Author: Ashley Lingerfelt

Navigating Care

Psychologists, Counselors, and Psychiatrists: What’s the difference?

Ashley Lingerfelt

In my various community circles, I notice a lot of inquiries from parents asking for a provider to work with their child. However, they are often are unsure of what service they need. This is a question I see quite a bit, so I thought I would create a little guide to easily discern between the three major types of mental health care available to families. 

The following information is based on my professional experience as a licensed counselor and child and perinatal therapist. It certainly does not encompass everything there is to know about different types of care, but it briefly summarizes the major types and will hopefully be helpful for you!

Psychiatrists

Psychiatrists are typically associated with medication management. Usually, a plan of care is established and consists of meeting on a monthly or as-needed basis to manage prescription medicine. Families often seek out this option after they have received a formal diagnosis (such as ADHD, depression, or anxiety) and believe that the additional support of medicine will help alleviate their child’s symptoms and improve their quality of life. Some psychiatrists provide weekly or regular therapy services, but this varies across providers. 

Psychologists

Psychologists typically provide psychological assessments. They assess for autism, ADHD, mood disorders, and more, as well as provide IQ tests and reports on overall functioning. Most visits with psychologists are short term, only lasting a few sessions or however long it takes to complete the assessments. In my experience, many families seek out a psychologist when they need an IEP for school support or when their child’s presenting symptoms require further evaluation than a psychiatrist or counselor can provide. Psychologists do not prescribe medication nor offer medication management. Some psychologists do offer therapy in addition to assessments. It varies across providers. 

Counselors

Counselors assist with everyday regulation, emotional, and relational support to relieve stress and improve quality of life. This type of support is typically an ongoing relationship with frequent meetings (usually one a week or once every two weeks, but this varies across providers and client needs). Counselors screen for a variety of diagnoses (ADHD, anxiety, depression, OCD, trauma, and more), diagnose, and treat according to their specialty. When it comes to types of counselors, it is important to find a counselor that meets your specific needs. You can read more about finding a good counselor here. 

I hope this was helpful for you! If you are still questioning what type of care you or your child may need, feel free to reach out to me for a consultation. I offer developmental consultations for parents who are curious about the appropriate next steps for their child. Let me know if I can help guide you across next steps. Hopefully I can help this process seem less overwhelming! 

Wishing you success,
Ashley

Navigating Care

Types of Counselors: Who do you need to interview?

Ashley Lingerfelt

Looking for a counselor for yourself or a family member? First of all, yay! I’m so excited for you and the journey you are about to embark on. Finding a counselor is something that can be super exciting and once you find a good fit, it can be life-changing.

There are a few things to consider when you are looking for a counselor. Here are the options I encourage people to explore when searching for support:

Location

This is the starting point for many people. Location is important, especially for those who are seeking an in-person option for care. Finding a counselor who is local to you is a wonderful option for care, especially because this might mean they can provide you with other local resources relevant to you and your situation. However, virtual sessions are a great fit for some people and are worth checking out, as they can greatly open up the options for care in your state (for example, if a specialist you really want to work with is located three hours away, virtual care removes the barrier of distance).

Some questions to ask yourself:

  • Where is the office located?
  • Will the commute be convenient during the time of day your appointment is scheduled?

Some questions to ask your clinician:

  • Do you offer virtual sessions?
  • If so, what platform do you use for virtual sessions? Do I need to download anything special in order to use this method of care?

Payment

When it comes to paying for counseling services, there are a few options: you can use insurance, you can pay out of pocket, or your employer may actually cover it using a specific employee program. When interviewing clinicians, it’s definitely important to figure out what method of payment they use and to make sure they can be a sustainable option for you.

Some questions to ask:

The first question you should ask is:

  • Do you accept insurance or are you out of network?

If “yes,” then ask this:

  • Do accept my insurance (BCBS, Aetna, Cigna, Medicaid, Tricare, Kaiser, etc.)?
  • Do you check my insurance coverage for mental health services or is this my responsibility (some clinicians have billers and admin who confirm coverage for you, so be sure to ask how to navigate this step)?

