Going to a Social Worker for Psychological Issues

I have recently realized that I have likely been constantly battling depression for the past 3-ish years. To put it mildly, this realization has been very, very difficult. As a result, I’ve decided to at least consult with a professional. This decision was also very difficult, as I have problems asking for real-life help on anything, much less anything regarding the space between the front and back of my skull. But I digress. . .

I called my company’s mental health plan provider*, and they said that they only have one doctor in either the city I live in or the city I work in (the third and eighth largest in the state, respectively). That doctor is, however, a registered social worker, not a registered psychologist.

I can’t help but think that a social worker’s view of depression and its accompanying issues is going to be very different from a psychologist’s view of the same issues. However, I’ve never had a long-term relationship with a therapist or a psychologist, so I don’t know how relevant my view is. I worry that my plan might just want to send me to someone that can just talk to me, regardless of their credentials or area of expertise.

(Note: I am not disparaging social workers; I know a grand total of one social worker, and she works with disadvantaged chidren. I simply view their area of expertise as being more involved with the, ah, social aspects of life, whereas psychologists are more involved with the mental aspects of life. It’s more complex than this. I’m just not expressing it well).

I know that at least a few people on this board have had experiences with mental health professionals of all stripes. For those people–would a social worker be someone that you would see about depression? I know this is kind of a weird question for a message board, but I honestly don’t know who else to ask. Thanks!

First of all, good for you for going to talk with someone, especially if you haven’t done so before. Social work training focus and expertise vary widely, but a social worker who is clinically licensed has been trained to provide psychotherapy. You can ask what that person’s areas of specialty are, how many years s/he has been providing counseling services, and (if relevant) what relationships s/he has with prescribers. I would not hesitate to see a social worker with relevant training and experience. In fact, my own best therapy experience was with a social worker, and if I needed therapy again and were in that state, I wouldn’t hesitate to see her again, even though I am a psychologist.

Your other option is to pay out of pocket and see a provider who feels like a good fit for you, rather than the person contracted with your plan. I paid out of pocket (I had no insurance) and more than a decade later still consider it money well spent.

I am concerned that your plan has only one mental health provider to serve two cities. What do they do when that person is full and has no openings for new clients?

Best of luck!

Mental health professionals are all over the map and they tend to overlap to some degree. I am bipolar and it took me a while to sort out their roles in today’s managed care environment.

I will give you the extremely short overview but note that individual practitioners vary:

  1. Psychiatrists - the ones that can prescribe medicine. Certainly don’t discount this one for depression treatment in conjunction with the others. There are a lot of good meds out there now with few side effects with most people. They usually do only limited talk of half an hour or less and usually aren’t the best choice for just that.

  2. Psychologists - have some type of doctorate degree and they tend to have some type of theoretical focus. Honestly, have of the ones I have seen have had a theoretical focus of nodding for 50 minutes and I didn’t like that much. Others do things like cognitive therapy which is changing the way you think.

  3. Licensed social workers - these do mostly practical type therapy. If you want to discuss a relationship problem, these tend to be the best. They tend to give actual life advice as well which is surprisingly rare in the other two. I would say these are the best for the back and forth talk sessions.

I don’t know who the specific therapists are, but if I were you, I’d go to see one of them, and then you can decide if they’re helping you. My son and I have seen a variety of psychologists, social workers, nurse practioners (“clinical nurse specialist”), psychiatrists, etc. I don’t think it’s fair to generalize about an entire profession, but I think the more of a medical background they have, the more of an open mind they’ll have about the entire range of treatments available to you. That being said, all of the social workers my son has seen (they’re called “psychiatric social workers”) have been truly wonderful, understanding and helpful people.

If whatever therapist you see feels that medication might help you, a regular M.D. is allowed to prescribe it; and I’m sure there are regular M.D.s in your plan. While I would NOT exclusively go just to an M.D. for depression, I think the combination of a psychiatric social worker plus an M.D. (if needed) would be a good place to start.

(OK, I’ll allow myself one generalization – the psychologists we’ve seen bring to mind the saying “If all you have is a hammer, everything looks like a nail.” But that’s only true of the particular ones we’ve seen.)

I have seen a variety of psychiatrists, psychologists & social workers, depending on my health plan. IME, as long as they didn’t just get their license and/or have some years of practical experience, as long as you like them and/or their style, it doesn’t really matter. On the other hand, it doesn’t matter how many certificates and degrees they have on the wall if you can’t stand them or work with them. See what you can google up about the practitioners in question. Do they have a website, have they taught classes or written books or papers, have any special certifications or specialties? Any complaints against their license? Interview them on the phone before going to see them.

Be an informed consumer; it is the only way to get effective mental health care in this country. I’ve seen lists online of questions to ask your therapist during the interview. Regardless of the fact that they are the one and only in your health plan, YOU are hiring THEM to take care of the most sensitive and delicate part of your body - your mind. Does your employer offer an EAP plan? Depending on the plan, sometimes they will see you on an on-going basis for a reduced fee. There are also support groups out there for people with depression, through NAMI, for example, which are usually very low cost ($5) or free. Your local hospital may offer something similar. There are lots of resources out there, the hard part is finding them when you are depressed. Try the government pages in the phone book, your city or county may offer mental health services or have referrals to low cost services.

Whew! That’s a lot. All that said, if cost is not an issue, you may want to research therapists on your own and pay them out of pocket. Does your insurance offer any coverage at all for out of program service providers, say 50%?

Also, make sure it’s that you actually dislike them and their style, and not because they bring out some painful truths that you don’t want to accept. There was a therapist I had who would bring stuff like that out, and I absolutely hated it - hated her - until one day I realized that I was playing the “yeah, but…” card and denying everything because it brought out painful truths about me, ones I’d been ignoring for years.

That helped a lot. I was eventually diagnosed as bipolar rather than clinically depressed, which cleared up a LOT of my issues. But now I try to think like that therapist when someone does something that I find insulting; they might actually be bringing to light something that’s wrong with me. Or they might just be pricks, you never know.

That said, drug therapy can be interesting, but it was always my last resort. None of the meds worked right with me, so my doc prescribed me neurontin (still undergoing tests for treatment of bipolar disorder) to take WHEN I’m having an episode, as opposed to every day. Thank God.