Guidance on how to go about finding a psychologist in T&T plus some other useful bits!
It is heartwarming that over the past several years counselling has become more mainstream in Trinidad and Tobago. The stigma is still there but finally shifting – 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 its benefits.
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.
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.
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. Some do a bit of counselling, but generally refer out to psychologists after a while.
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.
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.
If well-orchestrated and hopefully both professionals are open-minded - your therapist and psychiatrist can work together to assist you!
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 local phonebook
Online: websites and social media accounts of professionals (not professionals have websites or social media pages)
Ask one of your healthcare providers – they usually have some recommendations
You may contact the Trinidad and Tobago Association of Psychologists – they offer listings of their members only 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 access free counselling services. There are usually 5-10 sessions based on what the employer and the service provider have worked out.
Payment
Most psychologists will accept cash and cheque. Many accept online bank transfers and others Linx, debit/credit VISA and Mastercard.
If you are utilizing EAP services a predetermined number of sessions with the provider is available for at no charge.
Insurance. This has been quite a baffling and contrdictory experience to untangle and you would need to speak thoroughly to your agent. Most insurance companies have only recently begun to cover psychology visits. 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.
There are two ways this works:
You pay the counsellor in full, she/he fills out your claim form, you submit to your insurance company and you will be reimbursed.
The American way is now taking a foothold locally where you the client pay the therapist a co-pay (amount to be determined by your insurance but it is less than the counselling fee) and it is up to the therapist to file the claim and be reimbursed.
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
D.S.W - Doctor 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.
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.
Life Coaches
A life coach is not a counsellor or psychologist. Some life coaches do have at least a Bachelor's degree in psychology but this is not enough for them to counsel, diagnose or provide appropriate mental health treatment. Unfortunately, many coaches are marketing in a way that is not trauma-informed. Fortunately, some are fully aware that ethically they must refer to a professional if they determine that someone is not suitable for life-coach services.
Counselling Formats
Prior to the COVID-19 pandemic, many psychologists did not offer services online, but some did (they were ahead of the game!). Once the pandemic had taken hold, many were forced to shift to online services and since then have made a permanent change to this format or a hybrid. This online approach is called telehealth/telemedicine. Please speak with the therapist to determine your preference and their offering. Sometimes it is fine to undergo online services, and other times it may be best to be in-office with the counsellor.
There are also those who offer email and text/messaging counselling. These approaches have their own positives and negatives. I am unable to address these types and you have to do your own research and have your own experience to determine the fit of this.
Foreign Services
Thanks to the beauty of the internet, you can also access professionals not based in Trinidad & Tobago or the Caribbean. This opens up the potential of finding specialized support or more confidentiality.
There are many services like BetterHelp and Seven Cups, etc., that offer services. Unfortunately, if you choose a free plan you get a "listener" who is not a professional. If you want a qualified psychotherapist you have to pay a fee. As everything, the professionals on these platforms may not be the best and of course, sometimes you get a great one! They may have to find a local practitioner if they believe they cannot assist. These services do not accept insurance. Period.
You may also seek a foreign professional outside of these services and connect with them. Some are very willing to support people from all over the world! You can expect to pay between US$60-250 (roughly TT$400-1700) for 45-55 minutes. Not 60 minutes. Foreign practitioners are very, very strict about their time and will end the session at the 45, 55 or sometimes 60 minute mark. If you have foreign insurance, check with the practitioner to see if they accept it or not.
Although this is a lovely option, most times these therapists will not understand our local culture and the deep nuances therein. They are open to learning and working with it, but then most of the client time can be taken up in explaining this rather than getting the help necessary that you are paying for.
Professional Bodies/Associations – Membership
Most psychologists and counsellors hold membership in one or more professional associations. 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 and indicates a level of professional responsibility. These associations further have divisions for those who have special interests.
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 before a therapist can attain membership. 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 two years or so. This allows for a higher quality of bonafide professionals as part of their membership and better benefits.
Licensure
There is no licensure of psychologists and counsellors in Trinidad and Tobago at this time.
There is no regulation of the profession in Trinidad and Tobago.
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.
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.
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.
Okay – you found a therapist, now what?
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 and how friendly they may be he/she is not your friend – but an objective person working with you through your struggles.
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.
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.
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.
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.
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