If “no,” then ask this:

  • What are your fees?
  • Do you offer a sliding scale for those who might need it? If so, how do you determine your sliding scale eligibility?
  • Do you offer superbills for insurance reimbursement if my insurance company agrees to reimburse me for care?
  • What is your preferred method of payment?
  • Do you accept HSA and FSA cards?

Credentials

This is a huge factor for finding the right care. Does the counselor have specific training in your area of need? Many counselors consider themselves “generalists,” meaning they feel comfortable covering and treating a wide range of issues. While it is true that some counselors are competent across many areas, it is super important that they actually have the appropriate training to provide their advertised services. For trauma, it’s good to know how they specifically treat trauma and where they received their trauma training (for example, do they use EMDR, Brainspotting, Trauma Focused Cognitive Behavioral Therapy, or something else?). For couples counseling, it is important to know what model of care they use (some popular ones include Gottman and Emotionally Focused Therapy (EFT)). For children, it is important that they have appropriate training and experience treating whatever specific childhood issue you need support with (anxiety, depression, OCD, trauma, divorce, etc.) and they need to be able to provide you with an idea of a general treatment plan for this diagnosis (like how much parental involvement their treatment approach requires, how long typical treatment lasts for a child, will the sessions be held individually or with parents present, etc.). The same idea applies to counseling for substance use, divorce, perinatal mental health, and more. Working with someone who is under-qualified can not only be unhelpful, but it can actually be harmful.

Some questions to ask:

  • Do they hold a valid license within your state?
  • Do they have additional training allowing them to work with a specific population (grief, trauma, substance use, marriage, children, etc.)?
  • Have they worked with a similar issue (like yours) before?
  • Can they share a general idea of a typical treatment plan?
  • What does a typical plan of care look like in terms of longevity (is this a six month endeavor or a few years)?
  • What is their typical plan of care if/when they no longer feel qualified to support you (how do they facilitate a termination – do they help connect you to another provider?)?

Goodness of fit

One major thing to consider is the counselor’s overall goodness of fit for you. This ranges from practical things like availability and location to deeper things like personality and character. After considering all of the above factors and questions, it almost always comes down to goodness of fit. Below are some initial questions to consider regarding goodness of fit.

Some questions to ask:

  • Are they accepting new clients or do they currently have a waitlist?
  • Do they offer appointments that fit within your typical window of availability (mornings, evenings, weekends?)
  • What is their theoretical orientation (basically, get an idea of their approach and their model of care)?
  • What is their approach to coordinating care between providers (like communicating with your psychiatrist or general physician to support medication management, for example)?
  • What does a their therapeutic process include (an intake, treatment planning, check-ins, termination, etc.)?
  • How do they typically handle emergencies?
  • What is their availability to you outside of your scheduled session time (how responsive are they to emails, voicemails, etc.)?

Don’t give up!

Finding a suitable counselor can be a daunting process. This relationship is often one that is special, as you will typically invite them into the details of your life. You’ve got to trust your counselor and feel confident in their ability to appropriately support you. I hope this information serves as a solid starting point for you as you begin this process. Best of luck!

-Ashley

Parent Support

The Importance of Reflective Functioning: m.o.r.e. l.o.v.e.

Ashley Lingerfelt

When was the last time you found yourself reflecting, genuinely enamored with, curious by, or totally engrossed in what your child is experiencing and how they are experiencing it?  Reflective functioning is the ability with which a parent can understand, empathize, and experience their child’s inner world.  For some parents, this comes easily when their child is discovering a new toy or sensation.  For other parents, this skill is hard to tap into when their child is having a difficult moment and is dysregulated.  In both joyous and difficult moments, it is important to be in touch with our own reflective functioning while parenting our child.  In fact, research supports the idea of reflective functioning and parental alignment in regards to strengthening a child’s emotional resilience, the parent-child relationship, and building a child’s ability to engage in emotional regulation (Camoirano, 2017).  Furthermore, a parent’s reflective functioning also impacts their attachment relationship with their child (Slade et al., 2005).  

