Short, Kaylee

Starting therapy – even thinking about it – can be overwhelming. How do I find a therapist? Do I want to do individual therapy, or family therapy? With my busy schedule, how will I find time to attend sessions? All of these are valid questions that come up for people about to begin their therapeutic journey. This article will guide you through the process by explaining words and phrases often seen in therapists’ online profiles, describing common provider types, offering suggestions for finding a provider, and describing what to expect when your sessions begin. In addition, we will debunk common therapy stereotypes. Therapeutic Words and Phrases on Profiles Two therapy-related terms you may see or hear on provider profiles (e.g., Psychology Today), are counseling and psychotherapy. Often, these terms are used interchangeably, but there are differences between the two. Counseling’s traditional focus is on a specific issue and its intention is to address a particular problem (e.g., stress management). Counseling can also include developing coping strategies or problem solving for different situations. By contrast, psychotherapy is a longer-term approach to therapy and dives deeper into the underlying processes of a person’s thoughts, emotions, and behaviors. Psychotherapy can address multiple problems simultaneously and is often used for diagnosis and the management of various mental health diagnoses, such as depression or anxiety (Sailing, 2021). You may also see providers mention theoretical orientation, which is how a therapist approaches their work and how they perceive their clients’ challenges (Sailing, 2021). For example, some theoretical orientations focus on early childhood experiences and relationships with parents, while others focus on the thoughts, behaviors, and emotions related to your current concerns. Theoretical orientations that you may see on profiles include Cognitive Behavioral Therapy (CBT), person-centered therapy, or a psychodynamic approach. Therapists who mention using a holistic perspective may adjust their approach based on the needs of a given client. Common Provider Types When searching for a therapist, it is important to understand the differences between the types of providers. Licensed Professional Counselors, Licensed Clinical Social Workers, Psychologists, Psychiatrists, and Marriage and Family Therapists can all provide therapy, but their training and overall approach may differ. Licensed Professional Counselors (LPC) and Licensed Clinical Social Workers (LCSW) are mental health professionals with at least a master’s degree in psychology, counseling, or social work. Upon graduation, they work in a clinical setting (e.g., counseling center) to accrue additional training focused on treatment, after which they take a licensing exam. LPCs and LCSWs are qualified to provide counseling to evaluate and treat mental health concerns for children and adults. Beyond this qualification, LCSWs also have the opportunity to engage in additional advanced training and receive their doctorate degree, at which point they become DCSWs (Doctor of Clinical Social Work). Psychologists have a doctoral degree in psychology focusing on the study of the mind and behavior. After graduate school they must complete a lengthy internship for additional training in treatment and theories. Psychologists can evaluate and treat mental illnesses through various assessments, clinical interviews, psychotherapy, and counseling. Based on their training and experience, psychologists can provide individual services to children and adults, or groups. A Psychiatrist is a medical doctor who specializes in the treatment of mental illnesses through the use of medications. Typically, the goal of seeing a psychiatrist is to understand and adjust medications and discuss how the medications are addressing symptoms. Often, psychiatrists do not conduct psychotherapy with their clients; instead, psychiatric visits are combined with sessions with a counselor or psychologist. Marriage and Family Therapists (MFT) earn a master’s degree to treat a wide range of clinical problems and specialize in work with couples and families. Their form of treatment is typically brief, solution-focused, and based on specific, attainable goals a couple can work to meet. The focus of an MFT’s psychotherapy is family systems – which can mean having family attending therapy together – and