Movies and television shows often portray therapy for an emotional or mental illness as lying on a couch in an office while pouring out your heart to a doctor. In reality, this is not necessarily what happens in therapy. The term therapy is an all-encompassing term that includes medication and many different types of psychosocial therapies.
Psychiatrists and psychologists are both involved in therapy, but often the general public mixes up these two professions. Although psychologists and psychiatrists work together to treat the patient’s underlying mental disorder, they each have very different educational backgrounds, training and scope of practice, and play a unique integral role in the treatment of mental illnesses.
Psychiatrists receive the same medical school education as any other medical doctor, such as an internal medicine physician or a pediatrician and, therefore, hold a doctor of medicine degree (M.D.). They are required to learn all of the systems and functions in the human body, history and physical examination skills, and the specific treatment plans for each medical condition.
After medical school, psychiatrists undergo a four-year residency training, during which they specialize in psychiatry to learn about the diagnosis and treatment modalities for each psychological condition, such as bipolar disorder and schizophrenia. After completing their psychiatric residency, which includes extensive psychotherapy training including cognitive behavioral therapy techniques, they can choose to further their training through a sub-specialization in a fellowship. Some psychiatrists specialize in psychopharmacology, forensics, geriatrics, adolescents, neuropsychiatry, etc. I happen to also have my boards in psychiatry and in addiction medicine.
In the vast majority of states, psychiatrists are legally and clinically the lead professionals responsible for the overall mental health care of the patient. In other words, the buck stops with them. Psychiatrists diagnose mental health disorders clinically utilizing criteria from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). A psychiatrist may also ask for and utilize the results of psychological testing, computerized tomography (CT) scan and clinical chemistry testing to help better understand a complicated patient.
Psychiatrists are also responsible for diagnosing mental disorders and managing medications, as their expertise focuses on the chemical imbalances within the brain. Similar to any other physician, they can write prescriptions.
Patients are often referred to psychiatrists by their primary care physicians or by psychologists to ensure that they are on the right medication and correct dosage.
Psychologists do not attend medical school; rather they attend graduate school and obtain a doctoral degree, such as a Doctor of Philosophy (Ph.D.) or a Doctor of Psychology (Psy.D.). A Ph.D. degree implies that the psychologist’s graduate school was research-based, where he or she had to create an intensive research study and paper — a dissertation. A Psy.D. is a clinical degree and focuses more on the clinical aspects of psychosocial therapy. Unlike a Ph.D., a Psy.D. is not research based. Psychologists may also have a Master of Science (M.S.) and work under the supervision of a Ph.D. or Psy.D.
Psychologists may also use the DSM criteria to diagnose, but they are not trained in general medical principles. Rather, they can use psychological testing — such as the Minnesota Multiphasic Personality Inventory (MMPI), the Rorschach Inkblot Test, among others — for which they have had specific training in administering and interpreting. Except for New Mexico and Louisiana, psychologists cannot prescribe medications in most states, but efforts are underway to expand this authority. Psychologists are experts in providing psychosocial therapy and concentrate on the patient’s mind and emotions.
How they work together
Psychologists and psychiatrists work together to coordinate and provide the best therapy for patients. Psychologists often see their patients on a weekly basis for psychosocial counseling. Psychiatrists may see their patients weekly or monthly for psychotherapy and/or psychopharmacology, depending on the patient’s clinical needs.
One professional is not better than the other, but rather both work as a team to help heal the mind.
Contributed by Kristen Fuller, M.D.