Psychiatrist vs Psychologist: A Rose by any Other Name or Something Different?



Recently, a friend of mine revealed that he needed some counselling support for a family member and that he wondered about my reviews of a particular psychiatrist for the person. Having had this conversation very often with random people, family and friends and of course, clients, I felt the need to clarify a few things about the key

differences between the terms “Psychiatrist” and “Psychologist” in very simple terms.Those key differences in job function will better help you to decide which professional is the more appropriate one for your needs. Both use the title “doctor” but, their ability to do so is based on stark differences.


On a very basic level, the major difference is that a psychiatrist is a medical doctor with additional training in psychology and psychopharmacology. Simply put, this person went to medical school and decided to specialize in the use of drugs to treat and manage severe clinical mental disorders. They would have completed a residency in a hospital or clinic setting where they address the concerns of people with chronic issues like mood disorders, personality disorders and other “diagnosable” conditions. They do provide “talk therapy” like psychologists and counsellors do, but they are able to prescribe drugs to help manage mental disorders and the scope of the work is different.


A psychologist, on the other hand, is someone who has completed a Doctorate in

psychology. Someone with a Masters degree in psychology in North America or the

The Caribbean, cannot call themselves a psychologist although in some other countries, a Masters is sufficient to qualify for the title given a certain number of years in practice. People with a Master’s in psychology in either clinical or counselling are called therapists, associate psychologists or counsellors and the difference between this group and a Psychologist is usually the ability to conduct professional assessments after more years of school. This field is focused on greater depth work with people who may or MAY NOT have a mental health diagnosis and require longer term work on patterns of behaviour, early childhood and family factors and a host of other longer-term features of their lives. They also work with people with non-diagnosable issues like relationship concerns, life transitions, grief and loss, family problems and a host of other human experiences. This means that one does not have to be considered “mentally ill” to see a psychologist.


For this reason, when people are trying to make a choice between the two, I often ask what are the concerns they want to address? My question, although it feels nosy, is based on the desire to determine if the person needs a medical model practitioner, (psychiatrist), or a talk therapist (psychologist) or, if the person would benefit from

seeing both.


Seeing both would make sense if someone has a diagnosis of Post-Traumatic Stress Disorder (PTSD) for example, after experiencing, witnessing or hearing about a dangerous or life-threatening situation. Indeed, many people have experienced at least one traumatic event and would benefit from addressing it. People who have severe PTSD may initially benefit from anti-anxiety medication to help them stabilize long enough to do the deeper talk therapy. These prescriptions are administered by the psychiatrist and often the deeper work on the issue is done by the psychologist. Most counsellors and psychologists do specialized training in working with trauma and so they usually collaborate with psychiatrists to better care for the client. Often, as the person manages to go through the trauma counselling with the psychologist (or counsellor), the psychiatrist can wean them off the drugs given to stabilize them. This is but one example of how these two related professions collaborate. However, there are many situations in which either one or the other is better suited to the individual’s needs.


When deciding whether or not to see a psychiatrist or a psychologist, there are a few questions to ask yourself;


1. Do I think that I or the person for whom I am seeking support has a mental disorder?


The answer to this question includes observing their behaviour to determine whether or not their behaviours, thoughts and mood are negatively affecting their lives. For example, if a person is acting impulsively and is spending money

recklessly, not sleeping, is talking rapidly and seems to believe in their invincibility and creativity, this person may be exhibiting warning signs of a mood disorder and would benefit from seeing a Psychiatrist first to have an assessment

done to potentially get a diagnosis.


2. Is there an issue between me and my romantic partner, child or another family

member?


Most relationships experience challenges at one point or another. Conflict is inevitable but, not everyone has the ability to manage it effectively. Sometimes, there are concerns about closeness in the relationship, there may have been betrayal or some other inter-personal problem which is causing you to go into therapy. Situations like this are better served by a Psychologist or a Counsellor as both of these professionals has trained specifically to address these kinds of dynamics. Should they suspect though, that there is a component of mental illness operating in the relationship, they will often refer the client to a Psychiatrist to see if drug therapy is necessary and will collaborate with the client’s Psychiatrist to provide better care for them.


