Choosing the right mental health provider

When faced with mental health conditions such as depression, anxiety, or other symptoms of the mind and brain, it can be difficult to know where to find the best care. In part, the challenge of finding the right professional for you stems from the highly variable manner in which mental health concerns can emerge. One person’s depression, for example, may be very different than someone else’s, and the same can be said for anxiety, post-traumatic stress, obsessionality, attentional issues, substance use disorders, and even psychosis.

There are also lots of different kinds of mental health providers out there doing all kinds of distinct clinical work. It can be intimidating to even know where to start searching for help, but often telling your primary care doctor about your symptoms, and if necessary asking for a referral to a specialist, is a good place to begin.

If your doctor determines that specialized care is needed, you may be referred to a psychiatrist who can do a global assessment of your clinical needs. It may be the case that you will benefit most from an integrated treatment approach that features both psychotherapy and medications, or you may be referred primarily to one treatment or another. Here’s some additional information about the different kinds of mental health providers and the treatments they offer to help diagnose and treat psychiatric issues.

Psychiatrists

Psychiatrists are medical doctors who have graduated from medical school and completed at least four years of additional specialized training, through residency and often fellowship, in the medical treatment of mental disorders. Because of their advanced medical training, psychiatrists are able to prescribe medicine and also have at least basic training in most evidence-based psychotherapeutic approaches. Some choose to see patients for medication management only, while others focus on therapy and still others integrate both approaches into the same clinical sessions. Also, psychiatrists are generally the only mental health providers who can perform electroconvulsive therapy, transcranial magnetic stimulation, or other neuromodulatory treatments that use devices to noninvasively stimulate the brain in severe or medication-resistant cases.

Though some psychiatrists still practice traditional psychoanalysis involving multiple sessions “on the couch” each week, this kind of approach has become less available and less common in recent years, in part because insurances generally do not cover it, and in order to practice it providers must complete additional psychoanalytic training for several years after residency. Often, psychiatric nurse practitioners or other appropriately trained “physician extenders” can take on the traditional role of a psychiatrist, though it is important that they have access to adequate supervision, particularly for complex cases.

Therapists and counselors

Many types of professionals can provide the variety of psychotherapeutic approaches used in the treatment of mental health disorders. Therapists who have obtained PhD or PsyD degrees with a focus in clinical psychology, for example, have perhaps the most extensive training in providing talk therapy, including psychodynamic or “insight-oriented” therapy, cognitive behavioral therapy, interpersonal therapy, and others. Clinical social workers and mental health counselors may also have excellent training in particular therapeutic areas that can be very helpful to patients. Therapists and counselors may even offer some therapies, such as eye movement desensitization and reprocessing (EMDR), that psychiatrists generally have less experience with.

In each of these areas, it is important to remember that there is a spectrum of quality, and so it is essential for people with mental health concerns to find well-trained and credentialed providers that seem to be a good fit with them individually.

Related Information: Understanding Depression

Comments:

  1. Joe K

    My son was a Youth At Risk. We started mental health care at age 8. After 7 years, 2 hospital stays, and 23 different mental health care providers, the diagnosis was to institutionalize him. One doctor would say it was Bipolar, the next would say ADHD, trying every medication. Dr Stanley Greenspan was the only help. Floortime. 20 minutes a day doing what he wants. Don’t ask about school, homework, friends. Then, I stopped all medications and doctors and only talked with him about his future. He is 26 now, married, and a programmer. All is well. Psychology is being thrown in the trash now by neuroscience. GOOD RIDDANCE!

  2. Betsy Bohanan

    Dr. McGee are you accepting new patients?

  3. Laura K

    This article didn’t go deep enough. I had hoped to see tips for deciding if your therapist is a good fit for you. Then when I realized that the author was comparing types of practitioners, I expected a separate section for psychiatrists, psychologists, psychotherapists and other practitioners that provide mental health assistance. I was disappointed to see all mental health practitioners other than psychiatrists lumped together.

  4. Beth

    I would say start with referrals by friends or someone else who knows you and you trust. If you have friends who work in the medical industry and know docs or know practitioners, that’s a good bet. You can also use the EAP at work or a pastor or rabbi or nun. I am so happy to see this issue addressed, having been given excellent short-term care by a PhD, Dr. Wiegertz for OCD, after receiving terrible care and trauma from a weird EST-lite treatment center that had the right licensing for their state. I also have very good experience with the free 12-step model. For medication, my current PCP recommended , while I waited a while to get in, I feel extremely fortunate.

