Warning: serious alphabet soup ahead. A helpful guide.
People get confused about who does mental health care. (Or, as insurance companies call it, behavioral health care, because that encompasses not only what’s wrong with your brain and your childhood, but also your drinking problem and your marriage.) If you talk about a “therapist,” people think you mean anything from a 15-minute medication checkup to hours-long Freudian-style psychoanalysis.
The old stereotypes are that a psychiatrist sits behind the couch and says, “I see,” a nurse takes your temperature, and a social worker takes your children. More modern people think that psychiatrists prescribe your medication, psychologists do psychotherapy, and social workers shuffle papers or work with the homeless or something.
I wanted to see how true any of this was, so I decided to start with a listing of who insurance companies list as behavioral healthcare providers.
Methods: I got the list of behavioral health providers within twenty miles of me (this encompasses the greater Boston area) from my insurance website (Anthem/Blue Cross). I drew a list of 100 practitioners.
Limitations: I started with the Zs and drew 60 names before realizing they skewed Jewish, which might affect career choice, so I switched to names starting with T, which seemed to be more ethnically mixed. Also, Boston may be skewed in various ways because it has a lot hospitals and a high cost of living. And maybe providers who take Blue Cross are skewed in some way. Plus there are people practicing (not-yet-licensed folks under someone else’s supervision) who aren’t going to be listed officially.
social workers: 43
licensed mental health counselors: 3
licensed marriage and family therapists: 2
licensed clinical mental health counselors: 1
Within some of these fields, there are multiple types of license. The psychologists were PhDs (doctors of philosophy, presumably in psychology), PsyDs (doctors of psychiatry), and EDDs (doctors of education). The nurses were RNs (registered nurses) and NPs (nurse practitioners). Some of them can prescribe medication. All the social workers were LICSWs (licensed independent clinical social workers).
This is a measure of providers, not visits. A prescriber might see three or more patients in an hour for medication adjustment, while anyone doing psychotherapy is probably only seeing one client an hour. (Rumor has it there are still a few psychiatrists doing 50-minute psychotherapy sessions, but I’ve never met anyone who’s actually met these people.) So those 15 psychiatrists and 5 nurses might be seeing the same number of patients as the other 80% of non-prescribing practitioners.
While there certainly are social workers out there running domestic violence shelters, etc., it also seems that most psychotherapists are social workers. (I’ve heard that psychologists do a fair bit of administering tests, which might pay better than therapy.)
This is the result I was hoping to find, but I promise I would have published even if it hadn’t been.