Treatment Terms and Definitions
When you or your loved one enter the therapeutic world, it can be overwhelming. You will hear terms you are unfamiliar with or are unsure how one differs from the other. Whether it is the type of therapist, treatment level, or therapeutic genre, knowing the difference can help you make the best decision for you.
Types of Treament Providers
There are different types of people who can provide you therapy or be part of your therapeutic team. Most of them should have a higher degree that represents the type of education they received. This list covers the typical licensed professional, but you may find that many have additional certifications in the field of eating disorders, addiction, or other specialized areas of study.
A psychiatrist is a medical doctor whose focus is on mental health. While some psychiatrists will also do therapy sessions, this is rare. Typically, a psychiatrist will focus on diagnosing mental illnesses and prescribing and monitoring psychiatric medications. It is not unusual for follow-up appointments to be scheduled in fifteen minutes increments after the initial consultation.
Psychologist (Psy.D or Ph.D.)
Psychologists have training based on clinical psychological research into human behavior. They use this training to provide their clients with a variety of effective methods for dealing with mental illness. They follow a strict code of ethics and confidentiality and often share very little about their personal life or experiences.
A psychologist with a Psy.D. works directly with clients in a variety of therapeutic settings.
A Ph.D. can work with clients but typically focuses on research and statics.
Social Worker (LCSW, LMSW)
Social workers often have a more holistic approach to mental health, focusing on a strength-based approach to counseling. This approach helps the client assess their situation to determine both their strengths and perceived weaknesses or obstacles. Social workers tend to be more relaxed by sharing personal experiences, which some clients find helps build trust.
A Licensed Master Social Worker(LMSW) has their masters in social work but cannot practice psychotherapy independently without supervision until they achieve the necessary clinical level licensure.
A Licensed Clinical Social Worker ( LCSW) has their masters in social work and met post-graduate work requirements in their state and may practice psychotherapy in a variety of settings.
Counselors (LMHC, LPC, LMFC)
Mental health counselors provide consumer-oriented therapy that is often more flexible. They combine traditional psychotherapy with a practical, problem-solving approach.
A Licensed Mental Health Counselor (LMHC) and Licensed Professional Counselor (LPC) serve the same role but may have different names based on the state in which they practice. They have completed a master's program along with post-graduate work and can work in a variety of roles in the therapeutic field.
A Licensed Marriage and Family Counselor (LMFC) focuses on relationship, marital, and family problems related to mental health. Specializing in the family, they work to help the client solve problems within the context of their family and social environments.
You may find others that use a counselor's title, but that does not mean that they have the training or oversight of a licensing board. The term counselor can be used by life coaches, spiritual advisors, clergy, etc. Seeing an unlicensed counselor may be less expensive, but it is essential to fully understand their level of training before doing so. These individuals typically do not have the level of training to work with mental illness. They are more suited to helping address behavioral patterns that may problematic but not mental illness based.
Registered Dietitians (RDs) or Registered Dietitian Nutritionists (RDNs) are food and nutrition experts who have completed the minimum of a bachelor's degree. Their course study will include a variety of subjects, including food and nutrition sciences, biochemistry, physiology, microbiology, anatomy, chemistry, foodservice systems, business, pharmacology, culinary arts, behavioral, social sciences, and communication. They will also complete 1200 hours of supervised practice and pass a national exam administered by the Commission of Dietetic Registration (CDR). To maintain their credentials, they must complete continuing professional education requirements.
Some RDs or RDNs hold certifications in specialized areas of practice awarded through the CDR or medical and nutrition organizations. All states accept the RD or RDN credential for state licensure purposes.
A CEDRD is a registered dietician that has advanced expertise and proficiency in the field of eating disorders. To obtain this certification, one must have 2,500 supervised patient care hours directly in the field of eating disorders, complete courses that are eating disorder-specific, and pass an additional exam.
