This blog may not be about what you expect. It is not an announcement, nor is it about ADHD, communication, or “attention-seeking” (a term I do not care for). It is about one of the few things most of us can actually control in our lives, and a sure-fire way out of overwhelm when it feels life is completely out of control.
You can control your attention in this very moment. And this one. And this one, too. You can choose to continue reading this blog, or tune into a sound nearby, or the pain in your left pinky toe, or the pile of bills on the table, or the television, or a million other things. You can attend to your anxiety, or the anxious thoughts, or the pounding of your heart, or the tapping of your foot. OR, you can notice the fact that in this moment, you are okay. The feared thing is not here RIGHT NOW, your chair is holding you up, you are still tethered to the earth by gravity. There is something in your field of vision that would be pleasant to look at if you just noticed it. Maybe there’s an animal nearby to look at or talk to or touch. If you are outside, you might notice a plant or the sky, or smell fresh air or a flower, or feel the crisp winter (or warm summer) air entering your lungs. Maybe it is possible to just notice your breath and feel gratitude that it continues without your effort. All of these choices are available, even when it feels like you have absolutely no control over what’s happening in your life.
You may be thinking, easier said than done, there, Katie. But it is easy. Try it right now. Look back at the title of this blog and then find your spot HERE, again. There, you did it. Now imagine a purple elephant. Got it? Now stop thinking about it, whatever you do, do NOT think about that purple elephant. Difficult? Look at this circle:
Imagine it filled with your favorite color. Let it pop in, fill up bottom to top, or swirl into the circle. Now change the color. You can change what’s in your mind not by trying to push something out, but by turning toward something different in this moment. And in each and every moment, only you control what that is. Are there exceptions? Sure. Extremely loud noise, for example. But most of the time, no one chooses what you attend to but you. Have ADHD or another executive dysfunction? You can choose to attend to a video game, or other thing that interests you, so I know you can do this. Hard to stay with one thing? Keep changing your focus moment to moment, it’s fine to do that. It doesn’t even have to be something positive, just neutral. Look at the ceiling. Is there anything there you never noticed before? Look at the floor. What would you call that color if it were a Crayola™ crayon? Notice the sensation of your feet contacting the floor or ground, directly or through socks or shoes. Wiggle your toes and see what that feels like. Even watching television or video or listening to music, you can change your focus from foreground to background; this can be especially interesting if it’s a show you’ve seen many times (“I never noticed that on the wall before!”) or a familiar song (turn your attention to the drums or the harmony).
I teach most of my clients the concept of mindfulness, which is more than attention but revolves around it. We have good scientific research to support that practicing mindfulness changes your brain, lights up the most human (evolved) parts, in the cortex, which changes our mental state. You don’t need to know how to “do mindfulness” or name brain components to use your control of your own attention to help alleviate your suffering. Just choose to turn towards something good (or just “not bad”), inside or out, in this moment.
When I was little and spooked by the dark at bedtime, I looked for the light. One little piece of light coming in through the window and shining on the wall. I chose not to stare into the darkest corner and fear what might be hiding there, but to look for the light. I discovered that when I focused on the light, my eyes adjusted faster and the darkness became less dark. I encourage you, in your darkest moments, to exercise your human choice to control what you give attention to. Maybe, just for a moment, look for the light.
Blog number 3: September 17, 2019
This is the first in a series of blogs intended to be published monthly. Topics will include mental health content related to therapy, technology, specific disorders, coping strategies, and more.
Blog number 1: April 15, 2019
Image borrowed with gratitude from accidentalcreative.com
This is the third in a series of blogs intended to be published monthly. Topics will include mental health content related to therapy, technology, specific disorders, coping strategies, and more.
Blog number 2: June 3, 2019
(photo borrowed from unknown facebook page post, with gratitude)
This is the second in a series of blogs intended to be published monthly. Topics will include mental health content related to therapy, technology, specific disorders, coping strategies, and more.
