This past year has put most Americans under tremendous mental health stress. For those having trouble dealing with that stress, a mental health professional may be necessary to help right your mental ship.
There are a wide range of such caregivers. They can be found in a variety of settings, from hospitals and mental health clinics to private practices, schools and even houses of worship. They have titles ranging from psychiatrist and psychologist to therapist and pastoral counselor.
But what type of mental health professional is right for you?
Types of Providers
Here's how it's broken down by titles and qualifications:
-- A psychiatrist is a licensed medical doctor -- meaning a doctor of medicine, or M.D., or a doctor of osteopathy, or D.O. -- who can diagnose and treat the most serious mental health conditions. They can prescribe and monitor medications. Some also receive training in specialty areas like child and adolescent mental health, geriatric psychiatry or substance abuse.
-- A psychologist holds a doctorate, or Ph.D., or has a doctor of psychology degree, or Psy.D., and is trained to evaluate a person's mental health using clinical interviews, psychological evaluations and testing. They provide individual and group therapy, often specializing in specific modes of therapy, like cognitive behavioral therapy and dialectical behavior therapy.
-- A psychiatric or mental health nurse practitioner also can treat mental health conditions or substance use disorders and, in some states, can prescribe medications. They may also need a master's or Ph.D. degree, depending on the state.
-- A licensed therapist typically has a master's-level degree and may be called a counselor, clinician, therapist or something else depending on the treatment they offer. They sometimes specialize in areas such as marriage or family therapy.
-- A clinical social worker can assess and treat mental health issues based on specific training programs, including drug and alcohol abuse and other behavioral issues.
Mental Health America, a nonprofit organization dedicated to addressing needs of those living with mental illness, lists some other mental health care providers:
-- A school psychologist earned an advanced degree in school psychology, and is trained to diagnose, provide therapy and work with school staff and students.
-- A pastoral counselor is a member of the clergy who has been trained in clinical pastoral education and can provide individual and group counseling.
-- A peer specialist is a counselor with "lived experience with mental health or substance use conditions" who can help clients with similar situations, according to the MHA.
-- Specialized therapists earn an advanced degree in such specialties as art therapy and music therapy.
How to Choose
It's important to know that, given the highly stressful times combined with a national shortage of health care professionals, it's hard just to get an appointment these days. For that reason, "don't let perfect be the enemy of good enough," says Debra Kissen, chief executive officer of Light on Anxiety CBT Treatment Centers in Illinois. "Right now, there is such a demand for mental health services, which is good thing because people realize its OK not to be OK. At the same time, a lot of practices have waiting lists."
That may mean being less picky. Some patients may be too specific when looking for a therapist, she says. "Sometimes people think it's like ordering the Starbucks TikTok drink of the month. They only want a female who has had a similar life experience. Don't let that get in the way of what you need."
The best place to start for someone with mild to moderate mental health concerns is, in fact, their family doctor. Primary care physicians, family nurse practitioners and pediatricians can screen for depression and anxiety and can prescribe antidepressant medication. PCPs also know who to refer patients to if they need a higher level of care, Kissen says. "If you don't have a primary provider, get one. That's a good starting point," she says.
Friends and family may also be able to make a recommendation.
Once you've found a candidate you think might work for you, interview the provider before making an appointment. "Ask about their educational background, types of services they offer, years of experience, treatment approach, office hours, fees, whether they take insurance," says Simon A. Rego, chief of psychology at Montefiore Medical Center and associate professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine. "Get a sense of whether you think you can connect with them, as the research shows that having a good connection with your therapist is important. If it doesn't seem like a good match, keep looking."
Kissen agrees. "Connection matters. You want to feel heard and acknowledged. If you feel the person 'does not get me at all, is not hearing what I'm saying,' listen to your inner voice," she says, and find someone with whom you feel a stronger bond.
For many mental health patients, a combination of talk therapy and medication is most successful. "Therapy and medication have the biggest bang for the buck," Kissen says. These days, psychiatrists mostly provide medication management. "I don't know any who provide therapy -- it's not their billing model," she says. But they work in concert with therapists to coordinate care.
Of all the modes of therapy, CBT has the strongest research behind it. According to the Anxiety and Depression Association of America, CBT is "the most studied psychotherapy for depression," and it has "the largest weight of evidence for its efficacy."
CBT is an "action-oriented approach," Kissen says. "The therapist is coaching and offering tips and tools, and the client plays an active role." Thus, it's best suited to someone who understands they are expected to be an active participant, with "homework," she says. For example, someone who is feeling anxious about re-entering social situations after a year of pandemic isolation may be asked to do one outside activity a day, "like going to the supermarket instead of ordering delivery," Kissen says. "CBT is about teaching the brain new ways to think and act."
"Other approaches found to be helpful in treating depression are called interpersonal therapy (IPT) and behavioral activation (BA) therapy," says Michael D. Yapko, a clinical psychologist and marriage and family therapist in Fallbrook, California. "Each of these therapeutic approaches involves teaching skills: CBT in thinking and information processing, IPT in relationships and social skills, and BA in effective behavior management."
Those with mild disorders may not need medication. Carol Landau, clinical professor of psychiatry and human behavior and medicine at the Alpert Medical School of Brown University, says those with mild to moderate depression should try just psychotherapy first and wait on medication. She notes that CBT is as effective as an SSRI antidepressant, a commonly prescribed medication that helps the brain take in seratonin, a neurochemical associated with mental well-being. "CBT teaches you skills that go on forever, whereas you might stop the medicine." She recommends a "staged treatment" -- if CBT isn't effective after eight weeks, then "let's go try some medication."