For a variety of reasons, some people with mental health problems do not seek treatment. Some believe they can handle the problem on their own. Many are unaware that a mental health problem is what is making them feel bad or function poorly. Stigma continues to be an obstacle to treatment for some people. Concern about confidentiality and a lack of understanding about Federal and state privacy laws and how they protect people is sometimes a barrier to treatment. Some believe that their health insurance will not pay for mental health treatment and, so, they think they cannot afford it. Others lack confidence that treatment will be effective.
The good news is that mental health treatment most often is effective. Understanding the possibilities for how mental health treatment is usually provided helps to make it more accessible.
Today, many medical providers (e.g., primary care physicians, internists) recognize that mental health problems, sometimes with coinciding alcohol and other substance abuse problems, pose significant challenges to the physical health, safety and well-being of their patients. As a result, many doctors and other health care providers routinely screen their patients for depression, anxiety and alcohol or other substance abuse. A lot of effective mental health treatment actually happens within regular medical settings. Primary care physicians are, in fact, the most frequent prescribers for antidepressant medications, which makes treatment for depression significantly more accessible than it otherwise would be.
Referrals to mental health professionals are sometimes needed and often helpful. Counseling or psychotherapy is most often provided by social workers, counselors, marriage and family therapists or psychologists. The primary care provider may prescribe medication and refer their patient for counseling because research shows that the combination of medication and counseling is usually the most effective approach. Sometimes, a psychiatrist may be the one to provide an evaluation and prescribe medication or make recommendations to the primary care provider who then prescribes medication.
There are a variety of different types of mental health professionals who provide services that are unique to their specialty. Psychiatrists are physicians whose specialty is to evaluate mental health problems and prescribe medications and other treatments. Advance nurse practitioners also may evaluate and prescribe medications. Counseling or psychotherapy is usually provided by a psychologist, social worker, counselor, or marriage and family therapist. All of these mental health professionals hold advanced degrees and have completed post-graduate supervised training and are licensed by the state to practice. The credentials for the various disciplines can be a bit confusing. The letters after a provider’s name indicates the type of provider they are:
- MD – medical doctor
- ANP – advanced nurse practitioner
- PhD or PsyD – psychologist
- LCSW, LICSW, LCSW-R – licensed clinical social worker
- LPC – licensed professional counselor
- LMHC – licensed mental health counselor
- LMFT – licensed marriage and family therapist
- CASAC – certified alcohol and substance abuse counselor
How to choose a therapist or other mental health provider
What difference does a degree make? When looking for counseling or psychotherapy, the degree the therapist holds is probably not as important as the expertise they have and the goodness of the fit between you and the therapist. The therapist should have a state-issued license to practice that indicates that minimum education and experience qualifications have been met. In most states only and MD or ANP can prescribe medication. A primary care provider, psychiatrist, or psychiatric nurse practioner can prescribe medication. Sometimes a primary care provider will require consultation with a psychiatrist, psychiatric nurse practioner, or other mental health professional for an evaluation to help with diagnosis and to assist with managing treatment. There are a variety of treatment options win seeking mental health services. What you choose should depend on what you need.
Theoretical orientation
When selecting a therapist it is helpful to understand that they usually identify themselves as having a “theoretical orientation.” These include:
- cognitive-behavioral which focuses on how thoughts and behaviors influence feeling and often involves “homework” between sessions
- behavioral which focuses solely on changing behaviors
- psychodynamic which is based on a relationship between the therapist and the client to that provides support and understanding for a corrective emotional experience
- family systems which views the problem in the context of present family and family of origin history and frequently used to address problems relating to alcohol or other substance abuse
- solution-focused which is a short-term cognitive-behavioral approach that helps clients focus and act on solutions rather than engage in problem thinking, feelings, and behaviors
- eclectic which uses a variety of perspectives
Two practical steps
Many people start with a word of mouth referral from a trusted friend or family member or with a referral from a primary care provider or insurance company. Once you have some names make some phone calls and start with some basic questions.
- Where are you located?
- What are your fees and/or do you take my insurance?
- What appointment times do you have available?
- What is your experience with my issue?
Then based on the information and experience from those phone calls, schedule an initial consultation with a therapist. This provides the opportunity to “try it on” before making a commitment.
I’ve scheduled my first appointment, now what?
During the initial consultation you can expect to:
- talk about the problem that leads you to seek therapy and provide other relevant information
- identify goals for the therapy and how you and the therapist would work together
- be informed about the limits of confidentiality and privacy
- have the opportunity to ask questions to determine if this is the right therapist
If you are comfortable with the outcome of the discussion, this may be the right therapist for you. If not, keep looking.