The many faces of psychotherapy…

Given what is going on with legislation on a state level in NY state, (see my earlier post about signing the petition), it seems timely to clarify terms for people less familiar with the field of psychology and psychotherapy. I hope this will be helpful information about the different types of healers , doctors, and therapists out there and the kind of choices you have, as well as how these separate paths to becoming a healer are viewed by American society…

People of course often ask me what I do and what is art therapy.

Some of this blog has involved giving people an idea of the scope of the work of an art therapist in private practice, but the blog has also provided an opportunity for me to write about all kinds of topics ranging from psychology  and related issues to cultural diversity and rituals. I even posted on here about Facebook and other random topics like the healing power of companion animals and ways lawyers sometimes occupy therapeutic roles…

As I said, I will focus on New York state also because the treatment you find varies from state to state as does health insurance. I actually think that licensing and credentialing should be on a national level, so as to avoid the kinds of conflicts between different kinds of psychotherapists that are going on right now with this Proposition issue that I just posted about…

Psychiatrists and Psychopharmacologists are usually the only therapists with an MD. It used to be that only a psychiatrist, nurse practitioner or primary care physician could prescribe “psychotropic medications.” However that has changed since just recently. I think at the moment, only in New Mexico can psychologists with a doctoral degree also prescribe medications. See this article on the NAMI website:

http://www.nami.org/Template.cfm?Section=Issue_Spotlights&template=/ContentManagement/ContentDisplay.cfm&ContentID=8375

Whether it’s a good idea or not for doctoral psychologists to prescribe medication is a very controversial topic…

Anyway, back to the point about psychiatrists and nurse practitioners. Many people prefer to have a psychiatrist just as a “Psychopharmacologists” to prescribe their medication and check in with him or her once a month or every 2 months once that know what medications are helping them and working. An appointment with a psychiatrist in this role could range from 15 minutes to 45 minutes depending in the doctor. Many psychiatrists also have patients that they see weekly or twice a week for therapy. Some psychiatrists also have formal training in psychoanalysis and/or other fields. This leads to the term, “primary therapist” when there is a clinical team involved (mostly at clinics and other outpatient services.) In private practice it is usually that you see your primary therapist once or twice a week and your psychiatrist monthly. Also nurse practitioners sometimes specialize in psychiatry and also prescribe medications. I know a nurse practitioner who is also a psychoanalyst and works in private practice. In fact, many clinicians have more than one kind of training or license…

So thus as a licensed Creative Arts Therapist, I have some patients who also see a psychiatrist or nurse practitioner but consider me to be their “primary therapist.”

Many people who seek treatment through some form of psychotherapy or other kind of therapy do not take any medications at all. They have a wide range of choices in terms of the type of therapist they want to work with. Ultimately, people often choose their therapist based on how they feel about the person rather than his or her training. Students will often choose a therapist trained in the field they are studying.

In New York state, most kinds of therapists cannot now practice without a license. Licensed Social workers actually have two licenses. The first one they receive after grad school in social work when they pass the first of two licensing exams. The first one makes you an LMSW, Licensed Masters Social Worker, and the second one involves many supervised hours of work and another exam to become an LCSW, Licensed Clinical Social Worker. To be in private practice social workers have to have a certain amount of experience and an LCSW.

Most people put a whole bunch of letters after their name. Usually for masters level clinicians (those whose highest degree is a masters degree, the first is their masters degree, such as MA or MPS, Master of Art or Master of Professional Studies, and the next is either other credentials or the kind of license they have. For art therapists, for example, the first credentialing post masters degree is the “ATR”, which stands for Registered Art Therapist and then if the person is Board Certified it is ATR-BC. LCAT is the term for Licensed Creative Arts Therapist and includes a variety of kinds of therapists, including art therapists, dance therapists, poetry therapists, music therapists and drama therapists. I am not certain whether “expressive arts therapists” are included. Anyway, if you just see “LCAT” after someone’s name, you will not know which is their “modality” in which they work.

Dance therapists: “There are two different credentials offered by the Dance Movement Therapy Certification Board, Inc: the Registered Dance/Movement Therapist (R-DMT) credential and the more advanced Certified Dance/Movement Therapist (BC-DMT). A BC-DMT can provide training and work in private practice, while an R-DMT can work only in a clinical or educational setting and cannot provide training. To earn the BC-DMT, several thousands of hours of clinical experience are required.”

