What is a “No Secrets” Policy?

Understanding Therapy Consent Forms

The first step in starting therapy is always looking over and signing a consent form about the treatment you will be receiving. By nature, most people skim over these documents and go right to the signature line, but do you really know what you are signing off on? These treatment agreements outline how therapy can help, what to expect about your confidentiality, your fee for services, and so much more. Today, I want to focus on the “No Secrets” policy that is often included in consents for couples or family therapy services.

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Who does a “No Secrets” policy apply to?

This policy is in place for couples or families participating in therapy together. If you are in individual therapy, this policy most likely wouldn’t affect your treatment. However, if you are entering into therapy with someone else to work on a relationship, this policy may be in place.

What is a “No Secrets” Policy?

This terminology is used by therapists to describe a unique policy in place for couples & family services. It is intended to prevent information important to a relationship from being hidden from either party participating in services. It comes from the understanding that when a couple or family are participating in services the “relationship” is the client, not one or the other participants. So in order to uphold what is best for the “relationship” the therapist will not hold secrets for one or the other participants.

Where would I find information about a “No Secrets” policy?

Now this is one of those questions where “it depends” is the only answer. Personally, I include this policy in my informed consents because I want clients to be well informed about this aspect of therapy prior to starting services. However, every therapist has differing ideas on how or when to tell a client about a “no secrets” policy. Some only verbally inform their clients of this policy once they enter into therapy, some will post this policy online or in their office without actually including it on a consent form. While other therapists may not utilize this policy at all, and are open to keeping certain “secrets” a secret.

When would a “No Secrets” policy be implemented?

The policy only gets implemented when something pertinent to the relationship (or detrimental to the relationship) is shared with the therapist by one participant in treatment, but not the other participant. For example, therapists may separate a couple for two individual sessions to assess for certain dynamics within the relationship. If one spouse discloses that they are having an affair in this individual session a therapist may invoke the “no secrets” policy because the information shared would be detrimental to the treatment if not shared with both parties of the relationship.

Why would a therapist have a “No Secrets” policy?

Ultimately, it is to keep the therapy space an open and honest one. When two people consent to participating in therapy treatment it has to be a space where they can both trust the therapist. If the therapist is holding a secret from one participant, it can become a breech of trust not only between the partners, but in the therapeutic relationship as well. Rapport and trust is the foundation of any therapy relationship, so upholding these things are of the utmost importance.

Understanding the consent forms is an important first step in starting the therapy process. Check out my understanding therapy consents series by reading more of the blog here. If you are interested in starting couples therapy reach out for an initial consultation here.

peace, love, happiness, Lee

How Do I Find the Right Therapist?

The Difference Between Various Mental Health Providers

If you have been trying to find the right therapist for your needs, you have likely run into a lot of acronyms that look like a bunch of gibberish. Have you asked yourself, “What’s the difference between an LPCC, LCSW, LMFT, PsyD, PhD, MD, or PMHNP??” What you didn’t realize are those little letters behind someone’s name can tell you everything you need to know about the education a mental health professional has and what their specialty and training is in. Let me explain what those little letters mean, and why it is so important to be able to distinguish them in order to find the right mental health professional for you.

Key Providers

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What if they don’t have any letters behind their name?

You may have come across a lot of Instagram pages giving out amazing mental health advice from someone who calls themselves a “Mental Health Advocate” or a “Coach”. These accounts can be positive additions to your IG feed, but they shouldn’t be relied upon for professional mental health treatment. Mental health advocates and coaches have good intentions, but are not legally allowed to diagnose or treat any mental health conditions. If you are looking for someone who will provide direct advice and personal anecdotes about how to cope with stress in your life, these individuals may just be a good fit. However, if you want to have a professional assist with your mental health management and treatment, keep reading.

What’s the difference between Licensed Professionals like LPCCs, LCSWs, and LMFTs?

Each of these acronyms stand for a different licensed mental health provider with at least a Masters level education in their perspective fields. They also distinguish between those that have passed their perspective licensing board examinations and those who are still associates (AMFT, APCC, ASW, etc.). Counseling, Social Work, and Marriage & Family Therapy are all closely related fields with slight variances on how they approach treating clients’ needs.

A LPCC stands for a Licensed Professional Clinical Counselor, and their education focuses on treating mental health illnesses in individuals. They often treat co-occuring substance use and mental health diagnoses, and focus their treatment around the individual and their unique needs. LPCCs often provide individual therapy or group therapy treatments.

