My Child Needs to Talk to Someone

It’s probably the most common question I hear in my practice: What is the difference between you and a psychiatrist? Or a social worker? Or a counselor?

The short answer is: Don’t look at titles; look at the person’s training and experience and ask your pediatrician, family doctor, or friends for recommendations.

The truth is–all mental health professionals are about the same. The relationship between your child and the mental health provider makes the difference in therapy success. Studies on therapy effectiveness show that the quality of the therapy relationships is just as important to the outcome as the type of treatment used.

If you want to be precise about understanding the titles and the differences between mental health providers, here is a short explanation:

• Therapist or counselor. Most often, these are persons with an advanced degree in Social Work or Counseling (LCSW, LPC, or LMFT). They earned a master’s degree and knew how to provide psychotherapy to children. They spend significant time supervised by an experienced therapist and are often trained in multiple kinds of therapy for mild-to-moderate mental illness. For example, a counselor is often trained in managing children’s grief after losing a parent or helping a family through divorce. They are licensed by the state they are in.
• Psychologist. A person who earned a doctorate in Clinical or Counseling or School Psychology (Ph.D. or Psy.D.). Psychologists spend at least five years in doctoral programs learning to provide various clinical services to children and adults. They usually spend one to four years receiving advanced training in a particular mental health condition, and they have a certain specialization because of that training. Usually, psychologists specialize in moderate-to-severe mental health illnesses. For example, a psychologist is often highly experienced in treating panic disorder, PTSD, OCD, and depression. Psychologists can diagnose mental illness by either asking your child and you about the symptoms or by performing psychological testing. They are licensed by the state they are in.
• Neuropsychologist. A person who earned a doctorate in Clinical or Counseling or School Psychology (Ph.D.) but had training of at least three years and experience of even more years in testing and diagnosing children with learning or developmental disabilities. Most often, your insurance will cover the testing and diagnosis if your child has a medical condition, was born prematurely, or had a brain injury. You will need to pay out-of-pocket if none of the above applies. They are licensed by the state they are in, most often as psychologists, but the state usually verifies they have expertise in neuropsychology.
• Psychiatrist. A person who completed medical school as a physician and then obtained advanced training/residency/fellowship in Psychiatry (M.D.) Often, psychiatrists employ psychiatric nurse practitioners with advanced nursing degrees and training in psychiatry. Usually, psychiatrists specialize in moderate-to-severe mental illness. Psychologists can diagnose and treat mental illness with medications, psychotherapy, or both. They are licensed by the state they are in.

Ultimately, which professional you choose depends on what you hope to accomplish.

“I want to know the diagnosis for my child’s illness” – See a psychologist or a psychiatrist.

“I need to find out if my child has a serious learning problem; they had cancer”– See a neuropsychologist.

“My family is struggling to deal with divorce, moving to a new city, bullying”–See a counselor, family therapist, or psychologist.

“My child needs medication for severe depression”– See a psychiatrist.

“My child has severe social anxiety and can’t go to school”– See a psychologist or a psychiatrist.

My best advice to all parents about selecting a mental health provider is to allow your child to tell you whether they like the provider and whether they enjoy the relationship with this provider. If your child doesn't like someone, it doesn't matter how much the provider spent in training or what expertise they have.

To find a therapist, visit the Psychology Today Therapy Directory.