Katie Grant, MS, LCPC
Licensed Clinical Professional Counselor
Today is the 6 year anniversary of opening my private practice. 13 years ago, when I received my Master of Science degree in Psychology, the idea of having a private practice was but a glimmer in my eye, a goal that seemed glamorous and ideal but unreachable in the real world, yet I did not wipe it away. Some tiny part of me believed in myself enough to allow it to stay and grow, slowly but surely. As I wound my way through the beginning of my career, learning a lot through experience, training, and caring mentors, I found myself not quite fitting, not quite settled, not doing what I really wanted or not feeling like I could help enough, trying very hard and inevitably burning out. I saw others seeming to handle the settings and circumstances, but I just couldn’t find the balance. I finally landed in a peripheral field, as a case manager and human resources manager for my good friend’s self-made company serving folks with disabilities. It wasn’t what I wanted to be doing, but I felt at home in the team of people and the organizational culture. I admired my friend for making the place she wanted to work, creating it from scratch, building it up with her own determination and ingenuity. I count her among the bosses I have had who have appreciated and inspired me. And I realized, if she can do it, so could I! I had decided at that point that the stressful overload of community mental health and the negative, oppressive work culture of other work environments were accurate predictors of burnout for me. Where was I to find the place to work that would allow me to have a reasonable caseload and expectations of productivity, supportive supervisors, encouragement of self-care, and freedom to provide quality psychotherapy to clients I can really help while making enough money to support myself? I was pessimistic about the chances that such a workplace even existed. So, it became clear that if I were to find it, I must create it.
Still, to trace the true beginnings of the glimmer that became Katie Grant LCPC, LLC, we must go much further back. The first time it became a concept in my mind was around 1985, when I was 8 years old. The sitcom “Growing Pains” showed a father and psychiatrist (unlikely today, but that’s another blog) played by Alan Thicke who ran a private therapy practice out of his large and lovely home. I thought “that seems like a cool job.” Every few years growing up, thoughts would come and go about being a therapist, but were never really seriously considered as daily life demanded much more of my attention and a good future seemed less and less of a possibility. In community college, I started out as an accounting major, wanting a career that I could start quickly and would have a decent salary. After learning that I hated accounting with a passion in my first class, I had to pick a new major. I scanned the list of options, and when I saw “Psychology” I remembered really enjoying my high school psych class, so in lieu of finding interest in anything else listed, I chose that. Each course I took fed my soul and excited me more, and I began to work towards becoming a Psychologist, still doubting that I would ever run my own practice, but believing that I could make a living really helping people. In the back of my mind, Dr. Jason Seever continued to sit with people in pain in a comfortable office and do his best to help. In my senior year, a classmate pointed out that you could “hang out a shingle” with a master’s degree, and my brain lit up, solidifying and anchoring that dream, despite feeling it as very, very distant.
Until I worked for my friend, it never felt truly possible, but I never let my dream die. It was more like a fantasy than a goal. But holding onto that fantasy allowed me to get to the point where it transformed into a possibility, and then a reality. It gave me the space to take the steps necessary to get there—April 15, 2013, the day my private practice became official. Since then, there have been many challenges to finding “success” (the definition of which is quite fluid), but I can say today that I feel proud that I have built a business and career in which I can feel fulfilled, allow myself to direct my path and maintain the balance I need, and make a living. No matter how improbable they may seem, if you do not let your dreams die, they may someday become reality.
Today, I want to help clarify the different roles and credentials in the mental health fields. I often hear from clients that they don’t know the difference between a psychologist and a psychiatrist, or who to go to for medication versus therapy. I know it is confusing as there are so many of us out here! So I am going to break it down. I will categorize different providers by their roles, list possible credentials (degrees and licenses), then discuss each role.
