Mental health professionals have a variety of jobs. Some of them, such as psychologists, specialize in testing for a variety of indicators. The testing itself does not accomplish any goal except to identify strengths and weaknesses, and to suggest directions.
All mental health professionals, including psychologists, have to engage the patient, to encourage (and monitor for) the best effort, and to help establish a direction and support the patient in his or her effort to move in that direction.
Perhaps the most important job of mental health professionals is to form some concept as to what makes people tick. Some conditions are idiosyncratic, can happen to anyone, and need specific treatment. Most conditions depend, for understanding them, on an overarching theory about why people develop and function as they do, what influences that functioning, and how functioning can be addressed when it is maladaptive for the individual. If, for example, the mental health professional thought that what makes people tick is neurotransmitters, then the treatment approach would be something that adjusts neurotransmitters. There are a few things that are thought to do that, and perhaps the commonest one is adjusting neurotransmitters (brain chemicals) with medications. So a professional who thought the main determinant was neurotransmitters would tend to write a lot of prescriptions. There are few reliable concepts of which neurotransmitters need adjusting for which conditions, and which medications will adjust them as intended.
The problem with this approach is that there is no agreed sense of balance or imbalance of neurotransmitters, so the concept of choosing a medication to adjust them is somewhat blind. And there are very many medications, with new ones frequently developed (mostly for the financial benefit of drug companies), and professionals/prescribers/psychiatrists who have their own preferred medications. A medication is preferred because of training, habit, experience, or for some other reason.
A common alternate, in a sense, theory of what makes people tick is their “formative years.” Childhood is commonly referred to as the formative years for a reason. A mental health professional who believes that formative years are the most powerful determinants of what makes people tick will gravitate, in a sense, to psychotherapy, as a way of understanding what has formed the patient, and as a basis of forming a psychotherapy direction. There are various forms of psychotherapy, some having nothing to do with others, and as with medications, some representing vogue, or a wish for something new, more than “tried and true” benefit. And some forms of psychotherapy, such as behavior therapy (“systematic desensitization”) for something like PTSD is abandoned in favor of medication treatment, because the latter is easier, if essentially ineffective.
The related thing that mental health professionals have to understand, or even just try to figure out and decide, is how and why whatever treatment they customarily use works. Theories about this are variable, and these theories are more often offered as concepts than they are proven.
As a personal matter, I have come to have vastly more confidence in psychotherapy than I have in medication treatment. I have spent far more of my career dismantling medication regimens that were never needed, or not for a long time, than I have beginning medication treatment. This, of course, depends on the diagnosis. For some diagnoses, medication treatment is the first choice, and maybe the only necessary intervention. For most, that is not the case. Psychotherapy is vastly harder for the treater than is medication treatment, and the patient commonly enough thinks it’s harder, too. But the results are very different, and successful psychotherapy results in a much more independent, flexible, and self-sufficient patient. To simplify one of the differences, medication treatment is treated as the prescriber’s responsibility (not the patient’s), and patients allow themselves to expect perfection. Psychotherapy is a partnership between treater and patient, and it results in an acceptance and tolerance of imperfection. Since almost nothing is ever perfect, then psychotherapy is more realistic than is medication treatment (except in those clinical situations where medication treatment is essential and central).
