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View Full Version : All About Therapists: Because choice matters



DabblerWizard
2011-07-22, 01:31 PM
Hey folks.

I decided to write a piece about the different kinds of psychotherapists that are available in the U.S. Some of this may apply to other countries, but I wouldn't know for sure.

This clarification is meant to provide people with a broad understanding of what their potential options are, in case you're thinking about therapy for yourself or someone you care about.

You can expect the views stated below to be significantly impacted by my own interpretations. I am, however a graduate student in counseling, and I've done some significant reading on these topics, since they interest me and have much to do with the field I'm studying towards.

I'm not offering any services or anything like that. This is partially because I don't yet have the credentials to make claims of being a professional of any sort.

However, I'd love to hear about other people's thoughts and experiences with therapists, or if you're in the field, your views on what it means to be X kind of therapist.

Concerning forum rules This thread is not an attempt to advertise any service by me or anyone else. I also am not presenting any professional "advice".

My aim is to talk primarily about psychologists, counselors, and psychiatrists. I'll be mentioning a bit about social workers.

Just to shorten the amount that I write, I won't be mentioning other significant clinicians like marriage and family therapists, creative arts therapists, animal assisted therapists, or psychiatric nurses.


Psychiatrists

Sometimes confused with psychologists, psychiatrists are medical doctors (usually MDs) with specialized training in psychiatry.

Decades ago, psychiatrists used to be the ONLY practitioners that practiced therapy. They were almost all trained in psychoanalysis at that point.

Turning things completely around today, therapy is not part of a psychiatrist's standard training. SOME psychiatrists do practice therapy, but that's largely their personal choice to get even more training, vs. part of their standard fare.

Psychiatrists often prescribe medication, often but not always in conjunction with a therapist. They also provide final consent to hospitalize people, voluntarily or otherwise.

General practitioners, pediatricians and internists who give you physicals, etc. can also prescribe psychiatric medication. They don't tend to have specialized training in psychiatry though. They also don't always mention therapy as an adjunct or alternative to medication.


Psychologists

There are all sorts of psychologists. Most of them do not practice therapy.

The two types that do, include clinical and counseling psychologists. They can have either a PhD or a PsyD.

Debate over the differences between these two sub fields has gone on for decades. A lot of literature ultimately suggests that they have a lot more in common than they have differing them. Both counseling and clinical psychologists are trained to be competent therapists.

Their primary difference seems to focus on the kinds of theories they rely on. In other words, they may think differently about treatment and mental illness and such. This difference is somewhat unimportant since much literature points to the fact that many therapies can positively impact a given concern.

These days, variables like the relationship between the client and therapist have shown to be much more important than type of theory used.

A PhD psychologist can have more training in research than a PsyD psychologist. Though there's some disagreement, both kinds have good training in therapy.


Counselors

Counseling as a field is less known than psychology. It's been around almost as long as psychology (mid 1800s), but it hasn't been involved with therapy as long. Interest and practice started to grow around the 1930s and 40s when therapists of all sorts were stepping away from psychoanalysis.

The primary group of counselors trained to do therapy are mental health counselors. This group used to be divided further into community and agency counseling, but these two have recently been taken on by the broader term (Clinical) Mental Health Counselor.

School counselors, sometimes called guidance counselors, also receive some significant training in therapy, but not as much as MHCs, assuming they don't go for extra training. Typically, educational restrictions prevent them from practicing as therapists in schools, where they primarily work.

There are other sub fields of counseling, but they tend to receive less training in therapy: pastoral, rehabilitation, college, career, etc.

Counselors are trained, certified, regulated, and accredited in all 50 states, like psychologists.


Social Workers

I don't know too much about this group.

Many social workers are not trained as therapists. The ones that are eventually get licensed as Licensed Clinical Social Workers (LCSW), compared to Licensed Masters Social Workers (LMSW) who don't do therapy

Historically, the social work movement has been attributed to public service and human helping efforts long before psychology or counseling began.

I'm not sure when its involvement with therapy began.

No research exists (that I could find) to indicate social workers are better or worse trained than counselors or psychologists.


So how do these folks compare?

