It is heartwarming that over the past several years counselling has become more mainstream in Trinidad and I can only hope Tobago as well. The stigma is still there – but people are seeking assistance with their struggles even if they do not share their journey with others. I will admit that after a while, my clients do reveal that they are seeing a psychologist or counsellor with family and/or friends. It is good as it opens up a conversation about therapy and hopefully its benefits.

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This is a guide to help Trinbigonians traverse the local landscape to find a counsellor. I will attempt to cover as much as I can so that you can make an educated decision.

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What exactly is counselling/therapy/psychotherapy?

These terms all describe the work that an individual undertakes with a professional to help ease the mental, emotional, physical and spiritual toll a problem is having on them. These struggles can be related to family, work, friends, partners and the Self. They may stem from childhood experiences, various traumas, perceived wrongs, complicated situations, social pressures and much more. The main aim of this work is to help ease the challenge, find solutions that fit the individual, impart a greater sense of awareness, a better understanding of Self and all-round well-being.

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Psychologist vs. Psychiatrist

There is a difference. Psychiatrists are medical providers specializing in mental health. They will speak to you about your issues and can provide prescriptions for psychotropic medications.

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Psychologists are not medically trained – they are trained in behavioral science and spend time talking and using various techniques to assist in alleviating individual struggles. They can, however, offer referrals to psychiatrists if needed.

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The general rule-of-thumb is - if you are seeing a psychiatrist you should also be seeing a psychologist.

 

If you are seeing a psychologist you may need a psychiatrist.

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If well-orchestrated and hopefully both professionals are open-minded - your therapist and psychiatrist can work together to assist you!

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Where do you find a counsellor:

• The telephone directory under the headings “Counselling” “Psychologists” and “EAP Services” (not all professionals are listed)

• Online: there are online directories that have culled information of providers from the internet and the phonebook

• Online: websites of professionals (not professionals have websites)

• Ask one of your healthcare providers – they usually have some recommendations

• You may contact the Trinidad and Tobago Association of Psychologists – they usually offer up only the services of their members and not all counsellors/psychologists choose to be members

• If you are a student at a university: the university usually has a counselling centre. Check your student handbook or ask the Registrar

• Ask a friend or family member

• If you work at a company, there are oftentimes Employee Assistance Programs (EAP) wherein you the employee and either your immediate family or household (check to be sure) can have services covered. There are usually 5-10 sessions based on what the employer and the service provider have worked out.

 

Payment

Most psychologists will accept cash, Linx, and cheque.

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If you are utilizing EAP services a predetermined number of sessions with the provider is available at no charge. If you require sessions beyond this, you may have to pay for them yourself.

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Insurance. This has been quite a baffling  and contradictory experience to untangle and you would need to speak thoroughly to your agent. From what I have garnered –most insurance companies have only recently began to cover counselling/psychological services in Trinidad and Tobago, usually after a medical doctor has referred you to such a service. They WILL cover psychiatric services as psychiatrists are medical practitioners. Some people have managed to file claims successfully and others have not. Some company plans do cover services – only if professionally recommended by a medical practitioner. I cannot stress enough your investigation of what your insurance covers. IF by chance it is covered – you pay the counsellor in full, she/he fills out your claim form and you will be reimbursed. I mention this as some people may be accustomed to the foreign systems where they do not pay up-front and the counsellor must file the claim themselves.

 

Counsellor/Psychologist/Therapist – what is the difference?

In Trinidad and Tobago all the terms are used interchangeably. As there are no licensure or legal standards of practice, practitioners use the terms freely. In the US, UK, Europe, Australia and New Zealand however, each term has meaning with the term “psychologist” being protected by law.

The main differences are based on the training of each – which I will not get into here. Training is similar in many ways and different.

 

What qualifications are you looking for:

It is your right as a client to know the qualifications of your practitioner. Your therapist MUST hold at least a Master’s degree and at most a Doctoral degree in the discipline. Disciplines include Counselling Psychology, Clinical Psychology and Social Work. There are also Marriage and Family Therapists (MFT’s or LMFT’s). You may find the following abbreviations within these disciplines:

• M.Ed – Master of Education

• M.A – Master of Arts

• M.Sc. – Master of Science

• M.Phil – Master of Philosophy

• M.S.W – Master of Social Work

• Ph.D – Doctor of Philosophy

• Psy.D – Doctor of Psychology

• Ed.D – Doctor of Education

 

Many psychologists may have specialized and they may have additional credentials that indicate such. Specialties are very, very much wide-ranging but some include: child psychology, trauma, eating disorders, substance abuse, learning disabilities, mood disorders, etc.

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It is extremely desirable for a therapist to attain additional formal certified training in an area of specialty. However, in some cases, years of working with a specific population, much reading, conference attendance, short courses and time allows a professional to specialize or be considered an expert.

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Professional Bodies/Associations – Membership

Most psychologists and counsellors hold membership in one or more professional associations.

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As in all else, “professional associations” vary in their quality, offerings, leadership, activities and relative importance.

