Shrink Rap: Choosing a Psychotherapist, Part I

Psychotherapy is the treatment of mental, emotional and personality disorders through focused talk and relating with a therapist. This includes addressing attitudes, thoughts, beliefs, feelings, dreams, behaviors, fantasies, and memories.

In the training and credentials listed below, keep in mind that there is no sure-fire way to determine the best therapist for you. The type and quality of the work any therapist does is more a function of his/her individual training, experience, and commitment to offering quality care, than of the degree or license held.

A registered nurse may offer psychotherapy, typically in a hospital setting, and may have additional specialized training to do so. It is rare to find nurses doing psychotherapy in private practice, unless they have further education and become licensed beyond the nursing discipline.

A psychiatrist is a medical doctor who has specialized training in the treatment of mental illness and emotional disorders. A psychiatrist's training begins with the frame of reference of a medical model-using the concepts of disease and mental illness, and the use of medical interventions (medications) as well as psychotherapy (if they get additional training). Psychiatrists have gone through an internship and residency in a hospital setting, which may also have included outpatient treatment. They may or may not be "board certified" (which indicates they meet certain standards of training and experience, and have passed examinations by the board certifying psychiatrists), but may still use the term "psychiatrist." Typically, today's psychiatrists are strongly biologically oriented. They focus on evaluating patients, prescribing medication, and managing more severe disorders requiring hospitalization.

A psychologist has a doctoral degree (usually Ph.D. or Psy.D., sometimes Ed.D.) with an emphasis in psychology and related course work, an internship in a mental health agency or hospital, and at least 3000 hours of supervised experience providing treatment to individuals, couples, families, and groups. In addition, a licensed psychologist must pass written and oral examinations for licensure in California. In most states, the terms "psychologist" and "psychological" may legally not be used except by licensed psychologists. Psychological testing is usually done by psychologists.

The terms counselor and psychotherapist are more generic terms, encompassing a wide range of education, training, and certification. Their academic preparation ranges from non-degreed (called "lay counselors") up to doctoral level. The words "counselor" and "psychotherapist" are not regulated in most states. A pastoral counselor probably has some specific training in counseling, and may be certified by a professional board of pastoral counselors. Their religious belief system strongly informs their interventions. "Coaching" focuses on short-term problem solving, growth and mentoring and is popular in the business community. Coaches may be licensed as psychologists, marriage therapists, or unlicensed. There is a wide variation in their training and education.

Marriage and Family Therapist is another licensed discipline in California and many other states. They specialize in working with family systems and the family as a context in which individuals experience emotional and other distress. Specific requirements for this license include graduate training (M.A. or Ph.D.) and supervised experience, as well as examinations.

Social workers have a degree (from bachelor's to doctorate) in social work. Their training can range from community assistance to psychotherapy. Those in private practice as licensed clinical social workers will have specific education and training in psychotherapy and social systems, a masters degree, and have passed licensing examinations.

Questions to ask when evaluating a psychotherapist to determine who is right for you include:

• What kind and level of training to you have? Are you licensed?
• How long have you been in practice? Do you have any advanced training in specialty areas?
• How much experience do you have working with problems like mine?
• Has a complaint ever been filed against you with your licensing board?
• What is your orientation or philosophy? Do you identify with any particular approach to therapy?