Guide to Psychiatry and Counseling

Psychiatry and psychology are overlapping professions. Practitioners in both -- psychiatrists and psychologists -- are mental health professionals. Their area of expertise is the mind -- and the way it affects behavior and well-being. They often work together to prevent, diagnose, and treat mental illness. And both are committed to helping people stay mentally well.

But there are differences between psychiatry and psychology. And people sometimes find those differences confusing, especially when they are looking for help. To make matters even more confusing, psychiatrists and psychologists aren't the only mental health professionals you can choose from. There are mental health counselors, social workers, nurses and nurse practitioners, and others who deal with issues of mental health. And if you consider the multiple approaches to treatment, ranging from counseling to various forms of psychotherapy, the whole mental health system begins to look like a maze that's nearly impossible to navigate.

But here's a guide you can use to help you make your way through that maze.

Where to Start

Issues with mental health, especially if they're chronic (persistent or recurring often), can be debilitating. Your body can respond physically to depression or anxiety much like it does to physical illness. And sometimes, mental problems can actually be caused by a physical condition. So the first person to see if you think you are having a mental problem is your primary care doctor.

Your doctor will ask about your symptoms, how long you've been having them, and whether they're constant or come and go. Your doctor will check for physical problems that could be causing your symptoms and help you decide what type of mental health professional and what kind of therapy might be best for you.

Types of Mental Health Professionals

Your doctor might refer you to any of the following mental health professionals:

Psychiatrist. A psychiatrist is a medical doctor (M.D. or D.O.) who specializes in preventing, diagnosing, and treating mental illness. A psychiatrist's training starts with four years of medical school and is followed by a one-year internship and at least three years of specialized training as a psychiatric resident. A psychiatrist is trained to differentiate mental health problems from other underlying medical conditions that could present with psychiatric symptoms. They also monitor the effects of mental illness on other physical conditions (such as problems with the heart or high blood pressure), and the effects of medicines on the body (such as weight, blood sugar, blood pressure, sleep, and kidney or liver functioning).

As a medical doctor, a psychiatrist is licensed to write prescriptions. Many mental disorders -- such as depression, anxiety, ADHD, or bipolar disorder -- can be treated effectively with specific drugs. If you are working with a psychiatrist, a lot of the treatment may be focused on medication management. Sometimes medication alone is enough to treat the mental illness. Sometimes a combination of medication and psychotherapy or counseling is needed. If that is the case, the psychiatrist may provide the psychotherapy, or the psychiatrist may refer you to a counselor or other type of mental health professional.

Psychologist. A psychologist has a doctoral degree (PhD, PsyD, or EdD) in psychology, which is the study of the mind and behaviors. Graduate school provides a psychologist an education in evaluating and treating mental and emotional disorders. After completing graduate school, a clinical psychologist completes an internship that lasts two to three years and provides further training in treatment methods, psychological theory, and behavioral therapy.

Licensed psychologists are qualified to do counseling and psychotherapy, perform psychological testing, and provide treatment for mental disorders. They are not, though, medical doctors. That means that, with the exception of a few states, psychologists cannot write prescriptions or perform medical procedures. Often a psychologist will work in association with a psychiatrist or other medical doctor who provides the medical treatment for mental illness while the psychologist provides the psychotherapy.

Licensed Mental Health Counselor. A psychological counselor is a mental health professional who has a master's degree (MA) in psychology, counseling, or a related field. In order to be licensed, the professional counselor also needs two additional years' experience working with a qualified mental health professional after graduate school. A mental health counselor is qualified to evaluate and treat mental problems by providing counseling or psychotherapy.

Clinical Social Worker. A clinical social worker has at least a master's degree in social work and training to be able to evaluate and treat mental illnesses. In addition to psychotherapy, social workers can provide case management and hospital discharge planning as well as work as an advocate for patients and their family.

Psychiatric or Mental Health Nurse. Some nurses have had special training in providing mental health services. Depending on their level of training and certification, they can evaluate patients for mental illness and provide treatment in the form of psychotherapy. 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 provide case-management services and serve as patient advocates.