A drama therapist will have the initials RDT, LCAT, meaning Registered Drama Therapist. A music therapist will have MT-BC, which means s/he is Music Therapist-Board Certified. Poetry therapists are “Certified Poetry Therapist (CPT) or Registered Poetry Therapist (RPT).” The difference between these two credentials is that I think the RPT has more advanced training than the CPT…

There is another term called “psychodrama” therapy, which is not the same thing as drama therapy! Psychodrama is usually a group modality involving a lot of intense role play. It seems the credentials are “national certification offered at two levels: Certified Practitioner (CP) or Trainer, Educator, Practitioner (TEP).” It appears that Psychodramatists are included with Creative Arts Therapists: The New York Coalition of Creative Arts Therapists (NYCCAT) is an association made up of professionals from the field of Creative Arts Therapy including Art Therapists, Dance/Movement Therapists, Drama Therapists, Music Therapists, Poetry Therapists, and Psychodramatists.,but I am not sure if there is a separate License for psychodramatists, as usually they are trained in another field and have another license, which makes figuring out credentials confusing…

Licensed Psychoanalyst, (LP). New York State also now recognizes Psychoanalysts as being capable of being licensed practitioners without need of any other license. Psychoanalysis is difficult to describe as it varies so much depending on the training program the clinician completed. Examples include the Jungian Institute, NPAP, IEA (Institute for Expressive Analysis), the White Institute and many others. Most of these programs are very rigorous and the students often have extensive training in other areas: many are social workers, mental health counselors, creative arts therapists, even psychiatrists. Psychoanalysts have many years of post graduate study and usually an oral and written presentation of a case study as well as years of supervision and required analysis 2 or more times per week. So if you find an institute where the fee is low to work with a student, do not dismiss the person as too inexperienced as for example, I have a colleague who has an LCSW and an LCAT who is training to be a psychoanalyst.

For more specifics on the history of psychoanalysis and what they actually do, see this link:

http://www.med.nyu.edu/psa/psychoanalysis/

Then there are psychologists who are either PhD or PsyD, which are two types of doctoral programs, the first placing more emphasis on research and the PsyD on other aspects of the discipline, but I’m not too clear on this and am myself confused as I see coleagues who are getting one or the other for various reasons. Well it seems I do have the general idea as those with a PsyD focus more on clinical work whereas a big component of the PhD involves resarch, however lots of psychologists who are PhD focus on clinical work in private practice. A psychologist with either degree has what’s called a doctoral degree, which is much more advanced than just a master’s degree. Also, you may see them referred to as Dr. Jane Smith, PhD. This does not mean they are a medical doctor but that they have a doctorate.

More to say… to be continued.

Very Important: Please read and support Art Therapy

You do not have to read this whole post to help out. Basically, there is a petition that anyone, (ie. you do NOT have to be a therapist, and I don’t think it matters if you live in NY state even though this is to the state government) can sign to help Art Therapists as well as other clinicians ensure that the New York State Legislature will clarify the scopes of practices of Mental Health Practitioners and authorize the ability to diagnose our patients. (very important, see my explanation below.)

Here is the link for signing this petition: If it is not easy to click on the link, I will post a separate “link” post above.

http://www.change.org/petitions/the-new-york-state-legislature-amend-scopes-of-practice-of-licensed-mh-practitioners-to-include-diagnosis?utm_source=share_petition&utm_medium=url_share&utm_campaign=url_share_before_sign

Below is a copy of the email I received that asks for everyone to start grassroots work to ensure that the proposition in the law is amended. In my opinion, it makes no sense to license creative arts therapists and then limit their abilities to diagnose patients, as adding a diagnosis to an insurance claim is mandatory in order for patients to get their needs met and their sessions paid for in part by their insurances. As Licensed Art Therapists in private practice in New York State, many of us are now in network with some insurance companies and rely (like other kinds of therapists also do) a lot on the referrals from being on the insurance “panel” as in network providers. In addition. as out of network providers for other insurance companies, we also are required to submit a diagnosis for each patient. For those unfamiliar with this process, basically when you seek therapy with a private practitioner through your insurance, it is considered in the category of outpatient mental health/behavioral health benefits. Not everyone covered by their insurance company needs to also see a psychiatrist, so we are required to provide the diagnosis, especially if there is no psychiatrist involved.