A certified nutrition specialist has an advanced degree in the field of nutrition and has passed the nutritionist certification boards. This protected title is obtained through the Certification Board for Nutrition Specialist. The holder must have a master's degree in nutrition or a similar field and at least 1,000 hours of practical experience before they are allowed to sit for the exam.
The certified clinical nutritionist title is a post-graduate certification for those with advanced degrees in nutrition or a similar field. It is also a protected titled gained by completing an extensive program governed by the Clinical Nutrition Certification Board.
The title "nutritionist" is an unregulated field in the United States and can be used by anyone who offers general nutritional advice, even with no or very little professional training. Because of this lack of regulation, it is essential to ask for the nutritionist educational background, training, and certifications from nationally accredited programs.
The danger of these untrained "nutritionist," particularly when it comes to eating disorders, is due to lack of education, they may encourage behavior that actually fuels the eating disorder. The removal of entire food groups, promoting fad diets, and encouraging exercise that is inappropriate for the situation are some of the dangers of seeking assistance from an unqualified professional. Most notably, they are likely to attempt to treat a severe mental illness without the proper qualifications.
Levels of Treatment
The level of recommended treatment is typically based on the degree of behavioral and medical intervention needed to provide appropriate support to facilitate recovery.
Seeing a treatment provider for a scheduled session in their office while maintaining your job, home life, or regular living arrangement.
Outpatient treatment is on going and in the case of eating disorders often takes place over a span of years.
Partial Hospitalization Program (PHP)
This level is typically recommended when a person needs more structure and support than outpatient therapy can give but is medically stable enough not to require 24-hour support. This program (sometimes referred to as day treatment) can be a half-day or a full-day and run five to seven days a week.
While at PHP, one will attend various therapeutic groups as well as individual therapy. They will also receive support around snacks and meals provided by the program, returning home in the evening.
The average length of stay is several weeks to several months. Insurance coverage or limits can dictate the length of stay in a PHP program, as can the severity of eating disorder behaviors and other mental health issues.
Intensive Outpatient Program (IOP)
This level is for those who are stepping down from a higher level of care but still need more support and structure than outpatient care. It can also be the first level of more intensive treatment when outpatient care does not provide enough support.
At this level of treatment, eating disorder behaviors are typically more under control, and the attendee is medically stable. The program may run 3-4 hours a day and meet from a few days a week to seven days a week. The hours are often late afternoon or evening hours to allow those attending to maintain their normal work, school, and social schedules.
While in IOP, you will attend various groups and may have support for one meal or snack. Depending on the structure, you will typically be responsible for providing your meals and snacks that meet your nutritional requirements. You will see your therapist and dietician outside of the program.
The average length of stay can be between a few weeks to a few months, depending on the individual's needs and the ability to pay or insurance coverage.
Inpatient Treatment (IP)
Inpatient treatment is recommended when someone with an eating disorder becomes medically unstable, or is showing signs of becoming medically unstable, and needs the highest behavioral intervention level. It may also be recommended if eating disorder behavior worsens, or there is a decline in overall mental health.
It is not uncommon for inpatient programs to be connected to a medical facility to provide around the clock medical care. These are usually locked units with locked bathrooms that include a very regimented schedule. While inpatient, the attendee will attend a variety of therapeutic groups as well as individual therapy. All meals and snacks are supervised.
Length of stay is determined by medical stability and, in some cases, weight restoration. Cost and insurance restrictions can also impact the length of stay. Inpatient stays can vary from a couple of weeks to several months.
Residential treatment is for medically stable individuals and does not require a higher level of medical intervention but is not responding well to a lower level of care. While still providing 24-hour supervision and support, residential facilities are often in a more relaxed, home-like setting that does not include locked units.
While there, one will attend a variety of therapeutic groups as well as participate in individual therapy. All meals and snacks are supervised. Some residential treatment centers will offer a broader range of therapeutic experiences, such as equine therapy.
Length of stay can depend on therapeutic progress, ability to pay, and insurance coverage but can vary from several weeks to up to one year.