LCSW is short for Licensed Clinical Social Worker. Licensed Clinical Social Workers can identify and implement a treatment plan that incorporates multiple community supports. These professionals can diagnose and treat individuals or families, and are great at navigating community systems and seeing how larger systems impact a family dynamic.

As a LMFT myself, I know a great deal about the treatment I can provide as a Licensed Marriage & Family Therapist. LMFTs hold at least a Masters degree specializing in marriage & family therapy, and can recognize the impact family of origin and larger societal constructs can have on an individual. LMFTs do a great deal of studying how relationships form, interact, and influence each individual involved, and utilize this knowledge to assist in the treatment of both individual’s mental health and couple’s/family’s mental health needs. We work with individuals, couples, and families on navigating life’s stressors, childhood trauma, parent-child relationships, pre-marital or pre-natal counseling, and often specialize in couples counseling. LMFTs can diagnose using the DSM-5 and often times collaborate with other healthcare professionals to make sure you are getting the most well-rounded treatment for your unique needs.

What’s the difference between a PhD and PsyD?

This is a question that I hear a lot, and actually has a very important distinction between the two. A PhD stands for a Doctorate of Philosophy, while a PsyD stands for a Doctorate of Psychology. It is important to distinguish what the PhD is in (such as Psychology, Marriage & Family Therapy, Theology, etc.) due to the fact that one may have a PhD, but not be licensed to practice in a certain state. For example, someone may go through 4 years of additional schooling to get a Doctorate of Philosophy in Theology, but not be licensed as an LPCC or LMFT, and be unable to diagnose and treat mental health illnesses. So when you see “PhD” behind someone’s name, do some additional digging to decipher if they also have other credentials to meet your specific needs.

A PsyD distinction means someone has done the research and/or additional clinical work to attain a doctorate of psychology. They often have an extensive knowledge of mental health diagnoses and pharmacological needs of clients, and have studied in depth how the mind works. However, it is important to note that the presence of the acronym PsyD does not mean a practitioner can prescribe medication for mental health needs. Depending on the state you live in, a PsyD may or may not be able to write a prescription for your mental health needs.

What about PMHNP or MD?

These two distinctions address the professionals who have the medical knowledge to treat mental health diagnoses in more traditional healthcare settings. PMHNP stands for Psychiatric Mental Health Nurse Practitioner. You may recognize the nurse practitioner designation as those medical professionals at your PCPs office or at a hospital that provide basically all the care that your primary care physician would. These individuals usually have Masters degrees and/or doctorate degrees in nursing practice, and can diagnose, prescribe, and treat mental health diagnoses.

A MD is a Medical Doctor, but doctors that specialize in diagnosing, researching, and treating mental health diagnoses are known as Psychiatrists (not psychologists). Psychiatrists can prescribe and treat mental health diagnoses using the latest research and medically backed practices. They often provide condensed forms of therapeutic interventions alongside medication management to help manage a client’s mental health needs, and refer out to other licensed mental health providers for ongoing therapy treatment.

So, who is the right therapist for me?

All these little groups of letters basically give you a snapshot of a professional’s resume. Making note of the type of professional that will be the right therapist for you can minimize your search time and maximize your time in therapy. Before running through the lists of profiles on the various directories out there, this can help narrow down your search and match you with the right therapist for you. Finding a good fit is one of the most important aspects of your mental health journey, so I’m glad I could help you navigate this important step.

Telehealth Therapy Services in California

Reasons to Offer and Participate in Virtual Mental Health Services

Being quarantined means being open to alternative forms of everything you normally do outside of your home. Trips to the gym are now Youtube workouts, brunch with friends is now group texts with an exponential amount of emojis, and trips to your therapist’s office is now teletherapy from the comfort of your couch. For therapists and those participating in mental health services, this can be an unwanted, but necessary shift. Participating in telehealth therapy services is a great way to connect however, and access mental health services for both the professional and the client.

