It’s going to be a mental health day, I think.
Here is a guest post from Patty Guzikowski, the force behind www.freethoughtcounseling.com on how to find an atheistic counselor/therapist. She originally wrote this for Phil Ferguson’s blog. Phil is the generous donor who pretty much allowed Skepticon 3 to happen. Visit his site and say hi.
In Search of the Elusive Atheist Counselor
By Patricia Guzikowski
Originally published on Skeptic Money blog, July 2010
As an openly atheist mental health counselor, I am frequently asked, “How can I find an atheist counselor to talk to?” One person even asked me if I knew of an “Underground Railroad” of atheist mental health care providers. Sadly, in all my searching I haven’t been able to find it, so I’m inclined to say it doesn’t exist. Right now, I am the only atheist counselor I know—although I suspect my former co-worker, the one who told us all he thought Jesus was really just a schizophrenic with grandiose delusions, is a closeted atheist.
One of the reasons I’m so often asked this question is that counselors are not supposed to advertise that they are freethinkers. The general consensus among counselors, which is endorsed by the ethical codes published by their professional organizations, is that it’s perfectly OK, even desirable, to advertise yourself as a Christian Counselor, for example. But somehow it’s considered non-diversity-friendly, and therefore somehow unethical, if you advertise yourself as an atheist counselor. It’s a double standard and one that I have been outspoken in my disagreement with. Not only do I believe it’s wrong, but I believe creates a hardship for freethinkers and skeptics seeking a counselor with whom they can build a good rapport.
I do have some advice to offer for atheists, humanists, agnostics, skeptics and all other freethinkers who are thinking about looking for a “counselor” or “therapist” (these terms are interchangeable).
DISCLAIMER (did I tell you I am married to an attorney?): These recommendations are based on my education, experience, and opinions. Please don’t take them as anything more than that. Other professionals might have different recommendations.
If you have any questions on the advice I’m offering, please feel free to e-mail me directly at email@example.com or post your question in the comments.
First, think about the reason you are seeking counseling. If you think you may be want information about medication for a mental health concern, you should first talk to someone with a medical degree—either your primary doctor or a psychiatrist. If circumstances (translation: your insurance plan) allow, then I recommend a psychiatrist. Psychiatrists specialize in, and have extensive knowledge of, mental illnesses and psychopharmacology (psych meds). Primary care physicians have limited knowledge, mostly about depression and antidepressants. Depending upon your insurance, you may have to see a counselor or psychologist first in order to get a referral to a psychiatrist .
If you are looking for help with substance abuse, you’ll want to at least consider seeing someone who has a special credential in addictions/substance abuse. Avoid all 12-step programs (Alcoholics Anonymous, Narcotics Anonymous, etc.) They are based upon the idea that you are powerless and that you must give yourself over to a higher power.
Next, decide whether you want face-to-face counseling or are comfortable with distance counseling. Face-to-face offers the benefit of being able to use facial expressions and gestures in your communication. With distance counseling, you and the counselor are not only in different places, you may not even be communicating with each other in real time. Some distance counselors use live chat with video, but most distance counseling involves telephone or e-mail conversations. Insurance does not cover distance counseling, at least not yet, so if you choose distance counseling, you are automatically choosing self-pay. Don’t panic, distance counseling is very reasonably priced, and offers a lot of advantages. Read more here: https://www.freethoughtcounseling.com//Client%20Assets/Client%20Rights%20and%20Responsibilities.pdf
If you decide you want to try distance counseling, I offer a free, no-obligation consultation by telephone or e-mail, or you can use a search engine to find hundreds of other distance counselors online.
Now the hard work begins. Whether you’re looking for someone to see face-to-face or via distance counseling, I’m afraid it will take a little work to find the right person, especially if you are insistent on having a counselor who is dedicated to evidence-based counseling. Evidence-based treatment (EBT), also called empirically-supported treatment (EST) refers to use of mental and behavioral health interventions for which systematic empirical research has provided evidence of statistically significant effectiveness. If you’re using insurance to pay for counseling, this could be tricky, since the insurance company usually gives you a list of people in your network, without regard to their counseling philosophies (also referred to as therapeutic or theoretical orientation).
