Help with mental health: Which professional shall I call?

There are so many different types of mental health professionals out there who all help people in distress. This post offers a straightforward guide to the key professions of  psychiatry, counselling, psychotherapy, and clinical psychology. 

Lewis’ parents were becoming increasingly worried about him: In the last six months he had become withdrawn at home, and just last week they found out that he was being bullied at school. They were worried that their 16 year old’s self esteem had dropped and that the long periods he spent in his room was more than just “teenage behaviour”. Lewis was reluctant to talk about the bullying to his parents and refused to see the school counsellor. They were at a loss as to where to go for help: Local services had long waiting times and, anyway, they felt Lewis had not yet reached the point where he would meet the criteria for the mental health service. When they looked into getting help privately, they were confused by all the different types of counsellors, therapists and other practitioners offering mental health related services. What kind of help would be best for their son?

The dilemma faced by Lewis’ parents is very common for people of all ages who find themselves needing help for mental health. So what is the difference between a psychologist and a counsellor or a therapist? What is a psychiatrist and how can they help? As a clinical psychologist and mental health practitioner, these are also some of the questions I am most frequently asked by people who contact my practice. In this post, I will try to explain the different types of help available and what the differences are between some of the key professionals you may come across in the world of mental health.

Before we consider the different types of mental health specialists out there, lets start with a mention of one of the most important mental health professionals in practice in the United Kingdom today – and the first port of call for many patients when they are experiencing psychological problems – your GP.

Start with your GP!

If you are at all worried about your own mental health, or the mental health of one of your loved ones, a really good place to start is with your GP. You won’t be wasting their time. General practitioners are very aware of the intricate links between body and mind and well-placed to advise you on whether the difficulties or symptoms you experience have a mental health component to them, and also if they can be linked to a physical health problem which may need treatment as well. They are also often able to offer first line treatments such as antidepressant medication, or a referral for talking treatments in primary care, or to more specialist community mental health services.

If the problem warrants a referral to a more specialist mental health practitioner, you may come across a wide range of professionals, including psychiatrists, psychologists, therapists, or counsellors. All these professionals have in common that they aim to treat mental illness and improve the well-being of their clients or patients, but their training and the aspects of mental health they specialise in, differ. The differences can be confusing and deciding who would be best to approach with your issues, may be a very difficult decision. The following paragraphs offer some perspectives on the various professionals, their approaches and how they are able to help. Some of the information comes from the NHS careers website which can be accessed via  www.healthcareers.nhs.uk which is a great resource for further information on different health professions and their training routes. I have also used information published by the British Psychological Society (www.bps.org.uk), and asked some colleagues to provide their perspectives.

 Psychiatry

Dr Suzanne Stacey, consultant psychiatrist for older people explained to me the role of the psychiatrist:

“Psychiatrists are medical doctors who specialise in caring for those with mental disorders.

Psychiatrists want to help patients to become as mentally well as possible, in order to live as well as they can.  After they have finished their training to become doctors, they have undertaken around 7-10 more years of training to become consultants in psychiatry.  During that training, they will have specialised more, so that at the end, they will be consultants in some area of psychiatry, such as psychiatry in children, adults, later life, eating disorders or learning disabilities.

Patients would usually be referred to see the psychiatrist by their general practitioner.

When possible, psychiatrists generally take time getting to know and understand someone’s problems.  They will wish to understand what has been happening for a person in terms of how any problems started, what may have triggered it, things that make the problem worse or better.  They will also want to know if a person has thought of or attempted to hurt themselves or any other risks that could be associated with someone being mentally unwell.

In addition, if appropriate, a psychiatrist might well ask about what has happened in a person’s past.  This might include any mental health problems in the past, physical health problems, medication, use of drugs or alcohol, a person’s life story, and some information about what they are like as a person.

Depending what the problem is there are lots of options as to what treatment a psychiatrist may wish to consider with each individual patient.  Psychiatrists can prescribe medication to help with mental disorders. They may also undertake talking type therapies with a patient. Alternatively, they may help the person to have talking therapies with another professional, such as a counsellor, psychotherapist or clinical psychologist. Psychiatrists would commonly see patients in an outpatient setting over the course of time to monitor how the treatment is going and provide on-going support.”

Dr Stacey continues, “We want to work with our patients to find the road to maximum mental health and wellbeing that is right for each individual”.

Counselling and Psychotherapy

According to the UK National Health Service, a counsellor is someone who helps people talk about their feelings, look at their choices, and make positive changes in their lives. Psychotherapists, in turn, help people to overcome stress, deal with emotional problems, or overcome troublesome habits. There are also counsellors and psychotherapists who specialise in working with different kinds of clients or using different kinds of therapy, including group and family work, art psychotherapy, and mental health.

