What Type of Mental Health Professional Is Right for You?
It’s key to ask the right questions
Posted May 30, 2013
By David J. Bridgett, Ph.D., and Michelle M. Lilly, Ph.D., guest contributors
Once having decided to seek out help for emotional or behavioral difficulties, the type of mental health professional you choose for treatment can be a difficult decision.
This decision will likely involve your beliefs about the costs and benefits of therapy versus medication. A decision to pursue medication-based treatment alone or in combination with other treatments will put you in contact with a medical professional, such as a psychiatrist. On the other hand, a psychologist or another type of mental health professional may be among your first choices when seeking therapy or counseling, as few psychiatrists offer therapy.
Although your beliefs about treatment type will play a key role in deciding which type of professional to see, other important factors are frequently neglected, including the following.
1) What is the problem that needs to be treated?
To identify the best treatment approach, it is often necessary to complete a thorough evaluation before starting treatment. Many mental health professionals will start with such an evaluation, often called a diagnostic evaluation, to get a better idea of what the presenting problem is.
2) What is the best treatment?
This is an increasingly complex question. For some difficulties, medication might be the best treatment, whereas for others, a combination of medication and therapy might be best. Yet, for other mental health problems, therapy or counseling is likely as good an option, and in some cases, a better option, than medication. Some specific examples follow.
Although therapy or counseling can be important components to treatment, some conditions for which medication might be well suited include Bipolar Disorder, Schizophrenia, and Attention Deficit/Hyperactivity Disorder (ADHD). Why? The bulk of the scientific evidence suggests that medications are effective for the treatment of the core symptoms of these conditions.
For the treatment of core ADHD symptoms (i.e., hyperactivity-impulsivity and inattention), for example, research suggests that medication is more effective than behavioral interventions (Van der Oord, Prins, Oosterlaan, & Emmelkamp, 2008). Yet, many children, adolescents, and adults who have ADHD are also anxious or have difficulties controlling their anger. For these individuals, a combination of medication and behavioral treatment might be best (e.g., Jensen et al., 2001).
For depression, some medications have demonstrated effectiveness in reducing the symptoms and impairment associated with the condition. On the other hand, psychotherapy and counseling, and particularly cognitive-behavioral and interpersonal therapy approaches have also demonstrated good effectiveness, even when compared to medication (e.g., DeRubeis et al., 2005; Dimidjian et al., 2006).
So, which one is better? Unfortunately, there is probably not a “right” answer, and the answer often differs for each individual. Moreover, the different treatment approaches for depression can be used to illustrate several additional important considerations.
For example, there is evidence that medication and psychotherapy lead to some similar changes in brain functioning in those diagnosed with depression as treatment unfolds and symptoms become less severe (Frewen et al., 2008; Kennedy et al., 2007). On the other hand, there is evidence to suggest that people who are primarily treated with medications for depression are at greater risk of relapse once they stop taking medication (Dobson et al., 2008; Hollon et al., 2005). These points illustrate that two seemingly different treatments can lead to similar outcomes and that factors, such as the risk for relapse, could be important considerations when choosing a treatment approach and, consequently, your treatment provider.
For anxiety, although medication can be effective, treatment studies have found that behavioral interventions are as good as or may even outperform medication treatments (e.g., Roshanaei-Moghaddam et al., 2011). Unless there are complicating considerations, many mental health professionals recommend behavioral interventions for the treatment of anxiety.
Other types of problems also frequently come to the attention of mental health professionals. For example, people often seek out help because of trouble with interpersonal relationships. While a skilled therapist or counselor can help determine if there is a condition, such as depression, contributing to relationship problems, the relationship problems are usually treated with therapy or counseling.
3) When should I notice treatment effects?
This is a critical question to ask your provider before and during treatment. Contrary to the “quick fix” notion of medications, some medications may take several weeks to reach therapeutic effectiveness. On the therapy side of the coin, therapy and counseling can take longer to have treatment effects, and one typically needs to make the time to see a therapist or a counselor at least once a week.
4) What type of mental health professional should you see?
Good mental health professionals, whether you initially see a psychiatrist or see a therapist, should have some knowledge of the full range of treatment options, as well as expertise in treating disorders that fall into areas covered by their practice. It is important that you ask how much experience the mental health professional you are considering has in treating individuals who are experiencing problems similar to what you are having.