One noticeable difference involves the necessary degree.

A psychology PhD is both the professional and academic degree, leading to training in therapy, research, and teaching (or therapy and less research for the PsyD). Masters degree psychologists can't get certified to practice therapy, so sometimes they sneak get certified as a counselor or social worker.

For counselors and social workers, the MS/MA/MSW is their professional degree. They need a masters degree to practice therapy. If they want an academic degree, or further training in research and teaching, then they get a PhD or EdD.

Counselors and social workers separate their practice and teaching degrees, while psychologists don't.

I'm not really sure why the degrees break down the way they do. But some people use this distinction to claim that psychologists are better therapists. No research actually indicates that.

In practice, therapists of either type can be awesome and helpful, or terrible and not helpful.

The only clear training difference between psychologists and counselors is that psychologists typically receive more training in psychological testing, using instruments to determine what diagnosis fits, etc.


I hope this was a helpful start. Please let me know what you think.

Don Julio Anejo
2011-07-22, 02:32 PM
C+.

You missed the most important distinction: they all treat different problems.

Other comments:

1. You're somewhat confusing psychiatrists with psychopharmacologists. Most shrinks work in a hospital setting. Either with disorders that require hospitalization, which are typically either extremes of mood disorders like bipolar, unipolar manic, unipolar depressive with suicidal tendencies, severe drug dependencies, etc. Or with psychotic disorders like schizophrenia.

If they have a private practice and do talk therapy, they have to get training in it, which is generally _more_ intense than that for PhD's and PsyD's, however it's shorter and more condensed since they don't have to conduct original research. That said, techniques they practice are similar to clinical psychologists (mostly cognitive or cognitive-behavioural therapy).

2. Psychopharmacologists are the ones that deal exclusively in medication. That said, they are extremely expensive and work in conjunction with talk therapists. Their goal is to develop medication therapy targeted to each particular person, which is quite difficult considering drugs in addition to their prescribed effects can also affect each person differently and have unintended side effects, especially when taken with other drugs (i.e. stimulants like Ritalin and MAOI's _will_ *bleep* you up in a bad way when taken together).

They also deal mainly with disorders that have to be managed primarily with medication, like bipolar disorder, schizophrenia and major depression. Training wise they're something in between a psychiatrist and a neurologist and have an MD and a fellowship. You usually need a referral to see one.

3. Counseling psychologists deal primarily with psychological disorders that don't require medication per se except as a supplement to talk therapy or in some extreme cases. These include anxiety disorders like shyness, phobias (phobias are a form of anxiety disorders), substance or behaviour dependencies (i.e. addictions), behaviour modification (like impulse control), OCD, personality disorders (i.e. narcissistic or borderline).

4. Clinical psychologists deal with more clinical problems and receive similar talk therapy training to psychiatrists. That said, they can also treat same problems as counseling psychologists, although they more typically specialize in talk therapy treatments for things like schizophrenia, major depression and psychological trauma/PTSD.

Both clinical and counseling psychologists treat depression, eating disorders, personality disorders, bipolar, substance abuse and anxiety disorders.

5. Counselors generally do not receive as much training as any of the groups above and do not hold above a master's (in contrast, to be called a psychologist you need a PhD). Their goal is more often to provide support for their client and help them work through their own problem (i.e. humanistic or Gestalt therapy, rarely - behavioural). They do not generally practice cognitive or cognitive-behavioural therapy which leaves them ill at ease to handle more extreme cases or diseases (contrast vs. disorders) like schizophrenia and bipolar. They are, however, quite effective when it comes to treating substance abuse/dependency.

Vacant
2011-07-22, 05:58 PM
The school of thought from which a therapist comes matters quite a lot, as well.

WarKitty
2011-07-23, 05:17 PM
What I'd really like to see? A guide on getting help from a therapist that you don't really click with or like their style. For those of us whose options are see this person or not see anyone at all.

Themrys
2011-07-24, 04:20 AM
What I'd really like to see? A guide on getting help from a therapist that you don't really click with or like their style. For those of us whose options are see this person or not see anyone at all.

The only advice I can give on that is: Listen to them and try some of the things they tell you to do.

