How To Select a Mental Health Professional

January 20, 2017

As both a bariatric patient and a counselor, I am a big fan of behavioral interventions serving as a foundation for long-term weight loss surgery success.  And you may ask, why should we bariatric post-op folks see a mental health professional? It’s very normal that we have behavioral issues after major life changes—and it rarely gets more major than bariatric surgery!

Counseling and Obesity

We don’t need to navigate these without help.  Many of us also had other issues underlying our obesity.  Counselors can help with all of this by assisting us in managing our symptoms, teach coping skills, and provide social support among many other things.  While not everyone needs therapy, for many of us, counseling has gilded the lily of our weight loss, so to speak.  Obesity is often the symptom of another issue.

This is because our mental and physical health is a reciprocal relationship that often (though not always) gets overlooked or ignored, particularly by primary care providers.  Physical health doesn’t occur in a vacuum.  Additionally, many behavioral issues can masquerade as physical illness.

A good behavioral health provider not only provides therapy—they also give us much needed social support post-operatively, and this is definitely a vital component of weight loss success.

Despite this, figuring out what sort of care we need is often a huge obstacle, particularly in the American healthcare system.  Providers are often difficult to find, and they may have long waits for service.  We also may not know what kind of care we need or how to ask for help. Many times, smaller private bariatric programs aren’t necessarily clear in the direction their patients should go. The fact that there are several types of providers doesn’t help.  It can be confusing to distinguish which would be the most beneficial to see.  Your best bet is to start by asking your primary care doctor after explaining what’s going on.  They can give you some direction or suggestions.

Types of Mental Health Professionals

Who are the most common professionals you might run into?  These are the most common individuals that routinely administer care: psychiatrists, nurse practitioners, psychologists, social workers, and licensed counselors.  Psychiatrists, psychologists, counselors, and social workers all can conduct psychotherapy.  Psychiatrists and nurse practitioners (and, very rarely, psychologists) can prescribe medications.

PSYCHIATRISTS

So where the heck do we start? Let’s begin with the most well-known clinician: psychiatrists.  These are typically medical doctors (an M.D. or D.O).  Following their graduate education, they must sit for, and pass licensure.  Then they are required to complete special training in psychiatry known as a residency.  They may opt to take a board certification exam after this.  Psychiatrists are trained to diagnose and treat mental illness, and behavior disorders using medication management, psychotherapy, and occasionally other more atypical treatments such as ECT (electroconvulsive therapy), depending on the needs of each patient.  Typically, younger psychiatrists don't provide extensive psychotherapy.  Some may specialize in it, but many focus on medication and other medical treatments.  It is always my suggestion for my clients to have any psychiatric medication prescribed by a psychiatrist, even antidepressants because they are typically more educated regarding their uses and interactions than your usual primary care provider.

NURSE PRACTITIONERS

Nurse practitioners’ educations vary state to state, as do their prescribing rights.  At a minimum, they should have a master’s degree, if not a doctorate.  Many can independently prescribe, and they are a great alternative to psychiatrists, who often have very long waits for service.  Nurse practitioners are no less skilled, and they may, very rarely, conduct psychotherapy, as well.  I have greatly enjoyed working with the nurses I have met in the field.  They are frequently more knowledgeable than the average person may expect.

PSYCHOLOGISTS

Psychologists have five to seven years of graduate education.  After this, they typically must have a one-year year doing post-doctorate work, after which they can sit for licensure.  They have a doctorate, however, it is not a medical degree.  They can also diagnose mental illnesses, and can also conduct psychotherapy.  In some states, they also have very limited prescribing benefits.  However, what they are the most known for is that they perform psychological assessments.  Only psychologists typically perform IQ tests, assess for neurodevelopmental disorders (such as Autism or ADHD), and conduct extensive and complex assessments such as the MMPI.  They are the most common providers who conduct bariatric assessments, however, be aware that in many cases, any masters-level clinician can do them, as can psychiatrists. Psychologists receive quite a bit of training in this area.

COUNSELORS & SOCIAL WORKERS

Counselors and social workers can both perform psychotherapy and diagnose mental illness. There is one big distinction, counselors are regulated state to state, and social workers are regulated on a federal level.  They can both bill insurance, but currently, only social workers, psychologists, and psychiatrists can bill Medicare. Federal law has not yet caught up to allow licensed counselors to do so.  They can also conduct the bulk of psychological assessments, though typically not neuropsychological ones.  Instead of assessments, their focus is primarily on counseling and treating pathology with psychotherapy.

After sorting out which type of provider has the services you need, go to your appointment prepared.  This helps counteract nerves, and it also gives you a chance to reflect on what you are seeking help with.  I recommend clients bring a notebook with questions and observations.  Write down how you feel and why you want to seek out help.  Do you have mood swings?  Are you irritable?  Tired all the time?  Have chest pain?  Write it all down and let us know.  Don’t hesitate to take notes during, or after, the conversation with your provider.  This serves a few purposes - it helps you remember what issues were discussed, and it also helps to reinforce any therapeutic interventions.  While we do therapy together in the office, all the hard work happens after the session once you’re out the door.

Ask about their Training and Certifications

I’ve also noticed that people are reluctant to do is question their providers.  You absolutely have the right to ask a counselor about their credentials, training, and philosophy!  How we approach our craft can tell you a lot about our expectations and biases.

For example, I am an integrative clinician who is both pragmatic and goal-oriented, which I explain to my clients.  Not all counselors are like this, and I tailor or tone down my approach depending on each individual.  We also, as counselors, do not expect to be the best fit for every client, and that’s also okay.  Ask and inquire.

Just because we are licensed does not mean we take insurance.  Many providers are cash-only or only use out of network benefits.  Be sure to establish this first.

Questions to Ask a Mental Health Provider

• Do you take my insurance?
• If you don't take insurance, do you have a sliding scale series of payments?
• What is your personal philosophy?
• What is your experience with depression (or anxiety, binge eating, etc)?
• I have been feeling (sad, angry, afraid), and I’m really struggling with (eating, relationships, my family).  How would you approach this?
• If the provider is prescribing you medication: what are the side effects of this medication that I may experience?  Are they temporary or permanent?  How long does the medication take to work?
• How long will I be in therapy? (Be aware that complex problems may take longer, and require more therapy, to resolve.)
• Are you licensed in this state?  What license do you have?
• Do you have a graduate degree?  What is your degree in?
• Do you have any specialized training that you received after graduation?  If so, how long was the training and what was it for?
• Have you ever been in therapy yourself? (This may seem weird, however, I would never go to a counselor who has not been to therapy, or a marriage/couples counselor who has never had a long-term healthy relationship.  No clinician should be offended by this question.)

One final tip—even if a provider does not have specialized training, it does not exclude the possibility they can assist you.  Often it is the relationship between therapist and client that is therapeutic in and of itself.  It is worth exploring especially if you feel rapport after meeting your new clinician.

ABOUT THE AUTHOR Donna Lordi, MA, is a counselor in the state of Illinois. Donna graduated from Lewis University with a Master’s in Counseling Psychology, and she has additional certification in working with children and adolescents.  Donna is also a contributing author for the book Hooking Up: The Psychology of Sex and Dating by Dr. Katherine Helm, PhD. Read more articles from Donna!

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