Choosing a therapist is as important as any decision you can make in your life.

Bill explains why.


FIrst: Therapy Can Often Determine the Quality of Your Life.

While this is a strong statement, I think it is true; therapy can many times leave you feeling better about yourself and better about others, leaving you more effective in dealing with both. Who you see makes a huge difference.

About Psychiatrists

Many people assume that if you really have problems you must see a psychiatrist. This is not true. Most psychiatrists are not willing or able to do psychotherapy or counseling. Most no longer are being trained to do either in their residency. Most if not all residents are committed to a biological approach to mental health care. With managed care and pressures to use quick solutions, medication is now being used as a first resort rather than a last resort.

Thus psychiatrists who are legally and professionally capable of prescribing medications now focus their practice primarily on medication management and, of course, dealing with the chronically mentally ill patients who suffer from schizophrenia and manic depression. Unfortunately, these pressures to prescribe medications also result in the patient not being encouraged to also seek psychotherapy. All research shows clearly the best results come when both medications and psychotherapy are used jointly in the treatment of clinical depression severe enough to warrant medication.

About Clinical Psychologists

A second mental health discipline consists of clinical psychologists who have a doctorate in psychology and do not prescribe medications in most states. They are skilled and trained to give psychological testing and evaluations as well as perform psychotherapy. The clinical psychologist is often helpful in defining the clinical problems more clearly and can be helpful in giving directions for therapy as well as determining need for medications.

About Master Social Workers (MSWs)

The third discipline I want to mention is, of course, the Master's Degree level clinical social worker who has a Masters Degree in social work. Interestingly, it is this discipline that now provides more psychotherapy in the United States than either of the other two professions. We usually refer to this mental health professional as an MSW. The clinical social worker traditionally has been seen as an expert on the family, social systems and when trained in psychology as well, can provide psychotherapy.

I should mention other disciplines less common in the field of mental health providers. Those include licensed mental health professionals who have degrees in counseling or psychiatric nurses. They too are required to have Master's Degrees, are trained in psychotherapy, and must be licensed in most states.

Making The Choice

Consumers need to trust their gut and feelings when picking a mental health professional to work with. If the person doesn’t feel right, it might mean this is not someone you will benefit from.

It is important to realize that each of these three professional disciplines should be trained in psychotherapy. Yet you might often find that only the psychologist, social workers and mental health professionals with Master's Degrees are trained in psychotherapy. Surprisingly, many psychiatrists are not trained or experienced in providing this terribly important service. The seriousness of a problem is not the determining factor in who you should seek out—with the one exception being that the psychiatrist is better trained to deal with the schizophrenic patient or when neurological problems are a factor. This is largely due to the fact that schizophrenia is much more likely a neuronal-biological problem that, in my opinion, should not be included in the problems we're considering here.

I have worked with colleagues over my thirty years of practice who were social workers, psychiatrists, psychologists, mental health professionals, and psychiatric nurses. I have known colleagues in each of these disciplines who were wonderful psychotherapists.

My first experience in doing group therapy was with a psychiatrist who was extremely effective. I was trained in family therapy by a psychiatrist who was a huge influence on my work. And I experienced small group supervision for a year and a half by another psychiatrist in which I was the only non-psychiatrist. I have much respect for psychiatrists who know and understand psychotherapy.

Likewise, I have worked with several wonderfully effective clinical psychologists from whom I learned a great deal. And of course I have also worked with many excellent clinical social workers.

I encourage you to seek out a therapist with whom you feel comfortable, regardless of what their discipline might be.  What matters is their comfort level and skill set in working with all types of individuals such as the LGBT community, minorities and people of color.  I have experience and training in working with all of these groups.