So, let's say I think I am depressed. Should I seek out a psychiatrist, a psychologist, or a clinical social worker?
I sort of think psychiatrist is someone who treats personality disorders like schizophrenia, bipolar, borderline, etc. Almost always will involve use of medication as primary treatment.
Psychologist more for depression, anxiety, mood disorders. Not an MD so can't prescribe meds but often works with the patient's primary care physician if this is needed.
Clinical social worker for .... not sure? Interpersonal issues, behavior issues, anger management, etc.?
But no idea if that is even close to being on target.
Psychiatrists can prescribe medication (I think the "ch" are related - psychiatry and chemical?). They can do what I'd call "conversational therapy" but they're main job is dealing with medication.
Psychologists are usually more of a traditional conversational therapy - and there's different forms of that, CBT, DBT, etc.
Social workers - I'm not 100% sure but in my experience they're more of a "intermediary" - they diagnose and refer you to an appropriate therapy. That or they're more of a "general psychologist" say with a school. I don't think you really meet with them regularly. There's a huge shortage of Psychiatrists/Psychologists at least here in Michigan, and a becoming a social worker requires less schooling I believe.
(I've suffered from depression for years, I've met many doctors, social workers, etc. and currently see a Psychologist and Psychiatrist regularly)
You've got this somewhat wrong. It's true that many psychiatrists these days focus on med management rather than therapy, but until maybe 30 years ago psychiatrists were actually the only mental health professionals who were allowed to become psychoanalysts, the folks who more or less pioneered talk therapy.
Also CBT/DBT are not forms of psychodynamic therapy (which is what people usually think of when they think of talk therapy). That's why they're called "behavioral" therapies.
My answer is based on what I find true today and from my experience. I'm only 20 so that explains that part.
Not sure what you mean by "CBT is not a form of talk therapy". The first sentence according to the Mayo Clinic is "Cognitive behavioral therapy (CBT) is a common type of talk therapy (psychotherapy)." [0]. Are you confusing CBT with CBD?
I'm just using a phrase that the average joe understands (And is also used by the Mayo Clinic). We can agree to disagree if you want, but to be fair what I call it doesn't really matter, I'm but a young lowly programmer :)
It matters in the sense that the difference between a "list" and an "array" matters. I'm just trying to clarify the language so anyone who reads is on the same page. When most people think of talk therapy I think that they think of lying on a couch and not stuff like CBT but perhaps I'm wrong.
All three have talk therapy within their scope of practice, and "the talking cure" originated with 19th century German doctors. Until the middle of the 20th century it was exclusively the domain of MDs.
In modernity, insurance reimbursement policies incentivize psychiatrists to focus on medication management, but there are still many of the old guard (and cash-only practices that set their own rates) who will perform psychotherapy. Additionally, in certain states, Licensed Psychologists (PhDs and PsyDs) who have completed additional training in psychopharmacology are allowed to prescribed a limited set of psychotropic medications in collaboration with a fully licensed MD (not necessarily a psychiatrist). Also in the prescribing realm are PMHNPs, mid-level providers trained in the nursing model who focus on psychiatric care. As with psychiatrists, they tend to focus on medication management, but are able to provide talk therapy as well.
Psychologists (PhDs and PsyDs) are Doctoral level providers trained in research, talk therapy, and administering psychological assessments such as personality inventories, IQ tests, and capacity determinations for forensic purposes.
Licensed Clinical Social Workers, Counselors, and Marriage & Family Therapists are all Masters-level providers trained to provide talk therapy. There are different histories and underpinnings that have created these distinctions and is reflected somewhat in the specifics of their graduate studies, but it's largely irrelevant to you as a client; much like engineering, therapy is as much art as science, and most of the "real" training comes once you have graduated and begun working in the field.
The current trend in outcomes research indicate that the license and professional background is not a significant factor in the efficacy of psychotherapy. To quote Irvin Yalom, a giant in the field of talk therapy (and a psychiatrist by training), "it is the relationship that heals".
There’s a lot of overlap. The main difference is in what they’re allowed to do, but not in what they treat. As you identified, psychiatrists can prescribe medicine. Psychologists and psychiatrists can administer tests and make diagnoses, an LCSW can’t.
I would also note that bipolar is not a personality disorder, it is a mood disorder like depression.
The overlap in professions can illustrate a lot of what is wrong with this branch of medicine. If you see a psychologist they'll recommend more sessions, CBT, books etc. If you see a psychiatrist your're walking out with a prescription.
When you're a hammer, everything starts to look like nails.
Hm, this doesn’t even remotely match my personal experiences. In my experiences, they’ll refer you to each other as warranted but ask you for your preferences first. I’m sorry that you’ve had such a bad time. What happened for you?
This is mostly observation from myself and people I've known. Most of them, when referred to a psychologist, simply go through therapy sessions. Definitely if there are issues that are likely not treatable through talk therapy options they would be referred to a psychiatrist, but I've never seen someone walk out of a psychiatrists office without a prescription or a recommendation for one.
This year, I walked out of a psychiatrist's office without a prescription or recommendation for one. I went into the office:
1. With the specific goal of treating my condition with medication,
2. An ongoing condition which was diagnosed years ago,
3. I am already treating the condition with therapy, and have decided that therapy is not enough, a conclusion which others agree with,
4. The condition responds well to a variety of different medications, and is considered "very treatable",
5. The medications do not have much risk for abuse. We're not talking dexedrine or xanax, here. I couldn't sell these medications on the black market if I wanted to.
For sure there are plenty of psychiatrists and psychologists out there which aren't very good at their jobs, and I've heard plenty of horror stories. Fortunately, the people I know who have had bad experiences have switched doctors or switched therapists.
There is plenty of selection bias. For me, and the people I know, the purpose of visiting a psychiatrist in the first place is in order to evaluate medication. If you don't want to take medication, then you don't schedule an appointment with a psychiatrist, which is hard anyway (due to the psychiatrist shortage--it's difficult in at least the US and UK, to my knowledge). If you want therapy, you see a psychologist, LCSW, or someone else. And if you think that you need therapy, I don't find it unreasonable when the therapist agrees with you!
I don't mean to diminish the problems in the field of psychiatry, but by no means is the field on the level of alchemy or astrology.
And if you or anyone is trying to navigate the mental health system, I am more than willing to provide what little advice I have.
I think you should seek out someone whose priority is understanding your problems and helping you understand them. Practitioners from any of the groups you mentioned can take that approach but not all do. My opinion is that, all things being equal, a psychologist or psychiatrist with an analytic approach is the best general purpose choice.
I sort of think psychiatrist is someone who treats personality disorders like schizophrenia, bipolar, borderline, etc. Almost always will involve use of medication as primary treatment.
Psychologist more for depression, anxiety, mood disorders. Not an MD so can't prescribe meds but often works with the patient's primary care physician if this is needed.
Clinical social worker for .... not sure? Interpersonal issues, behavior issues, anger management, etc.?
But no idea if that is even close to being on target.