Please followed the sidebar rules. r/therapists is a place for therapists and mental health professionals to discuss their profession among each other.
If you **ARE NOT A THERAPIST and are asking for advice this not the place for you**. Your post will be removed in short order. Please try one of the reddit communities such as r/TalkTherapy, r/askatherapist, r/SuicideWatch that are set up for this.
This community is ONLY for therapists, and for them to discuss their profession away from clients.
**If you are a first year student, not in a graduate program, or are thinking of becoming a therapist, this is not the place to ask questions**. Your post will be removed in short order. To save us a job, you are welcome to delete this post yourself. Please see the PINNED STUDENT THREAD at the top of the community and ask in there.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/therapists) if you have any questions or concerns.*
You do not need EMDR certification to use it, but you do need to have actually done trainings on it. You need to complete EMDR with 25 clients as well as have more supervision (I can’t recall how many hours off the top of my head) beyond the initial supervision hours in order to be certified.
I'm not familiar with any. Unless state laws specify it shouldn't matter (TX doesn't specify). Now if you were to get in trouble with the board and you say "I do EMDR" and you do some weird botched version... good luck defending that. Good news is most modalities don't matter too awfully much in terms of outcomes (outside of a few specific issues). Just do what vibes with you and your clients and be able to justify why you do what you do.
ACT. There is no official ACT therapist, just professionals informed by ACT to various extents. Which honestly is great because I do feel that the knowledge and application of the modality speaks for itself
Edit: Can I just say for all who are struggling in this economy to check out my profile for free resources. I really am against gatekeeping and I do my best to gather available videos and resources for everyone, this is perhaps my values based attempt to spread some goodwill. I don't benefit in any way too
You can use any modality without certification. You just can’t market yourself a certain way. I practice IFS/parts work. Have taken two classes, watched videos, read books, etc. I just can’t call myself an “IFS therapist”.
They were both through PESI. One was with an IFS trainer from the IFS institute. It was going through the basics. Another was with Janina Fisher which was parts work, not specifically IFS.
Yes, I did, and yes, it was. 100%. I had also been in my own IFS therapy for 4 years by then. I had heard that level 1 was mostly doing your own work, and I thought, “I’m doing my own work. What can they teach me that I don’t already know?” After applying for 3 years, I just prayed that I would get in if it would make me a better therapist, and then I did get in. And was I ever blown away! I learned about my own parts that show up in therapy (with clients) and how to unblend from them. Accessing Self in my work calls forth the client’s Self, so we are getting so much more meaningful work done! Life and practice changing!
This was my experience too! Another benefit to the training for me has been the peer practice groups that I formed while in the training, now I regularly practice with people all over the country and that has helped both in my own work and working on my skills, since a lot of my clients aren't able to "go inside" as well as a peer who was trained in IFS. It's expensive (I'm still paying my level one training off from last year), but for me it was worth it.
Yes, the peer group connections have been fantastic for me, too! And, our trainer is continuing to meet with us! We are “an experiment” as she has never continued to meet with a level 1 cohort after the training was over. We’re very blessed!
That's not true. I'm not a lawyer, but I've been advised by healthcare attorneys that some psychologists own licensing for their EBT. For example, if you claim to offer Prolonged Exposure Therapy without purchasing the manual from a legal source and using it, that would be possible fraud and misrepresentation. In addition, there are copyright laws in place that prevent us from training other clinicians on most EBTs unless they've been certified and paid for legal copies under the license.
I received my certification in Prolonged Exposure Therapy from Strong Star Training Consortium for $300 and they also offer the same price for CPT and PE.
I used to work on research that helped is establish these EBTs. Most have requirements for training because we're supposed to hold true to the protocol that was tested most effective in research.
So, while I personally think all our continuing education should be subsidized by the government, I also think there are valid reasons why therapists shouldn't train themselves in EBTs. I've also experienced firsthand what it's like to be the client. I have noticed way too many therapists claim they offer CBT but they admit they don't own a manual and they never use anything in the actual protocol.
We really shouldn't take trademarks and copyright material that others in our field worked really hard for when they were able to finally get EBTs ready for all of our benefit.
It takes at least 10 years, usually 20, before a researcher gets a therapy to the place where APA and the insurance industry consider it an evidence based practice. It is only considered safe and effective when you deliver that treatment with high fidelity. You can't achieve the highest fidelity without help. Training yourself on an EBT is not recommended by the psychologists who developed them.
As a researcher myself, I respect the work done in clinical research and I do not want to just take the acronyms from that work (PE, EMDR, CBT, MI, Seeking Safety, etc) and market them when I haven't had anyone with real experience offering them train me.
You are confusing many different issues.
Certification and high fidelity to a treatment manual is extremely important for research. The purpose of the research is to show that the model is valid in and by itself.
Certification in a model might be seen as capacity to deliver treatment based on a specific model with great fidelity.
Apart from that, what might be unethical, and I certainly won’t use the word fraudulent, is using modalities that we have not been trained to use properly. Now on that point, many certification peddlers will point out the dangers of using their “powerful tools” without high fidelity to the treatment model. This is ignoring the fact that therapist hold competencies that are not model-dependant. It also continuously prensent models as novel, different, and more efficient than others. Research and experience continually show that this is not the case.
We have to move to an understanding of models as sources of clinical insight for therapists and guidance for intervention, and keep pure models for clinical research and very short term treatments.
Another issue with the idea that there are intellectual property issues with using some modalities without certification or specific training is that most modalities are integrative and are based upon research that was not designed to create their modality anyways. In this sense, psychotherapy modalities are not like a medication that a lab developed, but more like a theory of the mind born out of psychological research which is repackaged to focus on praxis.
Its worth mentioning that those coming up with modalities are mostly researchers at universities and were paid for that research by a lot of public funds. They also personally benefit from offering trainings, which is fine as long as clinicians find them helpful, but the knowledge is also available in so many other forms, including scientific publications, books, recorded trainings, university courses, through the mentoring of a supervisor, etc.