often addresses mental health within those systems. Suggestions for Finding a Provider Finding a provider or a therapy style that works for you is like test-driving a car, and you shouldn’t feel obliged to go with the first car you tested out. One way to find a provider is by reviewing profiles on websites like Psychology Today or Inclusive Therapist. Providers’ profiles will typically include the presenting concerns in which they specialize (e.g., children, LGBTQ+), their training, and even the insurance they accept. Another option for finding a therapist is to consult with family and friends who have been to therapy. Personal stories and referrals can be a great way to find the right therapist for you. Consulting with your medical provider, with whom you have an established relationship, is another way to find local providers in your area. It’s worth noting that sometimes a profile sounds great, but, once you officially meet, your connection with the therapist feels different. That’s okay! Feel empowered to take the time to find the best fit for you and your needs (just like test driving multiple cars!). What to Expect in Therapy Before attending your first therapy session, make sure to consult with your provider and ask about sliding scale rates and whether they accept your insurance. This way, you won’t have to worry about the cost of obtaining services and will know that your chosen provider is within your budget. Cost is often a barrier to attending therapy, so sorting out the issue beforehand may ease any feelings of stress or worry. It’s also important to ask about the structure of your appointments. For example, clarify how long sessions will last. Counseling and psychotherapy sessions typically last an hour unless a provider indicates otherwise. You might also inquire about the overall treatment length. The duration will vary, depending on your provider and your presenting concerns, but it’s important to understand how long you will be in therapy – whether several months or several years. And confirm whether your sessions will be in-person or virtual: discuss which would be best for your treatment and your schedule. During your first session, ask questions about the things that matter most to you in therapy. You may want to know how many years your therapist has been practicing, or their approach to someone with your concerns. The first session can also be a time to address values important for you to have recognized within the therapy setting. Common Myths about Therapy Something must be wrong with me if I need to attend therapy. People attend therapy for a variety of reasons, from managing daily life stressors (e.g., work-related stress, family relationships) to navigating severe mental illness (e.g., major depressive disorder, bipolar disorder, schizophrenia). I will be judged by my therapist. For those who have never attended therapy before, one fear is that they will be judged when sharing vulnerable information. However, therapy is intended to be a safe space anyone willing to be vulnerable and authentic in their experiences. If anyone finds out I am going to therapy, I will be ruined. People will see me as weak. There is still a stigma around attending therapy, but it’s important to know that this service is confidential. Just like with any doctor’s visit, your attendance in therapy and what you share there stay within that space and are not something that will be shared unless you feel inclined to do so. Once I start therapy, I will be in therapy forever. The length of time that you attend can vary and depends on a variety of factors, including your presenting concerns and the form of therapy you choose. It’s also important to know that it may take time to see results – therapy is not an immediate process. All types of therapy are the same. Therapy can look different based on presenting concerns, the theoretical orientation of your provider, and the type of provider from whom you are seeking services. Therapy is a resource that is often underused due to unclear information on how to find a therapist, a lack of knowledge about the types of providers, and various myths that keep people from attending. Seeking therapy can be an individual, couple, or family choice, one centered on well-being and mental health. Remember that seeking therapy doesn’t mean you are weak. Instead, therapy gives you an opportunity for growth and additional support.

