So we have different kinds are professionals
and I'll just put those all three up there. You should be able to distinguish
between those three
on your... those three categories on your test.
A lot of people, I find, don't know what their therapist is. For example, they say I got a therapist
or I got a counselor.
And you say, OK, what's their degree? And they're like, well I don't know.
They're just my therapist, right? What's their license?
"I don't know." Or they'll say to me, "Well you're my psychiatrist, right?"
And I'll say, "Well, no, actually, I'm not your psychiatrist, I'm a licensed, clinical
psychologist."
Now, from a lay person's point of view, that may not really matter.
What really matters is that the person is trained and that they are licensed
credentialed.
For protecting the public we should have minimal standards of competence in any
health care profession, including mental health care, and we do.
But we have people across the gamut trying to help people out.
Paraprofessionals have no formalized training. They might have a bachelor's degree.
For example, I had a bachelor's degree and I worked at a runaway youth shelter.
Runaway and homeless youth in Charlotte.
And I helped kids, but I was not a licensed,
clinical anything. I wasn't a masters level therapist and I certainly wasn't a doctoral
level therapist
and I wasn't allowed to call myself a counselor. They called us, originally, part
time relief counselors, but then
they changed that designation because, technically, we weren't.
We were people who cared and we were people trying to help people, but we did not
have advanced training
and could not call ourselves counselors. Much less, psychologists.
You can't do that. So, paraprofessionals have no formal training
in mental health care, right? They may have an interest
in mental health care. They may have some, you know,
initial education, but no formal training.
And that's important. Because when you move to different levels of
responsibility in the mental health care system,
it's not that somebody with a bachelor's degree, or even without any
education at all, couldn't be helpful to another human being, clearly they can be,
but when you are engaging services, paying for services,
to get a return on that investment where you should expect improvement in
your life,
you need to make sure that people have the requisite qualifications to deliver
those services.
So paraprofessionals are part of the mental healthcare paradigm,
but they don't have formal training in mental health care at
advanced levels. Psychiatrists are medical doctors.
They are M.D.'s or, theoretically, D.O.'s at this point.
So, a psychiatrist has a medical degree, but
you know there's all kinds of physicians, right? There's family medicine.
There's pediatricians and obstetricians. There's surgeons,
internists and on and on and on and all kinds of especially areas.
Well they're all medical doctors, but what they do is after they get their
medical degree,
they then specialize by getting additional training in some sub-area
of medicine.
So, for the psychiatrist, you have a medical doctor who now is specialized in
the treatment of mental
health issues. They are very likely
to perform.. excuse me... they are very likely to
prescribe medication, but very unlikely to perform
traditional talk therapy, which is kind of ironic because
it was medical doctors who developed therapy to begin with,
right? Early on you saw most of the
therapists were medical doctors. It was only after World War II
and we had this huge influx of veterans who had things that they called
"shell-shocked" back then, which we now
recognize to be PTSD and
they were overwhelmed so they reluctantly allowed doctoral level
psychologist to also
perform talk therapy, but then we talked about the onset of thorazine
and the pharmacological revolution that came along with that
and only medical doctors can prescribe medications.
I'm a psychologist, a doctoral level psychologist,
but in the Sate of Tennessee I cannot prescribe medications, right?
I can't take people off medications or put them on medications. Only in rare
exceptions. There are
a couple of states that allow for psychologists who get
extensive, additional training beyond their doctorate
to prescribe a very specific subset
of medications for treating mental health issues.
So, there's a difference. You look at psychiatrists. They're medical doctors
because what they deal with is not usually your run-of-the-mill depression,
which might very well be treated by a family
physician. For example, they
usually deal with really complex and severe
mental health issues where multiple medications may be indicated
and that takes expertise to manage.
Any physician could prescribe for depression like an SSRI or something
like that
or for anxiety, an anxiolytic agent or something like that,
but the more complicated the case is, the less
comfortable they will be prescribing medications and they might refer somebody
with really complex or severe issues
to a psychiatrist for complex medication management.
(A paraprofessional, would that be like a mental health tech?)
