Doctor Ducky Psychotherapy

Okay so you are starting to believe that therapy is for and about you, you have got a pretty good idea on how to start to look for a therapist, and you even know how to try to utilize your insurance. So maybe you are starting to search for a therapist and you start to notice that there are a lot and I mean A LOT of acronyms. LMFT… DBT… OCD??!??!?  It can be confusing to say the least! 

This post is my guide to the acronyms, explained in simple language, which you can read straight through but also use as a reference in reading my other posts and during your actual search.

There are four essential sets of acronym groups in the world of psychotherapy: 

–AUTHORITIES: These include regulating boards and organizations as well as authoritative texts and codes.

–DEGREES AND LICENSES: These will tell you how many years and the types of training a therapist has had.

–TYPES OF THERAPY: These describe theoretical frameworks from which a therapist will often work, and some associated tools that frameworks gives them to use during sessions.

–DIAGNOSES: These are names for clusters of symptoms that therapists (and other medical professionals) see together often enough that they’ve been given official status.

So now that you know in general what the four types are, let’s dive into the actual acronyms.

Authorities

APA – Refers to two different organizations: “American Psychological Association” and “American Psychiatric Organization”.

The American Psychological Association is an organization of psychologists who publish works, create training events, certify legitimacy of other training activities, and is something psychologists can join to gain access to consultation and other types of professional support.

The American Psychiatric Association does many of the same thing but for psychiatrists (most of whom do not conduct psychotherapy).  The big contribution to the world of psychotherapy from this APA is the creating and continuing evolution of the DSM.

DSM – “Diagnostic and Statistics Manual”

This is our big book of diagnoses. It describes agreed-upon diagnoses that can be used for things like billing your insurance, but also can give professionals a language in which to communicate with each other and you about a cluster of symptoms. 

Remember: A diagnosis can be helpful in guiding treatment. However, it should not be the only thing that is focused on in therapy and you are not your diagnosis.

CABOP – “California Board of Psychology” – Here is their website.

This is the licensing board for doctoral-level psychologists in the state of California.These state boards (along with state law) establish the requirements for psychologists to be licensed in the state, and issue licenses once an applicant meets the requirements. They also accept complaints and perform disciplinary actions against psychologists if necessary.

One important thing you can use their web site to do is verify the license of your therapist, which is never a bad idea.

CABBS – “California Board of Behavioral Science” – Here is their website.

This is the licensing board for masters-level psychologists in California. It operates much the same way that the Board of Psychology does, and most of the same functions listed above can be found through their site.

Degrees and licenses

Note that these abbreviations are typically found at the end of a professional’s name, and are often shown in their email signature. I, for example, am Dr. Amy Wiseman, Psy.D, because I hold a Doctorate of Psychology. 

Ph.D. – Doctorate of Philosophy

This is the set of letters I’m guessing most of you are familiar with! People can have Ph.D.’s in all kinds of subjects: From Art History to Zoology and everything in between including, yes, Psychology.  Ph.D. programs tend to focus more on academia and research.  Psychologists with a Ph.D. will have longer training periods (5-8 years) than those with a master’s degree (1-3 years) but their program will likely be less clinically focused than someone who holds a Psy.D.

Psy.D. – Doctorate of Psychology

The best degree!… okay, I might be biased.  A Psy.D. is a doctorate of psychology.  So someone with a Psy.D. will have the same longer training period as a Ph.D, and will also have completed a program that is more clinically focused. This means that the classes and requirements will be more focused on psychotherapy itself and less focused on research. Someone in a Psy.D. program will likely have a greater breadth of understanding of multiple theoretical approaches, utilization of assessment tools, and will have to train in more varied types of mental health facilities than master’s-level programs.

MSW/LCSW – Master’s of Social Work/Licensed Clinical Social Worker 

These two degrees are similar; the difference is the licensed status. MSWs are not yet licensed, LCSWs are licensed.

MSWs can be your therapist but will need to be supervised by a licensed professional, whereas LCSW’s can treat you without supervision. This is a master’s level degree which means the training is usually 1-3 years, and the focus is often on manualized treatments and evidenced-based practices.  

These programs typically focus on a single theoretical approach, most commonly Cognitive Behavioral Therapy (CBT, see below). These therapists tend to see individual clients (as opposed to couples or families). 

