Choosing a Mental Health Professional: Understanding Areas of Expertise
Written by Jennifer Perillo, who is the mom of a wonderful daughter who was diagnosed with DMDD. She lives in New Jersey with her family, dog, gerbils, fish, and parakeet.
Our daughter was diagnosed with DMDD when she was six years old. Her tantrums and outbursts had started years before, and at first we thought it was just a phase. When she didn’t improve, and actually got worse, we thought we could “fix” her ourselves. We read all the parenting books and tried every technique. Nothing worked. It was embarrassing, but also a relief, to finally agree that we needed professional help.
But what I thought would be the answer to our problems just turned into a different question: Who could actually help us? Over the next few years we saw a variety of therapists, psychologists, and psychiatrists. A few of these folks gave wonderful advice. Many meant well, but had no idea what they were dealing with due to the lack of fully understanding my daughter’s disorder. We even encountered one or two professionals who were downright damaging. (For example, one psychiatrist spent ten minutes with us and then diagnosed her as “too spoiled.” We left his office and never went back.)
If you are considering professional help, there are many types of professionals you might choose. Obviously, your options depend a lot on where you live and what sort of insurance you have. But unfortunately, even having access to a wide network of experts does not mean that you will easily find someone who has experience treating DMDD.
For one thing, DMDD has only been an “official” diagnosis since 2013, the first time it appeared in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). Since this disorder is relatively new and controversial, some professionals do not consider it an actual disorder. Secondly, DMDD can be confused or co-diagnosed with many other conditions (like bipolar disorder, ADHD, ODD, RAD, or ASD); even a skilled diagnostician may need to spend a lot of time with your kid before they can figure out what’s going on with your child. Finally, there are no formally approved therapies or medications for DMDD. What works great for one child may be disastrous for another. So even with the help of a great professional, it may take a while before you find something that works.
Still, having someone on your side who gets your kid, understands that their behavior is the result of an illness (not being spoiled or bad parenting), and wants to make your lives better can be priceless. It’s worth the work to find someone who can truly help you.
So here is a brief listing of the types of professionals you might consider. When selecting a provider, keep in mind his or her office location, cost, technique, and beliefs. It is important to note the rapport the provider has with your child. In italics, I’ve mentioned some of our experiences over the years. But every child is different, every professional is different, and you should use your judgment to pick the professional that suits you best.
Counselor: A counselor holds a master’s degree in psychology, therapy, or a specific form of counseling (marriage and family counseling, substance abuse counseling, etc.). Counselors have to be licensed and certified according to the laws of their state. Counselors, therapists, clinical psychologists, and clinical social workers all offer different kinds of “talk therapy” that may be helpful for your family. They vary by levels of education, experience, certification, and the type of therapies they offer.
Suppose you are considering therapy, but are confused by the choice between therapist, psychologist, social worker, counselor, etc. In that case, my personal advice is that the actual degree doesn’t matter so much as whether the person has treated kids with DMDD (or similar conditions) and can make a good connection with your child.
Social worker: Clinical social workers, like clinical psychologists, counselors, and therapists, can offer therapy. They have a master’s degree in social work (MSW) and must be licensed and certified according to the laws of their state. Common credentials include LCSW (licensed clinical social worker).
Early on, we saw a social worker who specialized in behavioral therapy. She saw all of us together as a family to understand our daughter’s behaviors and our reaction to them. While ultimately we realized that our daughter’s issues were more than behavioral, she gave us terrific advice on how to respond to the outbursts and tantrums in a calming, constructive way. I think many DMDD families can benefit from family therapy so that everyone understands how their reactions can make the situation better or worse.
Therapists: A therapist holds a master’s degree and can train in a specific form of therapy (marriage and family therapy, behavior therapy, art therapy, etc.). Therapists have to be licensed and certified according to the laws of their state. Play therapists are specifically trained to work with children through toys and games. This therapy is an option for younger children or children who find it difficult to verbalize their thoughts and feelings.
