This page describes various kinds of mental health providers and psychotherapies, as it can be confusing to understand how the different providers and therapies fit together. Listing here does not constitute a specific endorsement of a particular provider for a particular individual. Please consult your doctor if you have any questions about the appropriate treatment for you. For potential referrals in the LA area, please see here.
Mental health care in the United States is provided by a number of different kinds of professionals who have different training and different scopes of practice.
• Psychiatrists are physicians who have completed a bachelors degree that included at least 10 semesters of premedical basic science requirements, then completed 4 years of study and training in an allopathic (MD) or osteopathic (DO) medical school; they then complete at least an additional 4 years of postgraduate training in psychiatry. Psychiatrists have a general medical license and can prescribe medication. Most psychiatrists use medication including antidepressants, mood stabilizers, antipsychotics, stimulants, and anti-anxiety (anxiolytic) medications, among others. Some psychiatrists also do various kinds of psychotherapy, including individual, group, or family therapy, which are discussed below. While psychiatrists vary in the kinds of patients that they see—inpatient versus outpatient, and more psychotherapy versus psychopharmacology—psychiatrists in general have more experience than other mental health providers in treating severe mental illness. Many psychiatrists work together with another mental health provider who does psychotherapy, while the psychiatrist manages the medication.
Many psychiatrists are certified by the American Board of Psychiatry & Neurology (ABPN), which means that they have passed an additional exam and background check into theirs qualifications to practice psychiatry. Some psychiatrists also have subspecialty board certification in areas such as child and adolescent psychiatry, geriatric psychiatry, or addiction psychiatry. Some psychiatrists have additional training in or expertise in areas that do not currently have specific formal certification, such as HIV psychiatry, gender and sexuality issues, or eating disorders. Psychiatrists may or may not belong to the American Psychiatric Association, which is a professional organization of psychiatrists that periodically updates and publishes the diagnostic and statistical manual (DSM), which is the main guide to diagnosis for psychiatrists and other mental health professionals in the United States and Canada.
• Clinical psychologists have either a PhD (doctor of philosophy in psychology) or PsyD (doctor of psychology). In principle, the PhD degree involves more academic training including a research-based dissertation; psychologists with a PhD tends to have more familiarity with research methods, neuroscience, and statistics. Psychologist with a PsyD usually trained in programs that focus more on clinical skills. Some clinical psychologists have a Masters degree and typically work under the supervision of a doctoral-level clinician. A PhD in clinical psychology typically takes about 5 to 7 years, including at least a year of supervised clinical practice; a PsyD program is typically slightly shorter. There are also psychologists who do not have clinical certification; they mainly do research and teaching at universities, or research and consulting for private companies. Some psychologists have a degree from a school of education (EdD), but may be licensed as clinical psychologists.
Psychologists do not prescribe medication. In comparison to psychiatrists, the training of psychologists and compasses much more detailed knowledge of general psychological function, memory and perception, normal human development over the life span, normal behavior—and for PhD psychologists, more extensive training in statistics and research methods. Psychologists also usually have expertise in more types of psychotherapy which is their main form of treatment.
• Clinical social workers have a Master’s degree (MSW) which usually takes 2 to 3 years after their bachelor’s degree. Social workers can obtain clinical certification as a licensed clinical social worker (LCSW), in which case they may see patients for individual, group, or family therapy. They do not prescribe medication. Many social workers have undergraduate degrees in sociology, education, or social psychology, and their graduate training emphasizes an appreciation for the social context of problems, including family dynamics, economic considerations, and the institutions that people interact with.
• Marriage & Family Therapists (MFT) have a bachelors degree and postgraduate training in individual, couples and family therapy. They do not prescribe medication, and they have less training in research methods and general psychology. Their training also usually emphasizes seeing emotional and behavioral problems in the context of families and relationships.
• Psychiatric nurse practitioners (NP) are nurses who have both an RN degree with several years of experience in nursing that includes nursing care of patients with psychiatric concerns and postgraduate training (a masters or doctoral degree in nursing science) that allows them to diagnose and treat a range of psychiatric problems. Nurse practitioners usually work in collaboration with a physician. They can prescribe medications, but they often refer patients with more severe or complex illnesses to a psychiatrist. A nurse practitioner may also provide psychotherapy.