  5. Holley

    I KNOW I need help… PTSD, Anxiety, Attention Deficit, depression AND I have been prescribed various medications for the above, but they ALL made me gain weight.. which gets me depressed, so I won’t take them. So I am at a loss, especially at tax time when I need to focus, stay calm and barrel through, but feel overwhelmed. Now I have moved to a new house and I’m not sure who my new primary care Dr is because I’m still unpacking and papers are everywhere… Going to the Dr just seems to automatically result in chemical choices. This is not an option for me.. so I tell myself there is no option and at 76, I’ve decided to just hang in as long as I can and get my will in order. Still every once in a while I wonder… “Is there any help out there that would work for me?”

  6. Cynthia

    “Physician extenders?” really? Why alienate people who are not MDs? Ignorance extends beyond Mental Health field.

  7. Andrew

    Where does one start this journey of pairing with a Therapist\NA\Psychiatrist partnership? MassHealth, interviewing, friends, etc?

  8. Elisabetta

    I read the article and would like to provide my recent experience as an update with reality of what access to mental health care is out there now. The amazing difficulty and near impossibility in the process of getting even an initial evaluation preemptively, with any sort of provider, over several months, when one feels a relapse of depression coming on that continues for weeks, months then progresses–in the setting of urgency and of course, crisis–as predicted, is outrageously astounding—and frighteningly real!! Yes, the insurance policy is privately paid–for a whopping big chunk of money monthly–with a well known carrier with “a quality reputation” in a big metro area!! Yes, apparently you must wait to have some sort of crisis before you are noticed/treated; and oh, yes, they will tell you not to go to the ER! I absolutely told my person to go to the ER in any emergency–could not believe the potentially deadly direction given. I guess they figure you will figure it out. Or, better yet you get a friend to advocate–like me–well versed in the health care arena and their shenanigans, to put it politely. Initially I patiently went through the paddle line every patient goes through I imagine. I indeed also was still continually fed a malignant negligent care access protocol while trying to get treatment for my friend, and trying to figure why is this so difficult? She and I endured a relentless repetition of the same scripted messages from the insurance when describing the lack of access to mental health care. Multiple attempts at multiple points of service were to no avail. I was clear and firm in what was happening and the precarious and dangerous situation that was worsening, over and over. Over weeks, miraculously like a festering boil the situation explodes while waiting for an appt. and when you are referred for help, they give you the provider list again, and say they will put out a message to first provider available and call you. Not.
    Yes, here’s how it goes–you are initially referred to a list of providers on line–or mailed to you. Period. Good luck to you and may the force help you–estimate 80% of names on list not taking new patients or no longer on the provider list- a total fantasy list and I may say fraudulent. Lots of your precious time will be stolen trying to get basic mental health care access–you will even get referred to additional “providers” when you tell them this–these additional providers are facilities–yes–that are “rehab” “nursing homes” that purport to be able to provide the assessment and care you need. Ok, fair enough if they can provide the assessment. My person was cooperative and went to the “rehab” facility-was told-“a nurse does our assessments”(not even an NP or any mental health credentialing evident) And also told “You must agree to go “in-patient” or out-pt 3 times a week”–no matter if you have a job and can’t make it by 5PM–all this by phone when you call to make appt. even before you have been assessed–and without a diagnosis!!! The focus it seems is on your drug use!?? This was amazingly puzzling, and no one, not even primary care doctor could get us an appointment!! And why do you have to have a drug test to get an appointment???? Again, my person cooperated. I mean even if you have the history(was NOT the case in our situation and there is no shame in it), it should not be a factor for getting an initial appointment!! What is that all about? No one knew. Interesting. Well –there must have been divine intervention at the “rehab” because the nurse took temperature and my person had a high fever and sent home!!! The stress of this process can contribute to a physical illness, indeed. So, off to urgent care in full blown panic attack, given a bandaid drug to tide over the attacks while waiting for treatment!!!
    I am appalled that what I found exists presently in Feb. 2018. I suspect the insurance company/companies are permitted to make their own criteria for being approved for mental health services–a drug test? And no appt even after that. And the services are provided where and with whatever they please–in an appalling and not even close to medical community standard of care–but is the standard changing? A chill goes down the spine. Seriously, this raises the fear factor for the health and well being of all of us if allowed to continue. They would rather you go “in-patient” as must get more money for that–than prevent that crisis. OR ARE PREVENTIVE AND MAINTENANCE TREATMENTS GONE? And the most money should go into the assessment and accurate as possible diagnosis–or all the groups, “rehab” etc are a massive waste and lead to failure and a few feet advancement down the drain for ill patients. Luckily, miraculously, or more likely– someone at the insurance case mgt dept. finally–after a month or more– “woke up” to what was happening–only when someone like me that was “on to them and their gig”–and got us an outpt appointment with the appropriate provider credentialing within a week!! The illness is taking more to treat had it been treated earlier. It took a full blown panic attack and visit to urgent care(not ER–ER sounds like torture to some people I forgot to add and scared them away from ER) and an upper respiratory and bronchial infection. But remember–“don’t go to the ER”. Just lie down and go away is what I gathered from this ordeal. Never again will this happen. Right? We are facing the equivalent of a flu epidemic without any vaccine in mental health arena for many many reasons that I am sure people are already aware of. Mitigating shortages of professionals and programs in ALL fields that keep us mentally healthy is a priority–preschool/childcare, teachers at all levels, science and technology in pure form and/or integrated with tangible useful and fulfilling professions, and a focus on tending to and healing our minds is no easy task, or more accurately a fantasy, like the provider list that is shoved at you from insurance companies. They omitted a statement across the top of the list clearly stating “you’re on your own”. I was quite willingly in the middle between an ill patient in total despair growing more reluctant to seek any care, needing constant coaching and reassurance, and an incompetent? negligent ?insurance company unwilling to own any accountability for lack of access. I am incensed watching any person in need of medical care feeling helpless, and worse, hoodwinked by an insurance company unwilling/unable to provide mental health care in an appropriate time frame, setting and credentialed provider. And getting away with it.

