hi everybody! my name is riley, and i'm a substance use counselor. i've worked in both inpatient and outpatient, i've been in this field since i was 19 and have been professionally working for 2 years. i'm currently in grad school for clinical social work, pursuing my lsw and my clinical licensure (lcsw). i wanted to write a guide on what it "means" to be a counselor! i will be discussing the specifics of a substance use counselor in another post. (it will be linked below.)
disclaimer:
do not take this as professional advice for all counselors, therapists, psychologists, or social workers. this is my background, my information, my experiences, and my specific expertise. this will include the basics of schooling, training, certifications, frequently asked questions, and things you might not realize, as it all pertains to me! what works for my patients and i may not work for you, so be mindful this is not a "my way is correct and your therapist is wrong," as i believe in the pct model of meeting everybody where they're at.
even counselors at my exact experience level and education level may do things differently than me, and that's perfectly fine! i just wanted to write this to give some insight if you're interested in writing a character who is a therapist, or who goes to therapy. or if you're just interested in general! i could give reminders upon reminders but i just need to say that this is all my thoughts and path in life! this is not the end all, be all. and with that, let's get started. (if you have further questions or need something clarified, please feel free to reach out but just for clarification: i'm not your therapist, i'm not being paid for this, please don't trauma dump, and always remember i'm a human just like you!)
education:
your education is based a lot on your "experience" (which i'll talk about next) and i know that doesn't make sense but just stick with me! the very basics of what you need is a bachelor's in a "social work" setting. which includes, but is not limited to (because i forget): psychology, social work, sociology, criminology. these are the foundations for your specific field of work! i'll just be talking about counseling in general, or about substance use, as i am unaware of the other jobs / fields you can get with different degrees.
if you're trying to get a "good" job (livable wage) i would suggest getting a master's degree in your field of work. though, i will say, you can get lucky and survive off of your bachelor's (like i currently am!) but i would strongly, strongly encourage further education which will lead into certifications and licensure, and that will cement your place in the field and open up the job field entirely. with a bachelor's, they often want anywhere from 1-5 years of experience. with a master's, many places will take you with 0 years of experience, up to 5 years, depending on your field and what the company wants.
i currently have my bachelor's in psychology. psychology is such a broad degree that unless you're specifically going to be a clinical psychologist or gain your doctorate, i would choose another field. i didn't know i wanted substance use specifically until i was 19, which i'll speak about in experience, but if i did not choose the substance use field, i would most definitely would have had to immediately get a master's and be licensed in order to receive well paying jobs with just a psychology degree.
experience:
you don't need a master's to get a job in this field, but you do need experience (there will be places that take bachelor's with little to no experience, but will pay you next to nothing). the best thing to do is find an internship! i think the easiest way will be through your school, and when you're picking one of the aforementioned degrees, it should be an option when picking out classes - many times, universities have people that specifically work with internships.
when i was getting my bachelor's degree, it was my first semester and i was 19 when i was offered to interview for an internship through my school. i got accepted on the spot and was apart of it even after i got my "credit" for the semester and continued for two years! i worked in houseless shelters in my county and was running daily men and women's groups, 2:1 sessions (2 counselors to 1 resident), debrief sessions with the other interns, and supplying a resource booth for the residents.
without this internship, i truly and wholeheartedly believe i would not have gotten any job in this field. it's a dog-eat-dog out there in the realm of psychology (which includes all those fields above) and i truly got lucky to get my start this way. if you don't have the time, motivation, or money to gain a master's, i would highly suggest getting involved in internships as soon as possible in order to get those years of experience!
certifications:
this has a wide range of things! i can only speak to what i've received, and what i know about. this also includes specific training to the sud field, but i won't go in depth about it until the next post i do! the certification i will always need is my cpr. i know that sounds silly, but working with people, in general, i feel like everybody that is able to should receive their cpr certificate!
