There is an old joke about how many psychiatrists it requires to change a light bulb. The answer: one, but the light bulb has to really want to change. Change does rest in the hands of the individual, but at the same time they must know who to call. Individuals in the mental health field have varying degrees of education, experience, ability, fit for you as an individual and “alphabet soup” behind their names.
PMHNP (Psychiatric Mental Health Nurse Practitioners) For myself, as a PMHNP or Psychiatric Mental Health Professional, we are required to earn a Master’s in Nursing that specializes in the psychiatric field or in nursing and take additional courses to be licensed to practice in the field of psychiatry. As, a result a PMHNP can diagnose, prescribe medications (within limitations based on my location), and counsel others. In addition to an MSN, I also hold a Master’s of Science in Counseling. As PMHNPs, we take a course on Psychotherapeutic Modalities or what we might more commonly known as counseling. Most PMHNPs diagnose and manage medications, but can do counseling. This falls within their “Scope of Practice” or what we are allowed to do.
SCOPE of PRACTICE
Every mental health professional has their own “Scope of Practice.” It can be determined by their licensure, certification, level of formal education and continuing education. For instance, though I have a Master’s of Science in Counseling, there are certain therapies or therapeutic modalities that I won’t provide because I do not have the necessary education to provide it effectively. This is accurate for any mental health professional. As a result, not every practitioner within a given area will be exactly like another.
Psychiatrist
A psychiatrist is a Medical Doctor or an individual that has received the required education to attend medical school. In addition to medical school, they have also completed residency in psychiatry, which 4 years long. These individuals can diagnose, prescribe and provide counseling. A psychiatrist can practice independently, whereas a PMHNP may have various restrictions based on the state in which they practice. For instance, in the state of Texas, I must practice under the oversight of a MD and am unable to provide Schedule II Controlled Substances or stimulants in the treatment of ADHD. Instead, I will make recommendations or prescribe non-stimulants.
Addiction Medication Physician/ Doctor of Addictionologist
An Addictionologist is a medical doctor who specialized in chemical dependency.
Licensed Chemical Dependency Counseling (LCDC)
An LCDC is an individual who works specifically with individuals battling chemical dependency. These individuals are required to have an associate’s degree or higher. They can diagnose addiction disorders, but cannot diagnose or treat mental health difficulties. In addition, they can create a treatment plan and provide chemical dependency counseling.
Clinical Social Worker
Licensed Clinical Social Worker (LCSW), Licensed Independent Social Worker (LISW), Academy of Certified Social Workers (ACSW) Clinical social workers can evaluate someone’s mental health and provide therapy. They also have the ability to provide case management and advocacy services.
Licensed Practicing Counselor (LPC)
A Licensed Practicing Counselor or LPC is an individual that specializes in counseling others. These individuals must hold a master’s degree, but are not all the same. They use specific therapeutic techniques and training programs and at times specialize in particular populations.
Licensed Marriage Family Therapist (LMFT)
Many counselors work with couples and have skills that they have honed to be effect in treatment, but an individual that is an LMFT or License Marriage Family Therapist has gone the “extra mile” to meet criteria to be licensed as an LMFT. This means meeting requirements above and beyond holding a master’s degree and being licensed as a counselor or social worker, etc. They are required to have 3,000 hours of board-approved marriage and family therapy experience and 200 hours of direct supervised experience. Liked becoming and LMFT there are other added certifications or licensees that counselors can earn, so if you ever get confused about the “Alphabet Soup” you see behind someone’s name “It’s ok, feel free to ask the individual, if they have a problem explaining their credentials then they’re probably not the individual for you.”
PSYCHOLOGICST & LPAs
Psychologists are one of the most educated of this group, holding a doctoral degree; Phd. or Psy D. These individuals do in depth psychological evaluations that can include hours of screeners and assessments. They review this information and create a report with diagnoses that they would give and recommendations for care. They can also provide counseling, but it just depends on what they psychologist chooses to do in their practice. LPAs are License Psychological Assistants who have a masters degree and can practice under a psychologist providing similar services.
OTHERS
There are also other individuals that may not have masters or doctoral level education, can be helpful in their own right. One is a Certified Peer Specialist, an individual who has prior experience “with a mental health disorder or substance use disorder.” These individuals may have some training, but is limited. They are able to support, mentor and provide guidance. Another is a Life Coach. A Life Coach is an individual, that may vary in training level. These individuals do not typically treat severe mental illness, but “coach” individuals on how to improve their lives. Finally, Pastors, are individuals that here in East Texas we commonly think of as our “go to” for difficulties. They are individuals that specialize in interpreting the Word of God, how it directs our lives and helps others in relationship with God. They may have specialized formal education in counseling or additional training in counseling, but they might not. As a result, there may be limitations in how Pastors are able to help. Specific Pastoral Counselors have pastoral education and are trained to diagnose and provide counseling and may even have the equivalent to a doctoral degree in counseling.
PAYMENT
When you walk into a store or restaurant, you can expect that “most” will accept cash or credit. When it comes to seeking mental health services, the expectations are not all the same. Many mental health professionals attain “credentialing” or doing what is needed to bill insurance. Credentialing allows them to bill your insurance to cover some or all of the cost. Others, might ask that you submit claims to insurance companies. There are even some that accept only cash or are “Cash Pay.”
“FIT”
When I talk with individuals about possible counseling, I like to talk about “Fit.” Do you feel comfortable talking with that individual? Do you feel like you and that person work well together? Do they hear you? If you are a female and you were sexually assaulted by a male, you might not want to work with a male. Or, if the professional is also seeing your wife and you don’t want there to be a conflict of interest you might want to see someone else. Mental Professional may have some recommendations, but ultimately it is up to you. You are the consumer, who is paying for services. YOU HAVE PERMISSION to seek out another mental health professional, if it’s not a good “fit” for whatever reason. You have that freedom.
(*** I would like to add a disclaimer that at times you might experience “transference” or a situation in which an experience is redirected towards another individual, maybe the professional you are working with, and it might be most helpful to you to make them aware of how you feel and work through it with them. Also, if you get frustrated because the individual made a mistake or has done something, keep in mind they are also human. If needed, discuss it with them. You might be the person that allows them to grow as a professional and help others in doing so.)
DISTANCE
With the COVID-19 Pandemic and the advent of the internet, accessibility to services has evolved. We no longer need to drive to get everything that we need. BUT what makes you feel most comfortable, especially when discussing some of your most intimate thoughts? Talking to someone over the phone or internet or in person? There is no “right” path. But, what DOES matter is if it works for you. If you have found a counselor down the road 10 minutes that is a good fit, great. Or, if you turn on your computer and click on a zoom link to connect and it works for you, that is what matters. As an individual, it is important for you to identify what is most important to you and what you are willing to concede on.