Psychiatric Services

Sigmund Freud is probably the first person to come to one's mind when getting into a discussion of Shrink type people!. Which is largely because Freud helped to found the modern concept of psychology...

Originally there were no medical services available for psychological matters. Regular physicians and nurses took care of the extremely incapacitated person with what we now term a "mental problem." Sometimes these were specialists in the brain and nervous system (called Neurologists, medical doctors who specialize in brain surgery and spinal injuries). Freud was a doctor much along these lines and he concluded that conditions such as hysteria (a term used at that time to identify someone who had a numbness in one of their limbs for which no nerve blockages or injury could be identified) might be caused by the workings of the mind (the psychology of the individual, which was a very new science at that time). He devised a treatment plan for these types of conditions and described the workings of the mind. Freud also advocated "lay therapy." The practice of his methods by people who were not medical doctors.

By and large, the methods and concepts of psychology as devised by Freud are no longer accepted by the profession or even in wide use (although one branch of the profession, called Transactional Analysis or TI, is based upon some of his primary concepts).

The modern concepts of psychotherapy were probably originated by Psychologist Carl Rogers in the 1930's and 1940's. At this point in time psychiatric service was a three step process. 1). A social worker would write up the case history with the patient through initial interviews. 2). A psychologist would give the patient of barrage of tests designed to measure perception and other factors. 3). A medical doctor (specializing in Neurological-Psychiatric medicine) would then administer the current thinking in treatment (which could include Freudian methods).

Carl Rogers was one of the professionals in the field who helped to change a lot of these concepts. He was not a medical doctor but a psychologist.

We first need to see the differences. A medical doctor goes to college for 3 to 4 years. Then to medical school for 3 to 4 years. Then they train in a hospital for an additional 1 to 5 years. A psychologist goes to a school for 6 to 8 years learning psychology and getting an advanced degree in the philosophy of this subject (Ph.D.) They are not licensed to practice medicine or to dispense drugs.

Well, psychologists working in psychiatric wards eventually felt they could do essentially what most Freudian types of medical doctors were doing as far as psychotherapy (listening and talking to the patient). Eventually psychologists started going into private practice. Carl Rogers was among this group of early non-medical practitioners.

Dr. Rogers felt the concept of calling a person a "patient" made them feel like they were ill or sick, which he didn't fully believe. He felt the "client" as he liked to call them, was only troubled. And it was the therapists job to help the client work themselves through these troubled times using any tools they could find to obtain the results.

From the work of Carl Rogers came the modern concept of the 50 or 60 minute session. And the concept of counseling, which is primarily what the psychologist does for the client. There was no stigma or red letter attached to this more modern concept of psychiatric services. Also the concepts of family (and group) sessions evolved from the primary work of Rogers and other professionals working between 1930 and today.

Starting in the 1960's Social Workers also began to provide psychiatric services. These practitioners generally don't have the advanced degree of the psychologist (and you don't, as a rule, call them doctors) but they do go through a similar college program for between 5 and 6 years, plus they are required to work under the supervision of a doctor for one or more years before they can go into private practice.

Today psychiatric work can be broken into four distinct categories.

1). The bodily impaired person. This would be someone with a physical brain dysfunction or injury. These people probably will not recover, but can often live at home under supervision.

2). Insane people. Those who have a non-physical mental incapacitation that defies current treatment. A lot of these people are institutionalized, but many can live at home under supervision.

3). Chemically unbalanced people. These are treated largely by medical doctors (psychiatrists) because drugs or chemicals are required to help them maintain balance. For the last 40 years or so it has been realized that some people, for one reason or another, have a chemical imbalance, which can be easily treated today (although there are critics of the treatments and often serious side effects to some of the drugs).

4). Emotionally distressed people. These are totally functional without supervision and can be seen by Social Workers, Psychologists, Psychiatrists or even a Pastoral Counselor. They respond well to the Carl Rogers type of psychotherapy. They are not physically or mentally sick, they simply have problems. Some problems are minor, some are major. Still they can function and work or go to school.

All psychologists and social workers are trained in all the major theories of psychiatric work. All of them have worked under supervision for at least one year after graduating from college. Each, however, embraces their own concepts (usually what was taught to them at the schools and clinics) of how to conduct therapy.

Social Workers who are certified by the Academy of Clinical Social Workers (A.C.S.W.) have met the highest standards of education and experience as determined by law. Psychiatrists who are Board Certified have completed at least 4 years of resident training in a hospital or clinic after receiving their license to practice medicine. It is illegal for anyone to hold themselves out as a psychiatric worker or to use any terms associated with the practice (such as psychotherapy and the word therapist) unless they are licensed (all states in the U.S. license all practitioners since around 1975).

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