  9. CG

    Understanding who can help with different kinds and levels of problems is really daunting. Many of us have wanted to get counseling but just don’t know whom to trust, how to begin, . And yes, the expense is an issue. Making the first phone call is the hardest step, and who do you call? How do you judge if the person is going to be competent or helpful if this is your first attempt at therapy?
    And if a person is really burdened by a problem, he or she doesn’t want to go through having to reveal and discuss it with multiple therapists while trying to find the “right fit.” Such a hard situation, even in a town with lots of therapists – maybe too many.

  10. diane kopan

    TO HARVARD HEALTH:

    I HAVE RECEIVED THIS PUBLICATION ONLINE FOR MANY YEARS.

    THIS TIME I OBJECT TO YOUR CLEARLY PROMOTING PSYCHOLOGISTS AS MORE QUALIFIED THAN SOCIAL WORKERS OR COUNSELORS AS CLINICIANS.

    YOU CANNOT DENY THAT YOU PROMOTE THEM. SO DOES THEIR POWERFUL ORGANIZATION, AMERICAN PSYCHOLOGICAL ASSOCIATION , WHICH ALSO LOBBIES FOR THEM TO PRESCRIBE PSYCHOTROPIC MEDICATIONS. WHICH IS AN OVER-REACH IF I EVER HEARD ONE.

    SOCIAL WORKERS AND COUNSELORS ARE AT LEAST EQUALLY TALENTED, SKILLED, COMMITTED, RESPONSIBLE, MOTIVATED FOR, AND GETTING, ADVANCED TRAINING AND EFFECTIVE.

  11. Anne Thompson PhD

    It is hard to believe that this self-serving inaccurate piece has been distributed again, unchanged. Shame on you!!!

    I wonder if you will ever actually review my previous comment.

  12. Dave

    One often overlooked option for people who have a job is to find out who your company’s Employee Assistance Provider (EAP) is and give them a call. This is a great (FREE!!) way of getting into a professional counselor’s office, having the issue assessed, and if more treatment is needed than the EAP can provide, a warm handoff is provided to the best possible practitioner for the issue at hand. Family members usually have access to EAP benefits as well. Most people don’t need ongoing psychotherapy to survive, and a couple tools learned from the EAP can help. And for those needing ongoing care, they know the best experts in your area that may have the best chance of helping you with your particular situation.

  13. Dan McGee, Ph.D.

    Surprised at the limited information on non-physician mental health providers by Dr. Stern, since they provide a massive percentage of psychotherapy in America. I’ve directed a graduate program in family psychology, served 17 years as CEO of a regional mental health organization and directed a statewide mental health provider network for over a decade, made up almost entirely of 150 marriage/family therapists, professional counselors, clinical social workers, psychologists and a few psychiatrists. My Ph.D. major was in marriage/family therapy, and my research & dissertation was on the use of CBT with stress-prone individuals. I’m board certified in a number of specialties with over 40 years of clinical practice.

