What's the difference between a Psychiatrist and a Psychologist?

What are the differences between all the different types of Psychotherapists?

How do I choose a therapist?

Will my insurance cover therapy or will I need to pay privately?

Is therapy confidential?

Where can I get additional questions answered?
 

What's the difference between a Psychiatrist and a Psychologist?
Funnily enough, this is probably one of the most frequently asked questions about therapy. The confusion is understandable, as back in the early 1900s until relatively recently, there was no distinction. All "therapists" were "Psychiatrists" - medical doctors who specialize in the causes, symptoms and treatment of mental and emotional concerns (as opposed to physical ailments), hence the clichéd image of the patient on the psychiatrist's couch.

Recent years have seen astounding advancements in medication for treating conditions such as depression, anxiety and other mental health concerns. As a result, Psychiatrists (who are all M.D.'s) rarely have time to offer traditional "talk-therapy" in addition to providing expertise in medication. Instead, when they meet with clients to assess their symptoms, it is to prescribe and monitor the best medication to treat the concern in question. In short, today's "Psychiatrist" is a medical doctor who specializes in medication to treat mental health.

Yet research demonstrates that talk-therapy is effective in treating emotional and mental concerns too, both with and without accompanying medication. This creates a significant demand for talk-therapy that cannot possibly be met by Psychiatrists, and does not necessarily require a medical degree to do well. "Psychotherapists" (a collective term for Psychologists, Marriage & Family Therapists, Counselors and Social Workers) are the professionals who now carry out this much needed service.


So what are the differences between all the different types of Psychotherapists?
While there are some significant differences in the training and theoretical approach of all of these professionals, the reality is that the lines are blurring, especially when it comes to private practice. Many Psychologists offer couples therapy, and most Marriage & Family Therapists see individuals as well as couples. In addition, there are Marriage & Family Therapists working in government agencies or seeing clients in homes, formerly the domain of Social Workers who now also operate in private practice. The exact qualifications and title of a Psychotherapist may also depend on the state where he or she was licensed, as each state has different requirements for education, training and licensure.

The key difference between a therapist trained in Marriage & Family Therapy is the "systems" approach, which conceptualizes problems as occuring within the relational dynamic as opposed to within a specific person. Everyone exists in relationship, and to a significant extent, we can only know ourselves in terms of how other people relate to us. We may take on very different roles or responses depending upon the people that surround us.


How do I choose a therapist?
There are many factors at play in choosing the right therapist. The most obvious include location, cost, insurance coverage and appointment availbility, but there are a number of other important issues that are vital to consider before making that first appointment.

Firstly, research shows that the relationship between the client and therapist is the most crucial piece that makes therapy "work". Ensure that you feel your therapist understands you and has patience and respect for you. If you don't feel that in your initial phone contact, it's unlikely you will in person, so shop around until you find someone who makes you feel that it's okay to be you.

Secondly, it is important to recognize that all therapists - regardless of their type of licensure - offer different areas of experience or specialty. In the same way that you wouldn't expect an acupuncturist to offer a deep tissue massage, you should seek out a therapist with the right skillset to match your needs. Some therapists are excellent at treating anxiety while others are better at treating depression. Some therapists are wonderful with children while others only treat teens or adults. Some therapists specialize in couples therapy while other therapists do much better with individuals. Ask your potential therapists what they consider to be their areas of expertise and what issues they have most success with. If there isn't a match, or if they give you an exhaustive laundry list, look elsewhere.

Thirdly, good therapists rarely have time to offer "free consultations". Do your research up-front by asking friends, colleagues or other therapists for recommendations and by talking with therapists on the phone. Pay attention to the details, such as how soon you receive a call back and whether the therapist conveys that they have time to chat with you. While therapists can be notoriously difficult to reach, you should expect your phone messages to be returned on the same day, or at least within 24 hours. If the therapist has a website, read what they say about themselves and see how that leaves you feeling. Of course, if your first meeting with your therapist doesn't go well you are under no obligation to return, but if you've done your homework properly, that shouldn't happen.

Fourthly, finding a therapist who can "get you in as soon as possible" might not always be the best option. Most therapists book at least two weeks out and many have waiting lists. Since therapy is a medium to long term process, calling someone you've never met and demanding to get in by the end of the week may convey that you are looking for a quick fix and are not ready to engage in the necessary work ahead of you. While therapists vary in their scheduling flexibility, the adage "good things come to those who wait" may be appropriate here. If a therapist can't get you in right away and you don't want to wait, ask them for referrals.

Finally, be a little flexible. While it would be wonderful to find a highly reputable therapist 2 miles from home who specializes in what you're looking for, offers a sliding discount and can get you in tomorrow, it's unlikely that you'll get all those things. Decide whether it's worth it to drive a little further, wait a little longer or pay a little more to see the best therapist available to you.



Will my insurance cover therapy, or will I need to pay privately?
Unfortunately the only answer here is "it depends". It depends on your insurer, the specifics of your plan, your diagnosis and the size of your deductible. Some insurers only cover therapists in their own network; others will cover a wide array of therapists on an out of network basis. Some plans cover couples therapy while others only cover diagnoses such as depression or anxiety. You will need to call your insurance provider to find out a) if you have mental health benefits, b) whether you have out-of-network coverage and c) the size of your deductible - all of which will help you discern whether to use insurance or to pay privately. Jane does not work directly with insurance companies but several will cover her services on an out of network basis. For clients with insurance that won't cover, Jane offers a sliding scale fee based on income to ensure that therapy services are available for all. For more information on rates, payment and insurance, click here.
 

Is therapy confidential?
The confidentiality of therapy and all related health information is protected by both Federal and State laws. All organizations involved in handling health information - including therapists - are bound by HIPAA, the Health Insurance Portability and Accountability Act, which defines how and with whom personal health information may be shared. Personal health information is confidential and may only be released if the client signs a written authorization giving permission for a named individual or entity to receive it. Aside from this written authorization, information may only be released if there is a risk of harm to the client or another individual, including children and vulnerable adults. The only other exceptions to confidentiality include legal proceedings where disclosure of records is court-ordered and/or where either client or therapist is the subject of a civil or criminal case to which the records may pertain. The Notice of Privacy Practices details what constitutes personal health information and how it can be used. In addition, Jane will walk through all of the necessary legal aspects of therapy - including confidentiality and your rights as a client - during the first therapy session. Always feel free to ask questions if you are unsure.

Any other questions?
Please click here to send Jane a message via the website.

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