Sunday, 30 November 2014

What is the difference between a psychologist and a psychiatrist?

Many people get confused about what the difference is between psychologists and psychiatrists.  The difference rests primarily in the fact that psychiatrists have a medical background, whereas psychologists do not.  As a result, here in Manitoba, only psychiatrists can prescribe medication.  

Psychiatrists first train in general medicine and then specialize in psychiatry. While some psychiatrists do ongoing therapy with patients, more and more psychiatrists are devoting their time primarily to doing psychiatric evaluations in order to determine diagnosis and what, if any medication, is recommended.  

Clinical psychologists, on the other hand, spend their entire training learning how to assess psychological problems and how to do therapy.  Their practical focus is on doing assessments, therapy or both.  A family doctor is most likely to refer to a psychologist when a patient needs therapy, whereas, they are most likely to refer to a psychiatrist when there has been difficulty determining what the correct diagnosis is and/or when there have been problems sorting out what medication would work best.

Sunday, 23 November 2014

How do I find the right therapist?

I was going to entitle this entry "How do I find a good therapist?" but then changed the title realizing that you could find a very, very good therapist...a competent and knowledgeable therapist... but that would not necessarily mean that he /she was the right person for you.

It is always helpful when there is someone in your social network who can highly recommend a therapist based on first hand experience.  Interestingly, because birds of a feather flock together, it is likely that if a particular therapist helped a friend of yours, that therapist's style and orientation will be a good fit for you as well.  If health professionals are not a part of your social network and if you don't know of anyone who knows someone, do your research.  With the internet these days, there is access to all kinds of information.  Most therapists provide information about their background, orientation and areas of expertise.  Take those sites, though, that rate therapists with a grain of salt. While if there are many entries, you can usually get a sense of the therapist you are reading about, such sites also attract people who want to vent and complain!  If you don't know someone in the field, choose someone with education and experience. While we all know that credentials are not the be all end all, when you do not know the network, it makes sense to look for someone who has done both quite a bit of study and also has experience under their belt. As regards psychologists, here in Manitoba, in order to become a registered psychologist, the criteria are strict. Unlike in some provinces, you have to have a PhD which typically means years of graduate school and hundreds of hours of training with highly experienced senior psychologists.

It is not enough that a therapist be competent.  You need to feel a sense of connection and rapport that makes you feel comfortable, safe, and heard as well as a confidence that this person can help you to change and to be more true to yourself.  Some criteria used to determine whether a particular therapist fits the bill are similar to those one might use in choosing a friend (e.g., Can I trust them? Do they understand me?  Do they listen to what I have to say?  Do they show me respect?).  Then again, some criteria used to determine whether a therapist can truly help are quite different from those that would be foremost in choosing a friend.  For example:  Can they be objective?  Do they push me to see things from a different point of view?  Do they challenge me?  Do they know things about change and about how the mind-body works that I do not?  You need to listen to your own inner voice for this information and trust it.  Your own instincts are even more important than other people's opinions or how popular that therapist is.

Experienced therapists understand that they are not right for everyone and the confident therapist is one who is not going to be put off if you decide after the first session that for whatever reason, there isn't a match. So don't be afraid to speak your mind and call it quits after an initial interview if it does not feel right. You don't have to give "good reasons" to yourself or anyone else.  You may not be able to articulate it...you may just know that this person is not right for you.

Lastly, remember that a therapist is not a friend.  It's a one way street relationship where they are there to listen to you.  While I would never want to work with somebody I did not like, my primary purpose is not to like them or to have them like me, it is to help them!

Saturday, 8 November 2014

Can people really change?

For me, therapy has always been about the business of change.  If therapy does not result in an individual being able to manifest significant changes in their life, what is the point of all that talking and all those great insights?  Actually, many people do not realize this but insight does not occur using intellect alone.  To gain real insight, one has to experience the “aha” not just with the head but in one’s very guts and in the heart at a profoundly deep emotional level.  That is why it is possible to be very smart, grasp all kinds of new ideas about oneself and yet not change at all. That is why self help books continue to be a billion dollar industry.  Some clients laugh when I tell them that real insight is kind of like an “emotional throwing up”.  Something you thought was true is no longer and there is a whole new knowing that occurs at a gut wrenching level; old beliefs have to be discarded and then you have a piece of the puzzle that you never had before.  That’s insight and without it, real change, lasting change, does not happen.

Can people really change?  I think so.  No, I know so.  How?  Because I have seen it over and over again.  There is no way I would have stayed in this business if that were not the case.  Clients often wonder out loud how it is that I can do what I do...talking with people all day about their pain and their problems?  It is because I am in awe of the changes that I see people make, sometimes even jealous of their transformation and the rewards of witnessing such change is beyond inspiring. 

The reality, though, is that real change is hard and it is human nature to stick with what is familiar no matter how painful life may be.  It is because of this that most people do not come to see a therapist and do not make significant changes in their lives until they have endured a great deal of turmoil. Going to see a therapist is often a last resort after people having tried everything they know and have come up empty handed.  That is why, as clich├ęd as it may sound, crisis can indeed be breakthrough.  Some have called it “breaking open”.  In fact, significant change is not likely to happen without it.