This Is Why Getting Help Is So Hard, As Explained By A Licensed Therapist


Recently, I switched from being a family based clinician to an outpatient clinician.  In all my experiences in working with families, I have come to discover that many families who are seeking help for one or all of their family members do not understand what services they want, qualify for, or deserve.  I am hoping to shed some light on the services available to families or even what to search for when looking for services.  This is just part one as this is very complicated stuff.  Go figure, finding help is made difficult.

I will start with the things that I know to be true in Pennsylvania (mental health laws and services vary based on state then based on county if you are using services that get paid through Medicare or any other provider EXCEPT private insurance).  In the state of PA, anyone can technically call themselves therapists/life coaches.  Many people will go through a Master’s program and will practice as they are definitely able to do so.  Then some therapists will go through the process of licensure which has many requirements:

  • 2,000 hours of supervised work with clients
  • One full year of an unpaid internship (yup…unpaid.  I went to my full time job during the day then went to see kids at night)

So in a nut shell, as I work toward my licensure hours, for every 40 hours I spend with clients, I meet with my supervisor who is someone who has also completed all the steps needed and who has been in the field for a while.  Basically, I am being mentored for the first two years of my clinical work.  After that, I have to sit for an examination that tests my knowledge of the field.  Licensure is not required in the state of Pennsylvania to call yourself a clinician, however, why would you not want someone who is licensed as they have proven that they are qualified?  In a field where there are so many factors to consider and it is very difficult to prove improvement, it makes sense to look for someone who has proven their qualifications.

This leads me to the second part of what we should search for when looking for a therapist.  There are a few different types of therapists out there.  We have social workers (SW), professional counselors (PC), marriage and family therapists (MFT), and psychologists.  This is not a comprehensive list, but a general list to give you a sense of what you will typically find.  I feel MFT’s are the best fit for everyone, because that is how I was trained and believe it is the best treatment for anyone and everyone.

What do MFT’s do?  Marriage and family therapists have been trained in what is called “systems” work.

Here is an example of a family and their systems:

Johnny (5yrs) and his mom live in a home in a not-so-nice part of the city.  Johnny has not seen his dad in a few years and does not speak to him.  Johnny goes to school and will frequently stay at his Grandmom’s house while his Mom works.  His mom works at a nearby hospital.

The family system is Johnny, his mom, his MIA dad, and his grandma.  Johnny’s school is a factor in his larger system as well as the hospital where Mom works.  A system is a collection of people that directly impact each other.  A system’s approach to treatment is the belief that if Mom had a rough day at work and she comes home upset and late, that DIRECTLY impacts everyone in the system.  It is a beautiful way to look at family work because it eliminates the need to find what is “wrong” with one person in the system.  When MFT’s treat a child, the belief is that that child is the symptom barer of a much bigger, a systemic issue.

PC’s will work one on one with people and can also see families, but the MFT is clinically trained to handle a room full of people and their emotions.  Additionally, the thought process behind both lines of work are very different.  A PC is not trained to consider the full picture, rather, they like to handle the issue with the person in front of them.  There is nothing wrong with it, it is just a different way of doing therapy.  Social workers have been trained in helping families with more broad scope issues like housing.  They can be trained in how to talk with people, but think of it as the higher level of helpers, whereas with PC’s and MFT’s you are getting more specific and detailed in the help provided.

This “stuff” is very complicated, so hopefully I at least got your wheels spinning.