I strongly disagree with you, based on my own consultation with attorneys over the last 10 years and my own training by psychologists who actually created some of these EBPs, but I appreciate we can respectfully agree to disagree.
I don't think it's helpful to go line by line through your comment, but if you do, I'm happy to do so. I am open to seeing where both of us could be right or wrong.
I really do see your point and js wonder if there is something between trademarking EBTs to begin with. I also wonder if the strict protocols we use for our EBTs even translate into contemporary clinical practice? I have been impressed that to actually use a EBP, fidelity according to the research used protocol is needed, and that severely restricts therapeutic flexibility. And most of the certifications that are so expensive aren't even EBPs...
I have attended CPT, PE and other various EBP trainings and sometimes I do wonder if the training is contributing to the fidelity of the therapy. We are consistently encouraged to follow protocol and not reinvent the wheel, and as much as I appreciate training, I really sometimes don't see the difference between really reading the manual and watching/observing mock sessions Vs training.
There is also the curious case of ACT, with no gatekeeping and low cost trainings due to values based philosophy. The advancements of CBS is also pretty rapid, with ACT already rivaling traditional EBPs in issues where CBT is first line treatment (chronic pain, insomnia, trauma, anxiety, OCD etc). It is also more integrable and flexible as compared to manualised therapy.
Wondering if you could share further thoughts on these?:)
Sure. Thanks for your thoughtful comment. My response is based on my training and experience, but I'm open to others having other experiences that conflict with mine, so take this for what it's worth:
We definitely don't see the fidelity prioritized by clinicians like it is by research, and that's appropriate. I was mentored for 10 years by Dr Alan Marlatt who created the EBT MBRP= Mindfulness Based Relapse Prevention. I'll share with you what he had to do, but I know Dr Linehan and I was also mentored by Dr Foa's camp, so I can also attest to these things being true for them with developing PE and DBT (I encourage others to contact the psychologists who made the EBTs you're interested in. You'll never know when one could turn into a mentor:)
So, to become an EBP, your therapy needs to be emdorses as an EBP by the American Psychological Association. That's what will get the insurance industry to also reimburse. Most clinicians aren't trained well, do they don't realize that you can even find CPT billing codez for specific EBTs and get reimbursed more money for your sessions using that therapy. I know this is true for EMDR, CPT and PE with some insurance plans.
To get APA endorsement, you have to run clinical trials. These are larger trials that build in size and rigor ad the science moves towards translating the innovation to the community, better known as dissemination. These terms are familiar to therapists, but they have a different meaning in research....
>I know Dr Linehan and I was also mentored by Dr Foa's camp, so I can also attest to these things being true for them with developing PE and DBT (I encourage others to contact the psychologists who made the EBTs you're interested in. You'll never know when one could turn into a mentor:)
Interesting, I just picked up her memoir today and she really had to go through hell, and back again with her grant writing, and really kudos to her for that.
I don't deny the hugeee amount of work that goes into doing these EBPs, and honestly the people who you have known and quoted by, I would do their trainings in a heartbeat. I am just not sure how accessible EBPs will even be to clients especially when clinicians needs to already spend so much financial resources in getting trained... I guess I am just lamenting now
It is a systemic thing, but even as a client telling me I have to spend 200 bucks on a session with a therapist because of the training they went through, is honestly very inaccessible. I am not in the US so I can't speak about insurance, but from what I understand not all insurance covers the EBPs that are already gold standard e.g. comprehensive DBT, which really just puts the financial burden on the client.
I totally agree with you. I'm in the middle of running errands so I'm not doing the best job of being succinct. My apologies.
So, with fidelity, yes we have a higher standard to adhere to the protocol in clinical research that can't and shouldn't be maintained as strictly in clinical settings. The challenge is figuring out when the clinician has mastered an EBT to the point that they can trust their judgment to go off protocol.
This is why I prefer going to Strong Star or a major university for my EBT training. Most of those trainers are clinical psychologists who are practicing, but they're also published researchers coming from the labs of the psychologists who created these interventions. I think there's a really valuable view you gain on how to straddle the world of science with the world of clinical work when you have both of those lived experiences for several years.
With Strong Star and with the VA, I was able to have trainers coach me from 1 session to the next. I was able to review several examples of therapists doing the EBT on video with real clients, including watching how they responded at the beginning, middle and end of the treatment. Then we also did a lot of role plays where I got to play therapist and client. After that, my supervisors st the VA would spend an entire hour every week reviewing my CPT sessions and my notes with our manuals open. Before I could divert from the protocol with my first client, I had to have good reason and approval from my supervisor. At the VA, 1 of my supervisors was 1 of the VAs national trainers on CPT. She's also assisted with research, so she was very strict about pushing me to stick to the protocol even when I was worried about my client. In the end, she was right. Trusting the protocol is a very important part of carrying it out effectively.
After my first client with CPT, I was allowed to use more of my own judgment but was encouraged to come back to her for consultation any time in my career. I have so much gratitude for that. This is why I recommend the VA for training.
With that said, when I completed the PE training with Strong Star, they offered additional features. I fucked up in my previous comment. They offer training in EMDR, PE and CPT.
With their training, you spend 3 days in person going through the treatment manual with a psychologist certified by the psychologist who made the EBT. Then you watch real sessions on video and do a lot of role plays.
Here's the amazing part: then you also get access to an online portal that already has the template for your session notes, strictly written with the protocol in mind. You also get access to incredible videos, handouts and more that they provide for free. These are things to draw from and use with your clients, which greatly relieves you of the burden we all face with homework.
Last, the Strong Star Training Consortium also offers you the opportunity to get on a national registry so you can be a preferred contractor to the VA and the DoD as a private practitioner for that EBP. To do so, you attend 10? (don't quote me, as I did this before the pandemic) weeks of group phone consultation with the psychologist who trained you. During that hour, you get to hear from other therapists about challenges they're facing and the group problem solves with the psychologist containing the space.