MFT/LMFT – Marriage and Family Therapist/Licensed Marriage and Family Therapist

Just as above, an MFT is unlicensed and will need to be supervised to see clients, and an LMFT will not need to be supervised. 

MFT programs, similarly to MSW programs, are 1-3 years, but focus more on family and couples work than MSW’s. Many MFT/LMFT will still do individual work, but are trained most in the special skill of having more than one patient in the therapy room at the time. They are also limited to less training in theoretical models than a doctoral-level therapist.  

MFT/LMFTs are very popular programs, especially on the west coast and even more especially in CA, where they make up the majority of therapists. In other states, you may not see this type of therapist at all.  A therapist friend of mine in Texas literally asked me recently: What the heck is an MFT?

APC/LPC – Associate Professional Counselor/Licensed Professional Counselor

As above, an APC will need to be supervised and a LPC will not. (Are you sensing a pattern yet?)

This is a master’s level degree that is most closely focused on, you guessed it, counseling. Their understanding of psychology will be narrowed than that of a psychologist, and they are usually well-trained in one theoretical model. 

A word on the degrees and license: More training does not necessarily equal the best therapist for you! 

I have met other fully-licensed psychologists that I would never in a thousand years refer clients to, and I have employed unlicensed master’s-level therapists who were AMAZING.

These letters give you some broad information about the therapist, but the best information lies within you. Remember: therapy is for and about you. As I wrote about in my “how to find a therapist” post, listen to how you feel with the therapists you consult with. Maybe the one you feel safest and best with is an MSW and the worst you felt was with a Psy.D. (It seems crazy but it could happen!) If that’s how you feel, do not second guess yourself because of their relative levels of education–go with your gut!

Types of therapies

Some patients come to me with the mistaken idea that “therapy” means one thing, as if it’s a commodity like sugar or butter. This is, of course, mistaken. There are actually many different kinds, or “modalities” of therapy, and it’s really important to understand the difference between them, because what you will be doing in the therapy room will vary a lot depending on the type! Here’s some of the most common ones:

CBT – Cognitive Behavioral Therapy  

CBT views the client as having faulty cognitions (thoughts), and behaviors (actions) that impact their emotions. The CBT therapist will focus on challenging the way clients think about things and how that impacts the way they behave and feel.  There tends to be a lot of homework and skill acquisition in CBT. You can read about it in more detail here.

DBT – Dialectical Behavioral Therapy 

DBT was developed for a specific diagnosis, Borderline Personality Disorder (BPD, see more below). It is actually a type of CBT therapy and focuses on thoughts, behaviors and emotional regulation. DBT is a highly manualized treatment that can be conducted directly out of a treatment workbook. It’s a great therapy for people who really do not seem to have a lot of control over themselves. 

Also, in DBT the therapist can use the therapeutic relationship itself as a bargaining tool.  People with BPD are often afraid of abandonment, so making “do the homework” a condition of continued contact with the therapist can be a very effective motivator!

EMDR – Eye Movement Desensitization Reprocessing  

This therapy was originally developed for people with trauma, though is has now come to be utilized for other forms of distress as well. It is a process-focused therapy. The therapist sees the client as having the innate ability to move toward adaptivity with the right supports and processing. 

The therapist will start by helping the client create some strong internal resources they can rely on and then utilize highly specific (and somewhat bizarre-seeming) techniques to help the client very rapidly process past traumatic events or harms. 

This type of therapy does not usually ask the client to do much homework besides practicing tools learned in therapy. I personally use this model and have found it to be transformational with my clients. I will go into much more detail about EMDR in a later post in this series. 

IPT – Interpersonal Therapy.  

This therapy sees clients’ suffering as directly related to a lack of strong relationships in their lives, and seeks to help the client in their personal relationships. The focus tends to be on examining those relationships and identifying ways to connect with more people and connect more deeply.  There is often little to no homework with this therapy besides practicing enhancing supports. 

ACT – Acceptance and Commitment Therapy.  

This form of therapy is yet another form of CBT, and looks again at people’s thoughts and behaviors in relationship to their emotional life. It is a highly manualized treatment that helps people see their lives as they are (acceptance) and then make a strong commitment to the life they want to have. There is often specific game planning that goes on with this kind of therapy and an expectation that the client will follow through on those plans outside of the therapy room.

