All of us try to be strong and cope with loss as best we can on our own, but sometimes, despite the presence of friends, family, clergy, or a bereavement group, we’re just not sure that anyone understands the magnitude of our feelings. Sometimes we just don’t feel better, despite lots of support. Sometimes we wish that we had someone to talk to one-to-one, to help us sort out what we’re feeling and find out if it’s normal, or if it’s something we can’t do on our own.
However, people often think that talking to a professional about their feelings means they’re “weak”, or not “in control” of their feelings. Nothing could be farther from the truth. Many people who are very strong, and normally manage their lives quite well by themselves, can be at a loss to identify and cope with very powerful feelings of loss, especially if it was sudden and unexpected. Some literally don’t know what to do next once the funeral is over and they return home. If the relationship has been a long one, the bereaved person often has no idea how to be alone and be comfortable living their life. The sheer pain, the pervasive sadness and loneliness, the fear of going on alone and dealing with overwhelming issues of life transition are often more than one can bear.
If this sounds like you, please know that it’s alright to connect with a professional you can talk to privately about your emotional experiences after loss. First, don’t judge yourself, just consider this part of taking care of yourself instead. Maybe it’s your turn now to be looked after. Professional helpers do what they do because they care about others. They are compassionate and attentive listeners who can give you feedback about what’s going on inside you, and reassure you that you will be alright. You probably have many well-meaning friends who care, but don’t know how to help. In that case, it may be time to make the call.
If you’ve never been in counseling or therapy before, the idea can be daunting, but once you meet the person you will be talking to, your fears will very likely dissipate. People have many misconceptions about professional helpers. I’ve personally encountered this a great deal in my practice; people who have never been in therapy before sometimes think we therapists are unapproachable, cold, or judgmental. Nothing could be farther from the truth. We do what we do because we care about others. Usually, by the end of the first session, the person who is new to therapy feels comfortable and connected to someone who understands, and even more important, can reassure them that there is hope.
Most people don’t know where to start looking for a professional helper, what kind to look for, or even what the letters after their name mean. It can be very confusing, because there are many types of professional helpers who do similar work, but have different types of training and expertise. I think it’s important, to try to find someone who not only has experience with your particular issues, but who is a good fit with your personality as well. By the way, if you meet a therapist for the first time, and you don’t think it’s a good fit, it’s ok to let them know and to find another provider. Sometimes if you let them know you’re uncomfortable about something, they can resolve the problem. If they can’t resolve it for you, try another therapist. Your comfort level is important.
If you don’t know where to start, or what kind of provider to contact, I’d like to give you with some guidance, by outlining a list of the different types of mental health providers, what they do, and what the differences and similarities are. None are necessarily better than others, it depends upon your own issues and needs, and whether you and the provider are a good fit with one another. Each of the types of mental health providers listed below are independent professions, but they may provide similar, or different types of treatment, depending on their experiences in the mental health field. Most require four years of college (a Bachelor’s Degree), and one to three years of graduate school (Master’s Degree), and one (Psychologist) requires a PsyD (Doctor of Psychology). I would strongly recommend that you seek a provider who is licensed in their field, to make sure you are in good hands.
Of course, you can look in the phone book, but many good providers today aren’t listed there, since most people search on the internet these days. But if you’re not computer wise, look in the phone book under Counselors, Psychotherapists, Marriage and Family Therapists, Social Workers, Grief Counselors, Pastoral Counselors, or Mental Health Providers. Then call them and feel free to ask questions about what they do, and whether they think they can help you.
If the provider you are interested in has a website, it’s helpful to look it over before calling. You can usually find a website by just Googling the person’s name, or the name of their practice. This will give you some idea of the strengths the provider has, and the type of work they like to do. You can always find a provider in your area, or one that takes your insurance by calling your insurance company directly for a referral. If you do that, it’s still a good idea to find out something about the provider before calling, so you can decide if they might be a good fit for you. Some people have a preference for a male or female provider, and it’s OK to look for the type of provider you’ll be comfortable with.