Confusing, right? No wonder people are unsure. So, just because all of the people listed under “prescribe medication” CAN prescribe the medications meant for symptoms of mental illness doesn’t mean they SHOULD. The people with the most reliable expertise in this area will be psychiatrists and psychiatric nurse practitioners, as they have specialized training for psychotropic medications on top of their medical educations. Family practitioners are a great resource for starting a basic antidepressant or to continue medications originally prescribed by a psychiatrist that have not changed in over a year and patient is stable (although some docs will refuse). I have witnessed more than one family physician make things worse rather than better when prescribing psychotropics. Many community mental health agencies are hiring ARNPs and PAs to replace psychiatrists because there is such a shortage (and they can pay them less). You might ask how long they have worked in mental health and/or what kind of specialized training they have in psychotropic medications, but it is fair to assume that if they are working for a mental health agency, they have some background in them. Apparently 5 states, including Illinois and Iowa, have recently approved limited ability for licensed psychologists with extra training and testing to prescribe ONLY psychotropic medication, in order to address the incredible shortage of psychiatrists and increase access to medication treatment.
Generally, no one with less than a Master’s degree is allowed to provide psychotherapy by law (except in training programs with close supervision). However, I once worked with a therapist who received a “bachelor’s degree” in psychology in Australia, and her education appeared to be equivalent to my master’s. Also, no one should be practicing independently without an appropriate license. Anyone without a license must be supervised by a licensed practitioner. Certain licenses still require supervision by someone with a higher license. For example, in Iowa, social workers are licensed at three levels: LBSW, LMSW, and LISW. Only LISWs can practice independently. And, in Illinois, counselors are licensed at two levels: LPC and LCPC. LPCs cannot practice independently. In other states, the independent license level for counselors IS called LPC. And then, PhD level Psychologists are licensed as LCPs: Licensed Clinical Psychologists.
So, Katie, what’s the difference between social workers, counselors, and psychologists? Well, basically our education. We all end up in the same jobs unless we have PhDs, and then we either teach in universities or work for a large agency doing mostly testing or supervision. There are a few independent PhD or PsyD psychologists out there with therapy practices, but the numbers are fading. People with social work licenses went to social work programs; to my understanding, they sometimes focus on a more macro (community-wide or bigger) level change than clinical. People with counseling licenses went to counseling programs, or sometimes (like me), psychology programs. Although my master’s program was “terminal” (meaning not intended to lead to further study; intended to work immediately after completion), there are only a few states where there are independent master’s level psychologist license and none are local, so I had to apply for a counseling license instead. Counseling falls under the college of Education and Human Services, while Psychology falls under Arts and Sciences. At Western Illinois University, where I received my Master of Science degree, the Clinical/Community Mental Health Psychology program was 3 years long with an in-house free psychology clinic open to students and the community. We observed our professors providing psychotherapy during the first year, did our own clinical work beginning in year two, and ended with a 9-12 month internship. We focused heavily on theoretical case conceptualization and psychotherapy practice, but also learned how to administer psychological testing and research. Other fields might focus on different theories, techniques, or depth of change. We worked for deep change on the level of belief and personality or family structure, not just behavior or life choices. In general, I believe Psychologists (or counselors with psychology degrees) are best equipped for these types of goals, but I admit bias. On the other hand, my own therapist of 8 years has a social work degree and license! It is more about the style of interaction and quality of post-educational career training, in my opinion. But, I digress…
I am often asked if I can provide psychological testing. While I am fully trained in this service, the people requiring results (typically state disability judges, or Medicaid waiver case managers, or sometimes college student services accommodations managers) want a Licensed Psychologist (PhD level) to do the testing. Therefore, they will not pay me to do it.
Finally, to fully clarify, most Psychiatrists do not offer psychotherapy, ONLY medication prescription and management. This is good, because they do not usually get training in psychotherapy as part of their education. Psychologists, counselors, and social workers are all trained to some degree to do psychotherapy in some way.
But wait, Katie! What’s the difference between counseling and psychotherapy? Today, really, nothing. The terms are interchangeable. Medical billing is for “psychotherapy;” there is no code for “counseling,” or “social work” for that matter. I was taught that counseling is about short-term, surface, current life problems and therapy is longer-term, deeper and more possibly about the past, and more clinical. And that social work is about connecting people with community resources and influencing life choices. However you define them, we are all aiming to help people live better lives and feel happier with them. Hopefully this essay will help you keep us straight!