Here is the text of the announcement of the “Governmental Affairs Chair”: I will “Bold” the info that is key: (by the way, NYATA is the New York Art Therapy Association, LCAT stands for Licensed Creative Arts Therapist, and NYCCAT is the New York Coalition of Creative Arts Therapists.)

As Governmental Affairs Chair, I am writing to ask for your help in a very small window of opportunity available to art therapists and those in our LCAT family.This is a lengthy but quite possibly one of my most important e-mails I have written to the community so please bear with!On January 23rd, NYATA will join other Mental Heath Practitioners in introducing a proposition to amend Article 163 of Education licensure law.

This proposition and collegial coming together was the result of MANY hours, e-mails, phone calls and sleepless nights!

Over the years, I have heard from many of you regarding the various concerns regarding licensure and intended as well as unintended consequences of this law.  While not all of these concerns are addressed in the proposition, the ones in which during THIS window of opportunity we have the possibility of being most successful are.

Attached is a copy of the Proposition to Article 163 which as I write this is being viewed by your legislators and lobbied both for and against. You will see in reading the proposition that it addresses the issue of diagnosis as well as extending limited permits.  You may also note some necessary compromises.

Following this document is a 7 week strategic plan.  Please note, while this is labeled NYATAs plan ALL Supporting LCAT disciplines are encouraged to follow it as what is altered for one modality effects us all.

Your participation is of the utmost importance.  There is enormous opposition to this proposition particularly from Social Work and Psychology who have publicly denounced LCATs EVER being able to diagnose.  In an effort to gain more influence in Albany you will see that NYATA is not the only discipline supporting the proposition.  Opposition to this legislative amendment is great and it is only with YOUR support that this change has a fighting chance.

It cannot be stressed enough that this is a small window of opportunity that may NEVER come again.

Please view the 7 week strategic plan (attached) and participate as fully as you can.

Additionally from now until a decision is rendered in March you may be hearing from us quite often as we update with the next strategic step to take and/or reminders!

It is our hope that you will print and follow along with the steps as we work towards this goal.

Thank you for your support and for participating.
This is our time.
GET STARTED!

PS – The petition has gone “live� earlier than expected and you are welcome to click, sign and pass it on.
You will find the link in the attached documents.

Also: A quick “thank you� to our colleagues in Drama Therapy who worked so hard with me in making this moment possible…..you know who you are and you are fabulous!

Michele Amendolari MA, ATR-BC, LCAT
Governmental Affairs Chair, New York Art Therapy Association
http://www.nyarttherapy. org

Gift Giving: A Universal Ritual

I started writing this post yesterday and got bogged down in talking about different kinds of gifts I have given recently and the psychology of giving and receiving. Then I was thinking a lot about receiving gifts from patients and all that that means and what to do as well as when to give a patient some kind of “transitional object”… However, I realized that would be a great idea for another post, and that I was straying from my original intention to celebrate cultural rituals.

Not to get on a tangent, but I have worked with patients, especially those with depression or despressive negative thinking about themselves, who have had a hard time receiving gifts, compliments and just good things from others and the universe. Another reason why dogs and cats are so therapeutic. Even the most depressed person will engage in physical love exchange with their animal when they will not talk to any other human.

But I digress. Back to my series about Celebrating Rituals of Different Cultures. When I started it, my intention was to focus on major life events we all share as humans: pregnancy, birth, birthdays, weddings and commitment ceremonies, and funerals.

Gift giving is an interesting ritual to look at and compare attitudes of Westerners and Easterners and learn about specific countries and their customs around gift giving. The Irish people and the Greek people are known for their very wonderful hospitality, which is a wonderful form of “gift” giving: sharing your home with loved ones and even people you hardly know, or just generally making sure people visiting your country feel welcomed. I don’t know if they do this anymore or ever did it, but I swear I’ve seen a lot of movies where, the people are walking down the stairs of the airplane (old movies), and Hawaiians, especially girls in traditional clothing, come and put Leis around their neck (sort of big necklaces made of just flowers… ) Well, I just looked it up and the Honolulu airport has a special welcome recording greeting.