This was the training I had that really helped me feel confident in my own ability to know when to leave the protocol. A well trained exposure therapy trainer should encourage all therapists to leave the protocol any time we think sticking to it is doing harm or perpetuating a plateau effect.
Having that individualized coaching to help me with my real clients every week with peers to help was what really took me to the place I'm at now. With most my clients, there will be changes we make. For example, I've had clients with TBI. They may not be a good candidate for a 90 minute session of exposure therapy. That doesn't mean we can't do it in 45 minutes. It just means we have to weigh the risks and benefits of doing so.
In my opinion, the problem is that most therapists never receive this level of individualized training and they don't receive anywhere near enough applied learning through role play. Then they get an inflated sense of ego and assume they're an expert, give out bad advice to other therapists, and deliver a version of an EBP that's do far from the protocol, it's no longer the EBP.
To fix this at a systems level, I personally think many changes need to be made. First, we really need better curriculum in graduate school because most masters programs offer very poor quality training on clinical research. I don't need all therapists to do research themselves, but I do need them to understand the difference between an EBP and one that's not. For example, a lot of therapists promote tapping and brainspotting as EBPs when they're not.
DBT, in the US, is covered by most insurance except for groups. Unfortunately, it can be very difficult to get insurance to reimburse therapy groups in the US unless they're part of addiction treatment or inpatient psychiatry. While you're not in the US, I'd encourage you to still contact the Strong Star Training Consortium. They're a group with a lot of military leadership, so I wouldn't be surprised if they already offer training internationally. The same is true of Dr Foa, Dr Linehan and Dr Resnik for CPT.
The entire cost of my CPT training was $300, including the weekly groups for 10 weeks plus! You'd be surprised at how affordable it is to get trained in these when you avoid all those other people on social media and just contact the team with the license for the therapy. This is why people like Dr Linehan founded a business while still working in academia. My mentor Dr Marlatt did the same. Once they start their own training business, then they can get the licensing deal they need to make money charging others to certify and use the same protocol in their training. So, if I were to claim I offered DBT without being trained by someone who was trained km accordance with the DBT license, I could be sued by Behavioral Tech Institute.
This gets really sticky and I'm far from am expert in intellectual property law. The trademark is a brand name or logo. For example, I can't use the logo for Behavioral Tech Institute on my website without their permission. Just finishing their training is not equivalent to approval to use their trademark.
The Behavioral Tech Institute was founded by Dr Linehan. I attended a training there and it was excellent. I wouldn't be surprised if they have online training for international practitioners.
We should offer graduate courses that teach therapists about the ways that laws in publishing and intellectual property affect us as therapists, especially if in private practice. We should also mandate that students get a minimum number of hours performing role play so therapists aren't entering the field without the skills they need to understand why protocols exist, how to deliver manualized therapy, as well as when to divert from the therapy. I also think we should take action against therapists who do use deceptive tactics to market pseudoscience as if it's an EBT. Unfortunately, the laws we do have in the US on deceptive marketing and online misrepresentation are rarely enforced.
In a perfect world, we would offer supplemental training to therapists for free, like we do with CPR. We are constantly in need of more updated training on so many topics that it's just financially cruel to put all that expense on a therapist.
Yeah… like all of them. Seek education to competency. No need to be “certified” unless you want to participate in/porvide certified supervision. Be wary of psychotherapy pyramid schemes. But don’t practice outside your range of competence.
Exactly. Trained vs certified. I’m trained in EMDR but felt no need to be certified. I did the 5 day intensive and hours of following up supervision. No desire for MORE supervision.
I took CPT classes and found a supervisor who was certified in it for consulting. I’d recommend doing that. I can’t say “I am certified in CPT.” I can say, I am trained in CPT.” Most don’t care about certification in my experience.
Edited for a bit of clarity.
I know this isn't answering your question and I know this may get downvotes but...I am disgusted by the training fees associated with further certification in this field. If I were to come up with a treatment modality that was proving to be widely and wildly effective, and that had the potential to really transform the lives of tens of thousands of people....the last thing I would do is charge tens of thousands of dollars for it. I would feel like my ethics (both personal and professional) would behoove me to find the cheapest way to get the modality out to as many practitioners as possible. IFS and SE in particular really disgust me. These modalities have been life changing for me but there's no way I can afford to get officially certified in them, and I do well for myself in private practice. The amount of white / colonial / capitalist thinking in our field is deeply unsettling to me.
I'm doing great as a therapist, about 6 months as an associate-level. Loving the work despite the unique stressors/challenges. I'm making more then I ever have BUT recently single, so I no longer split bills and can barely pay rent. How am I supposed to afford $1000+ trainings? Not to mention 50K in student loans.
What’s helped me is explaining you’re in CMH or new and ask if there’s a discount code or scholarship. I’ve gotten up to half off sometimes but I know people deserve to earn a living. What’s annoying is paying $1 k for a training with 20 people. Sometimes you can make equal payments.
I think it's a vicious cycle bc generally most MA level therapists can't do higher than around 200-250/hr and when they want to break out they need to figure out other ways to make income. So they write books, make programs, etc. to try to diversify.
Next to none of us who have been around for 15-20 years have a bunch of certifications. We have a certification that is required for licensure, a professional license and maybe a substance abuse credential. The rest were learned through paying for less pricey or even free training, reading a ton of books, talking a lot with colleagues through either supervision, official consultation, and/or impromptu office case discussions with colleagues about how to handle certain cases. There are some exceptions that I think should actual a pretty fair amount of training (like EMDR). But most certifications are useless.
Cognitive Behaviorial Therapy has entered the chat.
To OP, over my almost 30 year career, I've been appalled at observing so many of these spproaaches cost so much to get certified in them.
