There are different professionals working in the National Mental Health System. Although cooperation between the different professionals is very important (in order to achieve a good treatment outcome), it may be useful to be aware of the different duties and competences distinguishing these figures.

The aim of this guide is to describe the different professionals working in mental health field, pointing out the differences between them, in terms of roles and competences; moreover, it will offer a brief description of the most important psychotherapeutic approaches.

The Psychologist, after obtaining a Bachelor’s Degree in Psychology and accreditation by the British Psychological Society, deals with supporting people affected by mental health issues, helping them to become aware of the nature of their own problems. The psychologist also helps the patient to find out a good way to use his own inner resources. The psychologist can also carry out diagnosis through assessment interviews and psycho-diagnostic instruments. Moreover, one of the main duties is to promote mental health. The psychologist can’t administer drugs or carry out psychotherapeutic treatments, unless he or she obtained a diploma in psychotherapy.

The psychologist can become a Psychotherapist after a four-year training in specialized centres. During this four-year training, the psychotherapist is taught to treat mental health disorders using specific techniques; he or she also gains experience through practicing psychotherapy (under professional supervision) and undergoes personal psychotherapy as well. In the U.K., psychotherapists are accredited by the British Association of Psychotherapists or the United Kingdom Council for Psychotherapy.

The main psychotherapeutic approaches are: psychodynamic, psychoanalytic, cognitive-behavioral and systemic-relational. The majority of the studies in literature agree that there aren’t that manydifferences amongst the various approaches in terms of outcome effectiveness, but that outcome is mostly related to variables such as the motivation of the patient, the therapeutic alliance and the severity of the pathology.

Cognitive-Behavioral Therapy (CBT) operates on the theoretical basis that mental health issues are related to dysfunctional beliefs. The psychotherapist works on these beliefs by paying close attention to the circumstances in which the symptoms appear; CBT therapist don’t emphasize the  previous story of the patient and the circumstances in which he developed the symptom. However,
modern Cognitive-Behavioral therapy pays also attention to the emotions associated to  dysfunctional beliefs.

Systemic-Relational Therapy emphasizes the role of the patient’s relational context. The mental health issue is the expression of a pathological relational context (the patient, with his symptom, would represent the dysfunction of the relational environment he or she belongs to). The majority of family therapies refer to this approach.

Psychodynamic Therapy, inspirited by Freud and his successors, focuses on the concept of “conflict”: the psychodynamic therapist believes that the nature of a mental health disorder might be explained by a conflict in the patient’s unconscious. In this context, particular attention is given to the story of the patient, his childhood and the strategies he uses to keep away traumatic experiences from consciousness.

The Psychiatrist, differently from the psychologist, is a Medical Doctor and can therefore administer drugs. Psychiatric treatment is more indicated for emergency situations, when the symptoms’ severity compromises the abilities of the patient during his every-day life and he can become dangerous to himself or others. In these situations, drug administration is necessary.
However, the psychiatrist nowadays is often also a trained psychotherapist and pays attention to emotions and feelings related to the pathology. Most professionals agree that the integration of drugand psychotherapy is propaedeutic for an effective treatment.

The Counsellor, instead, offers a counseling therapy, in order to promote the client’s potentialities and resources. In the U.K. and U.S.A., differently from Italy, this professional field has already been recognized and universities offer specific training to become a counsellor. This type training usually lasts two years. Counselling trainings at specialised centres are accredited by the B.A.C.P.

The Neurologist, is a Medical Doctor specialized in Neurology: he works with mental health disorders that are related to an organic dysfunction (often a Central Nervous System lesion), such as Parkinson, Alzheimer disease and neurological dysfunctions caused by ictus, brain injuries and so on. Nowadays a new profession is appearing, the one of the neuropsychologist, a psychologist
specialized in the diagnosis and in drug-free treatment for neurological diseases.

Piero Moliterni

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