    After decades of supervision of a variety of mental health providers in outpatient and inpatient settings I submit that Harvard publications could and should offer its readers a broader awareness of licensed and highly competent mental health providers. I was fortunate to receive 29 hours of continuing education (Advances in Behavioral Medicine) in psychology by Harvard-affiliated McLean Hospital in Boston where I found great appreciation and support of those of us providing research and non-medical mental health services, often in partnership with psychiatrists and other specialists in the practice of medicine. Dan McGee, Ph.D.

  14. Paula L

    I’ve had several primary care doctors over the years and not one has been able to refer to a psychiatrist because they know nothing about them. From my current PCP, got a list of names I check out. Many were psychologists instead, had a sub-specialty in forensic psychology, or just had terrible ratings. Turned out that these were names of people her patients recommended.

    No, we are on our own in parsing the difference between approaches & credentials.

    • Dr Janet s. Samuels

      You are always better going directly to the source. Call your state psychological association or state medical board for a referral. also calling a local hospital for a referral might be a good choice. Unfortunately, you are correct that many primary care physicians are poorly trained in this area and not only do not know to whom to refer, they also attempt to prescribe psychotropic meds without any real expertise. You might consider whether or not you wish to be on medication or see someone to do “talk therapy”. A licensed psychologist can work with you on your issues and if meds are needed should have a psychiatrist with whom they work.

  15. Annkatrine Gates

    To clarify: “therapists with a PhD or PsyD degree” are called Psychologists, and they do not just have “perhaps the most extensive training in talk therapy” – they do in fact.

    And clinical social workers “may have excellent training”? – And “may even offer some therapies (…) that psychiatrists generally have less experience with” ?

    This article seems to be a self promoting advertisement for Dr Stern, who of course is a psychiatrist. A shame because this is a well misunderstood topic and people are actually seeking clarification and support.

  16. Marie Blair, M.D.

    I am a family physician with 38 years of knowledge and experiences in human psychology, relationship difficulties and personality disorders. Mental health is the most important factor in our life. As the result to our childhood traumas and not receiving love and respect that we all we in order to grow up in a healthy fashion, mental diseases and addictions are epidemic in our country. I personally believe that in order to improve our mental health, patients need a great deal of knowledge, especially their own INNER WORLD. The first step to me is MEDITATION. I educate my patients how to meditate. This subject is my passion and there is a lot to talk about when we come to mental health. Dr. Marie Blair. Thank you.

  17. azure

    I want to live in this man’s world–a world where funds are unlimited, health insurance coverage of mental health care is broad and lavish. So you really really get to choose and if you don’t like one mental health care provider, you can try another, or another or another until you find the “right fit.”

    Well, I and many many others don’t in that world. Particularly, people living in rural areas don’t, nor do most people living in smaller cities or states w/low levels of public health funding. So how about discussing how to do as well as possible in the world that so many others do live in from time to time?

    • Terry Martin,PhD

      Your frustration is very understandable. A semi-solution that has come my way to distance, timely appointments and payment: Several counselors are now accepting insurances that allow for phone appointments. Several are extending to text and e-mail with limited visits for face to face. For those over 62 with Medicare, they are now accepting payment via Medicare and Medicaid including phone counsel. I agree with you, the writer seems to live in a world I have never even visited. However, there are those very fortunate people that have experienced what is suggested.
      My patients call, text, email, facetime and handwrite – we do work with patients on the sliding scale. Hope this helps in some way with needs.

    • diane kopan

      Thank you, Azure,

      I see it exactly the same way .

      So I got into politics to help voters know which candidates will be active for mental health/health if they get into office. I am not a politician, but I know EVERY VOTE FOR THE BEST/BETTER CANDIDATES COUNTS!

  18. pedro

    thanks

  19. Anne Thompson PhD

    This is not “information;'” this is simply a self-serving advertisement for psychiatry.

    He opposes “psychiatrists” to “therapists and counselors.”

    I was shocked to find myself described (briefly) as a “therapist” or “counselor”–when these are non licensed. I am a licensed clinical psychologist with a PhD. I do not have a “focus” in clinical psychology; I am a licensed clinical psychologist, an independent professional. Either the author doesn’t know the mental health field, or he is deliberately biased. This man’s blog is downright shameful.

    I ask the editors to withdraw this biased piece.

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