(55) Anxiety
Dealing with Panic Attacks & Anxiety
What is the difference between a psychiatrist and a psychologist, between a social worker and a nurse? Whom should I see?
Mental health professionals have varying degrees of training, but with so many avenues open to become a therapist and with so many people claiming to be therapists, it makes sense to understand these differences and to get the treatment that is right for you. A psychiatrist is a physician, meaning that he or she is a medical doctor (MD), went to medical school, and can both prescribe medication and understand the interaction of your medicine with other health problems and/or medications you may be taking. A psychiatrist might also practice psychotherapy, though many insurance plans today only cover a psychiatrist if the patient needs to be on medication. Feel free to ask your psychiatrist what kinds of therapy he or she practices. If you do need to be on a medication, working with a psychiatrist who also does skilled psychotherapy makes life a lot simpler because you can receive the medication and the therapy under one roof. A psychiatrist can also be a doctor of osteopathy (D.O.), which includes slightly different medical training.
A psychologist has graduate training in clinical psychology (if she sees patients)-either a master’s degree or PhD degree. Psychologists have extensive training in brain science, models of the mind, psychiatric diagnosis, psychologic diagnosis, learning theory and disorders, psychological and/or neuropsychiatric testing, and often excellent clinical training. Their practice is usually limited to diagnosis, therapy, and psychological testing; feel free to ask what kinds of therapy they practice. A social worker practices therapy with a master’s degree or a PhD in social work. His or her clinical training provides a relatively faster entry to clinical practice, but many have done further sub specialization in certain types of therapy and can administer these therapies as well as anyone. With so many types of training, it becomes less about one’s degree as about the intelligence and experience of the practitioner.
A psychiatric nurse can fall into different categories: registered nurse (RN), licensed practical nurse (LPN), or nurse practitioner (MNS). The exact training of your therapist is important, and you should feel free to ask about his or her credentials. Perhaps more important than the credentials per se is his or her experience in treating your type of anxiety. One of the most important factors is your feeling in the room with this person. Your comfort as the patient and your sense of this person’s ability to help you are critical factors in choosing a therapist. If there is some question as to whether you feel taken seriously or as to the appropriateness of fit with your therapist, do not hesitate to ask for a second opinion. If there is any question about your diagnosis, find a reputable psychiatrist who can figure out the subtle intricacies of your condition and make a proper diagnosis.
Remember that your mind is a part of your body, and therapists get in trouble diagnosing anxiety but forgetting that a medical condition might complicate or explain a patient’s mental distress. A psychiatrist can also discuss the use of medication with you to assess the risks versus benefits of a trial period. Practitioners who have trained as psychoanalysts specialize in longer-term psychodynamic treatments, so feel free to ask about this sub specialization if you intend to engage in a longer-term treatment. Psychiatrists, psychologists, and social workers can also specialize in cognitive or behavioral therapies and should be willing to discuss these treatments with you.
Selma’s comments:
These options can be helpful in different ways, but your decision would be easier if you seriously considered your goals. Our family practice physician referred me to a psychoanalyst for treatment of my depression and anxiety. I was young and a senior in high school; this provider did not practice in the town where I lived, so there were many logistical problems. Through the remainder of high school, I went to him twice a week, and sometimes four times a week if things were difficult. After I graduated I moved to his town and went two or three times a week for the next few years. This treatment was psychotherapy by a psychiatrist/psychoanalyst, which is vastly different from psychotherapy with a caretaker who does not have psychoanalytic training.
Often I felt his comments and viewpoints were not relevant and made no practical sense. I accused him of thinking only like an analyst, when it seemed to me that a nonanalytic point of view would make more sense. His answer was, “How else would you expect me to think?” I would leave annoyed and angry, but at the same time, I couldn’t get his comments out of my mind. The more I thought about his inane comments, the more a new way of looking at something—previously not even in my realm of already introspective thinking—opened up. I could then never go back to a past view, which became more superficial or irrelevant. I was amazed, at not only how his thoughts fit my dilemmas, but also how they incorporated me. I felt deeply understood in a way that I could not even articulate. There it was, not only a much-appreciated protection ofmyself, but also recognition of who I was. I saw that I had hidden myself from my own world and from myself. In those two years, I married, had a child, and moved away from that city. But then I knew that what I wanted in my life was to have a complete analysis, however long it took and at whatever cost. It became my top priority. I was less concerned that my theater be a psychiatrist, psychologist, social worker, or counselor, however intelligent and understanding, than that he or she be a psychoanalyst. I knew the others couldn’t provide me with the search I needed to do and would only lead to time- and money-wasting detours. My depressions had much eased and I was living a constructive, good life. But I knew my propensity for self-destructive behavior. I also knew that many of my problems were generational in nature, and I was determined that my children would have different responses and experiences than I had as a child. I was resolute that certain disastrous relationship patterns from my family of origin would end with my new family. I wanted not only to live a better life than my parents had, but to pass that wish on as well to my own children for their adult experiences. That was my rationalization for the time commitment and the expense. When I started analysis again, I had four children. I cannot describe the meaning of my analysis to my husband and to my children nor how it changed the structure of their experiences. Of course, my children can never know; their growing up years in no way paralleled my own because of my treatment. What remained true to both of these analysts was their comments and observations remaining so original to me and so different from anything I would have thought of myself. Once I could get over my anger or amazement, these comments brought an insight and awareness, that, once grasped, I could never forget. I developed in myself a feeling of having not only better choices but also a sense of having choices when I previously thought I had none. I became more constructive, creative, and happier when my anxiety lifted. For me, the only choice was treatment with a psychoanalyst.
Terms:
MD - Medical doctor. The degree that all physicians attain after successfully completing four years of medical school.
D.O. - Doctor of Osteopathy. The degree that physicians who study osteopathy, or a system of medicine that studies the effects of the muscular-skeletal system on the rest of the body, obtain after four years of medical school.
RN - Registered nurse. A nurse who has 2-4 years of education and training and is responsible for basic and advanced nursing care.
LPN - Licensed practical nurse. A basic-level nurse who has at least one year of training and has passed a state administered licensing exam.