A few words of types of therapies – This is just a very brief list of types of therapies that you can see in the world of psychotherapy. Most therapists are actually quite eclectic and utilize aspects of different therapies to meet the unique needs of each client. If you ever go into therapy and the whole thing is out of a workbook, I would be suspicious of that therapist; however, therapy is for and about you. if it is working for you and feels good then go with that!

Diagnosis

Diagnoses are terms that describe a cluster of symptoms sets. A diagnosis can be so validating: “Hey there are other people who experience what I experience!”  It can also feel scary: “Eeek there is something wrong with me!”  I want to start by saying YOU ARE NOT YOUR DIAGNOSIS.  

All a diagnosis does is cluster together your difficulties. This can be helpful in guiding how to best help you, as well as give the professionals you are working with a way to describe what you are dealing with, but no diagnosis is the last word in who you are or what’s going on with you

Here are some of the most common letters I see out there on the interwebs: OCD, PTSD, ED, MDD, GAD and BPD.

OCD – Obsessive Compulsive Disorder  

This disorder is characterized by the presence of either–but most commonly both–obsessions and compulsions. Obsessions are unwanted thoughts that are intrusive and intense for the person experiencing them. Compulsions are some kind of action the person feels they must do to get rid of the obsession.  

One pet peeve of mine is when healthy people casually say “I’m so OCD”, or blame something strange they do on “oh that’s my OCD”.  No, you are not, and no it is not, unless you’ve been officially diagnosed! Do you have some obsessive thinking sometimes? Yes, probably. Do you sometimes feel like you must do something? Almost everyone does!

Actual OCD is about the intensity of these thoughts and feelings, and about the level of disruption they cause in your day to day life. Severe enough intensity to warrant a full-on diagnosis is relatively rare, and most people should stop using those terms casually.

PTSD – Post Traumatic Stress DIsorder

This disorder is characterized by several symptom clusters: 

–Exposure to a traumatic event described in the DSM as actuall or threatedned death, serious injury or sexual assault. 

–Intrusive symptoms like dreams, intense memories, flasbacks,or intense reactions to things that remind the person of the traumatic event.

–Persistent avoidance of things that are reminders of that traumatic event. 

–A negative change in mood and thoughts.

–A change in the way people respond or react to stimuli.  

Not only must these symptoms all be present to warrant a diagnosis, just like OCD, they must be intense enough to create an ongoing disruption in a person’s life.

ED – Eating Disorder

This is not actually a diagnosis but describes a set of more specific diagnoses: Binge Eating disorder, Anorexia, and Bulimia. 

Binge Eating Disorder is characterized by binge eating often in response to stressors.  Anorexia is characterized by starvation and usually needs a BMI to support the diagnosis.  Bulimia is characterized by binge eating followed by some sort of compensatory behavior (throwing up, over exercising, or periods of extreme restriction.)

MDD – Major Depressive Disorder

This is the diagnosis most commonly given to people who experience depression. Depression is characterized by low mood, difficulty concentrating, low energy, loss of interest in things that bring joy and pleasure, weight changes, and sleep disturbances. Like many of these diagnoses, these symptoms must be intense enough to cause ongoing disruptions in the person’s life. 

GAD – Generalized Anxiety Disorder

This is the diagnosis most commonly given to people who experience anxiety. Anxiety is characterized by excessive worry that is difficult or impossible to control, difficulty concentrating, irritability, muscle tension and sleep disturbances. Again, these symptoms must cause an ongoing disturbance in the patient’s life in order to warrant diagnosis.

BPD – Borderline Personality Disorder

BPD is a personality disorder, which means that it must have been present since childhood and be persistent over time. It is characterized by frantic efforts to avoid abandonment, a pattern of unstable relationships (typically the relationship counterparty is either “the absolute best” or “the worst person who ever lived”, with no room for nuance), a lack of stable self image, impulsive behaviors, suicidal behaviors, reactive mood, chronic feelings of emptiness, and dissociative symptoms. 

Soapbox Moment: If you were given this diagnosis after speaking to a professional a single time, OR if you were given this diagnosis as a teenager: RUN!  This is a complex disorder that takes time to diagnose and is not ethically diagnosed in teens. This is an all-too-common practice among some therapists, and it’s flat-out wrong of them.

Okay these are a good swath of the letter grouping that I have most commonly seen out there on the web.  If there are more you are curious about please email me and I will take some time to put some more together.