Seeking mental health treatment can sometimes feel like you’re visiting a foreign country with no plan or tour guide. Unlike other health disciplines where it’s relatively clear the type of doctor you need based upon your symptoms, the mental health field can be much more complex, unclear, and downright confusing. If you’re worried about your heart, you seek the consult of a cardiologist. If it’s your thyroid that’s concerning you, off to the endocrinologist you go. But where do you go if you’re stressed and stretched too thin between your home and work lives? What happens when that one random panic attack turned into two, then three, and now you’re hesitant to leave your house for your regularly scheduled Tuesday night dinner with friends? With so many types of mental health professionals in the market, how do you decide which one is right for you? Whose job is it anyway?
Psychiatrist vs Psychologist
The clearest of the confusing distinctions between professions within the mental health community is those who have a license to prescribe medications, and those who do not. A psychiatrist is either a medical or osteopathic doctor who has completed medical school with a residency in psychiatry. Their primary role is to do just exactly what they have a license to do: prescribe medications. In some states, advanced practice registered nurses (APRN) can also receive specific training in psychiatry and function similarly to psychiatrists. While some psychiatrists are trained in specific types of psychotherapies (cognitive-behavioral, psychodynamic, interpersonal), others focus solely on the medication angle of mental health treatment, and elect to refer for psychotherapy to another mental health professional.
While psychiatrists (and APRN) focus on the medication management of mental health symptoms, other mental health professionals are tasked with specific assessment/evaluation and non-medical treatment of those symptoms. Mental health professionals can come in the form of a psychologist, licensed clinical social worker, professional counselor, marriage and family therapist (LMFT), among others. While each individual state is tasked with the licensing and practice of its mental health providers, there are some basic characteristics of each discipline regardless of their location of practice. These (albeit sometimes subtle) differences can help you to determine what type of mental health professional will best suit your needs.
Generally speaking, the distinctions between types therapists are their level of education and training, a given specialty area, and the types of services they may (or may not) be trained to provide. Psychologists have completed a doctoral degree (Ph.D. or Psy.D.) in Clinical or Counseling Psychology. Psychologists can practice as generalists, meeting the needs of a variety of patients with diverse symptom presentations, or specialists, focusing instead on one specific diagnosis or treatment modality. Additionally, many psychologists have specific training in psychological and neuropsychological assessment, a formal method for assessing symptoms, individual personality, cognitive abilities, and neuropsychological functioning. Licensed clinical social workers, professional counselors and LMFT have (at minimum) a masters degree in their respective fields, but may also have a more advanced degree. Each of these disciplines require completion of academic coursework, as well as practical experience through clinical placements prior to graduation and licensure. Mental health professionals within each of these disciplines are trained to provide a variety of psychotherapies, treating diverse populations with multiple clinical needs.
Weighing the Options
With so many disciplines providing similar services, how do you decide who or what you need? Start with identifying your concerns and considering your personal goals, then do your research, all while understanding that one single person may not be able to provide everything that you need. If you’re noticing that you have numerous concerns in multiple symptom areas that do not seem to fit together, it might be helpful to seek the help of a psychologist. A psychologist can complete a comprehensive psychological assessment to determine a diagnosis with more specificity, which will in turn inform a more accurate and comprehensive treatment plan. Not everyone will require psychological assessment to develop an appropriate course of treatment, but if indicated, a psychologist is a good first step. Licensed clinical social workers, professional counselors, and LMFT are appropriate if no formal psychological assessment is needed, and a clear picture is present regarding symptoms. These individuals are skilled in conducting a clinical interview to determine your diagnosis and subsequently a comprehensive treatment plan.
A psychiatrist is indicated if you know, or predict, that medication is going to be an important part of your treatment. Severe mental illness, such as bipolar disorder, schizophrenia, or acute psychosis indicate the necessity of a psychiatrist as a part of your treatment team, while other diagnoses such as mild depression or anxiety are not as clear-cut. These individuals can also use medication management as a part of their treatment plan, a tool in addition to those developed in psychotherapy to help jumpstart symptom relief. Many individuals who are experiencing severe symptom impairment start with medication management first to improve symptoms, so that they can better benefit from psychotherapy. In essence, if your symptoms are so high that it’s difficult for you to understand and practice the coping strategies you discuss with your therapist, medication management with a psychiatrist is likely indicated.
When deciding which type of therapist to seek out for treatment, find a professional who has a specialty or extensive experience in working with your particular set of symptoms. Feeling understood and “seen” on your first visit is important in the development of a therapeutic relationship, and working with someone who is skilled and knowledgeable with your set of symptoms is a good starting point. Don’t be afraid to meet with multiple professionals to determine which person is going to be the right “fit.” Research supports that the greatest predictor of change in psychotherapy is determined by the therapeutic relationship between patient and provider, not necessarily just the specific techniques used. If you don’t click with the first provider you consult, find another one. (You wouldn’t stop getting haircuts if you got one that didn’t suit, you’d just go find another stylist.)
It might seem daunting and will involve an initial time investment, but assembling a treatment team for your mental and emotional health will be worth your efforts. They’ll get to know you and your goals, collaborate, and establish a plan to help you get on the right path. The tools are within, you just have to find the right people to help you discover them.