1) LPC – Licensed Professional Counselor
An LPC is a mental health professional who has a Master’s degree in Professional Counseling, and has met the licensing requirements of their state to become a Licensed Professional Counselor. An LPC is able to assist you with life transitions and diagnose and treat mental health problems. Professional Counselors provide guidance and direction on a range of problems, depending on their particular experience. Always ask if they have experience with your particular issues, especially grief and loss. LPCs can be be found in many types of mental health facilities. The only drawback is that they cannot take all insurances, so be sure to check that with them first. Their professional association can provide you with more information about LPCs, at: www.counseling.org or by calling the ACA at 1(800) 347-6647.
2) LMFT – Licensed Marriage and Family Therapist
An LMFT is a type of mental health professional who is specifically trained to understand the relationships between people and among families, not just the mental health issues of one person, and they are specialists in family and in marital therapy. An LMFT may be best if your problem involves family members, and can help you with issues around your relationship with your late spouse as well. An LMFT has master’s degree in Marriage and Family Therapy, which also requires one or two internships, and they must pass the licensing requirements of their state. The American Association of Marriage and Family Therapists (AAMFT) is their professional organization. Being part of a professional organization is optional, but shows that the therapist is in good standing. An LMFT is a good choice if you have issues in regard to your past or current relationship, family conflicts, or parent/child problems, but LMFTs are also qualified to diagnose and treat major mental health problems in an individual. LMFTs can be found everywhere; hospital psychiatric units, outpatient programs associated with hospitals, community mental health clinics, bereavement programs, and child and adolescent treatment facilities.
The website of the American Association of Marriage and Family Therapists can provide you with much more information, or a referral to an LMFT in your area. You can call AAMFT at (703) 838-9808, or click on this link: www.aamft.org.
3) LCSW – Licensed Clinical Social Worker
An LCSW is a mental health professional who has a Master’s degree in Social Work, and has passed the licensing requirements of their state. They must complete two internships as part of their training, and they must be in different types of facilities.There are different types of social workers, but the Clinical type works directly in mental health care, like an LPC and an LMFT does. The advantage of choosing a Social Worker is that they have broad experience in social resources appropriate to someone’s needs, especially the needs of poor people. Social Workers usually work with individuals, but some are skilled in family therapy and couples work as well. Social Workers often work with the elderly, and can accept Medicare, which some other therapist s do not. Always ask about their particular experience and decide whether it suits your needs. Social Workers are often administrators in public social agencies and non-profit mental health facilities. Others work with individuals in mental health facilities, such as hospital psychiatric units, hospital day treatment programs, community clinics, and outpatient clinics. To find out more about LCSWs, you can call their professional organization, the National Association of Social Workers, at (202) 408-8600, or see their website at www.naswdc.org.
4) Clinical Psychologist – PsyD
A Clinical Psychologist is a mental health professional who has a Master’s Degree and a PsyD (Doctor of Psychology) degree, which is at least one year beyond the Master’s degree, and a psychologist must pass the licensing requirements of their state. While a Clinical Psychologist is addressed as “Doctor”, they are not medical doctors, and cannot prescribe medication. There are different types of Psychologists, so be sure you are contacting a Clinical Psychologist if you are looking for “talk” therapy. Ask if the psychologist has experience with bereavement, and the distinction between what is the normal grief process, and what is a complicated grief process which may require medical intervention. Psychologists see patients for psychiatric care, and can be found in hospitals, day treatment programs, community clinics, and outpatient facilities. If psychological testing is something that will be needed, a Psychologist is the best choice. You may find out more about Clinical Psychologists at the website of the American Association of Clincial Psychologists: www.aacpsy.org/ or call them at (813) 251-9284.
5) Psychiatrist – MD
A Psychiatrist is a Medical Doctor who specializes in the diagnosis and treatment of major mental illnesses, all types of psychiatric problems, and the prescribing and monitoring of an individual’s medications. Most Psychiatrists today don’t do “talk” therapy like they used to. For someone who has health problems in addition to mental health problems, a Psychiatrist is a good choice because they are familiar with all the psychiatric medications and how they might interact with your other medications or affect your health conditions.
