How do I choose a mental health professional for my child?

Parents and young people often tell me that they are confused by the different professionals that offer treatment for mental health problems. How can they sound so similar but the availability and costs be so different? This confusion isn’t helped by the fact that many terms, such as “therapy” and “counselling”, are not specific to any single profession, and that clinicians themselves are often quite bad at explaining what we do compared to others! As they progress in their careers, many professionals undertake further training, and this leads them to broaden their skillset in ways that naturally overlap with others, further blurring the distinctions. So how on earth do you decide on the type of help you need when supporting a child who is struggling with their mental health?

Below I’ll take a look at four of the most common training backgrounds you’ll come across and try to tease apart the differences between them.

What is a clinical psychologist?

I’ll begin with my own profession before wading into the hot water of trying to define others!

Clinical psychologists have a doctoral (level 8) qualification in the treatment of mental distress. All clinical psychologists have an undergraduate degree as well as three further years of full-time training, following two years of relevant experience. This means that the minimum time it takes to become a clinical psychologist is eight years after leaving school, though, as the training is highly competitive, in reality people often gain many more years of experience in NHS services as assistant psychologists before gaining a place on the doctorate, or even complete a master’s degree in the meantime.

The doctoral training incorporates teaching, varied placement experience within the NHS, and original research of publishable quality. It includes a practical knowledge of at least two psychological therapies, though many experienced clinical psychologists have a multitude of therapies in their toolbox and are able to integrate these dynamically in order to best serve the needs of the person they are working with. Clinical psychologists are also trained to work indirectly, for example with school teachers to inform appropriate support for students, as well as with organisations and teams. Clinical psychologists are considered to be “scientist-practitioners,” meaning they routinely integrate up-to-date scientific knowledge into their clinical work. “Clinical psychologist” is a protected title in the UK; people using it must have had this training and be registered with the Health and Care Professions Council (HCPC).

In my (biased) opinion, clinical psychologists can offer the greatest flexibility of approach given their broad training. However, this level of training also makes services relatively costly. Consider seeing a clinical psychologist if you’ve tried therapists who only offer one form of therapy and this hasn’t been successful, if the young person has multiple areas of difficulty (e.g. with their mood, memories of difficult events in their past, issues of identity or neurodiversity), or if you need a clinician experienced in liaising with other professionals (such as school, social care and psychiatrists).

You can find a clinical psychologist in your area by searching the BPS directory of chartered members.

What is a counsellor?

“Counsellor” is a broad term and for many professionals will be prefixed by a more specific adjective that indicates their theoretical grounding, such as “person-centered,” “humanistic” or “psychodynamic”. Counsellors tend not to think of themselves as providing “treatment” for mental health problems, instead offering an open and welcoming space within which the client can discuss whatever is of greatest concern to them, unlocking their natural human tendency towards growth and development. The approach tends to be non-directive, meaning that the counsellor does not try to move the client towards any particular vision of the future, of “recovery” or “wellness”.

It is possible to gain a counselling qualification that allows membership of a professional body with two years of part-time training. However, many counsellors will go on to seek further training in a variety of approaches; indeed, I have attended training where I have been far outnumbered by people who identify as counsellors. The short and accessible training has the advantage that counsellors are relatively numerous and their fees are comparatively low.

In the UK, “counsellor” is not a protected title. Many counsellors are well-qualified and highly experienced; however, if you are considering seeking help from someone who uses this term, you should seek further information about their background and whether they are a member of a professional body, for example the British Association for Counselling and Psychotherapy (BACP). Such membership should reassure you that they have an appropriate qualification, are practising within a professional code of ethics, and that you will have recourse to a third party if something goes wrong.

Consider seeking a counsellor if you are not sure what approach would be helpful or if a child’s difficulties constitute a mental health difficulty, but you think they would make good use of a supportive space to get things off their chest. You can find out more about counselling and search for a registered professional by clicking here to visit the BACP website.

(N.B. To add to the confusion, there is also such a thing as a “counselling psychologist” Counselling psychologists’ training is rooted in counselling theory but is of the same level as that of clinical psychologists and overlaps in many other ways including NHS experience. This is a protected title and indicates doctoral training and research.)

What is a child and adolescent psychotherapist?

Child and adolescent psychotherapists have undertaken a lengthy professional doctorate within the NHS focused solely on working with young people (unlike clinical psychologists, whose training encompasses all age groups). Their work is grounded in the psychodynamic approach of Sigmund Freud, Melanie Klein and others, whose understanding of the unconscious mind and relational dynamics is increasingly borne out by modern advances in neuroscience. Child and adolescent psychotherapists’ training begins with a close observation of a child in the first year of life, and from here they develop a deep understanding of the human mind and how it grows and develops during childhood and beyond.

I worked alongside child and adolescent psychotherapists in the NHS for a number of years and always valued their plain-speaking style and ability to be thoughtful even when situations were very worrying or complex. Consider looking for a child and adolescent psychotherapist if your child has a history of trauma, if there are problems in the relationships between parents and children, or if children are presenting with behaviours that are difficult to understand and manage,

Confusingly, “psychotherapist” is not a protected title in the UK, and a person might describe themselves as a psychotherapist working with children and young people while not having any formal qualifications to do so. Once again, you should always take steps to make sure the professional you are considering working with is reputable and suitably trained. You can find out more about child and adolescent psychotherapists and search for a registered professional by clicking here to visit the ACP website.

What is a psychiatrist?

This one’s a bit easier to define: a psychiatrist is a person with a medical training who specialises in the treatment of mental health. Doctors of medicine use the title by convention and may or may not have a doctoral degree, Although all psychiatrists now receive some training in psychological therapy prior to qualification, in the UK it is rare to find a psychiatrist who routinely undertakes long-term, weekly treatment of this kind. In the NHS, psychiatrists often act as “responsible clinicians” for services, taking overall responsibility for patients’ care, and leading on legal issues such as detention under sections of the Mental Health Act.

You might consider seeking an appointment with a psychiatrist in private practice if you think medication could be helpful or are wondering if it is appropriate to seek an assessment for a neurodevelopmental difference such as autism or ADHD. If you’re unable to access psychiatric care through the NHS, you could ask your GP for a recommendation for a private psychiatrist or look for a larger private mental health clinic in your area. (The Priory is one such example.)

In summary, the background and qualifications of the professionals I have talked about are quite distinct, though their post-qualification and experience may mean increasing levels of overlap in how and where their work is undertaken. Everything I have said above is therefore a generalization (and also specific to the UK), but it should give some idea of who is out there and how they might be able to help. If you’re looking for support for a child or teenager, who you choose will depend on cost, availability, and, most importantly, who you and your child feel “gets” your specific needs. Change happens within relationships that feel supportive and which respect the feelings of needs of every individual involved, so although it’s important to find a professional with the right skillset, often it’s the “who” and “how” of a relationship that’s more important than the “what” of a specific therapy or profession.