On December 2, 2012, I spoke at a parenting conference to a pretty good-sized audience given that it was only a month after Hurricane Sandy devastated the area.
After the panel of therapists was finished with small breakout sessions, a sampling of them met for a Q & A from the audience. I was one of them. The audience had some good questions. I was more interested in hearing how my fellow therapists were answering those questions than in giving my own answers. However, a question arose to which I could not resist responding.
The questioner wanted to know how to decide which type of psychotherapy approach to use in therapy for his child. I explained that family therapy, as opposed to psychology, operates on the principle that people are not sick and don’t have “diseases.” Therefore, taking his child to a family therapist would have the advantage of not placing a stigma on the child or the family. Furthermore, I was ready to add that he and his wife would be given effective tools to use with their child.
No sooner had the first words left my mouth then the moderator, a psychiatrist, cut me off. Standing at the podium and speaking with passion, he told the story of a person who went to family therapy without success because that person had an undiagnosed medical condition. “So,” he concluded, “it is better to go to a psychologist or medical professional.”
Until that moment, I had no idea that other psychotherapists felt threatened by family therapists. Talk about a learning experience! It now seems to me that giving readers a clear understanding of what family therapists do – and what the pros and cons are of using them – would be helpful.
It’s Healthy to Figure Out How to Bridge Our Differences
Before I do that, however, I can’t escape noticing the irony in my experience. Therapists of all stripes have the mandate to facilitate emotional healing in people. That is the very meaning of the word “therapy.” When people can utilize their differences to achieve a common purpose they will be happier.
So, for example, in a marriage, there are two people with different views, perhaps different values, and certainly different personality styles. They might even have several goals that are not in alignment: One may want to live in New York and the other, in L.A., for instance. But for sure they can agree that they want to get along. They most likely can agree that they want the best for their children, too. These over-arching goals are their “common purpose.”
If Sam is a slow, careful thinker who plans out everything down to every “i” being dotted and every “t” being crossed and Sally is a bit more impromptu in her style, but they can capitalize on these differences to map out their parenting, they will be happy and so will their children. They could agree, for example, that Sam will do homework with the children at a set time daily but that Sally is in charge of creative projects and fun outings.
In the same way, therapists themselves will serve their clients best when they can draw on their own differences in a harmonious way. One element of harmony between therapy professions would be to acknowledge the limits of one’s own approach and the value of their colleagues’ approach at times. No one profession can serve everyone.
With that said, let’s explore those differences.
There are Five Kinds of Therapists
There are five kinds of therapist: psychiatrist, psychologist, counselor, social worker, and marriage & family therapist. Each is a distinct profession with its own educational programs, degrees, and license as well as philosophy.
- Psychiatrists are medical doctors. As such, they use their diagnostic skills to determine what is wrong with a person and to write a prescription if necessary to address the problem. Doctors generally don’t do therapy.
- Psychologists are highly educated therapists; their education goes beyond a Master’s Degree to either a Ph.D or a Psy.D. Both are doctorates but the Psy.D. does not require a dissertation. A dissertation is a piece of original research in a completely new area and may involve several years of work. Both the Ph.D. and the Psy.D. require extensive clinical work as well. The field of psychology grew from two branches. The clinical branch arose from the work of Sigmund Freud and others. The focus was the individual, and what would be wrong with that individual.
The other branch originated during the first World War with the need to predetermine which soldiers might not do well emotionally in battle. Psychologists got to work creating individual tests to try to ferret out this possibility. To this day, psychologists are the experts at testing.
- Counselors have a similar outlook and philosophy to clinical psychologists but their education generally stops at the Master’s Degree level. They don’t do psychological testing. They often work in school systems although they may work in private practice and other venues.
- Social workers, like psychologists, focus on the individual but also on the organizational context in which the individual might find himself. They therefore learn about larger systems such as hospitals, schools, and other institutions. Generally, their education stops at a Master’s level.
Every one of these professions grew out of the medical model and therefore they look at the “disorders” that people may have. Their treatment, when done right, is kind, compassionate, intelligent, and based on various theories about how people tick and what the best approach to help them might be. In some of their programs, they may take one or two courses in working with couples and families.
Marriage & Family Therapy: A Distinct Profession
Family therapy grew, interestingly enough, out of anthropology, the study of social cultures. The founders of the field felt that the more information a therapist has about the context in which the members of a family exist, the better. For this reason, one therapist will often see different members of the same family. This is a no-no for psychologists but considered very helpful for family therapists.
Family therapists provide in-depth approaches to personal distress of individual family members while being systemic when the family assembles for sessions together. Thus family therapists facilitate individual healing of family members as well as healing for the relationships between them; they juggle several balls, always keeping their eye on on not dropping any of them. Marriage & family therapists may work at a Masters or a Doctoral level. The latter would either be a Ph.D. or D.M.F.T, highly educated levels, just as for psychologists.
Getting back to the concern raised by the moderator at the conference, a competent family therapist should have referred the client to a doctor to rule out a medical condition if the client was not responding as expected to talk therapy. That is not only common sense, it is doing ethical work. By the same token, a rush to prescribe medication when research shows that talk therapy will often be more effective is as much a mistake as not sending someone for a medical evaluation when it is needed. Both therapists should be open to the possibility that the person in front of him needs something a different therapist can offer better than he can.
People searching for help should check out the education, degrees, and licenses that their prospective therapist has. They should not be afraid to raise good questions on the phone in advance of setting an appointment. Just as we try on a dress or test drive a car, therapy consumers have a right to know what the methods and guiding principles are of the person who will be helping them. The questions they ask should help them decide if the person to whom they are speaking is wise, mature, and open as well; the personal qualities of a therapist are just as important as his or her credentials.