This article is reprinted from Harvard Health Blog
Originally published March 23, 2018, 6:30 AM
Adam P. Stern, MD
When faced with mental health conditions such as depression, anxiety, or other symptoms of the mind and brain, it can be difficult to know where to find the best care. In part, the challenge of finding the right professional for you stems from the highly variable way mental health concerns can emerge. One person’s depression, for example, may be very different than someone else’s, and the same can be said for anxiety, post-traumatic stress, obsession, attention issues, substance use disorders, and even psychosis.
There are also lots of different kinds of mental health providers out there doing all kinds of distinct clinical work. It can be intimidating to even know where to start searching for help, but often telling your primary care doctor about your symptoms, and if necessary, asking for a referral to a specialist, is a good place to begin.
If your doctor determines that specialized care is needed, you may be referred to a psychiatrist who can do a global assessment of your clinical needs. It may be the case that you will benefit most from an integrated treatment approach that features both psychotherapy and medications, or you may be referred primarily to one treatment or another. Here’s some additional information about the different kinds of mental health providers and the treatments they offer to help diagnose and treat psychiatric issues.
Psychiatrists are medical doctors who have graduated from medical school and completed at least four years of additional specialized training, through residency and often fellowship, in the medical treatment of mental disorders. Because of their advanced medical training, psychiatrists can prescribe medicine and also have at least basic training in most evidence-based psychotherapeutic approaches. Some choose to see patients for medication management only, while others focus on therapy and still others integrate both approaches into the same clinical sessions. Also, psychiatrists are generally the only mental health providers who can perform electroconvulsive therapy, transcranial magnetic stimulation, or other neuromodulatory treatments that use devices to noninvasively stimulate the brain in severe or medication-resistant cases.
Though some psychiatrists still practice traditional psychoanalysis involving multiple sessions “on the couch” each week, this kind of approach has become less available and less common in recent years, in part because insurances generally do not cover it, and in order to practice it providers must complete additional psychoanalytic training for several years after residency. Often, psychiatric nurse practitioners or other appropriately trained “physician extenders” can take on the traditional role of a psychiatrist, though it is important that they have access to adequate supervision, particularly for complex cases.
Therapists and counselors
Many types of professionals can provide the variety of psychotherapeutic approaches used in the treatment of mental health disorders. Therapists who have obtained PhD or PsyD degrees with a focus in clinical psychology, for example, have perhaps the most extensive training in providing talk therapy, including psychodynamic or “insight-oriented” therapy, cognitive behavioral therapy, interpersonal therapy, and others. Clinical social workers and mental health counselors may also have excellent training in particular therapeutic areas that can be very helpful to patients. Therapists and counselors may even offer some therapies, such as eye movement desensitization and reprocessing (EMDR), that psychiatrists generally have less experience with.
In each of these areas, it is important to remember that there is a spectrum of quality, and so it is essential for people with mental health concerns to find well-trained and credentialed providers that seem to be a good fit with them individually.
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