Question: What is the difference between a Psychiatrist, a Psychologist, Mental Health Counsellor, Social Worker and Clinical Psychologist?
Answer: A psychiatrist is a medical doctor and they use the medical model and can prescribe drugs and primarily treat with drugs. Some psychiatrist may do some talk type therapy. However, it is not their primary form of treatment. Psychologists, mental health counsellors and social workers, regardless of their degree cannot prescribe medication. They will generally refer you to a psychiatrist for assessment if you need that.
The difference between a psychologist, mental health counsellor and/or clinical psychologist at the Master Degree Level has little difference to the client or person seeking help. A title really doesn’t tell you a lot about the person’s skills, qualification or level of education or continuing education. So long as the therapist has at least a Master's Degree they will be able to assist people with a wide range of mental health issues.
As a consumer, you need to look at the education level i.e. what degree attained and any continuing education or training the therapist has received along with hours of practice. Upon meeting the person you want to make sure that you feel comfortable with the person, this is probably the most important consideration.
Question: So is there any difference between a Master Degree Level Mental Health Counsellor, Psychologist or Social Worker?
At a master degree level, therapists all receive similar training on mental health, diagnosis, theory and treatment. We all receive the training on counselling theory and assessment. The biggest distinction may be on emphasis. Historically psychology was concerned with formal assessment, diagnosis and research. Mental Health Counselling is more applied use of the research done by psychologists and skills building. But all degrees can work with all mental health issues. It's really up to the individual degree holder or mental health worker to decide and specialize in their practice. Social work is more focused on the macro or social environment and getting resources and is more often in government agencies, but not always.
For Issues around addiction, trauma and attachment, a therapist will require more training than is usually covered in a base master’s degree. Though. in the United States and CACREP USA schools, they now mandate 3 graduate classes on addiction. Most therapist will continue to get additional training and certifications to work with people that have more complex backgrounds. Just ask the therapist you are looking to work with what is their training and experience.
Question: So is what a person calls themselves really important? Like a Psychologist with a Master Degree or a Mental Health Counsellor with a Master Degree?
The title really isn’t as important. More important than the title is the education level attained. For example, in the United States everyone that has a master’s degree in psychology, mental health counselling and social work, is called a counsellor. In fact it is a legally protected title. In the United States, there is licensing, where people are required to have a master’s degree, work supervised for 3000 hours and then pass a test to be called a counsellor. In Singapore and other countries they have not developed this rigor. So as a consumer of mental health services, look at the person’s base degree, hours of experiences, continuing education and whether or not they receive continuing supervision from a senior therapist (i.e. someone with 10 years or more experience) of supervision.
In the United States, a psychologist can only use that title if they have a PhD from an APA school. In Singapore and other countries this is not true.
In Singapore, because mental health is new and still developing people can call themselves anything regardless of the level of the degree. So someone may only have a bachelor degree in or a diploma in psychology may call him or herself a Psychologist. But obviously this isn’t the same as a person with a Master’s degree or PhD in Psychologist.
Question: What should I pick?
Well what you should pick is someone with a master’s degree at a minimum. The therapist should have demonstrated that they have continuing education and supervision so they are current and update on clinical knowledge of mental health and have a certification in at least one counselling theory.
After that it is more about how comfortable you feel with the therapist. The therapist and you will form a relationship. Research consistently shows that above everything, it’s how comfortable and well the therapist and client (or couple) work together.
Question: I’ve heard about the medical model approach vs. the holistic or wellness model. What is the difference, and who does what?
Answer: Psychiatry is trained in the medical model whereas the mental health counselling professional are trained in the wellness or holistic model.
The medical model focuses solely on the malady and complaint/problems. They often treat symptoms without looking at other aspects of client’s life or links from environment or relationships that may contribute to the problem. They use drugs to get rid of the complaint or problem, so they’ll give you Prozac or something for anxiety, for example. Psychiatry often is focused on more much more serious and permanent mental health issues like schizophrenia, border line personality disorder, bi-polar disorder and so on.
The mental health counselling is focused on Holistic health (or holistic medicine) and is a diverse field in which the "whole person" is focused on, not just the malady itself.
So what does that look like in practice? When you see a psychiatrist, the appointment is generally 15 to 20 minutes and focused on what is wrong, symptoms and problems and medical history and allergy to drugs. They make a diagnosis and give you drugs to try for a few weeks and then come back. Now not every psychiatrist is like this but this is generally what happens.
If you see a mental health counsellor for same issue, the appointment is 50 minutes and we do a comprehensive evaluation. While we want to understand your problem, we also will do a 360 look at your entire bio-psycho-social context. Often the problem you have is just a symptom to something else and not the real problem. We need to understand what is going on in your life, your relationship and how you think and solve problems and approach life. We will look at how perhaps financial issues, or relationship issues or work issues may be contributing to what you are feeling. By looking at the big BIG picture we may see the issue different and give you new tools that will reduce the problem .
So it is a very different approach. Research also shows that drugs alone do not work for long term. After the body habituates, the drug doses need to be changed and altered. If you do not address the underlying issues that the drugs are being prescribed for you do not get better. Often there are thinking and behavior issues that the client needs to address. Drugs alone allow the person to tolerate their
Question: Aren’t all counsellors just the same, can’t I just pick anyone?
Answer: The short answer is no, we are not all the same. Ideally when picking a mental health counsellor or therapist, you want someone with a Master’s degree. Not all master degree programs are the same, but a master’s degree is a good point.
Next another differentiation is the theoretical orientation, clinical supervision and continuing education that therapist has receive. A professional and competent therapist will be anchored and formally trained in a theoretical orientation, this helps them to guide and run the session. Theory is the technology of counselling of counselling that helps the therapist asses and decide what interventions to use and how to proceed.
Also important is the focus and areas of training. Someone with just a master’s degree and no other training will not be as complete of therapist. Counselling or psychotherapy (both the same thing just different name) needs a professional that can assess for a wide variety of areas. The more training the professional the better equipped they are to see and handle a client’s needs. Given all the research continuing to come out, it is important your therapist have a lot of training.
Last each therapist, given their training and theory will focus on different aspects. Mental health is a broad category and all master degree level therapist will be able to help a client with the broad categories of depression, anxiety and anger. However, not all therapists can work with trauma, attachment couples, or sexual issues or relationship issues or addiction. Often, over time a therapist will start to specialize or focus on an area they prefer and develop deeper skills in such addiction or sexuality or relationships. So it’s important to find out, but generally a master degree level therapist can help you with a wide variety of mental health skills.