Finding A Psychotherapist

Things have been really rough lately. Work has been a lot more stressful, and you notice your anxiety is becoming more than you can manage on your own. You’ve started looking for help, but there are so many options - you don’t even know what kind of psychotherapist you need! Do you need a psychiatrist? A psychologist? What’s the difference between the two? And what about all these letters after everyone’s names. What’s an LMFT? LCSW? LPCC? Do you need medication, therapy or both?

 I know all of this can be confusing, so I’m glad I can help you out! I’d like to start out with a caveat: just because someone has more education, training an experience doesn’t necessarily mean they are the right therapist for you! I get into the details about the therapeutic alliance here, but let’s move on to why you are actually here!

Psychologist vs. psychiatrist

One of the most common questions people ask me when they find out I’m a psychologist is if I can prescribe medications. One important distinction between a psychiatrist and a psychologist is that a psychiatrist prescribes medications, while a psychologist provides some form of psychotherapy.

A psychiatrist is a physician who went to medical school and prescribes medication to treat mental health disorders. Someone who is diagnosed with Schizophrenia or Bipolar Disorder must be treated by a psychiatrist. Medications are required at the very least to stabilize these conditions. A psychologist alone is unable to provide the help needed in these cases.

Many psychiatrists and psychologists work closely together. Psychologists see their clients more often and spend much more time with them. This means that psychologists can closely monitor any emerging symptoms and can alert the psychiatrist regarding the possible need for medication adjustment. This alliance can help to prevent inpatient psychiatric hospitalization if symptoms are caught and treated early. While your psychiatrist will engage in some psychotherapy, your sessions will be focused on medication management and typically last for 15 minutes or so. When seeing a psychologist, you’ll engage in talk therapy for at least 45-50 minutes per session and this typically occurs on a weekly basis.

Many who are struggling with depressive symptoms like to try psychotherapy first, and if the symptoms don’t resolve, then try antidepressant medication. In some cases of depression, medication is of paramount importance - particularly in severe forms that include thoughts of self harm. However, if someone has symptoms of depression that are related to a specific life event or stressor, psychotherapy alone may be enough. I’ve learned over the years that if someone has depressive symptoms even when life is going well, then they likely need the added assistance that medications can bring. There is no shame in this!

It is important to highlight that the American Psychological Association’s guidelines for the treatment of depression recommend both medication management and some form of psychotherapy (begin at page 49 for treatment recommendations).

I’d also like to briefly mention medications and anxiety. There is a class of medications called sedatives/hypnotics/anxiolytics. These medications are only meant to be used for a short period of time (approximately 6 weeks) to manage anxiety. During this time, you should be seeing a therapist and learning behavioral techniques to cope with anxiety in the long term. Medications like Xanax and Ativan have high addiction potential and can be very dangerous to detox from and/or mix with alcohol. A responsible physician will not prescribe these medications long term.

Psychology

A psychologist is a mental health professional who has a doctoral degree. You will see psychologists with Ph.D.’s or Psy.D.’s at the end of their names. Typically, a Ph.D. takes around 2 more years to complete with a more extensive, research based dissertation project. (My master’s degree took me 2 years to complete with an additional 6 years for my Ph.D.). Ph.D.’s have the flexibility to facilitate research as well as treat clients. Psy.D.’s are more likely to focus solely on clinical work (though I do know a few Psy.D.’s who are very research oriented). Both degrees are highly respected, both are able to complete psychological assessments and treat clients.

When choosing a psychologist, it’s most important that you find one specialized in your specific needs and that you feel comfortable with their personality and style. Psychologists focus on the individual person and treating their individual symptoms and are less focused on family systems.

Other Types Of Counselors

There are several more types of clinicians in the Master’s level category. Each type has a different focus, but all are typically trained to do some form of talk therapy. Additionally, all of these counselors must have at least a Master’s Degree and have passed some form of licensing exam in order to legally treat clients.

LMFT: If you are looking for couples counseling or family therapy, you will likely find that a Licensed Marriage and Family Therapist (LMFT) is the way to go. While many psychologists do treat couples and families, an LMFT’s training specifically focuses on family systems and relationships. I prefer to refer people seeking couples or family therapy to an LMFT because of their specialized training. And yes, LMFT’s also provide individual therapy as well, though their way of case conceptualization is more focused on whole systems rather than the individual (while a psychologist focuses more on the individual).

LCSW: Licensed Clinical Social Workers (LCSW) are able to provide individualized therapy, however much of their training is focused on case management (helping individuals access community and government resources that they need, such as housing assistance). Many LCSW’s are employed in hospitals or clinics providing case management services.

LPCC: A Licensed Professional Clinical Counselor is someone who has general counseling training at the Master’s level. This is a “newer” degree, in the sense that it has been approved in California since 2009. These counselors provide individual and group counseling.

life coaches

Life Coaches are different from mental health therapists in the sense that there is no formal training or certification required to be a Life Coach. Life coaches typically assist people with self help needs, and for many people this is helpful. However sometimes there are deep, underlying issues preventing people from making the progress that they would like and Life Coaches do not have the training to competently address this.

Vet life coaches very carefully, I know of a handful of mental health professionals who either were unable to pass licensing exams or who have had their licenses removed due to unethical/illegal behavior and they became life coaches instead. This being said, I also know people who have had life changing experiences with Life Coaches, so I’d like to provide that balanced perspective.

Do I need counseling, therapy or psychotherapy?

There is a subtle difference between these terms, but ultimately people generally use them interchangeably. Therapy is a general term used by many different fields, such as massage therapy, speech therapy, etc. Counseling is considered to be more “surface” level help, and psychotherapy tends to dig deeper and into more areas of one’s life.

Once you have identified some possible treatment providers, you might have questions about using insurance. You can head here for some more info. I highly recommend you ask for a 15 minute phone consultation before committing to a session - and most counselors will prefer this so they can ensure they can meet your needs before bringing you in. Click here for some guidance about what to ask in this phone consultation.

I hope this helps you find the right mental health counselor .  If you need a little more direction, click here for a free 15 minute video consultation.

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