now, with a bachelor's, they're not really expecting you to have anything else. but! you can. i currently have my milieu certification. which sounds fancy but it just means i'm certified in "psychotherapy in which the patient's social environment is controlled or manipulated with a view to preventing self-destructive behavior." i could've explained it myself, but google does wonders and makes me sound smart! i got this through my internship. it was required and within the first two weeks, i went through trainings and seminars to receive the certificate.
another thing i can receive with only a bachelor's (that's specific to sud) is my cadc certification. it stands for certified alcohol drug counselor. in order to do this, you'll need supervision hours from a clinical / licensed or otherwise appropriate supervisor or director. once i receive upwards of 300 hours of documented supervision, i can take my cadc exam and become certified. this can also enhance what jobs are available to me because many jobs ask for this certification in place of a clinical license (some don't, but you know... some do!)
currently, i'm working on my master's and may potentially work towards my cadc along the way, but once i receive my master's i can get my caadc, which is certified advanced alcohol drug counselor. it's just more hours and an exam! not sure which path i'll take yet because grad school is killing me, but those are what's offered in my field and what i'm interested in! of course there's other certifications involved, but that's for you to decide.
licenses:
now comes the fun part. again, what license you want or go for is specific to your field. there's a ton of counseling licenses, but the main ones that are down my path are lpc (licensed professional counselor), lsw (licensed social worker), and lcsw (licensed clinical social worker). so let me explain a little bit about each of them, and what i'm personally doing!
lpc: licensed professional counselors "are trained to offer assessment, therapeutic interventions, consultation, program evaluation and follow-up services in a variety of settings including schools, hospitals, community agencies, private practices, religious centers, group homes and more. lpc's can also independently practice counseling, meaning they can establish or join a private practice and directly bill insurance companies or receive cash for counseling services." can: work independently, diagnose mental health conditions, and supervise for clinical hours. this license is primarily for direct mental health care.
lsw: licensed social workers can "render services that rely on a special knowledge of therapeutic techniques, human personalities, and social resources. this includes: helping people become socially adjusted as individuals and members of a family or community, you cannot work independently; you must work in the affiliation of an agency or social work service provider." cannot: work independently or diagnose mental health conditions.
lcsw: licensed clinical social workers "support people through various challenges by providing general counseling services, crisis intervention, mental health therapies, substance use support, and other key services. lcsw's may also supervise the work of lsw's. they may work in schools, hospitals, elderly care facilities, private practices, and even the courtroom—social workers are often called upon as witnesses in court cases. the main thing to remember is that this license gives them freedom and responsibility to make independent decisions about diagnosis and treatment plans." can: work independently, diagnose mental health conditions and supervise for clinical hours.
difference between lpc and lcsw: though both are similar in their ability to work independently, diagnose mental health conditions, and supervise for clinical hours, there is one main distinction between the two. lpc's are more patient focused and lcsw's utilize a patient's entire life. to put it, well... better, i've turned to google! lpc's "focus on helping clients with specific issues, such as mental health diagnoses, substance use, or behavioral issues. they also can specialize in different types of counseling, including substance use or marriage and family counseling." whereas lcsw's "assist their clients with finding and accessing resources that promote a client’s quality of life and may be involved in the legislative process dictating these services. social worker training usually includes counseling techniques and training, best practices, and finding resources for clients."
general overview:
so, with a bachelor's and no cadc or license, what can i do? well! i counsel<3 i speak to my patients about their substance use, i speak to them about their family, i conduct family sessions, i delve into their trauma, i utilize cbt, pct, mi, and grounding techniques. i run daily groups with my caseload, i run bi weekly groups for the entire community, and i initially assess them for proper level of care. i submit asam's, prepare treatment plans and update them weekly, and work with them on their goals while in and outside of treatment. all of this will be spoken about further in my sud counseling guide.
a day-in-the-life timeline looks like: clock in, check any updates / notes on my patients, go to treatment team with the clinical staff / case management / nursing and doctors (which pertains to the level of care my rehab is - you will not always have this, dependent on inpatient or outpatient and other factors), i run my daily group for an hour with my patients, i do group notes for them, i have my lunch, if i have that afternoon group for the whole community i run it, then i fit in any individual sessions or initial assessments that i need, i complete all progress notes for the day, and i clock out. in between, i handle patient crisis', ama's, behavioral issues, and general questions.
