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How do I know if I, or my child/teenager, needs therapy?

     There are many ways people decide if they need or want to seek therapy. We are all individuals and handle difficulties in our unique ways. If you are an adult and have tried to solve your issues on your own for some time (months or even years) without much success, that is a pretty good sign that you could use some input from an objective source. Sometimes, people notice that their mood is just not as good as in the past, maybe it hasn't been for some time, and they can't seem to get back to being 'themselves' again. Or, you may know you have had problems in certain areas of your life and have been putting off dealing with it. Now may be the time!


     For children and adolescents, the signs can vary also. Often, younger children are not skilled at telling us how they feel (not nearly as good as telling us what they want!), and you may notice behavioral changes instead. Perhaps a formerly outgoing child or teen has become more withdrawn or quiet, or a pretty well-behaved child has started being aggressive or getting in trouble at school. Teenagers, of course, are known for being emotional (though not all fit that stereotype). They may ask for treatment, or their lower grades, poor behavior, or family conflict that seems way beyond the norm might cause a parent to seek an evaluation.


     The good news is that simply seeing a therapist does not commit you to a lifetime of treatment, nor does it mean that you as a person are weak or have failed at life, parenting or whatever. In fact, the person who works up the courage to walk in my office for the first time is, despite their 'issues,' a very courageous individual!  Most therapists, including me, do NOT want to keep you in treatment for any longer than you need to be. If you are not sure if what you (or your family member) is experiencing warrants therapy, it doesn't hurt to ask.



How do you go about choosing a therapist, and what do all the initials after their names mean?

     The choices in therapy can seem overwhelming!  Many people choose based on the recommendations of their friends, colleagues, minister or physician. State and national associations usually have a directory of members on their website (for example, the one for Texas psychologists is http://www.texaspsyc.org/search/custom.asp?id=1942 ) . Some people just check websites and pick someone who sounds like a good fit for them and their problems. One way to go about deciding is to make an estimate as to whether the issue(s) you feel you need to discuss are the type that are likely to involve medication, or not. That is because in Texas, as in most states, psychologists and other mental health providers do not prescribe medications; those must come from an M.D., which could be a family doctor, OB/GYN, psychiatrist, or pediatrician, for example. So, if you know that you need to get your old prescription for "X" medication refilled (or get medication for the first time), and that is your main goal, you need to seek out a medical doctor first.


     If you prefer to avoid medication as a first step, then therapy is what you want. Psychologists will have Ph.D. (Doctor of Philosophy, usually in Clinical Psychology) or Psy.D. (Doctor of Psychology) after their names. This degree involves four years of graduate school (after college), then at least a two-year internship in which they train to do a variety of psychological activities under supervision. Psychologists often specialize in certain age groups (e.g. elders or children), problems they treat (e.g. anxiety disorders, relationship issues), and/or style of work (cognitive-behavioral therapy, psychoanalytic therapy, insight-oriented therapy, etc.). You might want to look for someone who talks about their area of specialty, especially if you feel your issues are somewhat specific. For example, if you want to address your fear of flying, you would want to find a cognitive-behavioral specialist, preferably someone who would go to the airport with you, when you're ready.


For a good summary of when to see a therapist, the evidence for the effectiveness of therapy, and the American Psychological Association resource for finding a psychologist, click here:   http://www.apa.org/helpcenter/therapy.aspx


     Master's level therapists have a variety of degrees, which all involve at least two years of graduate training along with lengthy periods of supervised practice afterwards. They may be LPC's (Licensed Professional Counselor; see http://www.counselor-license.com/states/texas-counselor-license.html#prefilter), LMFT's (Licensed Marriage and Family Therapist; see http://www.allpsychologycareers.com/therapist-licensure/texas-therapist-licensure.html), or LCSW's (Licensed Clinical Social Worker; see http://www.socialworklicensure.org/state/social-work-licensure-texas.html#prefilter). Many are excellent clinicians with years of experience, and they also may specialize in treating couples, individuals with alcohol or drug addiction, children/play therapy, or the like. You will note that all mental health professionals mentioned above are licensed. If you encounter someone using a label such as Psychotherapist or Coach (Trainer), they may have other kinds of training but are not licensed in Texas.   


     Finally, all the licensed professionals described above should be experienced at working with you AND your doctor, in the event you want or need medication to augment your treatment. There are many genetically-influenced psychological conditions that may cause you (or your child) to benefit greatly from medication, at least for a time. That is a decision you and your therapist can make together, with input from your physician or a psychiatrist.



Is it OK to 'check out' a therapist before making a big commitment to them?

     It certainly is! In fact, I encourage people to make an appointment with the provider they think might be a good fit for them, and talk to that person. You should feel accepted, comfortable, understood, and easily able to communicate with them. The outcome of therapy is highly dependent on the relationship the therapist and client develop with each other, so if you feel you cannot trust someone, or you aren't getting answers to your questions, consider seeing someone else. IMPORTANT NOTE: If you have worked with a therapist for a while, it's best if you first tell them that you don't feel things are working out, so that hopefully the issues can be resolved.  If you have never experienced therapy before, you might want to 'interview' two or three people so that you have some idea of the differences and how you might 'fit' with each one.


The American Psychological Association maintains an updated section for consumers to look up help on various topics. This can be found at:  http://www.apa.org/topics/index.aspx?tab=2


Another good website for help, online support groups, self-tests of personality and general information is: www.psychcentral.com.


If someone in your family has ADD/ADHD, please see this wonderful collection of articles and help by a variety of professionals:

http://www.understood.org/

Sarah H. Kramer, Ph.D, LLC.

Licensed Psychologist