How to grow reflective awareness:

Some questions you may ask yourself are: Am I parenting in this moment based off of my child’s needs or my own needs? Is my child dysregulating me? Where do I feel my emotions in my body in this moment? What is dysregulating my child in this moment? How can I regulate myself so that I can regulate my child? You may even question larger influences in your life such as religion, culture, environmental, and regional impacts on your life and your parenting approach. The key is giving yourself a lot of grace, patience, and humility as you build your own reflective awareness.

A simple guide: m.o.r.e. l.o.v.e.

There are many models that provide a framework for reflective functioning.  I have been influenced by many of them, both professionally and personally.  Here I am briefly sharing two acronyms I have created to help both myself and the families I work with in my clinical and supportive roles. As parents, we are looking for moments of relational engagement (m.o.r.e.) where we can practice l.o.v.e. (see below).  This is the foundation for each of our experiences.  

Our children provide us with so many opportunities to connect and reflect.  We call these m.o.r.e. moments: Moments of Relational Engagement.  These moments can happen anytime during the entire spectrum of emotion, from really difficult, “hard to be present with” emotions to exciting, overwhelmingly positive emotions.  During these moments, we strive to practice l.o.v.e.:

Label the emotion. -> builds parent’s emotional awareness of child’s experience

Observe the actions. -> helps parent and child build narrative around events

Validate the experience. -> lets child know you are trying to understand their experience

Engage with co-regulation. -> teaches child how to organize and process emotions

The reason I created this acronym is because it highlights the steps leading up to the ultimate goal of co-regulation.  By following the steps of labeling, observing, and validating, we can more easily and naturally arrive at co-regulation (it takes a lot of practice, though).  The skill of regulation is primarily learned through mutual moments of regulation with one another.  Children are not born with the ability to regulate themselves.  This is incredibly frustrating for many parents, as it requires a lot of patience and intention during really difficult moments.  However, when co-regulation is achieved, it helps the child’s brain form the proper neural pathways to organize emotions.  This type of experience leads a child to feel connected, respected, and understood.  

As always, if you have questions, please reach out to me!  I’m more than happy to help you engage in co-regulation with your child.  Every family is different and all children have different needs, but building your own reflective functioning will greatly improve your ability to support your child.  

References:

Camoirano A (2017) Mentalizing Makes Parenting Work: A Review about Parental Reflective Functioning and Clinical Interventions to Improve It. Front. Psychol. 8:14. doi: 10.3389/fpsyg.2017.00014.

Slade, A., Grienenberger, J., Bernbach, E., Levy, D., & Locker, A. (2005). Maternal reflective functioning, attachment, and the transmission gap: A preliminary study. Attachment & Human Development, 7(3), 283-298.

Parent Support

COVID & Kids: I’m losing my mind as a parent.

Ashley Lingerfelt

There is no doubt that the past several months have been difficult, to say the least.  Your schedule has been flipped upside down.  Your child is missing their friends and other social activities.  You barely have time to bathe, feed, and engage with your child, much less get yourself together enough to complete an entire work day from home.  You are frustrated, confused, unsure, and overwhelmed by the lack of predictability in your home, as well as society at large.  You feel touched out.  You may feel isolated.  Your relationship with your child might be suffering a little bit, as well as your relationship with other family members.  As a therapist, I have the unique opportunity of supporting families when they need it most.  During this global pandemic, I’ve received countless calls from new and seasoned parents, alike.  Here are a few common themes I’m asked about in both my personal and professional circles:

1. Is it actually important for my kid to socialize with other kids?

The answer to this question is age-dependent.  If we can instead think of socialization as “being in relationship with,” this will help clarify our child’s needs.  Your child being in relationship with others is very important.  However, the younger your child is, the more important it is for them to be in relationship with you and less important it is for them to be in relationship with peers.  Regardless of your child’s age, the most important person in their life is their caregiver.  As infants, the loving, attuned interactions between child and their caregiver are monumental in forming early perceptions of relationships and the world.  Into the toddler years, socialization with peers is important for building skills around sharing, caring, patience, reciprocal play, and creativity, but during a pandemic, these skills can be easily practiced at home.  If your child is unable to spend time with peers and friends, that’s okay.  Set up games and activities for your child to practice important social skills with you.  It will still be beneficial!  While it might not feel ideal, sharing and caring is important regardless of who it is practiced with.  Never underestimate the impact of your role in being in relationship with your child.

