I get asked all the time what the differences are between professionals in this field. The initials after our name can be confusing and generally will be insignificant to you. You want to know if we can help you.
Professionals who provide psychotherapy include psychologists, psychiatrists, clinical social workers, mental health counselors, marriage and family therapists, pastoral counselors, and psychiatric nurse practitioners.
All these professionals are trained to assess, diagnose and treat the range of emotional and mental disorders through the use of psychotherapy. Many have overlapping duties. The differences lie in their education, methods, training, theoretical approach and scope of practice.
There is wide variation in terms of specializations, the setting where people work, duties required, state licensing requirements, etc…What follows is a broad generalization for the sake of clarity in determining who you may need to see for your mental health needs.
Psychiatrist - A psychiatrist is a medical doctor (M.D. or D.O.) who specializes in preventing, diagnosing, and treating mental illness. 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 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, most 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.
Most of the Psychiatrists in the Jacksonville area focus exclusively on medication management. This allows them to see more patients than would otherwise be the case, which is a good thing because there is a shortage of Psychiatrists in this area.
Psychologist - A psychologist has a doctoral degree - Ph.D. (Doctor of Philosophy), Psy.D. (Doctor of Psychology), or Ed.D. (Doctor of Education) in Psychology. Licensed psychologists are qualified to do counseling and psychotherapy, and provide treatment for mental disorders. Many psychologists also choose to conduct research or teach in academic institutions.
Although there are exceptions, (some counselors and school psychologists) psychologists are the only professionals who are specifically trained in administering, scoring and interpreting psychological tests. These tests include personality assessments, cognitive or intellectual assessments, and other more specific tests such as those to provide or rule out a specific diagnosis.
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 masters-level mental health professions often perform similar work functions, they do so from very different underlying philosophies:
Licensed Mental Health Counselor, LMHC - Mental Health Counselors are trained in counseling and psychotherapy to treat individuals with mental and emotional disorders and other behavioral challenges. They address mental health, human relationship, education and career concerns within ethical, developmental, preventive and treatment contexts. Mental health counselors assist patients to develop skills and strategies to address issues such as parenting and career skills, problems in adolescent and family communication and functioning, couples, marital and relationship problems, and preventing the occurrence or re-occurrence of alcohol and substance abuse.
Licensed Marriage and Family Therapist, LMFT - Marriage and Family Therapists (MFTs) are mental health professionals trained in psychotherapy and family systems, and licensed to diagnose and treat mental and emotional disorders within the context of marriage, couples and family systems. They identify issues in relationships past and present while offering strategies for change. Interpersonal skills, communication and group dynamics are important areas of focus for LMFTs. Emphasis is on the individual-in-context and systems theory as foundational in conceptualizing relational and clinical issues. In marriage and family therapy, the unit of treatment is the set of relationships in which the person is imbedded.
Licensed Clinical Social Worker, LCSW - While social workers can be mental health therapists, mental health therapists cannot be social workers and the two jobs are not interchangeable. Many social workers work in a setting in which they provide psychotherapy to clients and practice alongside those who are professional counselors. However, the role of a social worker is broader than that of a therapist.
In addition to focusing on the improving the mental and emotional status of their clients, social workers also work to improve their client’s lives through providing a wide range of social supports throughout their communities. They take a holistic, strength-based approach to mental health therapy that separates it from other disciplines. This helps their clients develop concrete steps to create immediate positive change in their lives.
Clinical social workers focus on the biopsychosocial aspects of a person; meaning they take a "person-in-environment" approach that involves a thorough consideration and investigation of the biological, psychological and social factors that can affect a person's functioning and well-being. They are masters in social ecology – they understand how community, culture, family, occupation, relationships and environment affect each other. When one system in a clients’ life is impaired or breaks down, this affects all other systems in the person’s life.
Advanced Registered Nurse Practitioner, ARNP - 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 such as FL, 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.
As I said, there is considerable overlap among these titles and although many disciplines seem on the surface to be functionally very similar, there is wide variation in the way therapy is actually conducted.
Ask your therapist how they can help you so that you understand their approach to your issues. Most are more than willing to share their philosophies.