Of all the mental health professions, the distinctions between counsellors and psychotherapists of various types can appear to be a little confusing. This is not lost on counsellors and psychotherapists themselves: I asked Martin Limb who is both a qualified speech and language therapist and a qualified psychotherapist to explain: ”I tend to take the view the boundaries are blurred and no clear division, which some others also do. But that psychotherapy is about 2 people ( though family and couples counsellors/therapists will work with more), and that the interchange which takes place between the 2 helps the client to identify utilize her/his own resources to bring about change in the way she/he sees something, and develop  more effective strategies,  for that client, in dealing with it.”

Describing how counsellors and psychotherapists approach their work, Martin states: “It relies on active listening and a non-judgemental stance from the therapist. Within the bounds of confidentiality, and discussion with the client, the therapist may also do some work with significant others in the client’s environment.”

In the United Kingdom, there are various professional bodies that sets standards for training and clinical practice for different types of counselling and psychotherapy. Most psychotherapists, for example, have a postgraduate qualification obtained over (typically) four years, that includes time spent in their own therapy and a large number of hours of supervised clinical practice.

Clinical psychology

Clinical psychologists aim to reduce psychological distress and promote individuals’ and communities’ well-being through the systematic application of scientific knowledge based on psychological research. The British psychological society has published a document called the “Core purpose and philosophy of the profession” which elaborates this as follows:

“Clinical psychologists are more than psychological therapists; they are scientist practitioners. Whilst many do practice psychotherapy to a high level this is not a skill unique to clinical psychologists, … Like other applied psychologists, the background and training of clinical psychologists is rooted in the science of psychology, and clinical psychology is but one of the applications of psychological science to help solve human problems. The ability to design and undertake professional practice with individuals, groups, organisations and systems is developed to doctoral level.

Clinical psychologists aim to enable individual service users and carers to have the necessary skills and abilities to cope with their emotional needs and daily lives in order to maximise psychological and physical well-being; to develop and use their capacity to make informed choices in order to enhance and maximise independence and autonomy; to have a sense of self-understanding, self-respect and self-worth; to be able to enjoy good social and personal relationships; and to share commonly valued social and environmental facilities.”

So, clinical psychologists are trained to doctoral level to apply scientific psychological knowledge to human distress, including mental health problems. As scientist-practitioners, they take a holistic view of their patients, understanding that there may be social and systemic factors that contribute to people’s difficulties with their mental health and behaviour. Clinical work with a psychologist often centres on a joint process of exploration where both the psychologist and the patient or service user work together to develop a psychological explanation of the problem and an understanding of how the individual’s mental health difficulties “work”. This is called a formulation and forms the core of any psychological therapy. As the formulation becomes clearer over time, both the patient and the psychologist can use it as a source of new ideas to try out, and a yardstick against which to measure their progress.

Psychologists also have access to a unique set of tools that enable them to assess many of the difficulties their clients face, namely, neuropsychological and psychometric assessments. These tools are carefully developed instruments, that provide information on individuals’ personality traits, information processing abilities, and psychological adjustment. Psychometric tests are developed using very complex and sophisticated statistical procedures that enable individual strengths and weaknesses to be identified, and also the statistical comparison of someone’s performance with a reference group such as the general population, or with others of the same age or gender.

The strengths of clinical psychologists include their ability to take a broad range of factors into account – most are trained in several models of therapy which they can adapt to their patients’ needs, their ability to adapt and apply psychological research in a variety of contexts, and their scientific and systematic approach. They work in collaboration with their clients and strive to enable their clients to develop a shared understanding of the problems at hand and how psychological knowledge can be applied to overcome obstacles and develop resilience. Clinical psychologists also have a very clear philosophical stance on the value of individual human rights. The Core Purpose and Philosophy document explains, “The work of clinical psychologists is based on the fundamental acknowledgement that all people have the same human value and the right to be treated as unique individuals. Clinical psychologists will treat all people – both clients (across the life span) and colleagues – with dignity and respect and will work with them collaboratively as equal partners towards the achievement of mutually agreed goals.”

Going back to Lewis’ story, who might his parents call? They would be well advised to start with their family doctor. Lewis’ GP may be able to refer him to a local NHS or independent consultant psychiatrist who will be able to assess his mental health and advise if the changes in his behaviour represent a significant mental health problem or an adjustment problem. A psychiatric opinion  will help steer the next steps in Lewis’ journey which may be to wait and allow him to find a way to deal with his difficulties himself, or that further help such as medication or counselling is needed. A clinical psychologist may be able to provide Lewis with psychological treatment aimed at addressing identified difficulties such as anxiety or depression, and also offer advice and support to Lewis’ parents or school on how best to support him.

In this practice, we offer clinical psychology assessment and treatment to both adults and children, and we can also provide one-off sessions to parents and carers who are concerned about the well-being of their children where we discuss the problem and jointly devise a plan of action to address the issue in the most effective way, including where to go next to find the most appropriate help. If you would like to find out more, please complete the contact form below and we will get back to you.

 

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