Types of Therapists

Typically, your pediatrician already knows your child and family, sees numerous patients so he or she can recognize behavior that falls outside of the typical range, and can conduct medical tests to rule out non-psychiatric causes for symptoms that may indicate a mental health condition. When necessary, primary care providers can provide referrals to a mental health specialist. There are several different types of therapists. A psychiatrist is a medical doctor (MD) who specializes in the diagnosis and treatment of mental illness and can prescribe medication. Child and adolescent psychiatrists have at least two additional years of training focused on mental disorders arising during childhood and youth.

A clinical psychologist has an advanced degree in psychology [a Master of Arts (MA) or a Doctor of Philosophy (PhD) or Psychology (PsyD)] and one-on-one experience with patients in psychotherapy sessions, and evaluates his or her clients’ mental health through clinical interviews, psychological evaluations and testing. Psychologists provide both individual and group sessions and can be trained in specific forms of therapy like Cognitive Behavioral or Dialectical Behavior. Most people with psychiatric prescriptions see a psychologist for regular talk therapy and a psychiatrist every several months for medication management.

A clinical social worker typically has a Master of Social Work (MSW) and focuses on problem solving. [A Licensed Clinical Social Worker (LCSW) possesses a MSW and has completed supervised clinical social work experience and passed a licensing exam.] Psychiatric or mental health nurse practitioners have a Master of Science (MS) or a PhD in nursing with a specialized focus on psychiatry, and can assess, diagnose, provide therapy for mental health conditions and/or substance use disorders, and prescribe medication. If someone calls himself or herself a “psychotherapist”, you may want to verify whether he or she also is a psychiatrist, psychologist, social worker or nurse practitioner, all of which are licensed and regulated by the state.

Since there are no medical tests for mental illness, mental health professionals use the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to assess symptoms and make diagnoses. The DSM-5 lists criteria including behaviors and time limits for the official classification of mental health conditions. A clinician also should ask detailed questions about your (or your child’s) symptoms, developmental and family history, and any previous diagnoses. After diagnosis, the mental health care provider will help develop a treatment plan, which can include therapy, behavioral and environmental interventions, lifestyle changes and medication. (The success of psychotropic prescriptions depends on the correct dosage, which can be challenging to establish and requires continual monitoring, especially as children grow and develop. Six month check-ins are considered the norm with more frequent visits required when a new medication is started, an old one is discontinued or dosages are changed.)

If an individual has more than one disorder, it is important for care providers to understand how those conditions interact and to devise a treatment plan that responds to each one. Therapists and counselors typically have different professional perspectives and philosophical approaches, with the former often focusing on helping clients to understand themselves and how they perceive the world and the latter generally considering pragmatic solutions (i.e., “Why do you feel this way?” vs. “How can your needs be met?”) Questions to consider asking your mental health professional when beginning treatment include: How long will it last?; What are the goals?; What is evidence that this approach is effective, how will it be measured and when can we expect to see behavioral changes?; What is my role (for parents when their children are the patients)?; and What possible adverse effects may occur and when?

If you are unable to communicate with your clinician or you believe that he or she does answer your questions or listen to your concerns or if your child (especially a teenager) does not have a comfortable relationship with him or her, you probably should find a replacement. No matter what type of treatment they receive, youth do best when the professionals in their lives (pediatricians, psychiatrists, psychologists, social workers and teachers, etc.) communicate, share information and agree on goals and the steps to achieve them. (For example, a school counselor and/or psychologist can serve as a source of data from academic reports and be a valuable member of a larger intervention and treatment team.)