Last December I was honored to be a guest on “Let’s Talk Sex With Shanna Katz“, a live on-air talk show in Phoenix, Arizona. We were talking about sex and psychology and, naturally, the time flew by and we had barely scratched the surface when it was time to stop. I promised Shanna I would follow up my interview with some information for her listeners and readers. This is a short post for now, but please send me any questions and I will continue to add to it.
Types of therapists:
There are a lot of different kinds of therapists, and many different types of certifications and licensures. Here are a few common ones:
A psychiatrist will have a medical degree (MD) as well as specialized training in mental health. Psychiatrists can prescribe medication, and although some psychiatrists do provide counseling, many follow a more traditional medical approach and coordinate care with psychologists who provide talk therapy on a more regular basis.
Psychologists who provide counseling services typically hold either a Ph.D. (which requires a dissertation and is a research oriented degree) or a Psy.D. (which does not require a dissertation and is focused primarily on practice rather than research). Psychologists are trained in neurology, assessment and diagnostics, counseling, and research. Many also receive training in pharmacology, and in some states are allowed to prescribe certain medications. State licensure is required to be identified as a psychologist.
Marriage and Family Therapists (MFTs) hold a master’s degree and receive a great deal of training during and after graduation. They generally work with families and couples, although they are licensed and qualified to provide individual therapy as well.
Licensed Professional Counselors (LPCs) and Social Workers (LCSWs or MSWs) also hold master’s degrees and receive extensive training in areas such as social services, advocacy, and counseling. They work in a variety of settings and often specialize in particular fields, such as addictions or grief.
A Sex Therapist is someone who has training as a therapist as well as specialized knowledge about sex and sexuality. She or he may hold any of the licensures listed above, and there are also a couple of universities that offer graduate degrees in Sex Therapy.
You can’t really tell if a therapist is going to be a good fit for you based on their degree or title, but you should definitely look for someone who attended a reputable training program and who is licensed.
Finding a Therapist:
Finding a therapist can be difficult, especially if there are parts of your lifestyle or identity that are generally stigmatized by mainstream medical care. Even if you have insurance, you may want to consider looking out-of-network to find someone who is a good fit. Many counselors offer sliding scale fees or will provide insurance reimbursement forms. If you need to stay in a network, though, don’t give up. Sometimes you’ll need to meet a few therapists before you find the right one for you.
Word of mouth is always a great tool if you’re willing to ask around, but if seeking therapy is something that’ s private for you, that’s okay. Here are some other resources:
Choosing a Therapist:
When choosing a therapist, you’re looking for a certain fit. Therapists operate from a variety of different approaches, and what actually happens in the therapy room can vary widely. Therapy is intensely personal work, and will be challenging, so you need to feel connected to and safe with the person you’re working with.
First, make sure that the practitioner has training in the area you are seeking help with. If you are dealing with sexual assault, find someone who has experience working with that kind of trauma. If you need to address family issues in a multi-partner relationship, you’ll need someone who is skilled with systemic or family therapy. If you’re experiencing sexual dysfunction, you may want to seek a sex therapist or someone who has training specifically in the area of sexuality. Many therapists have training and experience in more than one area, which is good, because humans are complex and are often experiencing more than one problem at once!
When you are ready to make an appointment, you don’t have to say why you’re calling over the phone. When you sit down with the therapist and start talking about why you’re there, pay attention to your instincts. Is the counselor receptive to your concerns? Does she or he answer your questions? How do they react when you disclose your relationship style/occupation/sexual preferences?
A lot of counselors are not going to be familiar with sex-positive language. Ignorance about your lifestyle is not necessarily a bad thing, but a chilly reception or a closed perspective on it should be warning signs that it might not be a good fit. When I landed in my therapist’s office, she’d never heard of BDSM or Leather. I could tell by her reaction, though, that she was interested in me and willing to learn, so I gave her a few resources (books, websites, etc) and she was very receptive. In all honesty, her ignorance was actually helpful because it forced me to really evaluate what I do and why as I was explaining it to her. Her “outside” perspective often helps keep me from blindly accepting the things I experience and learn in the kink lifestyle.
Do not be afraid to voice your fears about therapy or the therapist herself. Any therapist that would take offense at that does not need to be your therapist! It’s not uncommon to feel awkward at first, but talking about your concerns is a great way to start to build that therapeutic relationship.
The Therapeutic Relationship
The relationship you have with your therapist is really unique. It is most likely the only relationship you will ever have where the other person has no connection to anyone else in your world and who is solely interested in your welfare. It truly is amazing, when you think about it! It’s like having your own private cheerleader and coach that no one else can touch.
The therapeutic relationship is often a comfortable environment where you can explore yourself in privacy and safety. At the same time, it can sometimes mimic your outside relationships. If you tend to get angry quickly, you’ll probably get angry in therapy. That’s a good thing because it lets you figure out what’s going on with the help of someone who is actually comfortable with your anger. Same idea with sadness, or any other emotion. We’re often taught to shut down our emotions, and that can make us uncomfortable with other people’s emotions too. It’s a unique experience to sit with someone who is comfortable with emotion.
The therapeutic relationship can take time to develop, and, since that relationship has been shown to be the most important factor in therapeutic progress, therapy does take time. It’s kind of like working out – you don’t go to the gym for an hour and then wonder why you aren’t looking more muscular. It takes time, consistent work, and some soreness too – therapy isn’t always comfortable, and it can sometimes feel worse before it feels better.
Because I’m not sure what issues you have run into or what information you’d like to know, I’m gonna stop there and open up this topic for questions. Please post them below, or email me and I will answer them here.