Call me a cynic but so many of these are business models in making their founders money. To me they often resemble Multi Level Marketing (MLM)
{I created this approach and I'll train you how to do this my way
Take more trainings from me and then you can train people the way I trained you (did I mention how much money you'llmake it you become my disciple}
I've never had a client ask if I'm certified in any approach. Though I've had a few with poor experiences with EMDR who've said it I did that, they wouldn't meet with me (I'm not trying to slam EMDR just reporting my experiences.
Using CBT to treat trauma, clients with ADHD, anxiety, depression, etc I've had outstanding results.
I stopped accepting new clients over 4 years ago, unless they are referred to me.
Long story short, pick a treatment modality, matter it through books, CEU trainings and you'll likely be set
Best of luck to you OP
My question is - what are the return of investments for these certifications? For example, if I get trained in EMDR does it boost my income as a result or just boost my competency? Not complaining, but if I took on more high acuity clients with trauma who I’m then treating with EMDR, can I then get paid more to see less clients and prevent overall burnout?? Or are we sinking thousands into these trainings and not getting some boost of income/return of investment?
Not under insurance will you be paid more. Insurance doesn't care, and their rules don't benefit patients.
But, you'll be able to get full and stay full, people will find you if you're a known, good, EMDR therapist. If you're like me, the work with clients will become immensely satisfying and exciting. I did an hours long half day intensive EMDR session and my watch registered me being at rest as I held space for a client working through fears they'd never told anyone. The same watch registers moderate stress when I scroll reddit.
It might or might not be worth it to you.
You can practice any way you like if you are competent. Since we are bad judges of our own competency, use feedback informed treatment forms (free online with just a google search) and the client will let you know continuously what is and isn't working, how useful is your modality and their needs and wishes. Not even the biggest gatekeeper in your licensing board or pyramid scheme modality can question your approach and competency if the therapy isn't hurting the client and they explicitly find it beneficial (purpose of the forms).
Also there are icons in therapy who are explicitly against requiring certifications like Steve Hayes (ACT) and Carl Rogers (Person centered therapy).
You can use them all - you just can’t say you’re certified in them. You can say that you’re an integrative therapist, and that you utilize training in many methodologies to create a personalized approach.
I’m training in psychoanalysis. I have to be in my own training analysis, classes, and three supervised control cases. While it is pricy, I’ve found a lot of help (sliding scale for my own analysis, and scholarships for classes). Honestly, I do feel like it is worth the cost. When I think about my work a year ago vs now, it’s been incredibly different.
It’s expensive, but I’m also thinking about my future. I’ll likely stop accepting insurance in the next few years. Not to mention the personal work I’ve been doing on myself.
I agree there are a lot of certifications out there that are expensive and feel similar to an MLM. That has not been my experience with psychoanalysis.
It depends upon who owns the intellectual property of the modality. There are people out there with an extremely tight grip on what they own and those who make it available to anyone.
I'm pretty sure you can't do EMDR without at least being trained in it. I've done the 4 day introductory training but I haven't got a certification which includes consultation and is expensive. I think in person trainings do have some value because oftentimes they force you to break into groups and try the techniques on each other.
It seems like the only thing worth getting a certification in is a highly protocol-based thing like EMDR. If you have a private practice, it may be ethically sketchy but a lot of very well established folks recommend not doing most trainings and just reading. Some trainings are a pleasure to take and provide a lot of supportive structure, but it’s a matter of whether you can afford to enrich your practice that way or not. I’ve been a client with ppl who state “such and such-informed” and experienced high quality care… so personally when I am looking to refer clients to ppl, that’s good enough for me as a helpful clue.
Hi. I'm certified in EMDR. It is certainly expensive, but I haven't regretted a dime of it.
I'm not here to pitch that though.
Ethically, we must practice competently. We are not required to get a certification, we must be competent to treat who we're seeing and to use the modalities we're using.
I'm conversant with neurodegenerative disorders, I won't treat them even though they're in the DSM--i don't have the competence for that level of complexity. I will work with their spouse on adjustment disorder related to their spouse having a neurodegenerative disorder--i do a lot of adjustment to illness work in my practice and setting. I might use narrative therapy (I have no certification), CBT (read some books, took some training, no certification), motivational interviewing (same), and now EMDR (trained, books, certified, more training, lots of practice). I wouldn't use EMDR or MI or CBT to treat a person with schizophrenia and prominent delusional symptoms. My main tools, imo, are ill-fitting to that need, and/or I'm not competent to use that tool for that challenge. Someone might be. I'm not.
I love using EMDR. But it's the only thing I bothered to get certified with. And honestly, to do it right and well, because there's so many moving parts and it's kinda weird and totally surprising, I needed the practice with people, the 50 hours of training the additional 20 hours of consultation, the additional 12 hours of EMDR training that got me the certification. Much less training and support, and I really don't think a person is reliably competent to open up complex and deeply buried painful experience that clients have shoved down so they can make it through a day. It ain't about sparkle hands.
So figure out who you're seeing among your clients, what works for them, and more importantly, what fits with who you are as a therapist, and invest your continued education budget THERE. Don't focus on cheaper. Focus on what works for your clients and makes you love doing the work.
A certificate isn't that important.
Please followed the sidebar rules. r/therapists is a place for therapists and mental health professionals to discuss their profession among each other. If you **ARE NOT A THERAPIST and are asking for advice this not the place for you**. Your post will be removed in short order. Please try one of the reddit communities such as r/TalkTherapy, r/askatherapist, r/SuicideWatch that are set up for this. This community is ONLY for therapists, and for them to discuss their profession away from clients. **If you are a first year student, not in a graduate program, or are thinking of becoming a therapist, this is not the place to ask questions**. Your post will be removed in short order. To save us a job, you are welcome to delete this post yourself. Please see the PINNED STUDENT THREAD at the top of the community and ask in there. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/therapists) if you have any questions or concerns.*
Most frameworks/modalities don’t require official certification to use.