Yeah, it could be a mental health tech, so for example, I had a bachelor's degree
and I was working at the youth shelter,
so I was helping people out. I was getting paid to help people out.
But I couldn't call myself certain things because it it denoted that I did not have
advanced training.
Very similar to that, I was a mental health tech at a place in Charlotte,
which was a
partial hospitalization program, so I work 40 hours a week
helping people out who had severe mental illnesses, but I couldn't conduct therapy
in the group, for example.
But the group therapists were all at least Master's level trained and licensed
professionals and that's the difference.
Yes, good clarification. Further,
there's other types of mental health workers besides psychiatrists
and psychologists. There are,
for example, licensed professional counselors. You can get a degree here at
ETSU to become a licensed professional counselor with a master's degree
and go and do therapy. You then have to become licensed,
right?, in addition to your training, which has additional requirements and you
have to be insured,
as do all the professionals in the healthcare provision. There's also
licensed, clinical social workers, for example. Then there are some specialties
inside of medicine where you might have somebody who's the physician's assistant or you
might have somebody that is a
nurse practitioner or
a psychiatric nurse. People who have medical training of different types and
then specialize in the care
of mental health issues. So, those are all possibilities.
If you're going to seek professional help there's some guidelines.
Identify the professionals credentials.
You look at the research and master's level practitioners
and doctoral level practitioners have roughly equal outcomes.
So, they both help a lot.
And you might go, "Well why would I go on to a doctorate if I can be equally as effective?" Well a doctorate
comes with additional kinds of training, for example, I'm a research scientist,
in addition to being a therapist. That takes additional training.
So, there's different levels of training for different outcome purposes,
but
the provision of therapy by a competent, licensed professional
seems to be roughly equivalent across different kinds of training. If you think about it,
somebody who gets their master's degree in,
say, two or three years then goes in practice for the next two or three years
that I am in school. I'm getting additional training, but they're getting
full-time practice in mental health care
supervised by other professionals. So they're getting
practical experience while I'm getting additional training and
the outcome is roughly equivalent. But, you need to know
that the people are qualified, so you should seek to know what their
qualifications are.
If they're an L.P.C., if they're L.C.S.W., if
they're a Ph.D, if they're Ed.D, if they're an M.D., those things matter because you want
to make sure you're getting
your health care from somebody who is qualified to deliver it. Give therapy time to
work and sincere effort. Some people get dragged kicking and screaming to therapy.
It ain't gonna work. You know, if you don't want to be there
and you don't think there's anything to be gained by being there,
it doesn't matter how much time you sit there listening to somebody,
you're not going do the required work on yourself
to see improvement. You have to give it time
and you have to give it effort. If you do give it time
and sincere effort, you should see change. And if you don't see change there's
something going on and you need to check into that.
You might want to see about switching providers
if you're not getting outcomes that are beneficial because
psychologists not only have the "do no harm model", in our ethics code,
actually have to be beneficial. We can't just take people's
money and see them week after week after week and
have no demonstrable, positive effect on their life.
That's unethical. So, you should be getting better over time.
It's no guarantee that you're going to get better quickly, but we do have evidence
that if you take this route,
the gains are more durable. You're less likely to have relapse and more likely
to be able to pull yourself
out of declines in mental health quicker
on your own. And then be a thoughtful, careful consumer. If it doesn't work,
don't give up on it, right? Use my plumbing analogy, right? If you got a bad plumber
you don't say, "Man plumbing's bullshit, man."
You get another plumber, right?
If you get a bad therapy experience don't go, "Therapy's a bunch of bullshit, man."
Get another therapist and try it again and if that one doesn't work,
do what happens when you get the next plumber that doesn't work. You get another one, right?
If you have serious issues in your life, this can be really helpful, but you have
to
engage it. And you're up against barriers. Paying for it ain't easy.
And some people, "Man, I don't have time to go to these things,
these therapy appointments" or "I don't have money for them."