3. Have I been stuck in my life and afraid of changing careers, moving to another country or city or trying to make sense of my feelings about retiring?


Life transitions are best handled by a psychologist or counsellor as these are normal parts of life with which most of us struggle. The benefits of talk therapy are usually enough to help you develop coping skills for your situation or to help

you figure out the ways in which your fears may be limiting your ability to live your best life. There are also counsellors and psychologists who specialize in career counselling to help you figure out the different career paths available for

you to capitalize on your strengths. This is the kind of work not done by psychiatrists.


4. Am I having questions around my sexuality, gender identity or issues with sexual

activity?


This is definitely not the work of a psychiatrist. Counsellors and psychologists who do this kind of work have to be specially trained in human sexuality and sex therapy in order to be able to provide this kind of service. The same is true for any work around your intimate relationships. Psychiatrists are NOT trained in couples and family therapy.


Please make sure that you ask the person you approach specifically if they are trained in these matters as this type of training is not standard in Masters and Doctoral programmes. Psychiatrists are not equipped to do this type of work

either.


5. Is the service for someone who is a caregiver or family member of someone with a mental illness or substance misuse problem?


People who support those who struggle with mental illness are better suited to work with a psychologist or counsellor as their work is around stress management, psychoeducation about the illness in question, self-care and emotional support.


Even for those who struggle with substance misuse, psychologists and counsellors are very effective in helping clients get to the root cause of why they are misusing substances in the first place. Psychiatrists may be able to prescribe

drugs like Methodone or Suboxone to help those whose drugs of choice have been opioids but generally the deeper work is done by psychologists and counsellors given the fact that usually, trauma is the underlying reason people

engage in substance misuse.


6. Is the person someone with a developmental disorder like autism, fetal alcohol

syndrome or a learning challenge?


If the person is dealing with a developmental issue, there are psychologists and counsellors who specialize in working with them. There are multiple types of psychologists and counsellors who focus on different aspects of these concerns. School counsellors and psychologists work with students and their families to help manage the child’s ability to function at school. Counsellors who specialize in working with children and adolescents help them with emotional regulation, social skill development and better relationships with peers as well as to a lesser degree, their parents. This type of work usually falls outside the scope of a psychiatrist’s work unless the child in question also has a mental illness.


Hopefully, many of your questions regarding the differences between a psychiatrist and a psychologist have been answered now. When you are in doubt though, it is always a good idea to contact a counsellor or psychologist to help you figure out which professional is best suited for you or your friend or relative.


Finally, it is very important that you know that both professions are ethically required to keep whatever you tell us confidential even when you have committed a crime in the past and are coming into therapy to discuss its effects. There are only three situations in which we are expected to break confidentiality with you which are done to protect

vulnerable people. For example, if you report child abuse or neglect, we have to involve the necessary child protection agencies to keep the child or adolescent safe. The same is true if you report the intention to harm or kill someone and we have reason to believe that you are serious or, if you tell us you plan to harm or kill yourself. Finally, if the court subpoenas our records, we are legally required to prepare a report for legal proceedings. Apart from this, anything you say to us is kept in confidence even after one of us has died.


Psychologists, psychiatrists and counsellors do not judge you. Most of the things you think are shameful, extraordinary or bizarre are things we are trained to handle and for the most part, have probably heard some variation of this before. We are always more concerned with what is best for you and we don’t talk to anyone else about what you have said to us as we could lose our license to practice on account of that type of unethical behaviour.


Ultimately, seeking support in times of distress is no indication of “insanity”. In the same way that you would visit your family doctor for a broken leg, migraines and all manner of other physical concerns, going to therapy are good for the mind and soul. It is time that we start to normalize talking to a trained professional about the problems we face as they are often able to help us in a confidential manner that our friends and family simply cannot. I would encourage everyone to act in their own best interest and try to access the help of a trained counsellor or psychologist so that you can create a life you do not need to escape from or endure.