There is a LOT of advice floating around out there (and here I am just adding to it!) Most of it is well meaning but it can be difficult to pick apart what might be relevant to your situation. Here are some practical things to know.
Therapists and what those letters mean.
As of this writing I am an LPC Associate. But what does that mean? I’m in Texas where people trained and licensed in community mental health treatment are called Licensed Professional Counselors. In some other states the same training is called LMHC Licensed Mental Health Counselor. What the “Asscociate” part of my license means is that my license is relatively new and I’m legally required to consult with a more experienced supervisor (LPC-S with special training in supervising) weekly until I have reached 1500 clinical hours with clients (and another 1500 hours of clinically related work)
Here is a rundown on what each acronym stands for:
LPC, LPC Associate: Master’s degree, and state issued license. Assessment, diagnosis and treatment of mental health issues. May have additional training in working with couples and families.
LMFT, LMFT Associate: Licensed Marriage and Family therapist: Master’s degree, state issued license. Assessment, diagnosis and treatment of mental health issues. Focus on relationships between people. Licensing requires relational hours.
LCSW: Licensed Clinical Social Worker, MSW Master Social Worker: Master’s degree, state issued license. Assessment, diagnosis and treatment of mental health issues. Also trained in case management and advocacy.
PsyD: Psychologist: Doctorate degree, state issued license. Assessment, diagnosis and treatment of mental health issues. Also trained in specific assessment tests such as IQ.
Do I need someone who is fully licensed? What does that mean?
Fully licensed is someone who is no longer under mandated supervision and has met certain requirements. This is where things can get a little more complicated because there are both benefits and drawbacks to working with both Associate level and fully licensed therapists. For LPC the supervision time can range from 18 months to 5 years. So someone who has recently become fully licensed may only have supervised experience of a year and a half but has seen more clients in that time. Benefits are they have that experience and drawbacks are potential burnout from seeing that many clients in that range of time and lack of processing of that experience. Someone on the 5 year range has had more time to assimilate their experiences and has had more supervision. At 18 months the person had approximately 75 hours of direct supervision, at 5 years the person could have 250 hours of direct supervision. Drawbacks here are this person is probably taking fewer clients and may be full, or may have other life limitations that required the slow progress. They may have taken a break at some point.
Other benefits to someone who has been licensed for a while is a range of experience working with clients. A question to ask is what is their range of experience working with Gifted clients. None of the training programs require any training in working with Gifted individuals. Any of that training will be independent of the license. A drawback to an “experienced” therapist is both the risk of burnout, and the risk of falling into patterns based on that experience. Someone who is freshly licensed might be more open to differences. Unfortunately, this isn’t something that is easy for a client to figure out based on a CV. So be prepared to ask questions about the provider's philosophy and approach to neurodivergence as well.
It really is all about the relationship
This is why it is really important to pay attention to how well you or your child is getting along with their therapist. All the training and experience in the world won’t matter if you don’t feel like you have some trust in the person you are working with. Shop around. Try someone for three sessions and see what you think. Or stick with someone for three years and decide that you might need a different approach for a different issue. A good therapist will understand. Do worry about hurting our feelings (we have ways to manage ourselves and if we do take it personally that is our own stuff to work through) You might even take a break from your therapist, try a different modality, and then come back.
Modalities? What are those?
In grad school I had to study hundreds of different theories and philosophies about how people get off track and how they get better. (you might notice that I don’t use the words “mental illness” or “disorder” and that is due to my own philosophies about how people can get lost in life and how they can find themselves. Many types of neurodivergence have been called disease throughout the years.) The theories are about how a therapist approaches the work they do. How they think about the world, clients, and themselves. What sort of lenses do they use to make sense of their work? If you believe that crystals and Tarot cards are key to your healing and your therapist does not, that can be an issue. (me, I believe in brain science which means that these beliefs are key, if you believe that crystals and Tarot cards will make a difference they will. If you don’t, then they won’t.)
Theories are part of who your therapist IS, Modalities are what your therapist DOES.
The modalities are the principles and techniques that therapists use to bring about change. Modalities tend to break down into two basic groups, though there is often a lot of crossover. These are talk therapy and experiential therapy. Talk therapy is what most people tend to think of when they think about therapy. It is based on mental and verbal processing while the client talks about issues. Experiential therapy is about having an experience that facilitates change, a number of these use the body or physical experiences. Experiential therapies are often good for Gifted people because they frequently can either be trapped in their heads, or in talk therapy will say what they think the therapist wants to hear, or will use intellectual defenses to keep away from important topics. A combo can be good too, because of these same intellectual strengths.