A therapist once told me to take dancing lessons (I was sixteen or so and everyone did). I was not interested in dancing at all, so I didn't. Today, I think it might have been a good idea to get some fresh air and see new people, even if the activity itself would have been boring. The activities I was interested in didn't really help to get to know other teenagers.

So...if you don't have an other option, just give it a try - and try to believe in the effectiveness of the prescribed treatment. Placebo effect can help, too.

However...why can't you choose your therapist yourself? I'd rather try to solve that problem if I were you, than to try and get along with someone whose style you don't like.

WarKitty
2011-07-24, 01:57 PM
The only advice I can give on that is: Listen to them and try some of the things they tell you to do.

A therapist once told me to take dancing lessons (I was sixteen or so and everyone did). I was not interested in dancing at all, so I didn't. Today, I think it might have been a good idea to get some fresh air and see new people, even if the activity itself would have been boring. The activities I was interested in didn't really help to get to know other teenagers.

So...if you don't have an other option, just give it a try - and try to believe in the effectiveness of the prescribed treatment. Placebo effect can help, too.

However...why can't you choose your therapist yourself? I'd rather try to solve that problem if I were you, than to try and get along with someone whose style you don't like.

Money and travel time, pretty much. There's a limited number of therapists that are within range, covered by insurance, and actually taking new patients. Plus in order to use the car I have to go to people my parents approve of, which includes a few criteria that I specifically dislike.

DabblerWizard
2011-07-25, 09:18 AM
"Not clicking" with a therapist's style could mean a couple things:

- Finding their personality oppositional (e.g. just too quiet; just too boisterous)

- Not liking the way they respond to certain subjects (e.g. he ignores this subject; she moralizes when we talk about x)

- Not trusting / caring for the therapeutic model they use (e.g. psychoanalysis is BS)

- Other options?


Just like with any kind of ongoing interaction, we'll all find undesirable qualities in a therapist. We just have to decide whether their style and manner and friendliness are good enough, or if those things can be tolerated, or ignored.

As for changing your situation WarKitty, consider sitting down and thinking about what exactly bothers you, and then talking about it with your therapist. If your therapist is worth his/her salt, they'll be able to take your comments and work with them, and not (1) get offended or (2) turn them back on you.

Juggling Goth
2011-07-27, 07:24 AM
What I'd really like to see? A guide on getting help from a therapist that you don't really click with or like their style. For those of us whose options are see this person or not see anyone at all.

Much sympathy. I've dumped two therapists and sworn off the whole business. I even suggested to my psychiatrist we could communicate by writing letters.

If it's a matter of their style/school, then you could find out if they'd be willing to try another approach. I mean, there's loads. There's analysis, and cognitive therapy, and Rogerian/client-centered counselling, and all sorts. Don't let them convince you that only one approach is unavailable, or X is proved to be better than Y.

If you just actively can't stand each other, I'm not sure. That's usually the point when I dump them. Um... focus on your goals and what you want from them as a service provider, and try to ignore their actual personality as much as possible? You don't have to be friends with this person; you just have to use them for your ends ;) Try to separate actions from intent/personality - "I don't like it when you do this thing" rather than "I don't like you and you suck". I dunno; to be honest, if you can manage it, you're a better person than me. I hope it goes well.


If your therapist is worth his/her salt, they'll be able to take your comments and work with them, and not (1) get offended or (2) turn them back on you.

Hahaha, yeah, that's when I knew I was right to dump my third therapist. (#1 was very good, challenging and perceptive without being a jerk, but was only funded for 6 sessions. #2 was NHS, and so only did cognitive behavioural therapy in a fairly one-size-fits-all manner, which didn't fit me. #3 was a stupid, defensive, manipulative waste of space who should've fixed his own crap before he started messing with other people's.)

And if it does all go horribly wrong... well, it's not because you did something awful, or failed at therapy. (I worried about this with #2.) A good therapist is a terribly difficult thing to find, especially since when you're finding them, you're not really in a fit state to make those decisions.

Also, this?


Plus in order to use the car I have to go to people my parents approve of, which includes a few criteria that I specifically dislike.

Absolutely sucks.