modalities:
what are modalities? "modalities are approaches or methods that a therapist will use to help you reach your goals. modalities fall into broad categories, such as cognitive and behavioral, somatic (body awareness), experiential (play or art therapy), and more." these vary by counselor-to-counselor. this is what works for the counselor and the patient and instead of including the quadrillions of therapy modalities, i'll just talk about the ones i use the most! (also side note that i believe most therapists, within reason, should be utilizing pct and mi but... that's a soapbox for another day). i'll be talking more about why i use - these in relation to sud - in my other post.
cognitive behavioral therapy (cbt):
i want to start this off by saying that cbt is very useful in the beginning stages of therapy! oftentimes, people utilize dbt or somatic therapy after they've "accomplished" cbt. i employ cbt due to, more often than not, patients not having a solid foundation for recovery or changing their ways. so what is cbt?
"cbt is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. cognitive behavioral therapy is one of the most effective means of treatment for substance abuse and co-occurring mental health disorders." in a shorter sense: i use cbt in order to "change" the way somebody thinks.
things that are apart of cbt therapy (and can be incorporated in other forms of therapy) include cognitive distortions, grounding techniques, actively engaging in combatting their automatic negative thoughts (ant's), and encompassing pct and mi in order for the patient to understand why they need to change their thoughts / actions, how they can change them, and the results of changing them. this will go more in depth in my sud post!
patient centered therapy (pct):
pct isn't necessarily for everybody, as many patients may have difficulty even coming up with what their issues are or potential solutions. but by utilizing pct, counselors may be able to support a patient to an "answer" or realization without giving them the answer - i find it beneficial to voice my issues and concerns so i'm able to form my own solution even without my friends saying anything! it's very limited involvement from the counselor as far as "telling them" what's wrong and giving them "choices" to fix it.
"during person-centered therapy, a therapist acts as a compassionate facilitator, listening without judgment and acknowledging the client’s experience without shifting the conversation in another direction. the therapist is there to encourage and support the client without interrupting or interfering with their process of self-discovery, as they uncover what hurts and what is needed to repair it."
pct is really important, in my opinion, because it allows patient the autonomy to make decisions for themselves, while also giving them support. a counselor is supposed to help, not be a brick wall, so as much as the patient is allowed to freely roam through their thoughts and feelings, i've found a nice balance between pct and cbt when the patient may not have a specific answer or understanding for themselves.
motivational interviewing (mi):
"mi is a guiding style of communication, that sits between following (good listening) and directing (giving information and advice). it's designed to empower people to change by drawing out their own meaning, importance and capacity for change. mi is based on a respectful and curious way of being with people that facilitates the natural process of change and honors client autonomy."
when i speak about "guiding" a patient to a different way of thought, or to a "solution", mi is what i'm talking about. my entire approach to counseling is not to give them the answer, because many times they may know the "right" thing to do (stay away from drugs - duh, not explode in anger, not cut people off, etc.) but allowing them this space to speak freely so i can ask them questions for clarification, let them know somebody is listening to them, and building up that therapeutic relationship is the entire point for me.
mi is where the trifecta of these modalities lays. i can utilize cbt in an effort to change their mindset or offer new ideas or "reasons" why they may think / act like that, as well as incorporating pct so that they can come to the realization themselves! it's all about balance and which modality is right for that exact moment, for that patient. it also allows me to be entirely present in the conversation. i often find myself dissociating in my day-to-day life, as many people do, but by using mi, i have to listen in order to ask questions or repeat what they said back to them. it's beneficial to all!
the end:
thank you so much for reading this! i know this was just the basics, but if you want to write a character who's a therapist or who's going to one, i hope this helps beef up that background for you! again, this is specific to me and my sud field, and there's a million other certifications and licenses for general counselors.
substance use disorder counseling post. (will update when post is done).
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