Psychiatric Nurse Practitioner: A nurse with a master’s or doctoral level nursing degree, with a specialization in psychiatric conditions. PNPs must be licensed by the state. They can provide treatment for psychiatric conditions, and in some states they can also prescribe medication.
Pediatrician: A medical doctor with specialized training in child and adolescent health. Pediatricians can perform or suggest medical tests to explore any biological factors that might be affecting your child’s behavior. A developmental-behavioral pediatrician has additional training in behavioral and developmental issues and can evaluate the psychological and social aspects of your child’s behavior as well as the physical ones.
If you choose to work with a mental health professional, it’s important to keep your pediatrician in the loop. Our daughter has taken a variety of medications for DMDD, and many of them changed her appetite, sleeping patterns, energy levels, and more. I update her pediatrician every time we try something new so that we can watch her weight, blood work, and physical development and make sure she isn’t getting too far off track.
Psychologist: A psychologist holds a doctoral degree (Ph.D. or Psy.D.) in psychology and must be licensed in his or her state. Clinical psychologists can assess and diagnose patients and provide talk therapy. They will draw up treatment plans to help guide their work with patients. They cannot prescribe medication. Child and adolescent psychologists specifically focus on younger patients.
We saw a terrific psychologist that my daughter loved. He taught her funny rhymes (“don’t get stuck in the negative muck”) and breathing exercises to help her calm down. In his office, she really seemed to get it--but her behavior at home and at school did not change. For her, therapy alone was useless until after she started taking medication. Medication improved her impulse control and her ability to think before lashing out; only then could she start using the techniques that he taught her.
Neuropsychologist: A psychologist with a doctoral degree (M.D. or Psy.D.) who specializes in brain function and how it impacts behavior. Neuropsychologists can determine whether a brain injury or illness, for example, is affecting someone’s behavior.
Psychiatrist: A medical doctor who must be licensed and complete residency training. Psychiatrists are trained to treat psychiatric disorders (such as depression, anxiety, and other mood disorders). Psychiatrists can diagnose and dispense medications. Child and adolescent psychiatrists specialize in younger patients.
We’ve seen quite a few psychiatrists over the years, and they were all very different in their manner and approach. One psychiatrist insisted on four visits before he would recommend any medications for our daughter; he needed that time to feel confident in his diagnosis. Others were extremely quick to suggest new medications or increased dosages. (“She seems anxious today. Let’s try Prozac.”) As a parent, you have a right to research, question, and even decline any prescribed medication. Mental health medications can cause a wide range of side effects — some of them serious — and you need to know what to look out for should your child experience any of them.
Another way the mental health professionals differed was in the amount of time and attention they gave us. Some focus entirely on “medication management;” they only discussed prescriptions, side effects, and refills. Others acted more like therapists; they spent time talking about how things were going at home and at school, and they watched our daughter’s behavior carefully to see how the medications were affecting her. I felt much more comfortable with those who took an interest in my child as a whole and who did not simply focus on the medication.
Finally, one comment specific to psychiatrists and DMDD to know about is the medication combination known as the “Matthews’ Protocol” (named after Dr. Daniel Matthews, the pediatric neuropsychiatrist who developed it). Many children with DMDD have shown great improvements on this brain-based treatment. Although it has been used for decades, it has not been formally tested or approved, so many psychiatrists are either not aware of it or not comfortable prescribing it. If you are interested in the protocol, you will first need to find a psychiatrist who is already trying it or willing to consider it.
Many of the websites listed here have online directories that can help you find practicing professionals in your area.
American Counseling Association
American Psychological Association
Association for Play Therapy
Child Mind Institute Guide to Mental Health Specialists
National Alliance on Mental Illness: Types of Mental Health Professionals https://www.nami.org/About-Mental-Illness/Treatments/Types-of-Mental-Health-Professionals
National Association of Social Workers