Oh, you’d be astonished at the number of well-educated people who don’t know the difference between a psychologist and a psychiatrist!   The same is true of distinctions among the other helping professionals, so here’s a short course:

Psychiatrists. A psychiatrist is a medical doctor, just like the one that delivered your child or set the bone in your ankle.  In medical school they took all the classes along with their colleagues going into other specialties.  At some point, however, they selected psychiatry as their special interest, and began to focus—not on psychology, but—on brain chemistry and how that relates to emotions and behavior.  They do spend time talking with patients about issues and progress toward goals, but their special area of expertise is in prescribing particular medications.  Insurance carriers almost always cover the services of a psychiatrist, but may require a referral from a primary care doctor.  Often individuals will see a psychiatrist in addition to the helping professions listed below.

Counselors. A counselor is someone who paid a fee and registered with the state board of health or licensing.  In some states no education or training are required, and in some states a rigorous testing process is required, to become a counselor. Some counselors specialize in particular issues such as addiction and recovery, or grief management, etc.  Most counselors have training in their area of specialization, and many have Bachelor’s degrees.  Insurance companies may cover services under limited conditions.

Psychotherapists. These professionals may also be more simply labeled as Therapists.  In general, these professionals have a Master’s Degree, which is usually two years beyond the Bachelor’s Degree.  Insurance companies often cover their services, especially when provided in a clinic or mental health center, but it is important to ask about this as many independent practitioners also accept insurance payments.  Psychotherapists/therapists often have an area of special expertise and some have training beyond education and supervised experience.

Social Workers. Like Counselors and Psychotherapists, Social Workers generally will have a Bachelor’s or Master’s Degree and have been supervised by a person of greater education and expertise.  Insurances often pay for their services, especially when received in a clinic setting or mental health center.  Independent practitioners may also be covered, so it is important to ask.   Social workers often look at whole systems, such as an entire family, or they will consider the interactions of an entire workplace, when helping an individual.  This can be useful in some situations, and may come up in the questions you ask (see Part Three of this series).

Psychologists. Individuals may not call themselves a psychologist unless have the following: a doctorate (Ph.D.  which is generally five years beyond the Bachelor’s degree) in psychology; have successfully completed an internship (on the job training) with credentialed, experienced professionals; and have worked independently under supervision; and have successfully taken the licensure exam.  Psychologists have been tested by fire, and that is why most insurance carriers will cover the services of a licensed psychologist without question.  You may, however, need a primary care doctor’s referral prior to making your first appointment, so check that out with your insurance carrier.

My biases, and the basis for them:
My strong bias is toward the helping professional with the most experience studying human thought processes, emotions and behavior.  I also favor the category of professional that insurance companies are most likely to fund.  My bias is toward finding an individual provider within that category who has done research, or at least keeps up with the current research on what is effective for the conditions they aim (or claim) to treat.  In each of the categories, there are professionals who are committed, generous and insightful individuals who intend to be helpful.  Unfortunately, some in EACH of the categories have “fallen in love with” their ideas about how to treat various conditions, and they feel no need to keep up with more effective methods that newer research offers.  Not all professionals in any of the categories keep up with the best evidence in their field, and for that reason I believe you must ask a lot of questions, no matter which type of professional you choose.  In my next columns, I’ll be suggesting ways to be particularly effective in asking those questions.