In my work as a Clinical Social Worker at outpatient mental health clinics, I have had the opportunity to work with many colleagues, and observe the field of private practice treatment.  As a parent of an ADHD child, I have also been “on the other side of the couch,” as a client of such services.  What I have seen is a very wide range of quality in the services offered to the community.  As such, I would suggest that the consumer of mental health services is much more likely to receive quality treatment if s/he has an idea of how to be an educated consumer. 

Increasingly, evidence suggests that specific treatments are effective for conditions such as depression, anxiety, ADHD, and others.  Effective therapy entails more than finding “a nice person to talk to.”  As in medicine, effective treatment is given by skilled and experienced clinicians.  In particular, treating children is both a pressing community need, and a difficult clinical challenge.  Not all clinicians are skilled in treating children.  While sessions with children are often not as focused as those of adults, treatment should be more than playing games.  Play may be an integral part of treatment, but it should be part of a therapeutic plan that is focused and points to improvement.  The unfortunate reality is that there are many inexperienced clinicians who spend people’s time and money playing chess with children, without a sufficient conceptualization of where the treatment is headed. 

The following are some suggestions for how to get the most out of treatment by finding the best person available.  Areas to examine in a mental health professional are: 1) Licensure, 2) Specialty, 3) Ongoing training, 4) Reputation, 5) Flexibility, 6) Treatment Planning, 7) Assessment, and 8) Presence

1. Licensure:  As a Social Worker, I will comment on my discipline.  There are other disciplines out there, such as family counseling, coaching, etc.  I am not familiar with these disciplines, and I would suggest that any consumer of such services investigate whether they are licensed by the State of New York, and their level of training.  Without going into detail, the State of New York licenses Social Workers at 2 levels, LMSW (Licensed Master Social Work), and LCSW (Licenses Clinical Social Worker).  The LCSW is the higher level of licensure, and is only conferred after 3 years of practice and supervision (in addition to a licensing exam).  Thus, the LCSW immediately informs the consumer of a level of training and experience.  An LMSW Social Worker who is operating in private practice is, by definition, a therapist with less than 3 years post-Masters experience.  Of course, in any profession, there are talented individuals who excel even without training and experience; however, I would suggest that the consumer should be wary of an LMSW in private practice.  Tragically, it is not uncommon for unethical individuals to misrepresent themselves to the public.  Fortunately, licensure is a matter of public record.  One only need check the website of the New York State Office of Professions to verify an individual’s licensure status by entering his or her name.  Here is the link: http://www.op.nysed.gov/opsearches.htm. 

2. Specialty: An educated consumer should inquire of the clinician regarding their area of interest/specialty/experience.  As patients of medical doctors, we are largely comfortable asking about our doctors’ experience with a specialized problem.  The same should be true for mental health professionals. 

3. Ongoing Training:  In the mental health field, Masters level training is understood to be only the beginning of comprehensive training.  The skilled mental health professional is one who attends institutes, trainings, and generally avails him or herself of ongoing education and supervision.  The educated consumer should ask clinicians about this.

4. Reputation:  A professional’s reputation and track record are important sources of information.  Reputation, however, should be based on observable results.  Do clients get better?  Are there improved outcomes?  Unfortunately, reputation is sometimes determined by the notion that “everyone goes to him/her.”  Popularity is not the same as skill.  An educated consumer would not be overly swayed by what “everyone” does, but would rather look into objective means of evaluating reputation.

5. Flexibility: We live in an age of specialization.  Many clinicians provide highly specialized treatment.  Specialization can bring the advantage of a particular skill done very well.  If the consumer is comfortable with this singular focus, it can be helpful.  My experience, especially in the area of my expertise, namely ADHD, tells me that there is no one approach that will always work.  I believe that a clinician needs to be flexible, and able to offer more than one, rigid formula for how to tackle problems.  As a postscript, a pet peeve of mine is workshops/lectures that advertise with phrases such as “the key to parenting,” or “the one thing that will bring peace to your home.”  I have found no such “key” or “one thing.”  Complex problems need varied and complex strategies.

6. Treatment Planning:  Along with asking about experience/expertise and treatment approach, it is reasonable to ask the clinician, either at the beginning or early in treatment, for a game plan for how to address the problem.  Of course, it is unreasonable to expect a detailed, rigid answer to such a question, but a quality clinician should be able to conceptualize at least a broad outline of a plan for change.  A vague answer to such a question may be a red flag that the clinician may be wasting your time.

7. Assessment:  Most of us would be put off by a doctor who is quick to give a diagnosis and treatment without getting a full medical history.  The same is true for psychotherapeutic treatment.  A good clinician (like an educated consumer) asks a lot of questions.  If a clinician is too quick to offer an assessment and/or treatment without getting a comprehensive history, it’s probably a bad sign.

8. Presence:  A therapist should be someone who you respect, and who projects confidence that there is a way to help.  This is obviously highly subjective, but if a therapist is overly reactive to the content, it’s a bad sign.  If the therapist seems just as confused as you are, or manipulated by your child, or unable to handle your child’s behavior, it’s a bad sign.  A therapist should project that s/he is above all the emotion of the problem, and can handle the situation logically. 

In any economic activity, the quality of a product is significantly influenced by how demanding is the consumer.  There is clearly a demand for therapists, especially for male therapists who can treat boys.  If the community settles for inexperienced, unseasoned professionals, simply because they are frum and fit a particular demographic, then the community will receive substandard service.  If, on the other hand, the community demands a high level of professionalism and experience from clinicians, then they are more likely to receive quality treatment.  It is my hope that consumers become more educated and demanding, and that this increases the likelihood that people get the treatment they need.

Evan Steele, LCSW is a Clinical Social Worker, and currently works in licensing as a Mental Health Program Specialist for the New York State Office of Mental Health.  He previously served as Administrative Supervisor at the JBFCS MBCS outpatient mental health clinic in Boro Park for over 5 years. Other previous employers include Ohel and FEGS. Mr. Steele completed the JBFCS Advanced Training Institute, and specializes in parenting difficult children.