Who can help me?

June 16, 2012 12:54 PM

How do you know what type of mental health professional you need?

I've been feeling immense anxiety because of issues at my work. My whole life I've had problems concentrating (I can only work for a few hours a day), and now with this added anxiety, I'm wholly unproductive. I thought I would seek the help of a professional. I looked through the listing of mental health specialists who participate in my insurance (I'm in the US). But there are many different kinds of specialists: psychiatrists, psychologists, licensed clinical social workers, psychiatric nurses, psychiatric social workers, etc. I've gotten some recommendations from people I know -- but these specialists also have different backgrounds (psychologist, counselor, nurse).

Which type should I choose? Thanks.

posted by anonymous to Health & Fitness (12 answers total)

It sounds like you're looking for talk therapy. Clinical psychologists and licensed clinical social workers are a good starting point. Typically it's they who offer counseling/therapy; they just come at it from slightly different training backgrounds.

Psychiatrists--at least in the US, these days--generally do not do talk therapy anymore. If your eventual therapist thinks you would benefit from pharmacological help for your anxiety, you'll get a referral to a psychiatrist who can prescribe medication. If you were to stay on medication for any length of time, you'd typically see the psychiatrist only once in a blue moon to check that your meds were still working, get refills, make changes, etc. And you would continue seeing your therapist at an interval that works for you.

Sometimes you get lucky and the group that your LCSW or psychologist works out of also has at least one prescribing psychiatrist in it or associated with it.
posted by ImproviseOrDie at 1:01 PM on June 16, 2012

In general, psychiatrists can prescribe medication, and are therefore much more expensive (i.e. they're not generally the people you see for talk therapy.) Psychologists and LCSWs, to the best of my understanding, tend to have a lot of overlap and/or be nearly indistinguishable in practice. (There are many kinds of talk therapy, and individual practitioners will have different specialties, but it's not so much related to the degree.) Counselor, I believe, varies a bit more by state as to what training and certification they actually have. I am not at all sure what nurses tend to do.

The simplest way to go about things is probably to make appointments with two or three recommended people and see which ones you get along with. If the therapist suspects you need medication, they'll refer you to a specialist for that.

(Not a therapist of any sort, however, my mother is a LCSW with a private practice, so I've absorbed a bit via osmosis.)
posted by restless_nomad at 1:01 PM on June 16, 2012 [1 favorite]

As general principle I would first see a psychiatrist or psychologist/psychiatric nurse if the latter two have prescribing privileges in your State. The management of anxiety and poor concentration can benefit from many of the newer drugs which are non addictive and where habituation/tolerance is not a problem. Also, a therapist who does CBT can be helpful. If you are experiencing significant role performance problems (which you seem to be) see some one who can prescribe while you concurrently participate in therapy/counseling if you wish. When it comes to therapy I think there is little difference between a clinical social worker, psychologist, psychiatric nurse etc. For counseling I would first rely on personal recommendation, etc.
posted by rmhsinc at 1:09 PM on June 16, 2012 [1 favorite]

I know several folks, myself included, that had a lot of success with psychiatric nurse practitioners who are dual credentialed as licensed clinical social workers or licensed professional counselors (LCSW, LPC).

Psychiatric Nurse Practitioners are advanced practice, Master's prepared nurses. They can diagnose and prescribe psych meds but they can't prescribe antibiotics. MD psychiatrists went through the whole kitten of medical school and have wider prescribing authority. PNPs are often easier than MD psychiatrists to get appointments with - at least in my area. I've also met far more approachable PNPs than I have approachable MD psychiatrists...but that's just my experience.

Psychiatrists and PNPs do have some grounding in talk therapy, but it's usually not their main focus. I look at them as medical professionals who focus on the medical aspects of mental health. As others have said, LCSWs and LPCs are Master's prepared talk therapists. I have never noticed any difference in clinical therapeutic skills/quality between PhD. and Master's level therapists.

Dual credentialed talk therapists/psychiatric professionals are hard to find, but they can be invaluable. With a talented pro you get the best of both worlds: someone who is trained in all manner of therapy and is attuned to how to help spark the changes you want to make. And you have someone who can prescribe meds, is fully versed in psychiatric pharmacology and can use their experience as therapists to inform their judgment on how well the meds are working.

Good Luck.
posted by space_cookie at 1:39 PM on June 16, 2012

Oh. My bias is such that I would recommend giving talk therapy the good faith college try before moving on to medication + talk therapy. Also, cognitive behavior therapy (CBT) is a dirt common therapeutic technique or a skill in their repertoire of skills. I would venture to say that almost all therapists know how to apply CBT or incorporate it with other approaches. Good therapists, effective therapists, will explain it to you and will help you decide if you think it would be a beneficial approach.
posted by space_cookie at 1:52 PM on June 16, 2012 [1 favorite]

There are books on topics such as choosing a therapist that may be available at your local library.
posted by XMLicious at 2:02 PM on June 16, 2012

A (good) psychiatrist isn't just going to prescribe medication because that's what they do. They will listen to your problems and give their opinion as to the treatment methods to try. That can include medication, but it can just as easily not.
posted by gjc at 2:33 PM on June 16, 2012

Forgot to add this point: think of them as a GP for mental health issues.
posted by gjc at 2:34 PM on June 16, 2012

I had a severe anxiety issue about 13 years ago, and much had to do with family and personal issues. i first went to a doctor who tested me for all things, and after 500 dollors, they said I was fine, but I was not. I finely went to a therapist who recomended a great phycotheripist. This solved my problems and they were intense. That's my experience and recommendatation.
posted by brittaincrowe at 5:52 PM on June 16, 2012

If you want medication, see a psychiatrist or a prescribing NP. There are psychiatrists and prescribers who do therapy, but in general, psychiatrists' appointments are shorter and with a greater focus on med management.

If you want talk therapy, see anybody else: MSW, LCSW, PhD, PsyD. One often cited study has found that all work equally well.

Any of these would be able to assess you. All of them might have a slightly different take on your problems, but they would probably be able to refer you down the right track.

It depends to some extent what you believe will be most helpful. I would just ask outright whether the person offers the service you are looking for: medication, steps for maintaining focus, or a conversation and coming up with options to fix the work issues that are causing stress.

It might help also to look for someone who has worked extensively with ADD-- not saying this is what you have, but it might help to see someone experienced in dealing with this question of not being able to focus.
posted by kettleoffish at 8:49 PM on June 16, 2012

If you have a GP you like and trust, ask for a recommendation. Try not to let him/her prescribe medication, though--it's generally better to have psych meds managed by a specialist, in my experience.
posted by xyzzy at 1:48 AM on June 17, 2012

With regard to talk therapy I've heard that patients who like their therapist are more likely to stay the course. So maybe focus less on the therapist's designation- instead just meet a few and see if there is one you "click with" or whose style seems to suit you.
posted by EatMyHat at 5:15 AM on June 17, 2012 [1 favorite]