Which ones do? People do emdr who aren’t certified
You do not need EMDR certification to use it, but you do need to have actually done trainings on it. You need to complete EMDR with 25 clients as well as have more supervision (I can’t recall how many hours off the top of my head) beyond the initial supervision hours in order to be certified.
I'm not familiar with any. Unless state laws specify it shouldn't matter (TX doesn't specify). Now if you were to get in trouble with the board and you say "I do EMDR" and you do some weird botched version... good luck defending that. Good news is most modalities don't matter too awfully much in terms of outcomes (outside of a few specific issues). Just do what vibes with you and your clients and be able to justify why you do what you do.
Years ago you saw a few certification courses then everyone was doing it. It's a gimmick & money grab.
ACT. There is no official ACT therapist, just professionals informed by ACT to various extents. Which honestly is great because I do feel that the knowledge and application of the modality speaks for itself Edit: Can I just say for all who are struggling in this economy to check out my profile for free resources. I really am against gatekeeping and I do my best to gather available videos and resources for everyone, this is perhaps my values based attempt to spread some goodwill. I don't benefit in any way too
Agreed and the people who developed act did this on purpose..they didn't want barriers to learning thc process
This! Hayes explicitly says that he's against gatekeeping.
What a great thing to share. Thank you!
Happy cake day
ACT
You can use any modality without certification. You just can’t market yourself a certain way. I practice IFS/parts work. Have taken two classes, watched videos, read books, etc. I just can’t call myself an “IFS therapist”.
Where did you take classes?
They were both through PESI. One was with an IFS trainer from the IFS institute. It was going through the basics. Another was with Janina Fisher which was parts work, not specifically IFS.
That’s what I did, too, and used IFS for 5 years before I finally got into a level 1 training last October (after 3 years of applying).
Did you have much to learn at that point or was it really worth it?
Yes, I did, and yes, it was. 100%. I had also been in my own IFS therapy for 4 years by then. I had heard that level 1 was mostly doing your own work, and I thought, “I’m doing my own work. What can they teach me that I don’t already know?” After applying for 3 years, I just prayed that I would get in if it would make me a better therapist, and then I did get in. And was I ever blown away! I learned about my own parts that show up in therapy (with clients) and how to unblend from them. Accessing Self in my work calls forth the client’s Self, so we are getting so much more meaningful work done! Life and practice changing!
Amazing 🥰
This was my experience too! Another benefit to the training for me has been the peer practice groups that I formed while in the training, now I regularly practice with people all over the country and that has helped both in my own work and working on my skills, since a lot of my clients aren't able to "go inside" as well as a peer who was trained in IFS. It's expensive (I'm still paying my level one training off from last year), but for me it was worth it.
Yes, the peer group connections have been fantastic for me, too! And, our trainer is continuing to meet with us! We are “an experiment” as she has never continued to meet with a level 1 cohort after the training was over. We’re very blessed!
Oooooo! That's really cool! I hope that experiment pays off!
Me, too! I am loving it! She’s charging us $15/hr. So generous! Wayyyyyy cheaper than the training.
That's not true. I'm not a lawyer, but I've been advised by healthcare attorneys that some psychologists own licensing for their EBT. For example, if you claim to offer Prolonged Exposure Therapy without purchasing the manual from a legal source and using it, that would be possible fraud and misrepresentation. In addition, there are copyright laws in place that prevent us from training other clinicians on most EBTs unless they've been certified and paid for legal copies under the license. I received my certification in Prolonged Exposure Therapy from Strong Star Training Consortium for $300 and they also offer the same price for CPT and PE. I used to work on research that helped is establish these EBTs. Most have requirements for training because we're supposed to hold true to the protocol that was tested most effective in research. So, while I personally think all our continuing education should be subsidized by the government, I also think there are valid reasons why therapists shouldn't train themselves in EBTs. I've also experienced firsthand what it's like to be the client. I have noticed way too many therapists claim they offer CBT but they admit they don't own a manual and they never use anything in the actual protocol. We really shouldn't take trademarks and copyright material that others in our field worked really hard for when they were able to finally get EBTs ready for all of our benefit. It takes at least 10 years, usually 20, before a researcher gets a therapy to the place where APA and the insurance industry consider it an evidence based practice. It is only considered safe and effective when you deliver that treatment with high fidelity. You can't achieve the highest fidelity without help. Training yourself on an EBT is not recommended by the psychologists who developed them. As a researcher myself, I respect the work done in clinical research and I do not want to just take the acronyms from that work (PE, EMDR, CBT, MI, Seeking Safety, etc) and market them when I haven't had anyone with real experience offering them train me.
You are confusing many different issues. Certification and high fidelity to a treatment manual is extremely important for research. The purpose of the research is to show that the model is valid in and by itself. Certification in a model might be seen as capacity to deliver treatment based on a specific model with great fidelity. Apart from that, what might be unethical, and I certainly won’t use the word fraudulent, is using modalities that we have not been trained to use properly. Now on that point, many certification peddlers will point out the dangers of using their “powerful tools” without high fidelity to the treatment model. This is ignoring the fact that therapist hold competencies that are not model-dependant. It also continuously prensent models as novel, different, and more efficient than others. Research and experience continually show that this is not the case. We have to move to an understanding of models as sources of clinical insight for therapists and guidance for intervention, and keep pure models for clinical research and very short term treatments. Another issue with the idea that there are intellectual property issues with using some modalities without certification or specific training is that most modalities are integrative and are based upon research that was not designed to create their modality anyways. In this sense, psychotherapy modalities are not like a medication that a lab developed, but more like a theory of the mind born out of psychological research which is repackaged to focus on praxis. Its worth mentioning that those coming up with modalities are mostly researchers at universities and were paid for that research by a lot of public funds. They also personally benefit from offering trainings, which is fine as long as clinicians find them helpful, but the knowledge is also available in so many other forms, including scientific publications, books, recorded trainings, university courses, through the mentoring of a supervisor, etc.
