It is always surprising to me how confusing the mental health system is in our country. Many people suffer with depression, anxiety, substance use problems, or other mental health problems, simply because they don’t know where to turn.
Should I see a primary care doctor? A therapist? A psychiatrist? What is the difference between Psychologists, Psychotherapists, Psychiatrists and Nurse Practitioners?
Is one kind of provider better than another? In short, NO! The reality is that mental health is a puzzle and the solution is different for different people. In some situations it may be best to work with a psychotherapist, in others a psychiatrist may be better, in another it may be a nurse practitioner and psychotherapist team, etc.
Let’s first define the different types of providers and their roles:
PSYCHOLOGIST – is someone with a degree in psychology, this degree can be a bachelors, masters, or doctorate level. Sometimes a psychologist with a PhD will use the title “doctor” to emphasize they have completed the highest level of education for this work.
PSYCHOTHERAPIST – this can encompass many different types of degrees, but is typically used by people with a master’s level degree in social work or counseling. A PhD psychologist or a psychiatrist may also refer to themselves as a psychotherapist. Sometimes you will see different letters at the end of their name, (ex: LCSW, LMFT, LPC) which describe the type of training they have completed.
PSYCHIATRIST – is someone who has completed 4 years of medical school and 4 years of residency in adult psychiatry. They can prescribe medications and offer psychotherapy. Many psychiatrists are “board-certified” meaning that they have completed a high level of examination by the American Board of Neurology and Psychiatry. There are specialists within psychiatry, including Child and Adolescent Psychiatrist, Addiction Psychiatrist, Geriatric Psychiatrist, all of which have an additional year of specialty training called a fellowship.
NURSE PRACTITIONER – more and more often NPs are providing mental health care, often prescribing medications when a psychiatrist is not available. An NP is largely independent, but will have a supervising MD who helps supervise his/her clinical work. Some NPs undergo specialty training in psychiatry, others have had many years working in different mental health treatment settings.
How do you know which provider(s) are best for you?
There is no one answer to this question, but here are some guidelines. If you need medication, you will need a Psychiatrist or a Nurse Practitioner. If you want psychotherapy, there are many different options. Sometimes it makes sense to do therapy with your Psychiatrist, especially if your medications are complicated. In other cases, you may want to see a Psychologist or Psychotherapist that has specialty training in your issue. You may want to work with a Psychologist if you need certain kinds of assessment or testing that only Psychologists are certified to perform. If cost is an issue, you may want to find a Psychotherapist that is in your insurance network or who has sliding scale fees.
So how do I figure out the pieces of the puzzle?
The first step is to have a consultation visit with either a Psychiatrist or a Psychotherapist. They are BOTH skilled in assessment and if they think you need a service they do not provide, they will refer you to the appropriate provider. If you are already taking medication, you may want to start with a Psychiatrist assessment since they will be able to prescribe for you.
What happens if I need or want more than one type of provider?
This is very common and sometimes the TEAM approach is a very powerful tool for your mental health. Make sure that your providers have a good communication system to discuss your care, and make sure you sign release forms for each of them to talk with each other.
What is the bottom line?
You are a unique individual, with your own set of issues, your own personality, and your own culture. An initial assessment should give you a sense of what TYPE of provider might be best for you. However, for the therapeutic process to be successful, you must find a provider that is a GOOD FIT for you. A good fit provider will listen to you, will try to understand you, will coordinate care on your behalf, and will be your advocate. If possible, I recommend that you “interview” a few providers to find the one that is right for you. It takes more time and energy up front, but it will help you feel better, faster and have a trusted partner in your health.