If you have a problem, whom should you contact for help? Should you go to a coach? A psychotherapist? A changeworker? A psychiatrist?
It’s certainly a controversial issue, complicated further by the various commercial interests each party has. Presumably, each group would prefer to have their own field as the major go-to area. As someone in the field, I’m not completely objective either, but I can at least try to give a balanced perspective. Still, a conflict-of-interest statement: I’m a psychologist (master’s degree — we don’t divide between MA and MS in Polish universities), coach and changeworker myself, and this might influence my perspective.
So, in general, you should go to see…
A psychiatrist — if you are already under psychiatric supervision and especially if you are taking psychiatric drugs. The laws might differ in your country, but, generally, psychiatrists are the ONLY ones who can not only prescribe but also actually legally advise you about drugs. If your coach or changeworker suggests that you take more or less medication, be very, very wary. If they don’t mention that you should discuss the issue with your psychiatrist, RUN.
As a standard practice, if you are already under psychiatric care and go to a different professional, TELL THEM about your psychiatric care. This is very significant information for such a person. In fact, it is a good idea to tell your psychiatrist you’re seeing someone else as well.
If you’re not already seeing a psychiatrist, when should you go to see one (or when should you send someone you care about)?
1) Certainly in cases of severe inability to cope, severe depression, suicidal tendencies, very erratic behavior, hallucinations, etc.
2) If you believe your problem might be organic in nature — for example, your life didn’t really change, but suddenly you have problems with insomnia. That might be a good reason to see a doctor.
However, you should NEVER try to self-diagnose based on Internet sources. When I was studying psychology at Warsaw University, we had the so-called second-year syndrome: during the first semester of second year we had classes in psychopathology outlining the various kinds psychological illnesses, and suddenly everyone discovered they had numerous signs of mental health problems. The signs were clearly there in the book.
Now, obviously, most of us weren’t unwell. It’s just that it’s incredibly easy to over-diagnose yourself based simply on a list of symptoms. Therefore, it’s really best to leave the diagnosis to the professionals.
A coach — if you’re looking to improve a skill that you have already developed. If you’re good at something and you want to be better at it, then either specific training or coaching will be useful. How to decide which you need?
If you know specifically what you need to improve and there is a training course or an individual trainer capable of helping you with the issue, go for training.
However, if either you have no access to a trainer or you aren’t certain what area of your skills you should develop, a coach will be more useful.
Generally, coaching is best used by people who are already skilled and have a lot of varied resources but who wish to be more effective or more flexible in using those resources. For such people, coaching can work wonders, letting them cross boundaries that seemed permanent and get extraordinary results. This is especially true for the classic, indirect, ask-and-don’t-suggest coaching. The people who will benefit the most from this kind of coaching are those who dedicate a lot of time to learning things but little time to trying to put a structure on what they know.
On the other hand, people who lack certain resources will find this kind of coaching absolutely useless and—often—immensely frustrating. For example, if you want to learn Japanese, you need suggestions for how to do it and specific resources to use while learning. You won’t be able to do it through being asked questions.
A Changeworker or a Psychotherapist?
There’s a thin line between the two, especially since the abundance of changework and psychotherapy approaches means that the two will tend to mix quite a bit. In general:
Psychotherapists will tend to have at least four years of specific education behind them (this is a GOOD thing), and in many countries are required to have professional supervision (basically therapy for them as therapists, so that they don’t go bonkers or start believing they’re god—again, very good). On the other hand, they will usually be somewhat stuck in their therapeutic modality, the way they approach your problems or goals. If your situation happens to match their modality, great; it’ll work out very well. On the other hand, if your situation doesn’t match their modality, they will still tend to try to push you into their chosen approach. While there are some eclectic therapists, there aren’t all that many of them, and their eclecticism tends to mean combining two or more of the classic therapeutic approaches.
Furthermore, few therapists will be up to date with current psychological and neurological developments, as pretty much all therapies were developed in the first three quarters of the 20th century, and there has been little attempt since to update their basic approaches and claims. This means that therapists might be missing out on some of the newer solutions to the issues they’re dealing with—and their clients will be missing out as well.
Psychotherapy will tend to have more scientific evidence for its efficiency, and, aside from the treatment for select and specific issues like anxiety, generally there is little difference in the effectiveness of different psychotherapeutic modalities. This is usually explained through a claim that it’s the “other therapeutic effects” that play the decisive role in effective therapy — effects such as contact with the therapist and attention paid to problems. Personally I would rather suggest that the different approaches work best for a specific subset of clients who structure and experience their problems in a way that is well suited to a given therapeutic modality. Since clients are fairly evenly distributed in society and choose their therapy at random, the effectiveness of all therapies appears to be similar.
Finally, work with a therapist will usually be more long-term then work with a changeworker. It’s usually best for multi-level change, reaching into different parts of your life.
As mentioned before, it’s a bit hard to say specifically when you should see a therapist, since different therapeutic modalities might be best suited to different issues and the time available for work, among other factors. However, I would suggest that psychotherapeutic work is best left for when you have more time to devote to it, often when you need week-by-week support. It is less suited for quick, intensive change, which is where changework excels.
Changework can be a bit of a gamble. Among changeworkers, you’ll find both the best and brightest minds proposing groundbreaking techniques, and the worst kind of quacks, frauds and nutcases. The general level of skill and professionalism here will be lower then in the case of psychotherapy, since changeworkers officially need far less training and are usually not asked to participate in any supervision (nor do most of them show any desire to participate in it on their own). However, it is also here where you will find the real masters of their fields, excellent professionals with a very high success rate combined with a relatively short time required to obtain results. While one-session cures are not the rule in any method, they are by far the most common in changework.
Changework is best suited for quick, intense work concentrated on fixing or developing specific issues. It’s great when you know what results you want, or what problem you want to get rid of, whereas therapy is better suited for more general “I’d like my life to improve” issues.
When choosing a changeworker, you should be the most careful, however, and pay the most attention in order to get the best possible service and not end up with an incompetent fraud.
So, as a short summary, go to see a:
Coach — when you’re good at something and want to become better at it, and have no training options available.
Changeworker — when you have a specific issue you want to solve quickly.
Psychotherapist — when you are interested in general life improvement and can allow it be more of a long-term process.
Psychiatrist – when your issues are very serious and make normal life impossible for you, or when you are already under psychiatric care; other solutions might still be viable, but your psychiatrist should be made aware you are using them.
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