Yes, there are many many different ways of giving and receiving. One of my patients once said of psychological receiving that you can’t “sort of” receive a little of something (like love, compassion, empathy, etc.), you either receive it in full or if you sort of can’t receive it all, you are really not receiving anything…

Japan, of all countries, is known for their rituals of gift giving. I don’t think any other country matches this cultural ritual around giving gifts, physical things mostly, like tea sets, chocolates, Japanese candies which are visually quite beautiful but quite strange tasting to my American taste buds for sweets, vases, etc. as well as envelopes of money. I lived in Tokyo from 1977-1979 and I remember my parents coming home from events with beautifully wrapped gifts. (Nobody comes close to how wonderfully the Japanese know how to wrap gifts. I remember being intrigued and entranced by the beautiful paper and the way it was folded, by the diagonal approach to the paper and trying to imitate the folds of the wrapping many times…) My father would return from business meetings with gifts he’d been given. One man who was a client of his somehow found out I loved music boxes and gave me several beautiful ones that my father would bring home for me. But what is this constant giving of gifts to mark a special meeting, negotiation, business deal, lunch, dinner, party? How did this begin and why is it done?

Here is an explanation of the origin of the gift giving, and no surprise, it actually brings us back to customs around funerals and dead “ancestors”, so I guess this post is still connected to my funeral customs post…: The Japanese have a special holiday for thinking of the dead. Wow. I think that’s a great idea, to devote a day to that.

Major Gift Giving Holidays

The two most popular occasions for gift giving in Japan happen twice a year. Ochugen falls during the middle of the year and Oseibo falls at the end of the year.

Ochugen originated as an offering to families who had a death in the first half of the year and still takes place two weeks before Obon, the Japanese holiday for honoring the dead. Nowadays, gifts are given as a gesture of gratitude to the people who are close to them. Bosses, colleagues, parents and relatives are common recipients.

Oseibo is more widely observed and began from the custom of placing offerings on ancestors graves. Oseibo gifts are typically given to friends, colleagues, teachers, clients or customers, and to anyone he or she is indebted to. These gifts are specifically given to pay back favors received during the year. The value of the gift does matter as the gift reflects the giver’s evaluation of social indebtedness that he or she has incurred. The recipient can accurately determine the value of the relationship by the monetary value of the gift. Oseibo gifts are typically sent out by the 20th of December.

Gifts commonly given for Ochugen and Oseibo range from department store items to food and alcoholic beverages. People receiving gifts for these occasions usually express their gratitude either by writing or calling the person who gave them the gift.”

I also found on this website an explanation of the importance of the way the gift is wrapped. It is considered rude to open a gift when you receive it, which explains why back in 1978 my parents would come home with gifts that were always beautifully wrapped:

When giving gifts or sending presents in Japan, it is customary to show special care not only to the contents, but to the way a gift is wrapped and the wrapping itself. In Japanese culture, gift wrappingcan be as important as the gift, where the gift is viewed as a form of communication between the giver and the receiver. The chosen gift wrapping serves an important role in shaping the messaging associated with the gift. In short, the wrapping is considered as part of the gift itself and should reflect both the gift being given and the emotions behind the gift.

The distinction of a gift being wrapped is an important one when it comes to receiving a gift. Except among close family members, gifts must not be unwrapped in front of the donor of the gift. The recipient should wait until later to open the gift.”

This is from the following website post: http://www.giftypedia.com/Japan_Gift_Giving_Customs

Happy New Year! New Year’s: Another Cultural Ritual: Shogatsu

Happy new year to everyone! Thank you all for following and reading this blog! WordPress sent me an impressive email about all my blog “stats” and I’m quite amazed that so many more people are seeing this than I had imagined! It’s nice to know my writing is getting out there. I invite you all to comment on any posts in any way you like that is constructive! I thank my followers especially, and I am happy to be following more and more blogs out there, mostly concerning mental health. To all of you out there suffering with mental illness and related issues, I salute you for blogging and each day recommitting to fight to live despite all the pain and suffering you are experiencing. Taking care of yourself when you have a serious mental illness is a big job just by itself and if you have other jobs such as parent, partner and/or some kind of job job or “career”, you have even more to contend with. So give yourself a pat on the back for another year of doing your best to take care of yourself and for spreading information about what mental illness is really about and educating the public…

So in honor of new year’s, I thought I would post about at least one interesting or “different” new year’s ritual from our American ones (ball dropping, dressing up fancy, party hopping, kissing at midnight, etc…or just sleeping through it and celebrating with friends or family on the first day of the year); this time it is very personal for me as I lived in Japan a long time ago when I was in 4th and 5th grade and I remember New Year’s Day was one actually THE most important days of the year. ( I will have to post soon about Boys Day and Girls’ Day…) I don’t remember all the rituals but if I look it up it will probably bring up some memories and I can be more specific about how the Japanese celebrate New Year’s…

