Professional Counselor (L.P.C.)

Counselor Associate (application approved, master’s degree minimal, passing a national exam, allowed

to counsel, under supervision by an “Approved LPC Supervisor”)  

 

The author invites readers to check information - you might find more descriptive and perhaps more

accurate definitions. This is simply a start, for consumer awareness.

 

These are the primary licensed MHPs (Psychiatric Nurses with certain credentials under certain circumstances

 might also be included) or those pursuing licensure (e.g. Counselor Associate) allowed to independently practice

 in the mental health disciplines in accord to the laws of the State of Alabama. Psychiatrists and psychologists

 are generally more likely to be “insurance eligible,” yet, policies and provider agreements vary greatly. Licensure is

often associated with the degree held by the MHP, and below are descriptions of the usual kind of degrees held

 by licensed MHPs:

 

TYPES OF DEGREES GENERALLY REQUIRES FOR LICENSURE AS A MHP IN ALABAMA:

 

Doctor of Education (Ed.D.)

Doctor of Philosophy (Ph.D.)

Doctor of Psychology (Psy.D.)

Medical Doctor (M.D. who completed a specialty in psychiatry)

Osteopathic Doctor (O.D., who might complete a specialty in psychiatry)

Doctor of Social Work (D.S.W.)

Doctor of Divinity (D.D.V.)

Doctor of Theology (Th.D.)

Doctor of Nursing (D.N.)

Education Specialist (Ed.S.)

Master of Arts (M.A.)

Master of Science (M.S.)

Master of Divinity (M.Div.)

Master of Education (M. Ed.)

Master of Nursing (M.S.N.)

Master of Science in Social Work (M.S.S.W.)

Master of Social Work (M.S.W.)

Master of Science in Psychology (M.S.)

Master of Science in Counseling (M.S.)

Master of Science in Marriage and Family Therapy (M.S., MFT)

Doctor of Marriage and Family Therapy (Ph.D. in MFT)

 

The point is: historically persons with the above degrees have been awarded licensure by one or more

legislatively-recognized boards. At one point, a person with a Master of Arts degree in Psychology could be

 “grandfathered in” and practice as a licensed psychologist during the 1960’s due to the educational-degree

requirements being less stringent. Since that time, most Alabama Boards have become more meticulous and

precise about degree-coursework requirements. Currently, the Psychology Board requires a doctoral degree in a

related discipline. Those acquiring Ed.D., D.Min., Th.D., M.Div., degrees, while once being commonly recognized

as sufficient for licensure, fifteen to twenty years ago, are much less likely to qualify given current standards for

 licensure as psychologists, counselors, or marriage and family therapists. The Psy.D. degree has increasingly

 became more prevalent than the Ph.D., nationally. The licensure of counselors, requires a degree (M.S.) in

counseling, and since the M.S. in Psychology is less specific to the license being sought (‘counseling”), it is

often determined unacceptable for licensure as a “counselor.” The point is: more and more, degrees specific to

 education and the license being sought are aligned and degrees such as those in divinity, theology, and

education, have lost favor with licensure boards unless specific coursework meets the more stringent and precise

legal requirements and unless and until adequate supervision can be demonstrated. In recent years the degree

 obtained must reflect the licensure being applied for and the coursework for attaining that degree is quite

specific within the Boards’ policies.

 

Addressing “certifications,” “memberships,” “registrations,” and the associated acronyms,

some common ones are listed below:

 

AAMFT (American Association of Marriage & Family Therapy)

AAPC (American Association for Pastoral Counselors)

ABPP (American Board of Professional Psychology)

APA (American Psychological or American Psychiatric Association)

ASCH (American Society for Clinical Hypnosis)

ATSA (Association for the Treatment of Sex Abusers)

CADC (Certified Alcohol & Drug Counselor)

CFE (Certified Forensic Examiner)

CPT (Certified Play Therapist)

DAC (Doctoral Addictions Counselor)

EMDR (Eye Movement Desensitization Reprocessing)

NRCGP (National Registry of Certified Group Psychotherapists)

RCE (Registered Custody Evaluator)

SPA (Society for Personality Assessment)

 

Once licensure is achieved, the MHP typically gets bombarded with “invitations” to affiliate with certain national,

 state, or local groups, and to become “certified,” or become part of a “registry” in certain organizations. As noted

prior, affiliation can be lengthy, involved and detailed, or in some instances mere application and payment of

a fee, or completion of a workshop, can result in “certification.” Some professionals choose to add these acronyms

 to their business cards, brochures, etc. In some cases this might appear confusing, and in other instances this

could reflect being familiar with utilizing a critical technique or affiliation that is of importance to the

consumer. Of greatest importance, licensure comes before “certification,” and the above list is miniscule – there

are hundreds. I suggest that consumers simply ask the MHP, or “Google,” recognizing that the acronym might

cross-over into other fields (i.e. Department of Defense, computer abbreviations, etc.).  

 

Finally, but of great importance, once you’ve reviewed the “main bullets,” and found some MHPs as a potential

 “fit”; once you’ve made a list of potential MHPs, or decided on one; make an appointment and meet with them.

 Begin to form some ideas about what attributes or deficits would fit your style. Ask yourself: “do they appear like

 someone with whom I feel at ease; sufficiently comfortable to talk about difficult personal history, thoughts, and

honest feelings; and do I get a sense I can accept feedback I might not like; or not? If not, try giving the process a

 couple of more meetings but if the first impression is a total misfit, don’t waste further time or money.  The

point is: difficult issues didn’t occur immediately, and time might be required to see of you can achieve that

comfort rather than immediately concluding the person and the time isn’t right, perhaps an excuse to run

(maybe what keeps you “stuck”). After a good faith effort, if you can’t answer the questions in a positive manner,

move on. There are numerous MHPs in the Huntsville-Madison-North Alabama area; some in large practices,

 some in quaint solitary places; some MHPs are naturally easy to speak to, and others who are quite difficult;

their office atmospheres appear inviting, and some do not. These are among factors which cannot be

 dictated by education, licensure, continuing education, etc., and for some people these attributes or lack thereof,

 are very important. You are the only one who can gage the “quality of ambiance.” If you feel interpersonally

 uncomfortable, that you’re being judged, the “ambiance” is missing, you might have limited success, so don’t

feel as if you’ll be disapproving of the MHP. The fact is most of us have had these experiences, and we will likely

have these experiences again, so if you sense this relationship as being tense, uncomfortable, etc. exercise your

 options. MHPs are not immune from quirky personalities, or character flaws.         

 

Whether you find a typo or an inaccuracy, I’m open to feedback at: scisnerof@aol.com

(this is: forensics spelled backwards). 

 

 

 

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