Psychiatric medications are best not prescribed by your PCP (Primary Care Doctor) because they aren’t as familiar with them as Psychiatrists are. All types of therapists (LPCs, LMFTs, LCSWs, PsyDs) may refer clients to Psychiatrists if the client requires medication, and the therapist then works collaboratively with the Psychiatrist to ensure that the medicine is working, and to keep the Psychiatrist aware of any crises that occur which might require a medication change, increase, or decrease. Since the Psychiatrist usually sees the client for a short period of time for the specific purpose of managing the medication, they often rely on the therapist to let them know how the client is doing. For more information, call the American Psychiatric Association at 1-888-34-PSYCH, or 1-888-357-7924, or see their website at: www.psychiatry.org.
6) Grief Counselors
Grief Counselors sometimes have a CT (Certification in Thanatology), which means that they have been specially trained in issues of death, dying and bereavement. They sometimes also have a degree in another type of treatment, such as Social Work or Counseling, but have extensive experience with bereavement issues. Grief Counselors understand loss, and how normal grief presents itself. Group therapy is the optimal way to address normal grief, as grief is a nearly universal experience at some point in everyone’s life, and one which many others share. This is why grief not considered a mental illness by mental health professionals. Being in a group led by a Grief Counselor makes the bereaved feel less alone, and reassures them that there are others who understand their feelings. Grief Counselors work in hospitals, clinics, hospices, and nursing homes.
The best way to find a Grief Counselor is to call the chaplain of your local hospital or hospice, or ask your doctor. You may find out more about Grief Counselors at The Association for Death Education and Counseling (ADEC) website: www.adec.org/adec or by calling 1-(847) 509-0403.
7) Pastoral Counselors
Sometimes an individual’s issues are spiritual in nature, or involve feelings or conflicts about their religion. According to The American Association of Pastoral Counselors, a Pastoral Counselor must have a graduate degree from an accredited university, experience and training in the ministry, a relationship with a religious community, as well as significant training and supervised counseling experience. People who are grieving, or those who have serious illness often want to be able to talk to someone who can address their spiritual needs. Many people seek out Pastoral Counselors due to lack of insurance coverage, or no access to other mental health services. Some Pastoral Counselors charge a fee, and some do not. It is a good idea to make sure your Pastoral Counselor is Certified by the AAPC (see link below), as they are the best trained. Many faith leaders do counseling with the members of their congregation, but not all have the same training. Pastoral Counselors are a good choice for issues of grief and loss, and associated issues of faith.
If you feel that you’d like your issues addressed by someone who understands and takes into account your religious views, then you might want to choose a Pastoral Counselor. You can call the local church of your chosen denomination, or look at this webiste: www.aapc.org/about-us/pastoral-counseling-today/ or call them at (703) 385-6967.
An APRN is an Advanced Practice Registered Nurse. There are many types of advanced practice nurses, ( too many to go into, and frankly, above my pay grade), but the type you would be looking for is a Psychiatric APRN. They can diagnose and treat mental illness, and can prescribe medications just like a Psychiatrist can, but often are more flexible in terms of openings for new clients, and charge less that a Psychiatrist. Some APRNs do psychotherapy, and others only prescribe and manage the medications. So the amount of time you spend with an Psychiatric APRN depends upon the range of their practice. Many therapists refer clients to Psychiatric APRNs, due to lack of availability of Psychiatrists, or because the latter have no openings. But not to worry, the APRNs are great, and can offer the client more time to understand their situation than the Psychiatrists can. If the Psychiatric APRN you’re considering does “talk” therapy, it can be “one-stop shopping”, in that you don’t need a therapist as well. The nurse is obviously trained to recognize medical problems that might complicate the treatment. If you think a Psychiatric APRN might be right for you, you can call the American Nurses Association at 1-800-274-4262, or see their website at: www.nursingworld.org.
Before you pick a mental health provider, it’s a good idea to check your insurance company website to make sure the provider is in network, to narrow your search down to the providers that your insurance will pay for. You can also call your state public health department to check as to whether the provider is in good standing. There are more professional organizations than I have listed, and don’t forget that the provider themselves may have a website that will tell you something about their philosophy and what kind of treatment they do.
And I repeat, there is no shame in asking for help. It’s part of taking care of yourself. In fact, it takes courage. Once you reach out, you will be pleasantly surprised at who you might find, and your relationship with them can be life-changing. Having someone by your side for the journey through loss can make all the difference. So make the call. There is always hope, and you can get better if you ask for help.