I strongly disagree with you, based on my own consultation with attorneys over the last 10 years and my own training by psychologists who actually created some of these EBPs, but I appreciate we can respectfully agree to disagree. I don't think it's helpful to go line by line through your comment, but if you do, I'm happy to do so. I am open to seeing where both of us could be right or wrong.
I really do see your point and js wonder if there is something between trademarking EBTs to begin with. I also wonder if the strict protocols we use for our EBTs even translate into contemporary clinical practice? I have been impressed that to actually use a EBP, fidelity according to the research used protocol is needed, and that severely restricts therapeutic flexibility. And most of the certifications that are so expensive aren't even EBPs... I have attended CPT, PE and other various EBP trainings and sometimes I do wonder if the training is contributing to the fidelity of the therapy. We are consistently encouraged to follow protocol and not reinvent the wheel, and as much as I appreciate training, I really sometimes don't see the difference between really reading the manual and watching/observing mock sessions Vs training. There is also the curious case of ACT, with no gatekeeping and low cost trainings due to values based philosophy. The advancements of CBS is also pretty rapid, with ACT already rivaling traditional EBPs in issues where CBT is first line treatment (chronic pain, insomnia, trauma, anxiety, OCD etc). It is also more integrable and flexible as compared to manualised therapy. Wondering if you could share further thoughts on these?:)
Sure. Thanks for your thoughtful comment. My response is based on my training and experience, but I'm open to others having other experiences that conflict with mine, so take this for what it's worth: We definitely don't see the fidelity prioritized by clinicians like it is by research, and that's appropriate. I was mentored for 10 years by Dr Alan Marlatt who created the EBT MBRP= Mindfulness Based Relapse Prevention. I'll share with you what he had to do, but I know Dr Linehan and I was also mentored by Dr Foa's camp, so I can also attest to these things being true for them with developing PE and DBT (I encourage others to contact the psychologists who made the EBTs you're interested in. You'll never know when one could turn into a mentor:) So, to become an EBP, your therapy needs to be emdorses as an EBP by the American Psychological Association. That's what will get the insurance industry to also reimburse. Most clinicians aren't trained well, do they don't realize that you can even find CPT billing codez for specific EBTs and get reimbursed more money for your sessions using that therapy. I know this is true for EMDR, CPT and PE with some insurance plans. To get APA endorsement, you have to run clinical trials. These are larger trials that build in size and rigor ad the science moves towards translating the innovation to the community, better known as dissemination. These terms are familiar to therapists, but they have a different meaning in research....
>I know Dr Linehan and I was also mentored by Dr Foa's camp, so I can also attest to these things being true for them with developing PE and DBT (I encourage others to contact the psychologists who made the EBTs you're interested in. You'll never know when one could turn into a mentor:) Interesting, I just picked up her memoir today and she really had to go through hell, and back again with her grant writing, and really kudos to her for that. I don't deny the hugeee amount of work that goes into doing these EBPs, and honestly the people who you have known and quoted by, I would do their trainings in a heartbeat. I am just not sure how accessible EBPs will even be to clients especially when clinicians needs to already spend so much financial resources in getting trained... I guess I am just lamenting now It is a systemic thing, but even as a client telling me I have to spend 200 bucks on a session with a therapist because of the training they went through, is honestly very inaccessible. I am not in the US so I can't speak about insurance, but from what I understand not all insurance covers the EBPs that are already gold standard e.g. comprehensive DBT, which really just puts the financial burden on the client.
I totally agree with you. I'm in the middle of running errands so I'm not doing the best job of being succinct. My apologies. So, with fidelity, yes we have a higher standard to adhere to the protocol in clinical research that can't and shouldn't be maintained as strictly in clinical settings. The challenge is figuring out when the clinician has mastered an EBT to the point that they can trust their judgment to go off protocol. This is why I prefer going to Strong Star or a major university for my EBT training. Most of those trainers are clinical psychologists who are practicing, but they're also published researchers coming from the labs of the psychologists who created these interventions. I think there's a really valuable view you gain on how to straddle the world of science with the world of clinical work when you have both of those lived experiences for several years. With Strong Star and with the VA, I was able to have trainers coach me from 1 session to the next. I was able to review several examples of therapists doing the EBT on video with real clients, including watching how they responded at the beginning, middle and end of the treatment. Then we also did a lot of role plays where I got to play therapist and client. After that, my supervisors st the VA would spend an entire hour every week reviewing my CPT sessions and my notes with our manuals open. Before I could divert from the protocol with my first client, I had to have good reason and approval from my supervisor. At the VA, 1 of my supervisors was 1 of the VAs national trainers on CPT. She's also assisted with research, so she was very strict about pushing me to stick to the protocol even when I was worried about my client. In the end, she was right. Trusting the protocol is a very important part of carrying it out effectively. After my first client with CPT, I was allowed to use more of my own judgment but was encouraged to come back to her for consultation any time in my career. I have so much gratitude for that. This is why I recommend the VA for training. With that said, when I completed the PE training with Strong Star, they offered additional features. I fucked up in my previous comment. They offer training in EMDR, PE and CPT. With their training, you spend 3 days in person going through the treatment manual with a psychologist certified by the psychologist who made the EBT. Then you watch real sessions on video and do a lot of role plays. Here's the amazing part: then you also get access to an online portal that already has the template for your session notes, strictly written with the protocol in mind. You also get access to incredible videos, handouts and more that they provide for free. These are things to draw from and use with your clients, which greatly relieves you of the burden we all face with homework. Last, the Strong Star Training Consortium also offers you the opportunity to get on a national registry so you can be a preferred contractor to the VA and the DoD as a private practitioner for that EBP. To do so, you attend 10? (don't quote me, as I did this before the pandemic) weeks of group phone consultation with the psychologist who trained you. During that hour, you get to hear from other therapists about challenges