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Reasons Why Teletherapy is a Positive Alternative

  1. Ease of Access: Utilizing telehealth therapy services means you can access therapy appointments from virtually anywhere. For mental health professionals licensed in California, that means being able to provide mental health services to any resident in California from Sacramento down to San Diego. It also means clients don’t have to travel too and from an appointment or find parking or hit traffic or miss their appointment all together.
  2. Best Fit with Therapist: Over the years, I have had many clients move to find better opportunities for their life, but a sense of continuity was felt when they knew they could continue seeing me from their new location within the state. Teletherapy also allows you a wider selection of therapists/clients to work with as you are not confined to those located within a 30 mile radius. Having options means being able to find the therapist that can best understand your story and guide you to the change you want to see in your life.
  3. Feeling Comfortable: Being able to talk to your therapist/client from the space that is most comfortable for you can make a huge difference. Having control over your space can be a invaluable part of being able to open up in your therapeutic process. I have personally noticed that from my first sessions with a client to my closing session with a client, there is definitely a difference in how they and I dress (yoga pants make a regular appearance) due to finally feeling more comfortable in that therapeutic relationship. Utilizing teletherapy means having some of that comfort on the front end of your journey and meeting your goals on your terms.

The Downside of Teletherapy

As with anything there are pros and cons to telehealth therapy, and highlighting one side with out the other would be unfair to you. Fortunately, the major cons of teletherapy have less to do with the therapeutic process and more to do with technology’s short comings. At the end of the day, teletherapy is a fancy term for Facetime with your therapist. Although, teletherapy should be used on a HIPAA compliant platform (such as doxy.me, Simple Practice, Vsee, etc.), if you’ve ever used a video conferencing application you know that poor connections, cyber security, and “hello. hellloo?” moments can all be a damper on a good conversation. Making sure you are in a safe space with a good connection is an easy fix to this problem however.

For therapists, our number one priority is always your safety, so it is smart to go over the nearest emergency room, emergency contacts, crisis line numbers, and any other safety precautions that can be made prior to starting your mental health journey.

With all this in mind, feel free to reach out for a 15 minute phone consultation, so you can see if teletherapy will be a helpful tool on your therapeutic journey!

peace, love, happiness, Lee

Why I have a Waiting List: What To Do in the Meantime

I know. You came here to schedule an appointment, but you saw I had a waiting list. You got yourself pumped up for starting therapy and were disappointed. I sincerely apologize. I created a waiting list so I know who to reach out to when an appointment opens up. I do not encourage rushing people through their therapeutic process, so as I help my current clients, I will try to leave you with some ideas on how to utilize your time and start the therapy process before your first appointment!

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Start Journaling

One way to document your emotions, events in your life, or just ideas and to-do lists is by keeping a daily or weekly journal. The first question I ask all my clients is, “what brings you into therapy?” If you keep a record of how you have been feeling, you will have collected all the data necessary to answer this question. The therapeutic process would have started before you even walk in the door, and you’ll feel prepared for the work that happens in the therapy room.

Do some Self Care

If you are willing to dedicate an hour a week to therapy that means you have an hour in your schedule already to do some self care. Take that time now to schedule something just for you. Self care can look like taking a walk around the park, lake, or by the beach. It could be spending some time doing something creative like painting, coloring, or knitting. It could mean practicing mindfulness or meditation in a peaceful setting you create just for yourself (candles, mood lights, and white noise machines welcome!). Self care could also look like setting up a coffee date with some of your favorite people every week. Whatever you choose to do with your time make it all about self love!

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Talk to your Support Network

Maybe you can’t grab coffee every week, but maybe you can incorporate some other form of communication. Write a letter to an old friend or to someone you never got to say how you really feel too. Call up a sibling and laugh about old shenanigans or vent about your crazy parents. Join a book club or support group that helps you learn how to open up about your thoughts. Or just carve out time for you and your partner to connect every week. Who ever you give that time to, make sure it is spent with those that will add to your life instead of take away from it.

Try Something New

You thought therapy would be a new adventure for you to take. Why not try something else new and different from your normal routine? Being uncomfortable is a skill you will definitely utilize in therapy, so might as well practice now. Whether that is a new restaurant in town or a new hobby, get outside of your comfort zone and try something that the new you could really dive into!

Reach out to one of the Referrals Provided

If waiting isn’t something you are open to, please utilize one of the referrals emailed to you after adding your name to the waiting list. You could also call the following numbers to get resources more quickly!

Mental Health Resources: 2-1-1

Access & Crisis Line (San Diego): 1-888-724-7240

Crisis Text Line: Text “HOME” to 741741

National Suicide Prevention Lifeline: 1-800-273-8255

 

I hope to see you soon along your path to wellness!

Young Therapists: 5 Questions to Ask Yourself Before Accepting that First Job

Diverting from my usual audience, I want to speak to my fellow blooming therapists out there.

Deciding to become a therapist means deciding to be selfless more hours out of the day than not. This is a daunting task and takes a special kind of person to take it on. So kudos to you for choosing to walk down that career path!