If you use insurance to pay for your counseling, be aware that insurance companies require the counselor to make a diagnosis, and often they require it to be made practically immediately—usually after the very first session. A hurried diagnosis is not usually helpful to your treatment. Sometimes a diagnosis is not even necessary. Your diagnosis, whether accurate or not, becomes part of your permanent medical record. Unless you are diagnosed with an illness for which you will be referred for a medication evaluation, the counselor probably won’t tell you how or when you have been diagnosed, or even with what condition, unless you directly ask (and maybe not even then!)
Once you decide whether to use insurance or to pay-as-you-go, I recommend you search for counselors that use cognitive behavioral therapies (CBT) and/or express a commitment to evidence-based/empirically supported practice. Specific therapies include the following: cognitive therapy, cognitive behavioral therapy, short-term solution-focused therapy, dialectical behavior therapy, and/or rational emotive behavior therapy. One of these therapies, Rational Emotive Behavior Therapy (REBT) was developed by Albert Ellis, an atheist. Ellis also wrote two essays related to religion, “The Case Against Religion: A Psychotherapist’s View” and “The Case Against Religiosity.” You can buy them together in one short (<50 pages) book if you’re interested in learning more about his perspective.
Counselors tend not to advertise their therapeutic orientations like I do, so you may have to ask. My advice is to be wary of counselors that say that therapy is “more of an art than a science” or who express contempt for evidence-based practice. If in doubt, ask the counselor to describe his or her therapeutic orientation to you and ask what you can expect from therapy. If they can’t clearly tell you what to expect in terms of the counseling process, don’t seek counseling from them.
You can certainly ask the counselor directly about religious/spiritual affiliation or perspective, but don’t expect the counselor to actually tell you. They have been taught that the question is irrelevant except that your having asked it says something about the kind person YOU are or the kind of therapy you YOU need. Do ask them how they feel about atheism or skepticism or naturalism or whatever term you want to use.
Look at the credentials. Counseling professionals can call themselves counselors, therapists, psychotherapists, etc. You won’t be able to tell the difference between them until you look at their professional credentials. Here’s what they mean:
LPC = licensed professional counselor, might also be LMHC (licensed mental health counselor) or some variation of this. They generally have a master’s degree in counseling.
LCSW or LCISW or APSW = licensed clinical social worker or independent social worker or advance practice social worker. They have a master’s in social work.
LMFT = Licensed Marriage and Family Therapist. They have master’s degrees and in some states have additional academic preparation beyond the MA or MS degree.
PhD or PsyD = Psychologist. The PhD will be in counseling psychology or clinical psychology or some other designation other than educational psychology. A PsyD will be similarly educated, except without as much focus on clinical research. Both are doctoral level degrees and take a lot of education and clinical experience to get.
M.D. = this is the Psychiatrist, he or she can prescribe meds. This person will have an M.D. designation because they’ve gone to medical school, but they usually won’t see you without a referral and they rarely do anything but medication evaluations anymore.
Other credentials which any counseling professional can get by meeting the requirements (which is not very easy) include:
NCC = National Certified Counselor
DCC = Distance Credentialed Counselor
Substance abuse counselor designations = the names and abbreviations for drug and alcohol counselors vary by state so if you see letters after the name that you don’t recognize, ask about them.
Check the counselor out with the local regulation and licensing agency to see if their license is current and if they have or have had any disciplinary actions. Type the counselor’s name into a search engine and see what comes up.
If you have a goal you want to achieve through therapy, tell the counselor up front. If at any time you feel uncomfortable with the counselor, talk to the counselor about it right away. Resolving conflicts and uncomfortable situations can be a critical part of the therapeutic process.
If you feel the counselor is pushing you in a spiritual or religious direction or is encouraging you to accept therapeutic interventions that are not rooted in evidence-based practice, end the therapy and find a new counselor, but talk to the counselor about it first. Of course, if something unethical or illegal happens during therapy, you have a right to report the counselor to the licensing board and his/her professional organization. Both the ACA (www.counseling.org) and APA (www.apa.org) have their ethical guidelines published online.
The bottom line: Finding the right therapist, especially for an atheist or skeptic, is not easy, but it’s worth the effort.
Patty Guzikowski, MA, LPC, DCC, NCC
(I am also on the board of the Atheist Alliance of America)