A Brief “How To” and 101 on Therapy and Psychiatry (Part 2)

This is the second part of a two-part short, surface-level introduction to finding a mental health professional, what to expect from therapy and psychiatry, and several other key issues. Hopefully it addresses some questions y’all might have. Please feel free to email more at <NML.Zoey@gmail.com>, and I will create an FAQ piece!

The first part of this post, which covers finding a mental health professional (MHP) and a basic explanation of therapy can be found here.


Diagnoses are most commonly given by psychiatrists, who also prescribe medication aimed at addressing the particular mental health issue diagnosed. Sometimes diagnoses are required for insurance to pay for the medication, or for similar reasons.

Diagnoses are based on specific conditions and associated symptoms described in detail in psychological reference books. Remember that these reference books are written, argued about, and constantly edited and re-edited by MHPs. The distinctions these references make between mental health conditions are not universal or absolute. In fact, they can be quite arbitrary. Receiving a diagnosis for “anxiety,” for example, means that your experiences simply best fit the criteria for an “anxiety” diagnosis—not that your experience is the same as other people with anxiety.

Some therapists may also find it useful or important to diagnose their clients. In some countries and contexts, this can facilitate receiving care or ensure insurance coverage of care.

Homosexuality and bisexuality are not considered mental illnesses. Both major psychological diagnostic reference books (the DSM—Diagnostic and Statistical Manual—and ICD—International Classification of Disease) declassified same-gender attraction in the 1970’s and 1990’s, respectively. The ICD-10 does include an “ego-dystonic sexuality” diagnosis (enabling treatment aimed at changing sexuality in some cases if it causes distress to the client). However, this diagnosis is likely to be removed from the new ICD-11 edition in 2017. This probable change is good news, as the “ego-dystonic” diagnosis problematically fails to take into account social stigmas, pressures, and other dynamics that erode individuals’ wellbeing and confidence, causing non-heterosexual sexualities to cause distress and prompt a client to see so-called treatment.

Trans-ness, however, is still included in one form or another in the current editions of the DSM and ICD; the DSM-V includes “gender dysphoria” while the ICD-10 less gently lists something similar called “transsexualism,” and another diagnosis of “dual-role transvestitism.” There are separate codes for trans children. While being transgender or cross-dressing (which are two very different things) both should certainly not be considered or categorized alongside mental illness(es), as medical systems are currently constructed, this diagnosis enables trans people (who are given an official diagnosis) to receive medical care (e.g. hormones, surgery) consistent with their needs and desires—sometimes covered by insurance. Without a diagnosis, surgery and hormones can be more expensive or harder to obtain. Many countries including India and the US require trans people to obtain a diagnosis and official letter from an MHP in order to receive surgery or hormones. Obtaining a diagnosis can sometimes be difficult or costly (although not always); and there are organizations and individuals who can assist with this process.

How is a psychiatrist different from a therapist?

Psychiatrists are able to prescribe medication that can address psychological issues in a targeted way, and help improve mental health. There are many types of medication that work for different people and different medications. Psychiatrists may or may not provide talk-therapy counseling as well. If you see a psychiatrist, remember that also finding a good therapist is crucial; medication works best accompanied by talk-therapy.

It is not uncommon for individuals to try several different drugs before they find the one that works best and causes no or few side-effects. Remember that drugs such as anti-depressants can take two weeks for the effects to be felt and six for full effectiveness.

People who take mental health medication do not necessarily take it for their whole lives, depending on the mental health issue and medication.

Concerns about drugs

Are you the same person if you take psychiatric medication? Concern about altering their core personality has discouraged some people I know from using medication to address various issues such as depression or mild bipolar disorder.

Mental health medication can restore one’s sense of grounding and self, rather than altering it. Moreover, even if small shifts occur, the benefits of psychiatric medication can be enormous.

Some individuals I know either personally experienced or witnessed a family member or friend have a negative experience with psychiatric drugs. In some cases, these people were children and their feedback that the drugs given made them feel worse was disregarded; other times loved ones stopped seeing a psychiatrist and, having learned about psychiatric medication, started self-medicating (dangerously).

Hence, it is important that a professional monitor you regularly (every 3-12 weeks or so) when you are taking medication.

Confidentiality and Privacy

In general, MHPs should guarantee and keep complete patient confidentiality. That means that unless they believe that their clients represent an immediate danger to themselves or others, MHPs will keep everything that happens in sessions private.

However, my research made clear that a MHP’s training and the culture they work in can affect their adherence to this policy. Confidentiality can be a major concern for LGBTI+/queer people who do not want their sexuality or gender to be public. Many LGBTI+/queer individuals described situations in which MHPs compromised the confidentiality of their clients—particularly when questioned by family. MHPs confirmed that some training curricula do not sufficiently emphasize the need for confidentiality.

Nonetheless, I also found many MHPs who deeply respected the need for confidentiality—and made sure they kept everything clients disclosed private.

When first setting up sessions with an MHP (or doctor even), I recommend that everyone ask MHPs about their attitude and policies toward confidentiality.