However passionate you are about this path, I would like to send the reminder that being a therapist is a lot more than just being an empathetic person to those that choose to sit in front of you…it’s a full blown job. A job that is both physically and mentally draining. Preparing yourself for what you are about to take on and preparing yourself for where this career path will take you in the future is important!

Making an informed decision about how being a therapist will affect your overall life will help you grow into your career with ease. That is why I want to pose to you 5 questions to ask yourself before accepting that first job…

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What are you doing for self-care?

As much as we preach “self-care is important!”, are you taking care of yourself? Can you think of one thing you do on a regular basis that is purely for yourself? If you can’t think of something, you better assign yourself some self-care ASAP. We tell our clients all the time that self-care is important, but we often forget that as “helpers” we are often the ones that need some self-care the most. Knowing your hobbies, happy place, or support systems can be life saving when working in this field. Also, think about how you will incorporate this self care when you begin your career. Establishing these self care activities into your routine NOW, will make it much easier when things start to get even more hectic.

What are your priorities?

Are you single, and hoping to still have time for finding love? Or do you have a  family where being present for all the big moments is important? Or do you really love taking trips and participating in events and get togethers with friends? No matter what your priorities are, make sure to take these into account BEFORE signing on to a new job or side project. Knowing what comes first on your priority list enables you to choose what will be a good fit for you. Also, take into account that these priorities may shift. Working two jobs and 60 hour weeks may seem fine when you are pre-licensed, but once you become licensed you may want to reduce some of these hours to fit in other more important activities.

What do you want your schedule to look like?

There is no typical therapist schedule, so don’t try to match what you see someone else doing. In grad school you may have been handed a class schedule that you had to work around, but it may have seemed easy to just fill in the space before or after classes each week. After graduation however, you have to figure out your entire 24 hours each day to really maximize your time. If you are considering agency work vs. private practice, choose wisely. You may expect a typical 9-5pm, but crisis happens at all times of the day, so therapy jobs often mean working nights and weekends. Something they don’t tell you in grad school.

Look at your schedule and decide what line of work fits into your lifestyle. Outpatient programs offer the most typical schedule, as they are mostly office-based (M-F, 9am-5pm). School-based jobs often give more flexibility due to school year schedules (expect working anywhere between 7am and 3pm, M-F, with all the typical school breaks). A community-based job will often involve more evening hours (think hours between 9am and 7pm, M-Sat., with minimal holidays). Though some add the flexibility of working a 4×10 (4 days a week, 10 hours a day). Private practice work can seem to be the most flexible, but at times it can be the most restricting, as you are catering to when your clients will most likely be available (think M-Th.+Sat., 4pm-9pm or 9am-12pm). With most clients working a typical 9-5, you’re often offering the off hours. Each job you apply for will come with a different set of requirements, so do not be afraid to ask what a normal work day/week looks like for their therapists.

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How do you set boundaries?

You may have been taught about legal & ethical boundaries, but personal boundaries can be just as important to establish in your career. Being a pre-licensed therapist, you often forget just how much you have to offer, which can be detrimental to your sanity. Pre-licensed therapists are often taken advantage of in the work place due to our natural desire to help. Be firm with your boundaries when it comes to working extra hours, taking home work, carrying your client’s baggage, and all the other ways in which you may be asked to go above & beyond your job description. Decide what will be hurtful to your well-being and what will be helpful to your goals. If it feels like too much, it most likely is WAY too much!

What are your career goals?

This is a major question, and arguably the most important. Some people go into the mental health field because they love the one-on-one contact with people, and doing anything other than direct therapy doesn’t interest them. Some people want to be the director of an entire non-profit because they want to see agencies run differently. Some people really want the ability to work for themselves, part-time, and have more time for their family. While others really love the educating aspect of therapy, and see themselves eventually teaching. And still others may have completely different goals tied into their mental health related degree. Figuring this goal out now however, allows you to line up and prioritize what is most important to you.

Think about where you see yourself in 10 years…what are you doing? Where do you live? How hard are you working? These questions will allow you to seek out a position that will help you reach your end goal. Finding a position that gives you room for growth and professional trainings can be game changing when you finally become licensed. Additional items on a resume or just additional knowledge in your head, can make all the difference in that professional transition. Start by making a vision board or writing a letter to your future self, then hold yourself accountable to accomplish the dreams you have.

It will all be worth it in the end.

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