Family Story

https://militaryreach.auburn.edu/ffTherapy.jsp

Over the course of their service, military families may experience events that can disrupt family functioning. For example, it is common for military families to experience long separations due to deployments or military training, as well as moving, on average, every two to three years (U.S. Government Accountability Office, 2022). Frequently finding themselves in new, fast-changing situations, military families can rely on resources, such as a parenting program, to help them successfully adjust to their surroundings. This piece will discuss the importance of using credible resources and identify some common barriers to resource utilization.

Garnes, Melissa

Over the course of their service, military families may experience events that can disrupt family functioning. For example, it is common for military families to experience long separations due to deployments or military training, as well as moving, on average, every two to three years (U.S. Government Accountability Office, 2022). Frequently finding themselves in new, fast-changing situations, military families can rely on resources, such as a parenting program, to help them successfully adjust to their surroundings. This piece will discuss the importance of using credible resources and identify some common barriers to resource utilization. \n\n #### THE IMPORTANCE OF EVIDENCE-BASED RESOURCES \n\n A study on community resource adequacy explained that having *access to resources* and *feeling satisfied after using them* can help Service members and spouses maintain emotional and physical wellbeing (Hobfoll & Lilly, 1993). In another study, the wellbeing of spouses and their satisfaction with resources was found to be the most important factor for staying in the military (Segal & Harris, 1993). Knowing that resource availability can influence family wellbeing and retention, it is important to figure out which resources are best. It is useful to know if resources are evidence-based or not, because this is a reliable way to understand causality. \n\n Resources created by institutions, like the U.S. Military or universities, are typically created based on need and supported by empirical research. Let’s dive into an example: *The Department of Defense (DoD) recently learned from a survey that many Service members feel disconnected from their units, so they decide to implement a program to improve unit cohesion. After reviewing many programs, or developing a new one, the DOD decides to implement a relationship-building program to increase unit cohesion among the members. Finally, after the program has been implemented, it is studied to determine if it is achieving its goal.* \n\n The example involves a lengthy, but essential, process! Resource evaluation can exist in different forms and is done at different time points in a program’s creation or implementation. But what makes empirically-based resources any different from those that aren’t? Well, they are supported by research. One way that evidence-based programs are differentiated from those that aren’t is through the methodology used for evaluation. For example, the [Clearinghouse for Family Readiness](https://www.continuum.militaryfamilies.psu.edu/search) categorizes programs by their use of a [randomized control trial](https://militaryreach.auburn.edu/DictionaryResult?term=Randomized%20Controlled%20Trial) or [quasi-experimental design](https://militaryreach.auburn.edu/FamilyStoryDetails?resourceid=063db49a-c73b-4148-a997-0dbb81126fdf#:~:text=quasi%2Dexperimental%20design), two methods that test the efficacy of interventions. Without these methods, it is difficult to determine the causality of an intervention. That is, how can we determine what caused the outcome of increased unit cohesion? Using the example above, an evidence-based method to test the efficacy of the relationship-building program will be able to determine if the program itself increased unit cohesion among members, rather than another variable such as leadership support. \n\n #### BARRIERS TO USING RESOURCES \n\n Navigating resources and deciphering which to use can be a balancing act, as there are so many. Knowing what to look for can make choosing one a little easier. As previously mentioned, using empirically-based resources can help military communities understand which programs have been proven to address a specific outcome. Creating a valid resource is only the first step, though. The program should address a need as well as be accessible. I had the opportunity to discuss this complex issue with Auburn University’s Extension Veterans Outreach Coordinator, Curtis Pippin. Though Curtis didn’t have the final answer, he did have some words of wisdom. “Bridging the gap [between resources and people using them] starts with giving [people] a voice. \n\n Trying to untangle the issue of why some people don’t use available resources is difficult. There may be several reasons – some may be environmental (e.g., not having reliable transportation), psychological (e.g., viewing getting help as a weakness), or simply because they do not address the need of the individual. The multi-layered reasons can make it difficult to determine the best solution because an approach may address one barrier but not another. \n\n For example, in the case of accessing mental health services after deployment, some of the barriers Service members may experience include stigma, military culture, general attitudes about treatment, and logistical concerns (e.g., long wait times, far distances to medical facilities) (Institute of Medicine of The National Academies, 2013). When resources are set up to target singular problems (e.g., housing) then all the person’s other needs end up not being met (Trail et al., 2017). Therefore, looking for a holistic resource that offers multiple types of assistance (e.g., housing, mental health services, childcare assistance) may be a better option for Service members who are experiencing a multi-faceted circumstance, such as deployment and reintegration (Trail et al., 2017). \n\n While resources are not one-size-fits-all, it is important for researchers to consider the needs being met, the efficacy of the intervention, and the accessibility of the final product. Creating accessible, useful, and evidence-based resources for military families can go a long way in terms of wellbeing, family functioning, and retention. To learn more about epirically-based, military-focused programs, visit [Clearing House for Military Family Readiness](https://militaryfamilies.psu.edu/), a research team that evaluates program effectiveness. Additionally, our team at [Military REACH](https://militaryreach.auburn.edu/) also helps identify and evaluate research, including that on empirically-based programs, and we even developed a [study](https://militaryreach.auburn.edu/dr?id=2337eb95-bfd8-48a8-a288-8d137882e259) to evaluate the effectiveness of our research summaries!

Family Story

https://militaryreach.auburn.edu/ffCredibleResources.jsp

Imagine you’re a Service member. Your commanding officer has reason to believe that certain civilians are making bombs at home and will use them against the public. Your unit is tasked with breaking in and finding the bombs. Entering the home is necessary to the mission – but you’ve been told your entire life that breaking into a person’s home is wrong and a violation of their privacy (not to mention against the law). However, you have a mission to fulfill. So, you break in, regardless of your inhibitions. The above scenario is one example of an event that could lead to moral injury. Moral injury is any act, whether perpetrated or witnessed, that may conflict with personal morals or beliefs (Douglas, 2022). While we often think of this conflict in the context of war, other examples of potential moral injury include abuse, rape, and violence (Moral Injury Project, n.d.). And although moral injury may have lasting effects on someone’s life (Litz et al., 2009), it’s still a concept of which many people aren’t fully aware. This article will explain moral injury and discuss some ways that mental health professionals can help Service members and Veterans work through issues related to it.