• There are several other kinds of psychotherapists with different kinds of training and usually more limited scopes of practice. School psychologists typically have a Master’s degree in education or development of psychology, and often work which schools to do assessments or counseling around developmental and adjustment issues. Hypnotherapists have undergone training in hypnosis and are often certified by one or more of the professional associations for hypnotherapy. Some clerics and other religious have training and certification in pastoral counseling, which tends to emphasize the faith and existential aspects of life crises.
Psychotherapy is any of several different approaches to helping psychological, emotional, and behavioral problems through some combination of talk, education, insight, and behavior change. Psychotherapy can be provided by many different kinds of providers. Evidence-based psychotherapies generally fall into one of 2 broad types, or a combination of these two.
• Behavioral or cognitive-behavioral therapies (CBT) are based on research in the psychology of learning and the cognitive schemas (mental maps or models or programs) that guide people's behavior. A large body of studies on learning and behavior change in other animals contributes to our understanding of the efficacy of CBT techniques. CBT treatments tend to be more focused on specific symptoms. They often have “homework assignments” or exercises for the patient practice swing sessions, and they are strongly oriented towards learning new skills and improving function in the here and now. Some of these techniques include learning how to break problems down into more manageable parts, learning to take different perspectives on problems, and overcoming stressful situations through practice an exposure. CBT therapies are particularly good for anxiety disorders, including phobias, generalized anxiety, and PTSD. They can also be very good for depression.
• Psychodynamic or psychoanalytic therapies (also called insight-oriented therapies) ultimately derived from the insights of Sigmund Freud and his colleagues and students. There are many varieties of psychodynamic psychotherapy's, but they share a number of general principles. First, they assume that much of our behavior is unconsciously motivated; that is, we are often not aware of the patterns of our behavior and we often do not know why we repeat these patterns over and over. Second, these patterns often result from fears or traumas in early life, or in our copying or trying to do the opposite of our parents’ less than functional behaviors. These maladaptive patterns were often solutions to difficult or stressful situations earlier in life, where they were a reasonable solution—perhaps the best solution available at the time, given that we were usually children or adolescents—but these behaviors have gotten “stuck” and are no longer always adaptive for appropriate in adult life. There may also be unconscious conflicts, in which our desires to do one thing run up against our feelings of obligation worst fears, such as wind anxiety over confronting someone leads to one feeling ill, thereby providing an excuse to avoid conflict. Psychodynamic psychotherapy is use a number of approaches, but most of them appear at the least initially to be somewhat indirect. This both allows the therapist to better pre-shaped the complexity of the situation and to see patterns of which the patient is not always immediately aware, and to allow the therapist and patient together to better understand the origins and maintaining factors in the problem. Psychodynamic psychotherapy's tend to be much more open ended and much more individualized. For these reasons they are less well studied,, also a growing body of evidence shows effectiveness for certain kinds of psychodynamic therapies in treating problems that do not always respond well to CBT therapies.
• Some so-called 3rd- or 4th-generation psychotherapies combine elements of these 2 broad approaches. These include dialectical-behavioral therapy (DBT) and mentalization-based therapy (MBT), which are two of the therapies designed for borderline personality disorder and related conditions, and cognitive behavioral analysis system psychotherapy (CBASP), which is designed for chronic and refractory depression.
• Family and couples therapies also represent a blend in some ways. These therapies tend to be informed by psychodynamic insights, but they also tend to be shorter and more focused therapies, and they are different from either CBT or psychodynamic therapies in that they strongly focus on the interaction among the partners in a couple or the members of the family rather than assuming that the “problem” lies in any one individual. Family therapies also tend to emphasize homework assignments designed to change patterns of behavior in interactions among the individuals.
• There are some other therapies, with varying levels of evidence for them. Hypnosis can be effective in changing habits, including problems with sleep. Movement-based therapies, art and music therapies, and so on have not been well studied.