Psychotherapy 101: A Who's Who In Mental Health

Thinking about seeing a therapist but confused about all the different titles? Psychiatrist, psychologist, psychoanalyst, psychopharmacologist, psychotherapist -- what a perplexing preponderance of "p-words!" So, as Richard Nixon used to say, let me make things perfectly clear. (Admittedly, Richard Nixon was not the best person to turn to on issues of mental health -- or clarity.) Here is a (remarkably incomplete) guide to the world of the mental health:

Psychotherapist -- This is an umbrella term for any professional who is trained to treat people for their emotional problems. Depending upon their academic degree, a psychotherapist can be a psychiatrist, psychologist, or social worker (among others), and work with individuals, couples, groups, or families.

Psychiatrist -- This person has a medical degree and, unlike most psychotherapists (with the exception of nurse practitioners), they can prescribe psychotropic (psychiatric) medication. Many psychiatrists -- referred to as psychopharmacologists -- provide only prescriptions and medication management; you would need to see a psychotherapist additionally for talk therapy. Traditional psychiatrists continue to practice psychotherapy, however.

Psychologist -- This person has a PhD in psychology. In addition to performing talk therapy, they have training in psychological testing (i.e., the Rorschach test, among others). They can also perform research protocols. (Psychologists who concentrate on research generally work in academic or research settings.) Some psychologists who are trained specifically to do clinical work (rather than research) have "PsyD" (Psychology Doctorate) as their academic degree, rather than PhD.

Social Worker -- When people hear "social worker," they think of professionals who provide social services in hospitals and agencies. However, some LCSWs (Licensed Clinical Social Workers) also practice psychotherapy. Their education is somewhat similar to that of a psychologist (although they may have a master's degree rather than a doctorate), but they are usually more attuned to the individual in their environment, and they do not provide psychological testing.

Psychoanalyst -- After receiving a professional degree, some psychotherapists go on to get extensive special training in this in-depth therapy modality that helps people get to the root of their problems. Psychoanalysis, as first invented by Sigmund Freud, is the only method that works with the unconscious -- motivations and defense mechanisms that are out of our awareness, and therefore cause us to repeat harmful patterns. The couch, free association, dream analysis, and transference (originally defined as the patient transferring his or her feelings toward their parents onto the analyst), are all exclusive tenets of psychoanalysis. The unfortunate stereotype of the silent therapist who only wants to talk about people's childhoods (rather unfairly) comes out of this model.

Today, many psychoanalysts are drawn to more contemporary models that build on, but also diverge from, Freud's original thinking. These therapists -- sometimes known as "relational analysts" -- are more active in the treatment and interested in people's current-day problems and how they are influenced by past experience. We look at how people interact with others in ways that only reinforce existing fears and patterns, and we look to create new experiences and ways of seeing oneself, including within the therapeutic relationship. Contrary to the stereotype, psychoanalysts sometimes do give advice and opinions, but we also do much more than that.

Traditionally, psychoanalytic patients came to sessions at least three times a week and lay on the couch. Today, many people in psychoanalytic (or psychodynamic) psychotherapy attend only once or twice a week. The couch is optional; some relational analysts never use it at all. Psychoanalysis differs from other forms of psychotherapy (like cognitive-behavioral therapy) in that it is more comprehensive and emphasizes getting to the bottom of problems, rather than simply alleviating symptoms.