Annino, Lily

Moral Injury: What Is It and How Can Professionals Assist? Lily Annino, Undergraduate Research Assistant Imagine you’re a Service member. Your commanding officer has reason to believe that certain civilians are making bombs at home and will use them against the public. Your unit is tasked with breaking in and finding the bombs. Entering the home is necessary to the mission – but you’ve been told your entire life that breaking into a person’s home is wrong and a violation of their privacy (not to mention against the law). However, you have a mission to fulfill. So, you break in, regardless of your inhibitions. The above scenario is one example of an event that could lead to moral injury. Moral injury is any act, whether perpetrated or witnessed, that may conflict with personal morals or beliefs (Douglas, 2022). While we often think of this conflict in the context of war, other examples of potential moral injury include abuse, rape, and violence (Moral Injury Project, n.d.). And although moral injury may have lasting effects on someone’s life (Litz et al., 2009), it’s still a concept of which many people aren’t fully aware. This article will explain moral injury and discuss some ways that mental health professionals can help Service members and Veterans work through issues related to it. Moral injury is more common than we realize among Service members and Veterans, and it can lead to negative outcomes, such as co-occurring PTSD (Maguen et al., 2022). In one study, 41.8% of veterans reported experiencing at least one form of moral injury; the majority had been betrayed by others or suffered a transgression (Wisco et al., 2017). Dealing with extreme levels of guilt and regret without understanding what you’re going through can be confusing. At the same time, being able to talk to your provider about what you’re dealing with and learning that it’s not abnormal are helpful for Service members (Douglas, 2022). Professionals familiar with the concept of moral injury and with therapeutic approaches that focus on acceptance and self-forgiveness can be beneficial for people working through the effects of moral injury (Maguen & Norman, 2022). Find the best therapist for you. Finding a therapist is like test-driving a car – it’s okay to take your time finding the best fit. It’s important for you to express your experiences freely without having to constantly explain details (e.g., defining acronyms, describing job-specific duties) that are well-known to those in the service (Douglas, 2022). Seek out a therapist who understands military culture and your unique experience as a Service member or Veteran. Connect with your chaplain. Therapists and counselors are trained to help Service members work through moral injury. In addition, military chaplains (i.e., U.S. military’s educated, religious leaders who provide services to Service members and their families) will talk with you regardless of your faith or beliefs. Chaplains combine their knowledge of military culture with their own resource awareness to help those in need. Connecting with a chaplain could benefit you during your healing process. Surround yourself with your support system. According to Chesnut and colleagues, moral injury can lead to the potential impairment of social well-being, social support, and social relationships (Chesnut et al., 2020). Re-engaging with your communities, friends, and family, and increasing your social support may help you in your struggle with moral injury. Moral injury is difficult to deal with due to its negative psychological effects. Nonetheless, there are ways to work through the challenges – such as receiving mental health services – and continue moving forward. If you feel you may be struggling with decisions your service requires of you, surround yourself with your support system and know that there are trained professionals who can help you work through these emotions. To continue learning about moral injury, check out the Military REACH library and access current research summaries, reports, and other educational resources, released monthly. References Chesnut, R. P., Richardson, C. B., Morgan, N. R., Bleser, J. A., Perkins, D. F., Vogt, D., …. Finley, E. (2020). Moral injury and social well-being: A growth curve analysis. Journal of Traumatic Stress, 33(4), 587-597. https://doi.org/10.1002/jts.22567 Douglas, C. V. (2022). A phenological study and investigation of moral Injury with veterans. [Doctoral dissertation, Liberty University]. Digital Commons. https://digitalcommons.liberty.edu/doctoral/3722 Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695–706. https://doi.org/10.1016/j.cpr.2009.07.003 Maguen, S., Griffin, B., Copeland, L., Perkins, D., Richardson, C., Finley, E., & Vogt, D. (2022). Trajectories of functioning in a population-based sample of veterans: Contributions of moral injury, PTSD, and depression. Psychological Medicine, 52(12), 2332-2341. https://doi.org/10.1017/S0033291720004249 Maguen, S., & Norman, S. B. (2022). Moral Injury. National Center for PTSD. 33(1), 1-9. https://www.ptsd.va.gov/publications/rq_docs/V33N1.pdf The Moral Injury Project. (n.d.). What is moral injury? Syracuse University. https://moralinjuryproject.syr.edu/about-moral-injury/the-moral-injury-project/ Wisco, B. E., Marx, B. P., May, C. L., Martini, B., Krystal, J. H., Southwick, S. M., & Pietrzak, R. H. (2017). Moral injury in U.S. combat veterans: Results from the National Health and Resilience in Veterans Study. Depression and Anxiety, 34, 340–347. https://doi.org/10.1002/da.22614

Family Story

https://militaryreach.auburn.edu/ffMoralInjury.jsp