Whether you are concerned about your own mental wellness or that of a loved one, taking the first steps towards getting help can be daunting. Should you see a psychotherapist, a psychologist or a psychiatrist? What are the differences between these professionals and the treatment they can provide, and how do you access care? This article aims to answer those questions and help you understand how to proceed.
The term mental health is commonly used in reference to mental illness. However, as the United States Centers for Disease Control and Prevention (CDC) states on its website, while mental wellness and mental illness are related, they represent different psychological states.
“Mental health is a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community,” the CDC said. “It is estimated that only about 17 percent of US adults are considered to be in a state of optimal mental health. Mental illness is defined as ‘collectively all diagnosable mental disorders’ or ‘health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning.’”
Whether you suspect mental illness, just feel you worry too much or want help regarding a specific dilemna, the first step towards seeking help should be to contact (PCP). Your doctor can discuss your symptoms with you and check for physical problems that could be causing them. If your PCP rules out a physical issue, you can request a referral or you can contact your insurance company for a list of providers. If your PCP feels medication can help your mood, he/she may feel comfortable personally managing your medication. Some PCPs however, may prefer to have you work with a psychiatrist instead.
“Much research has shown that taking medication alone may not be sufficient,” said Bethany T. Dwinnell, MA, MSW, LISW, a clinical social worker and psychotherapist.
“Talk therapy, known as psychotherapy, is a significant tool in improving your well being. There are several different professionals who provide psychotherapy.”
Who can help?
Let’s take a closer look at the various mental health professionals who can provide help.
Psychologist: A psychologist holds a doctorate (PhD, PsyD, or EdD) in psychology. Graduate school, followed by a two- to three-year internship, prepares psychologists for evaluating and treating mental and emotional disorders.
Licensed psychologists are qualified to conduct psychotherapy (“talk therapy”), perform psychological testing, and provide treatment for mental disorders. They are not medical doctors, which means that, except in a few states, psychologists cannot write prescriptions or perform medical procedures. Often a psychologist will work with a psychiatrist or other medical doctor who provides the medical treatment for mental illness while the psychologist provides the psychotherapy.
Psychotherapy also can be provided by a clinical social worker, psychiatric or mental health nurse/nurse practitioner or a licensed counselor.
Clinical social worker: A clinical social worker has at least a master's degree in social work and also has been trained to evaluate and treat mental illnesses. Like psychologists, clinical social workers provide psychotherapy in outpatient settings.
Psychiatric or mental health nurse: Some nurses have undergone special training in providing mental health services. Depending on their level of training and certification, they can evaluate patients for mental illness and provide psychotherapy/”talk therapy.” In some states, they are also licensed to prescribe and monitor medications, sometimes independently and sometimes under the supervision of a medical doctor. Nurses also can provide case-management services and be patient advocates.
Licensed counselors: There are a number of other licensed professionals who have undergone the education and training required to provide mental health services, including psychotherapy/”talk therapy.” These professionals have master’s degrees in psychology, counseling or a related field and have completed their state’s licensing requirements, which typically include gaining two additional years of experience working with a qualified mental health professional after graduate school. A mental health counselor is qualified to evaluate and treat mental problems via counseling or psychotherapy. These professionals’ job titles can vary from state to state and can include clinical mental health counselor, licensed professional counselor, licensed mental health counselor, licensed professional clinical counselor, licensed clinical professional counselor and national certified counselor.
Psychiatrist: A psychiatrist is a medical doctor (someone who has attended four years of medical school to obtain either a Medical Doctorate or a Doctorate of Osteopathy) who specializes in the prevention, diagnosis and treatment of mental illness. Following medical school, a psychiatrist completes a one-year internship and a psychiatric residency at least three years in length. As an MD or DO, a psychiatrist is licensed to write prescriptions, which are necessary in the treatment of many mental disorders. Sometimes medication alone is enough to treat certain disorders, and in that case the psychiatrist, after making a diagnosis and providing an initial treatment plan, will mainly fulfill the role of medication management. Many patients, however, will also benefit from psychotherapy Ms. Dwinnell said.
“Many insurance companies will not reimburse for psychotherapy provided by a psychiatrist,” she said. “So patients will either need to pay out of pocket for talk therapy with their psychiatrist if the psychiatrist performs psychotherapy. Or their psychiatrist will solely do medication management and have the patient see a separate provider for talk therapy.
How do you know you need help?
“When evaluating whether YOU need help, consider whether you’ve noticed a decrease in your level of life satisfaction” Ms. Dwinnell said. “You could benefit from therapy if you realize you want to function at a better level. Or if you need assistance with a specific problem. And, of course, if you find yourself starting to abuse substances, you should seek help.
Ms. Dwinnell acknowledged that until recently many people avoided or delayed seeking help because they were ashamed of their need to do so.
“There used to be a real stigma with seeking counseling,” she said. “This negative attitude however, has been rapidly changing. Folks are realizing how beneficial psychotherapy can be. In my experience, I find that most people who seek help actually have a higher level of insight. They’ve had the ability to monitor themselves and can realize that they are not on the path they want to be on and that they deserve better. I often explain it this way – if you were in business for yourself and you found out there was a consultant who could help you improve and grow your business, you wouldn’t hesitate to use their services. Counseling can do for your life what that consultant could do for your business. And, almost all insurances will cover it. It is treated the same as any medical procedure.
What if you are concerned about a loved one? When identifying whether a loved one needs professional help, look for concerning changes in their behavior.”
“You can suggest counseling to a loved one,” Ms. Dwinnell said, “But you can never force someone to go. If your loved one only goes because they were coerced, there is little chance that they will give the therapist a fair shot. Avoid ultimatums. You don’t want the person to feel resentful about going. Instead, you can be a sympathetic listener to that person and show that you are trying to understand what they are going through. If your loved one feels you ‘get it’, you will have a better chance of getting them to consider seeing a therapist.”
“Also, even though your loved one may not do counseling, it might help for YOU to go to counseling. It’s a stressor for you to see a loved one struggling and the external support can be crucial. Speaking with a psychotherapist can give you ideas to navigate the situation with your loved one. And there’s a chance that if they see you going to therapy and benefitting from it, they might be more likely to go.”
For example, Ms. Dwinnell explained, with marriage counseling, the marriage often can benefit from counseling even if only one partner is going.
“Whether you need help yourself or want to help a loved one, therapy can provide a wonderful opportunity to have your own space to talk about whatever it is that concerns you,” Ms. Dwinnell said. “Going to a counselor will give you an objective opinion and those can be hard to find. You do not have to wait until you are in crisis. Seeking assistance is probably the most self-preserving thing you can do. It really is like hiring your own personal consultant to ensure you are living your best life possible – the life you deserve.”