But then they might be on medication for years and years and years
that they may not need to be on, but they're paying for. If they had
put in the time on the front end, whoever knows how many sessions that might be,
it would be varied
by the individual, but if you put in
eight to ten hours of therapy by going to eight or ten sessions
and that could give you a positive outcome for years and years to come.
Those eight or ten hours will be well invested, right?, but
paying for it counts. {Text, text, text, ya'll, if I can here you up here, that's way too loud.
Text. Don't talk.} Managed care means that you have to
pay through a system. Now we're seeing
the Obamacare, which is not actually called that.
It's the Affordable Care Act, right? And it's actually a longer name than that.
It's a response to the fact that our health care system
is pretty messed up in a lot of ways. Is it gonna fix it?
Hell no. Is it gonna make us look at it more frequently and try to get better
and better?
That, it will do or we hope it will do that. It's been changing for years.
When managed care came on the scene, it was just as big an uproar
back in the 80s. When they talked about managed care, "That's
not going to allow me my choice of doctors and it's not allowing my choice of
types of therapies or treatments or whatever. There were implications to that.
There's always going to be implications of that because
services cost money. People providing them, they're getting extensive training
to do them
and they have to get a living out of it.
Now some people make a lot of money and some people don't make a lot of money providing
health care.
There's no simple solution and don't let people
convince you that there is and you can argue you from this side to that side.
I don't have the answer and guess what neither does anybody else
right now. What we got is a mess and if people will take the time
to realize that instead of yelling at each other and try to fix the mess, we'd be
better off, as a result.
One thing we definitely know is that it impacts your ability to get care.
Some people can afford very high quality care and that's fine
and that's good for them. Other people cannot even access
any care in the mental health field because it's not
available. Rural Mental Health Care is a problem in our country
because people who need access to good quality mental health care oftentimes
cannot find it within dozens, if not
tens, of miles beyond their house,
Tens meaning up to 100 miles away, perhaps. That you would have to drive
to get an appointment with the psychiatrist or psychologist
or licensed clinical social worker because they're just not available.
And if they are available, it doesn't mean you can afford it.
So, we have all of these options, but who's
advertising for these? I am, right here in this class to y'all
because it's part of this course, but what you see on TV is not that, 'hey there's a
lot of great talk therapies you can engage in
to try to make your life a better thing for yourself.' They just don't have those
very often.
There are pharmaceutical companies that do manufacture drugs
that do help with these kinds of issues, but those are the only
options that you'll see on TV because they are for-profit businesses
and their goal is, quite
logically, to make money. They invest millions and millions of dollars in
research and development
and then they invest millions and millions of dollars in advertisement to
help connect
their product to a consumer. These products,
you have to go looking for and these products, as they said, have
no risk of side effects and are shown to have a lower incidence of relapse
and are on average just as effective as medications.
So, in that sense, what we would look at from
our perspective as psychologists, as mental health care
options, we would certainly include medications in those options.
We wouldn't throw them out, but we would also include
augmentation of those medications at a minimum
with some kind of talk therapy, which, put together,
research shows, gives you the best possible outcome, at least with
issues of depression. Those are just the kinds of
professionals you might see. Clinical psychologist, psychiatrist, counselor,
psychologist,
school psychologists, social workers, psychiatric nurse, occupational therapist,
pastoral counselor. Some
preachers, some pastors actually get,
they get professional training, so counseling is kind of a part of being a
pastor, being
a leader of a church. People who have issues come there
and they seek guidance and they want it in the context of
religion or spirituality, which is perfectly legitimate.
But there's other things that would be helpful to know if your a provider of
any kind a mental health care.
And that's what you wanna do, is have people who are trained in it. It's not
that people can't be helpful if they're untrained.
It's just that if you have serious issues, you should seek someone with
training and oftentimes you can find them.
You can have a Ph.D or a doctor of divinity, but you would also have a training in
psychology.
And there are several doctoral programs in psychology that have Christian
foci
here in America. So, those are all possibilities
and when you see the amount of people doing this kind of work,
it's pretty interesting that nobody on the street seems to be able to
differentiate between these types of psychology or
mental health care.