Membership is based on level of qualification and payment. Everything from being an Affiliate to being a Fellow, the level of qualification the individual holds will indicate the membership level and fee they pay annually – memberships are based on fees. These memberships allow the member to obtain special publications (magazines, journals), discounts on services and products, networking opportunities, some training and conference attendance. General memberships include the American Psychological Association, British Psychological Association etc. Memberships to these are not necessary for every professional, but can have some benefit. These associations further have divisions for those who have special interests.

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There are some professional associations that do require a graduate degree (accredited Master’s and above), the completion of an exam, and recommendations by colleagues and licensed professionals in the field. These types of memberships require the member to continue their education in some capacity, perhaps be engaged in research and submit proof of such every five years or so. This allows for a higher quality of bonafide professionals as part of their membership and better benefits.

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Licensure

There is no licensure of psychologists and counsellors in Trinidad and Tobago at this time.

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There is no regulation of the profession in Trinidad and Tobago.

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This means that there are people who can (and often do) counsel without having what is considered the proper and formal education necessary. This leads to poor professional practices, lack of an appropriate body of knowledge and in many cases can harm the client further. Additionally, this may cause individuals to believe that psychologists and counsellors are “quacks” and this undermines the profession.

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You may find a few professionals locally, who due to their foreign studies and credentialing have licensure in various US states and provinces of Canada. Some do have registration in the UK and Australia – many times they do follow the Code of Conduct of these countries as much as they can in Trinidad and Tobago.

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The Council for Professions Related to Medicine is a local authority that has various Boards as their members including: The Society of Radiographers, Physiotherapists’ Board, Occupational Therapy Board and Nutritionists and Dietitians Board. As of the moment psychology and counselling are not represented.

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Okay – you found a therapist, now what?

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There are things you want to look for now that you have found one or more people who may be able to assist you. Shop around! You may attend one session and get a sense of the person you are working with and it’s okay to try another person until you are satisfied. Each person will require something different from their psychologist or counsellor – but there are simple things that should be common to all:

Respect – you should be treated with respect and courtesy at all times – in office, on the phone, via email and on random public encounters.

Respect encompasses much more than being pleasant. Simple kindness is necessary – you should never be called names or be berated. There are still boundaries that need to be kept by the therapist. No matter how long you spend with your therapist he/she is not your friend – but an objective person working with you through your struggles.

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Empathy and compassion – the ability of the therapist to stand in your shoes and understand to some extent the struggle – with no judgment. Some therapists can have sympathy as they may have experienced similar situations in their personal lives.

Another thing: It is the RIGHT of the counsellor to not offer services if he/she feels they are not capable of assisting you for whatever reasons they may have – be they personal or professional. They should however, offer a referral or two. Psychologists are human too and do what they need to protect their emotional and physical selves.

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Confidentiality

This is a BIG one and the issue most people are concerned with! So let’s talk about this sensitive area.

 

You have clear confidentiality if you seek out the services of an independent practitioner (person in private practice) and pay them from your pocket. They have no one to account to.

 

If you seek the services of a therapist via EAP through your workplace, there is at maximum 2 or 3 people who may know that you have sought assistance depending on the way the system is organized – and that differs from company-to-company. Usually the Human Resources person who requests the service will be aware, maybe the Occupational Health Nurse and a member of the EAP service. Paperwork must be completed before you are placed with a counsellor. You are assigned a code so you are not identifiable to anyone but the parties involved in your care. The counsellor must offer a report back to the EAP, who will then distill the report further before passing on to the company. In this way, the company may never really know exactly what the issue is.

I know some companies who do not want a report and just prefer to be invoiced.

If by chance, you can have services supplied via insurance, the counsellor/psychologist will fill out your form with discretion and you may submit it.

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Release forms – your counsellor CANNOT SPEAK TO ANYONE about your care UNLESS you sign a “Consent to Release” document that indicates to whom, about what exactly (you can limit the information released), and even set an expiry date. You have control with this document and it is your right. Information is usually released to other healthcare practitioners, sometimes to an employer and to academic administrations and if you choose – family and spouses. The counsellor should have a thorough discussion with you about the pros and cons of each in your unique situation and then a decision can be made.

 

There are however some clear cases where confidentiality is limited:

 

• If a client threatens to harm himself/herself, the therapist may be obligated to seek hospitalization for him/her, or to contact family members or others who can help provide protection.

 

• If a patient communicates a threat of physical violence against a reasonably identifiable third person and the client has the apparent intent and ability to carry out that threat in the foreseeable future, the therapist may have to disclose information in order to take protective action. These actions may include notifying the potential victim (or, if the victim is a minor, his/her parents and Social Services), and contacting the police, and/or seeking hospitalization for the client.

 

• If there is reasonable cause to suspect child abuse or neglect, the law requires that counsellors file a report with the police.

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• If there is substantial knowledge or have reasonable cause to suspect, that a vulnerable adult (disabled or elderly) has been or is being abused, neglected, or exploited, counsellors are required by law to immediately report such knowledge or suspicion to the police.