First, here is the link to the website I will be quoting from:

http://www.japan-guide.com/e/e2064.html

I remember the word “mochi” which was this white stuff that was eaten everywhere; I forgot it was in soup. As a ten year old, I did not like it at all because the texture was too strange for me; I think it’s a bit like thick tough tofu, but it is interesting that the Japanese have specific special dishes for the New Year. Also in this post is the emphasis of the symbolism of getting rid of the old year and having sort of a new clean space for a good new year, not so different from the Jewish rosh hashanah and Yom Kippur actually, although Jews separate two forms of thinking about new year’s (the welcoming of new year and new hope versus reflection upon one’s actions and repentance for the old year)…

“Here are some of the rituals and meanings for the Japanese. See if any of these speak to you and match something you do for the new year, such as making resolutions and sending holiday cards..

New Year (shogatsu or oshogatsu) is the most important holiday in Japan. Most businesses shut down from January 1 to January 3, and families typically gather to spend the days together.

Years are traditionally viewed as completely separate, with each new year providing a fresh start. Consequently, all duties are supposed to be completed by the end of the year, whilebonenkai parties (“year forgetting parties”) are held with the purpose of leaving the old year’s worries and troubles behind.

Homes and entrance gates are decorated with ornaments made of pine, bamboo and plum trees, and clothes and houses are cleaned.

On New Year’s eve, toshikoshi soba (buckwheat noodles), symbolizing longevity, are served. A more recent custom is watching the music show “kohaku uta gassen”, a highly popular television program featuring many of Japan’s most famous J-pop and enka singers in spectacular performances.

January 1 is a very auspicious day, best started by viewing the new year’s first sunrise (hatsu-hinode), and traditionally believed to be representative for the whole year that has just commenced. Therefore, the day is supposed be full of joy and free of stress and anger, while everything should be clean and no work should be done.

It is a tradition to visit a shrine or temple during shogatsu (hatsumode). The most popular temples and shrines, such as Tokyo’s Meiji Shrine, attract several million people during the three days. Most impressive are such visits at the actual turn of the year, when large temple bells are rung at midnight.

Various kinds of special dishes are served during shogatsu. They include osechi ryori, otoso (sweetened rice wine) and ozoni (a soup with mochi).”

The cleansing of the old year parties are a very appealing and interesting idea, and I like that there are specific foods to eat on New Year’s Day. We in the US emphasize New Year’s Eve revelry with all kinds of alcohol, and egg nog and some version of “punch” being the traditional drink, that there are no specific foods to eat on the first day of the year. White food seems to be connected to purity… It would be interesting if there were specific “New Year’s” cookies and soup, etc. but I guess for us, New Year also marks the End of a Long Holiday Period, which seems to start on Halloween and get really going by Thanksgiving, so by New Year’s, people are so sick of holiday food, drink and parties that I guess it wouldn’t be so appealing to have special New Year’s foods… Or maybe so?

Ok, so if you have read to the end of this post here is an extra treat I found online, some really “odd” or “weird” New Year’s traditions from around the world. Is anyone reading this familiar with any of them?

Love this one, wish it was done here! Denmark: “A strange and weird Danish New Year tradition is throwing breakable dishes at neighbor’s door. Strangely this makes them happy instead of annoying them. The family with the most huge tower of broken plates, glasses, cups and other crockery is considered to be the most lucky one because it means that they have lots of loyal friends.”

Here’s a funny one: “Residents of Brazil, Mexico, Bolivia and other South American states welcome the New Year by wearing colorful underpants. The usually wear red, yellow or other brightly colored under-wears past midnight to catch good fortune for the coming year. This also helps them find a loving mate. Red means an amorous love life ahead and yellow expresses the desire to gain money and wealth. The wishes of the locals are expressed via their underpants.”

And I’ll end with our American custom of the first kiss of the year as it actually has some meaning! “It’s a tradition in America to share a sweet midnight kiss with your girlfriend or boyfriend or with anyone in case you don’t have one. This will make the coming year incredibly beautiful for you. We believe that this practice brings true love. It washes away the bad memories and fate from the past and marks the beginning of a New Year full of love and life. A famous movie, “In Search of A Midnight Kiss” is themed on this New Year Ritual.”