A brief explanation of some common modalities.
There are so many different modalities! Some common ones are CBT, DBT, EMDR, IFS, Equine Therapy, Art Therapy, Play Therapy, Sand Tray, Nature Therapy, Somatic Experiencing.
CBT: Cognitive Behavioral Therapy. Works to change thinking patterns and behavior. Uses talking and worksheets.
DBT: Dialectical Behavior Therapy. Works with emotions. Uses talking and building coping strategies.
EMDR: Eye Movement Desensitization Reprocessing. A specific protocol using side to side input (eye movement or tapping) to process memories and beliefs, usually used to treat trauma.
IFS: Internal Family Systems. Sees the internal landscape of the mind as an interaction of parts of the personality. Uses introspection, meditation, and internal dialog.
Equine Therapy: Not all Equine Therapy is the same! There is Equine Assisted Psychotherapy EAP, Equine Assisted Learning EAL, Equine Facilitated Learning EFL, etc. Look for the words "Psychotherapy" or "Mental H when wanting a mental health professional involved. Below are some common ones but there are many more.
Trauma Focused Equine Assisted Psychotherapy: Sees connection as the means to healing, and uses experiences and relationship building with a horse. Typically uses a team model of a mental health professional and a horse professional.
EGALA: Equine Growth and Learning Association: Horses provide real time interactive feedback. Often focuses on problem solving. Uses a team model of a mental health professional and a horse professional.
PATH International: Professional Association of Therapeutic Horsemanship. Mainly treats physical and life skills issues, but some centers provide mental health treatment.
Art Therapy and Expressive Arts:
Anyone claiming to be an “Art Therapist” has to have special licensing. They have to have an art therapy specific degree and art therapy supervision.
Expressive Arts providers have a vast array of training from very little to enough to be an art therapist—but without the specific legal hoops needed to call themselves an “Art Therapist”
Play Therapy: Sees play as a child’s natural language. Uses toys, puppets, art materials, etc. Play may be child or therapist driven depending on therapist. A Registered Play Therapist has had specific training and supervision in play therapy.
Sand Tray: Taps into subconscious or non-verbal expression by building scenes in sand using miniature figures, natural items, and toys. A sand tray practitioner may be certified by the International Association for Sand Tray.
Nature Therapy: incorporates the natural benefits of being outdoors and often movement into either a talk therapy or experiential therapy process. There are various organizations that offer certification but no overarching body.
Somatic Experiencing: Trauma is held in the body. Is body focused and sometimes uses touch to heal trauma. Requires special training to use touched based interventions.
A note about certifications.
The most important element is that your therapist is licensed. This gives you an idea that your practitioner has training in handling difficult mental health issues such as trauma and suicidal thinking.
Your mileage may vary with certifications. Some require quite a bit of training and supported experience, others do not. Some certifications lean more towards indoctrinating a therapist with a specific protocol. If you are looking for something very specific like EMDR or Somatic Experiencing certification is important. However specific protocols may not have the flexibility to work with a Gifted person in a creative way. Another aspect to certifications is that they require a lot of time and expense on the part of therapist, someone who has spent a fortune on their training will charge more. Personally I think the therapeutic relationship is more important than many certifications, but you have to decide what makes you feel the most comfortable.
Pulling it all together.
A good therapist will be competent in a handful of tools in order to address your (or your child’s) current needs. A therapist may need to blend some more cognitive methods with some body based methods depending on the type of distress, and the typical ways in which you cope with distress.
A good therapist for gifted will have had training and experience in working with gifted individuals and it is even better if they also have lived experience as a gifted person themselves. They will have a positive philosophy about neurodivergence and want to work with strengths in addition to addressing areas that need growth. They will be flexible and creative in the ways they can approach giftedness--since it can come in so many "styles" and be open to input.
Most important, when you find the right therapist they will "feel" right, you will feel like they get you, and understand both your gifts and your challenges. (and how sometimes the same things can be both!)
*yes I'm publishing in this on April 1st--but the info is solid. I got distracted by my own neurodivergence and missed putting out in March... :)