The Difference Between Counseling and Psychotherapy

Although the terms counseling and therapy are often used interchangeably, there is a difference between psychotherapy and psychological counseling. Counseling focuses on specific issues and is designed to help a person address a particular problem, such as addiction or stress management. The focus may be on problem solving or on learning specific techniques for coping with or avoiding problem areas. Counseling is also usually more short-term than therapy.

Psychotherapy is more long-term than counseling and focuses on a broader range of issues. The underlying principle is that a person's patterns of thinking and behavior affect the way that person interacts with the world. Depending on the specific type of psychotherapy that is being used, the goal is to help people feel better equipped to manage stress, understand patterns in their behavior that may interfere with reaching personal goals, have more satisfying relationships, and better regulate their thinking and emotional responses to stressful situations. If someone has a form of mental illness such as depression, bipolar disorder, schizophrenia, or an anxiety disorder, psychotherapy also addresses ways in which the illnesses affects their daily life, focuses on how to best understand the illness and manage its symptoms and follow medical recommendations.

Types of Psychotherapy

There are numerous approaches to psychotherapy, also called talk therapy, from which mental health professionals draw their treatment practices. Different types of psychotherapies are often better-suited to specific types of problems. For example, some psychotherapies are designed mainly to treat disorders like depression or anxiety, while others focus more on helping people overcome problems with relationships or obstacles to greater life satisfaction. Some forms of psychotherapy are one-on-one with a therapist, while others are group- based or family-based. According to the American Psychological Association, those approaches fall into five broad categories.

Psychoanalytic or psychodynamic therapies. The idea behind this kind of therapy is that people's lives are affected by unconscious issues and conflicts. The goal of the therapist is to help the person bring those issues to a conscious level where they can be understood and dealt with. This may involve analyzing dreams or exploring a person's personal history.

Behavioral Therapy. This approach to therapy focuses on learning and behavior in an effort to change unhealthy behavioral patterns. Some therapists try to help patients learn new associations by using a system of reward and punishment to bring about certain behavioral changes. Another approach might involve a controlled series of exposures to a phobia trigger to desensitize a person to an unreasonable fear.

Cognitive Therapy. The emphasis in cognitive therapy is on a person's thoughts. The idea is that dysfunctional thinking is what leads to dysfunctional emotions or behaviors. The goal is to help the person recognize unhealthy thinking patterns and to recognize and change inaccurate beliefs.

Group Therapy. One or more behavioral providers leads a group of 5-15 patients a few hours per week. Groups are typically designed to help each other deal with a particular issues, including obesity, social anxiety, grief, chronic pain, or substance abuse.

Humanistic Therapy. This approach to therapy is based on the idea that people are capable of making rational choices and developing their maximum potential. This approach to therapy is often client centered, with the client being seen as the authority on what is going on inside.

Integrative or Holistic Therapy. This approach relies on integrating multiple approaches to therapy based on the client's individual needs. For instance, cognitive behavioral therapy is a combination of the two individual therapies and focuses on both thought and behavior.

Getting Started With a Mental Health Professional

Finding the right mental health professional and the right approach to therapy is as important as finding the right medical doctor. Whether you are planning to see a psychologist or a psychiatrist or another type of mental health professional, you should start with a phone call to the professional. Ask about the professional’s approach to dealing with mental issues and how they generally work with clients. Ask about whether or not they accept insurance and how payments are handled. You might describe your reason for wanting to make an appointment and ask if they are experienced in dealing with such issues. If you are comfortable talking with them, the next step is to make an appointment.

At your first office visit, the mental health professional will want to talk with you about why you think you need to come to therapy. They will want to know about what your symptoms are, how long you've had them and what, if anything, you've done about them in the past. They will probably ask you about your family and your work as well as what you do to relax. This initial conversation is important in developing the appropriate approach to treatment. Before you leave the office, the mental health professional should describe to you the plan for treatment and give you an opportunity to ask any questions you might have.

It will likely take several weeks before you become fully comfortable with your therapy. If you still aren't feeling comfortable after two or three visits, let the mental health professional know and explain why you feel that way. The two of you need to work together as a team in order to get the most out of your treatment.

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