That said, for medication-based treatments, a psychiatrist or other qualified medical professional will nearly always be involved in your treatment. If seeking psychotherapy or counseling, there are a number of possibilities, including clinical or counseling psychologists, social workers, counselors, or marriage and family therapists. In seeking support from any type of professional, you will want to make sure they are licensed to practice in your state.
5) Finally, what should you do if treatment does not seem to be working?
First, speak with your treatment provider – it is possible that some adjustments to your treatment can be made. All too often people see one counselor or therapist, decide that they don’t like that particular person or treatment approach, and stop seeking treatment. Unfortunately, these individuals often go on feeling unhappy, and some feel like they have “failed” therapy. Instead, starting treatment with a different therapist, or changing directions with your current therapist, could be all that is needed. While this may sound discouraging, treatment for mental health problems is not a “one size fits all” endeavor, and switching treatments or treatment providers for a variety of reasons is not uncommon.
At the end of the day, when you come into contact with a mental health professional, ask a lot of questions about what they can do for you, what the treatment process is going to be like, and what your other options might be for treatment. Arming yourself with this information is likely going to help you in the long run, and is the first step to being actively involved in your own treatment, which is another important part of successful treatment outcomes for mental health difficulties.
Dr. David Bridgett is a clinical psychologist and an Assistant Professor of Psychology at Northern Illinois University. His research focuses on developmental psychopathology, including risk factors for early childhood behavioral difficulties such as temperament, emotion, self-regulation, and parenting and family processes. Clinically, he has worked with children and adolescents experiencing a range of mental health difficulties. Dr. Michelle Lilly is a clinical psychologist and an Assistant Professor of Psychology at Northern Illinois University. Her research focuses on mental health and recovery in trauma survivors, including an emphasis on those who experience interpersonal violence and 911 telecommunicators. Her clinical experience has involved treating adults, predominantly trauma survivors, using cognitive-behavioral and interpersonal treatment approaches. She is also a licensed Clinical Psychologist in the state of Illinois.
DeRubeis, R. J., Hollon, S. D., Amsterdam, J. D., Shelton, R. C., Young, P. R., Salomon, R. M., O’Reardon, J. P., …Gallop, R. (2005). Cognitive therapy vs medications in the treatment of moderate to severe depression. Archives of General Psychiatry, 62, 409-416.
Dimidjian, S., Hollon, S. D., Dobson, K. S., Schmaling, K. B., Kohlenberg, R. J., Addis, M. E., Gallop, R., … Jacobson, N. S. (2006). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology, 74, 658-670.
Dobson, K. S., Hollon, S., D., Dimidjian, S., Schmaling, K. B., Kohlenberg, R. J., Gallop, R. J., Rizvi, S. L., & Gollan, J. K. (2008). Randomized trail of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression. Journal of Consulting and Clinical Psychology, 76, 468-477.
Frewen, P. A., Dozois, D. J. A., & Lanius, R. A. (2008). Neuroimaging studies of psychological interventions for mood and anxiety disorders: Empirical and methodological review. Clinical Psychology Review, 28, 228-246.
Hollon, S. D., Stewart, M. O., & Strunk, D. (2006). Enduring effects for cognitive behavior therapy in the treatment of depression and anxiety. Annual Review of Psychology, 57, 285-315.
Jensen, P. S., Hinshaw, S. P., Kraemer, H. C., Lenora, N., Newcorn, J. H., Abikoff, H. B., March, J. S., … Vitiello, B. (2001). ADHD comorbidity findings from the MTA study: Comparing comorbid subgroups. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 147-158.
Kennedy, S. H., Konarski, J. Z., Segal, Z. V., Lau, M. A., Bieling, P. J., McIntyre, R. S., & Mayberg, H. S. (2007). Differences in brain glucose metabolism between responders to CBT and Venlafaxine in a 16-week randomized controlled trial. American Journal of Psychiatry, 164, 778-788.
Roshanaei-Moghaddam, B., Pauly, M. C., Atkins, D. C., Baldwin, S. A., Stein, M. B., & Roy-Byrne, P. (2011). Relative effects of CBT and Pharmacotherapy in depression versus anxiety: Is medication somewhat better for depression, and CBT somewhat better for anxiety? Depression and Anxiety, 28, 560-567.
Van der Oord, S., Prins, P.J.M., Oosterlann, J., & Emmelkamp, P.M.G. (2008). Efficacy of methylphenidate, psychosocial treatments, and their combination in school-aged children with ADHD: A meta-analysis. Clinical Psychology Review, 28, 783-800.