Definitions are in order for these three designations: social worker, psychologist and psychiatrist. How else will you know the answer to ‘Who ya gonna call?’ Recently the local newspaper had a front page article in the “Your Health” section called “No Room On the Couch.” I was quite happy to see this coverage, especially in light of the opioid epidemic. And I am going to say right up front there are no easy answers to this problem. The mental health profession can be draining and not particularly financially rewarding compared with other medical endeavors, but the job is unique in its reward system. By that I mean it is always interesting and challenging, and the joy received from seeing an individual make connections that lead them to live better lives is hard to describe. I get to see the lights go on! So, on to definitions, and how to decide who to call for what.
Social Worker*, Psychologist and Psychiatrist: Defined
Social Worker, MSW, LCSW
Social workers attend graduate school, usually for a two year program, and must complete an additional 2-3 years of supervised practice, and pass a national exam to achieve licensure, designated by the letters “LCSW.” In North Carolina, they must also complete 40 classroom and/or online hours of additional training every two years. LCSW stands for Licensed Clinical Social Worker. Licensed Clinical Social Workers are specifically trained to perform psychotherapy, or ‘talk therapy.’ These mental health professionals do most of the heavy lifting in terms of 1:1 counseling in all sorts of arenas: addictions, couples counseling, anxiety of all types, depression, trauma, gender identity, etc. The primary reasons LCSW’s do most of the talk therapy, IMO, is that we are the least expensive and most available for appointments of the three categories discussed here, and we are licensed to accept insurance if we choose to do so. This will not be a popular opinion, I can assure you, but I believe it to be true. It certainly does not mean you would be shortchanged by electing this option, far from it. LCSW’s literally get the most practice at listening and sussing out what may best help a person sort out their emotions, stories, and misconceptions. We know how to hold a safe emotional space for you.
Psychologists attend graduate school in psychology. The American Psychological Association recognizes the doctoral degree as the minimum educational requirement for psychologists; these degrees include the Ph.D. (Doctor of Philosophy), Psy.D. (Doctor of Psychology), or Ed.D. (Doctor of Education). Some states allow people with Master’s degrees in psychology to use the term “psychologist.” Graduate training focuses on all aspects of human behavior, with an emphasis on research and scientific methods. In some states, they can prescribe medications, but this is usually left to MD’s, Psychiatrists (who are MD’s) or Psychiatric Nurse Practitioners. Psychologists are good at testing for categories in which they specialize such as ADHD, Learning Disabilities, or mental competency. They are often called on to provide documentation for individual school education plans known as “IEP’s.” They also do talk therapy, but generally tend to have less availability for this purpose due to the time demands of evaluation, psychological testing, and writing reports to summarize their tests. A good psychologist can be invaluable to getting the right school/work accommodations for your child.
Psychiatrists attend medical school and earn an M.D. (Doctor of Medicine) or D.O. (Doctor of Osteopathic Medicine) degree. They can go on for additional, specialized training in psychiatry during a residency (an additional 3-4 years). Training for psychiatrists focuses primarily on biological (vs emotional or mental) aspects of mental illness. Because of their medical training, psychiatrists can prescribe medications, and their work with clients may include talk therapy combined with medications. In the real world, they have very limited time for talk therapy because of their deep knowledge of psychiatric medications and the responsibility for prescribing the most appropriate medications. You will often sea psychiatrist for less than 15 minutes for medication management. An initial appointment can be difficult to obtain, and it is typical to have to wait for a couple of months or more to get in the door. As the referenced article above states, there is a shortage, and often practices are not taking new patients. Even more importantly, it is likely that the psychiatrist’s time is consumed by the most severe cases. In this area, the psychiatrist in the article mentioned that 50% of his cases involve opioid addiction.
*There are other types of licenses for various marriage and addiction counselors not discussed above for the sake of brevity, and because the ones mentioned are predominant in North Carolina, where I practice.
So to sum up:
- See a social worker (LCSW) for counseling.
- See a psychologist for in-depth testing for a specific issue.
- See a psychiatrist for severe disorders and medication management.
- But, you can also see a psychiatric nurse practitioner (NP’s) for med management, or your primary care physician.
P.S. I’m a big fan of psychiatric NP’s–they rock. And they know their meds.
If you need help sorting out what’s bothering you, call me or shoot me an email. I’m in your neighborhood and ready to help.