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Harvard Commentaries
35320
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


Minding Your Mind Minding Your Mind
 

Mental Distress: Where Do You Turn for Help?


October 24, 2012

By Michael Craig Miller M.D.

Harvard Medical School


When stress goes up and problems become more urgent, it becomes harder to put off getting help. But it's not always so easy to know where to turn. People often have questions about what kind of a professional to see. Many people don't know, for example, the difference between a psychiatrist and a psychologist.

Behavioral health professionals, also called mental health professionals, vary in their training. Some provide highly specialized treatment. But there is also a lot of overlap in the types of problems these various professionals treat.

Regardless of specialty, here are some of the qualities you'll want to look for in any mental health professional:

  • Good training
  • An ability to tune in to your problems and be practical about solutions
  • An awareness of their own limits as professionals
  • A willingness to refer you to someone else if you need something they can't provide

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Different Training for Different Professional

There are four major types of mental health professionals: psychiatrists, psychologists, social workers and psychiatric nurses.

Each specialty has its own requirements but the professional must be licensed to practice in your state. In addition, a sign that the professional is qualified is certification in their area of practice, usually by a national organization.

Psychiatrists

Psychiatrists have the same medical school training as other physicians. This includes training in the biological bases of medicine. They receive either an M.D. or D.O. degree. After medical school, psychiatrists do four years of specialized training before they are eligible to be certified by a specialty board. Psychiatrists are certified by the American Board of Psychiatry and Neurology.

Psychiatrists diagnose and treat mental health problems. Unlike psychologists and social workers, they can prescribe medicines. Many psychiatrists, but not all, provide talk therapy. You can find more information about psychiatry and psychiatrists at www.psych.org.

Clinical Psychologists

A clinical psychologist goes to graduate school for either a doctoral (Ph.D., Psy.D., or Ed.D.) or master's degree (M.A. or M.S.) in psychology. A doctoral degree takes several years to complete and is much more demanding than a master's degree (two years). Clinical psychologists are certified by the American Board of Professional Psychology.

Psychologists are experts in human emotion, thinking and behavior. Although psychology training may not emphasize biology in great detail, some clinical psychologists have strong training in neuroscience (the study of the brain). Clinical psychologists learn how to evaluate and treat patients through internships in clinics and hospitals.

Psychologists cannot prescribe medication, but doctoral-level psychologists are usually well trained in evaluating mental problems and providing psychotherapy.

Psychologists are the only mental health professionals who can perform psychological testing. Psychological tests are standardized tools (like intelligence tests or the famous inkblot test) for evaluating mental abilities, personal qualities or behaviors. More information on psychology and psychologists can be found at www.apa.org.

Social Workers

Clinical social workers complete at least a two-year graduate program and receive a master's degree (M.S.W.). Some go on to receive a doctoral degree (D.S.W. or Ph.D.). As part of their training, they do clinical internships.

Clinical social workers are licensed in the state where they practice (L.C.S.W.). The Academy of Certified Social Workers (A.C.S.W.) may also certify them. Since social workers work in many settings, it is important to consult one who has been trained to evaluate mental problems and provide psychotherapy.

The primary distinction between social workers and other mental health professionals is that social workers specialize in understanding patients in the context of a "system," such as the family or the community. You can read more about professional social work at the National Association of Social Workers website.

Psychiatric Nurses

A psychiatric nurse is a registered nurse (R.N.) who has specialty training and usually a master's degree (M.S.N.) beyond basic nursing training. All registered nurses assess mental health needs as part of their work with patients and their families. Psychiatric nurses are certified by the American Psychiatric Nurses Association.

Psychiatric nurses may have additional training to work as clinical nurse specialists (C.N.S.) or nurse practitioners (N.P.). In these roles, they can assess, diagnose and treat individuals or families with psychiatric problems or disorders. The licensing of nurse practitioners varies from state to state. In some states, they may prescribe medications, often under the supervision of a psychiatrist. Many provide psychotherapy.

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Other Types of Mental Health Professionals

You may find mental health professionals in your community who have other types of training. They may come from counseling traditions, such as pastoral counseling or expressive therapy. Ask about their training and clinical experience. It's a very good idea to find out what license your state requires for mental health counselors and to make sure anyone you see has met those requirements.

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Getting Specific

Usually it is not enough to know a mental health professional's degree. Even with the same training on paper, no two professionals are alike. So you may find it helpful to find out more about the individual's approach to treating mental distress.

Here are some questions you might ask:

  • How long have you been in practice?
  • What kinds of treatments do you provide?
  • What kind of treatment or therapy do you recommend to me? Why?
  • How does treatment work?
  • What are the advantages and disadvantages of the different kinds of treatment, even the ones you are not able to provide?
  • How soon should I start feeling better; how will we assess my progress?
  • What are the options if this treatment doesn't work?

There is no one right answer to each question. The goal is not to put the professional on the spot. Rather, these are questions to help you have a meaningful discussion about the value of treatment and what you can expect along the way. The key is to pay attention not just to the answers, but also to your reactions to the person answering your questions.

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Getting Comfortable

Finally, make sure you feel comfortable with the professional you choose to work with. People do best when they sense a good match and feel a personal connection to the person treating them.

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Professional Degrees and Credentials

Profession

Initials

Credential

Psychiatry
M.D.
Doctor of Medicine
 
D.O.
Doctor of Osteopathic Medicine
Psychology
Ph.D.
Doctor of Philosophy in Psychology
 
Psy.D.
Doctor in Clinical Psychology
 
Ed.D.
Doctor of Education
 
M.A.
Master of Arts (in psychology)
 
M.S.
Master of Science (in psychology)
Social Work
M.S.W.
Master of Social Work
 
D.S.W.
Doctor of Social Work
 
L.C.S.W.
Licensed Clinical Social Worker
 
A.C.S.W.
Academy of Certified Social Workers
Nursing
R.N.
Registered Nurse
 
B.S.N.
Bachelor of Science in Nursing
 
M.S.N.
Master of Science in Nursing
 
C.N.S.
Clinical Nurse Specialist
 
N.P.
Nurse Practitioner

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Michael Craig Miller, M.D. is editor-in-chief of the Harvard Mental Health Letter and an assistant professor of psychiatry at Harvard Medical School. Dr. Miller has an active clinical practice and has been on staff at Beth Israel Deaconess Medical Center for more than 25 years.

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