2. How much should I worry about my child’s recent meltdowns?

Many children are experiencing higher levels of dysregulation right now.  The stressors in their environment are difficult for them to deal with.  Truthfully, many adults are having a difficult time staying regulated right now, too.  Meltdowns occur when a child is overwhelmed and extremely dysregulated.  On a physiological level, their autonomic nervous system becomes activated.  On a cognitive level, their brains are overcome with emotion and they have a hard time thinking critically.  It is normal for children to have meltdowns.  However, if your child is having frequent meltdowns that last longer than a few minutes and it is causing significant stress to you or your family, then it might be a sign that you and your child need additional support.  

3. Why is my child acting younger than they are?

Many parents right now are experiencing regressions with their children.  Little ones who used to sleep comfortably through the night now wake frequently seeking comfort.  Preschoolers who have successfully used the toilet for years are now having accidents.  Children who used to eagerly try new foods now refuse many of their staple favorites.  These are all examples of regressions in children who are experiencing stress.  When a child experiences stress, this can throw them off emotionally and physically.  It is common for children with anxiety to try to exercise control over some aspects of their life.  During COVID-19, many children feel as though numerous things are out of their control, such as how and when they go to school, when and how they see their friends, when and how they spend time with their extended family, and more.  Things that used to be normal, predictable, and consistent are no longer accessible.  This leaves a few basic things left in the child’s locus of control, such as eating, sleeping, and going to the bathroom.  

If your child is experiencing any of the above, it is very important that you seek to connect with them during these troubling times.  Children do not strive to be difficult, frustrating, or annoying.  Their goal is to connect with those closest to them and be in relationship with those they love.  If your child is doing something to disrupt this relationship, it is because your child is experiencing something disrupting.  Your job is to help them identify the stressor and co-regulate with them.  Together, you can help your child achieve a regulated state amidst their environmental stressors.  

If you want more information about regulation, dysregulation, co-regulation, and regressive behaviors, please feel free to contact me.  It is my desire to help you help your little one. 

Child Therapy, Parent Support

“Where are we going?”: Preparing your child for therapy

Ashley Lingerfelt

How to Talk to Your Child About Therapy

Approaching the topic of counseling can be hard.  As a child therapist, I am frequently presented with the question “What should I tell my child?” by concerned parents.  This is a tough question! I totally get it. Over the years, I’ve come up with three things to help parents break the ice about counseling with their children. Bringing up counseling doesn’t have to be scary!  Here are some tips and tricks to help you:

1. Keep it simple.

There’s no need to explain therapy in great detail.  It’s okay to let your child know they’re going to meet a new friend who will play with them and help them with their feelings.  Depending on the age of your child and the specific circumstances surrounding their need for counseling, you can share more details.  Don’t feel pressured to provide too much information.  Follow their lead and answer questions as appropriate.  

2. Be honest.

It’s okay to tell your child they are going to spend time with a therapist or a special friend to help them with their feelings.  Don’t tell them they are going to see a teacher, a tutor, or something unrelated to counseling.  This can complicate the beginning of a really beautiful therapeutic relationship.  Children need to know from the beginning that their relationship with their therapist is unique and can be trusted. 

3. Stay positive.

While it’s important for your child to know what a therapist is and why they’re visiting one, it’s important to talk about the experience in an uplifting way.  Therapy shouldn’t be presented as a punishment for the child or as a consequence to some challenging behaviors.  Say something like, “This person is going to help us as a family” rather than “This person is going to help you be a better listener for mommy.”  By approaching it in a positive way, your child will be more receptive to their therapist and counseling, in general.  This will set a good foundation for trust and rapport.

While these tips may be helpful, you know your child best! Tailor these tips to fit your own child’s unique needs. At the end of the day, you are making a great first step for your family by seeking the additional support of a therapist. If you have any questions, please reach out to me!  I am more than happy to help you set your child up for a successful therapy process.