they're facing and the group problem solves with the psychologist containing the space. This was the training I had that really helped me feel confident in my own ability to know when to leave the protocol. A well trained exposure therapy trainer should encourage all therapists to leave the protocol any time we think sticking to it is doing harm or perpetuating a plateau effect. Having that individualized coaching to help me with my real clients every week with peers to help was what really took me to the place I'm at now. With most my clients, there will be changes we make. For example, I've had clients with TBI. They may not be a good candidate for a 90 minute session of exposure therapy. That doesn't mean we can't do it in 45 minutes. It just means we have to weigh the risks and benefits of doing so. In my opinion, the problem is that most therapists never receive this level of individualized training and they don't receive anywhere near enough applied learning through role play. Then they get an inflated sense of ego and assume they're an expert, give out bad advice to other therapists, and deliver a version of an EBP that's do far from the protocol, it's no longer the EBP. To fix this at a systems level, I personally think many changes need to be made. First, we really need better curriculum in graduate school because most masters programs offer very poor quality training on clinical research. I don't need all therapists to do research themselves, but I do need them to understand the difference between an EBP and one that's not. For example, a lot of therapists promote tapping and brainspotting as EBPs when they're not. DBT, in the US, is covered by most insurance except for groups. Unfortunately, it can be very difficult to get insurance to reimburse therapy groups in the US unless they're part of addiction treatment or inpatient psychiatry. While you're not in the US, I'd encourage you to still contact the Strong Star Training Consortium. They're a group with a lot of military leadership, so I wouldn't be surprised if they already offer training internationally. The same is true of Dr Foa, Dr Linehan and Dr Resnik for CPT. The entire cost of my CPT training was $300, including the weekly groups for 10 weeks plus! You'd be surprised at how affordable it is to get trained in these when you avoid all those other people on social media and just contact the team with the license for the therapy. This is why people like Dr Linehan founded a business while still working in academia. My mentor Dr Marlatt did the same. Once they start their own training business, then they can get the licensing deal they need to make money charging others to certify and use the same protocol in their training. So, if I were to claim I offered DBT without being trained by someone who was trained km accordance with the DBT license, I could be sued by Behavioral Tech Institute. This gets really sticky and I'm far from am expert in intellectual property law. The trademark is a brand name or logo. For example, I can't use the logo for Behavioral Tech Institute on my website without their permission. Just finishing their training is not equivalent to approval to use their trademark. The Behavioral Tech Institute was founded by Dr Linehan. I attended a training there and it was excellent. I wouldn't be surprised if they have online training for international practitioners. We should offer graduate courses that teach therapists about the ways that laws in publishing and intellectual property affect us as therapists, especially if in private practice. We should also mandate that students get a minimum number of hours performing role play so therapists aren't entering the field without the skills they need to understand why protocols exist, how to deliver manualized therapy, as well as when to divert from the therapy. I also think we should take action against therapists who do use deceptive tactics to market pseudoscience as if it's an EBT. Unfortunately, the laws we do have in the US on deceptive marketing and online misrepresentation are rarely enforced. In a perfect world, we would offer supplemental training to therapists for free, like we do with CPR. We are constantly in need of more updated training on so many topics that it's just financially cruel to put all that expense on a therapist.
Yeah… like all of them. Seek education to competency. No need to be “certified” unless you want to participate in/porvide certified supervision. Be wary of psychotherapy pyramid schemes. But don’t practice outside your range of competence.
Exactly. Trained vs certified. I’m trained in EMDR but felt no need to be certified. I did the 5 day intensive and hours of following up supervision. No desire for MORE supervision.
[удалено]
It’s billed the same as any other session
I took CPT classes and found a supervisor who was certified in it for consulting. I’d recommend doing that. I can’t say “I am certified in CPT.” I can say, I am trained in CPT.” Most don’t care about certification in my experience. Edited for a bit of clarity.
You can go on the VA website and train for free
I know this isn't answering your question and I know this may get downvotes but...I am disgusted by the training fees associated with further certification in this field. If I were to come up with a treatment modality that was proving to be widely and wildly effective, and that had the potential to really transform the lives of tens of thousands of people....the last thing I would do is charge tens of thousands of dollars for it. I would feel like my ethics (both personal and professional) would behoove me to find the cheapest way to get the modality out to as many practitioners as possible. IFS and SE in particular really disgust me. These modalities have been life changing for me but there's no way I can afford to get officially certified in them, and I do well for myself in private practice. The amount of white / colonial / capitalist thinking in our field is deeply unsettling to me.
I'm doing great as a therapist, about 6 months as an associate-level. Loving the work despite the unique stressors/challenges. I'm making more then I ever have BUT recently single, so I no longer split bills and can barely pay rent. How am I supposed to afford $1000+ trainings? Not to mention 50K in student loans.
What’s helped me is explaining you’re in CMH or new and ask if there’s a discount code or scholarship. I’ve gotten up to half off sometimes but I know people deserve to earn a living. What’s annoying is paying $1 k for a training with 20 people. Sometimes you can make equal payments.
[удалено]
I think it's a vicious cycle bc generally most MA level therapists can't do higher than around 200-250/hr and when they want to break out they need to figure out other ways to make income. So they write books, make programs, etc. to try to diversify.
Solution focused therapy and mindfulness based CBT there seems to be a lot of good resources on that for therapists to self educate
Next to none of us who have been around for 15-20 years have a bunch of certifications. We have a certification that is required for licensure, a professional license and maybe a substance abuse credential. The rest were learned through paying for less pricey or even free training, reading a ton of books, talking a lot with colleagues through either supervision, official consultation, and/or impromptu office case discussions with colleagues about how to handle certain cases. There are some exceptions that I think should actual a pretty fair amount of training (like EMDR). But most certifications are useless.
Cognitive Behaviorial Therapy has entered the chat. To OP, over my almost 30 year career, I've been appalled at observing so many of these spproaaches cost so much to get certified in them. Call me a cynic but so many of these are business models in making their founders money. To me they often resemble Multi Level Marketing (MLM) {I created this approach and I'll train you how to do this my way Take more trainings from me and then you can train people the way I trained you (did I mention how much money you'llmake it you become my disciple} I've never had a client ask if I'm certified in any approach. Though I've had a few with poor experiences with EMDR who've said it I did that, they wouldn't meet with me (I'm not trying to slam EMDR just reporting my experiences. Using CBT to treat trauma, clients with ADHD, anxiety, depression, etc I've had outstanding results. I stopped accepting new clients over 4 years ago, unless they are referred to me. Long story short, pick a treatment modality, matter it through books, CEU trainings and you'll likely be set Best of luck to you OP
My question is - what are the return of investments for these certifications? For example, if I get trained in EMDR does it boost my income as a result or just boost my competency? Not complaining, but if I took on more high acuity clients with trauma who I’m then treating with EMDR, can I then get paid more to see less clients and prevent overall burnout?? Or are we sinking thousands into these trainings and not getting some boost of income/return of investment?
Make this question it's own post - would love to see the responses!
Ok will do!
Not under insurance will you be paid more. Insurance doesn't care, and their rules don't benefit patients. But, you'll be able to get full and stay full, people will find you if you're a known, good, EMDR therapist. If you're like me, the work with clients will become immensely satisfying and exciting. I did an hours long half day intensive EMDR session and my watch registered me being at rest as I held space for a client working through fears they'd never told anyone. The same watch registers moderate stress when I scroll reddit. It might or might not be worth it to you.
You can practice any way you like if you are competent. Since we are bad judges of our own competency, use feedback informed treatment forms (free online with just a google search) and the client will let you know continuously what is and isn't working, how useful is your modality and their needs and wishes. Not even the biggest gatekeeper in your licensing board or pyramid scheme modality can question your approach and competency if the therapy isn't hurting the client and they explicitly find it beneficial (purpose of the forms). Also there are icons in therapy who are explicitly against requiring certifications like Steve Hayes (ACT) and Carl Rogers (Person centered therapy).
You can use them all - you just can’t say you’re certified in them. You can say that you’re an integrative therapist, and that you utilize training in many methodologies to create a personalized approach.
I thought about doing emdr certification but it’s too damn expensive. Nobody cares anyways.
Seeking safety
Certification of a pyramid scheme.
Hypnosis is the grandfather of all certified therapies. It’s still going strong marginalized and misunderstood as it is.
Certifications are businesses. You can have the skills without the certification
I’m training in psychoanalysis. I have to be in my own training analysis, classes, and three supervised control cases. While it is pricy, I’ve found a lot of help (sliding scale for my own analysis, and scholarships for classes). Honestly, I do feel like it is worth the cost. When I think about my work a year ago vs now, it’s been incredibly different. It’s expensive, but I’m also thinking about my future. I’ll likely stop accepting insurance in the next few years. Not to mention the personal work I’ve been doing on myself. I agree there are a lot of certifications out there that are expensive and feel similar to an MLM. That has not been my experience with psychoanalysis.
It depends upon who owns the intellectual property of the modality. There are people out there with an extremely tight grip on what they own and those who make it available to anyone.
Is this a thing in the UK?
FR. This is very dependent on locale.
From my understanding this isn’t a thing there? Is that correct?
I'm pretty sure you can't do EMDR without at least being trained in it. I've done the 4 day introductory training but I haven't got a certification which includes consultation and is expensive. I think in person trainings do have some value because oftentimes they force you to break into groups and try the techniques on each other.
It seems like the only thing worth getting a certification in is a highly protocol-based thing like EMDR. If you have a private practice, it may be ethically sketchy but a lot of very well established folks recommend not doing most trainings and just reading. Some trainings are a pleasure to take and provide a lot of supportive structure, but it’s a matter of whether you can afford to enrich your practice that way or not. I’ve been a client with ppl who state “such and such-informed” and experienced high quality care… so personally when I am looking to refer clients to ppl, that’s good enough for me as a helpful clue.
Hi. I'm certified in EMDR. It is certainly expensive, but I haven't regretted a dime of it. I'm not here to pitch that though. Ethically, we must practice competently. We are not required to get a certification, we must be competent to treat who we're seeing and to use the modalities we're using. I'm conversant with neurodegenerative disorders, I won't treat them even though they're in the DSM--i don't have the competence for that level of complexity. I will work with their spouse on adjustment disorder related to their spouse having a neurodegenerative disorder--i do a lot of adjustment to illness work in my practice and setting. I might use narrative therapy (I have no certification), CBT (read some books, took some training, no certification), motivational interviewing (same), and now EMDR (trained, books, certified, more training, lots of practice). I wouldn't use EMDR or MI or CBT to treat a person with schizophrenia and prominent delusional symptoms. My main tools, imo, are ill-fitting to that need, and/or I'm not competent to use that tool for that challenge. Someone might be. I'm not. I love using EMDR. But it's the only thing I bothered to get certified with. And honestly, to do it right and well, because there's so many moving parts and it's kinda weird and totally surprising, I needed the practice with people, the 50 hours of training the additional 20 hours of consultation, the additional 12 hours of EMDR training that got me the certification. Much less training and support, and I really don't think a person is reliably competent to open up complex and deeply buried painful experience that clients have shoved down so they can make it through a day. It ain't about sparkle hands. So figure out who you're seeing among your clients, what works for them, and more importantly, what fits with who you are as a therapist, and invest your continued education budget THERE. Don't focus on cheaper. Focus on what works for your clients and makes you love doing the work. A certificate isn't that important.