The professions of psychology and psychiatry are often confused. Many people believe they are interchangeable. Although psychologists and psychiatrists often work together, there are distinct differences in their training and how they practice. Let’s explore the contrasts between psychiatry and psychology.
Psychiatrists are medical doctors. They attend medical school where they receive training in general medicine. After earning their medical degree, they have four years of residency training in psychiatry. Psychiatry residency introduces them to psychotherapy orientations, therapy techniques, the administration of psychotropic medication, and psychiatric evaluation procedures.
Psychologists enter a doctoral program after they receive a bachelor’s degree. It is either a Ph.D. or a Psy.D. program. A Ph.D. program has more of a research emphasis while a Psy.D program has a more clinical focus. For approximately four years, they undergo education about psychological assessment, psychotherapy, and research methods. At the end of their graduate training, they participate in an internship that acts as on-the-job training. Psychologists must also complete a research project. For Ph.D. students, it is a full-blown scientific research study. For PsyD. students, it is less intensive, such as a comprehensive literature review. After internship, most states require a year or two residency, where the individual works under the supervision of a licensed psychologist.
What They Do
Although there is some overlap between the responsibilities of a psychologist and psychiatrist, they tend to perform different duties.
The prescribing of medication is usually the job of a psychiatrist. For many psychiatrists, it is their primary duty. Having a medical background is critical for knowledge of drug interactions and possible side effects. Psychologists generally don’t have prescription privileges. However, there are certain states (e.g., New Mexico, Louisiana) that allow psychologists to prescribe psychotropic drugs as long as they undergo specific training. States that allow prescription privileges to psychologists tend to possess underserved populations.
Psychological testing is primarily the domain of psychologists. They receive extensive training in a variety of assessment tools and their design. It is not unusual for a psychologist to focus only on assessment and spend all their time performing testing. Testing can measure for I.Q., achievement, psychological disorders, and personality factors. Psychiatrists are trained to evaluate and diagnose patients but generally do not receive specific instruction in administering assessment instruments. They are more likely to perform a diagnostic interview or a mental status examination. Both psychologists and psychiatrists use the Diagnostic and Statistical Manual (DSM-V) to diagnose individuals. Psychiatrists have the added benefit of being medical doctors, so they are better able to rule out physiological factors that may contribute to presenting symptoms.
Both psychologists and psychiatrists may perform psychotherapy. Practically speaking, very few psychiatrists actually do. In the last 50 years, as the number of psychotropic drugs has increased, the field of psychiatry has moved away from psychotherapy and moved toward medication management. As a result, psychotherapy has mostly become the realm of psychologists, licensed professional counselors, and clinical social workers. Cognitive-behavioral therapy (CBT) is the most popular type of psychotherapy, especially effective for anxiety and depressive disorders.
Both psychiatrists and psychologists may work in academic institutions. If you look at a university psychology department you will find almost all Ph.D. psychologists because of their focus on research. They are expected to split their time between teaching and conducting research. Psy.D. psychologists may teach at institutions that do not have as heavy a research focus, such as a professional school or a university with a Psy.D. program. You will primarily find psychiatrists working at medical schools, where they spend time training medical students and performing clinical work.
Where They Work
Besides academic institutions, you can find psychologists and psychiatrists in very similar settings. It is important to note, however, they may have different roles and levels of responsibility. For example, at hospitals, psychiatrists have admitting privileges, which gives them the right to admit and treat patients within that particular hospital. Psychologists only have hospital privileges in certain states. This hierarchical structure is generally going to give psychiatrists more power than a psychologist in a hospital setting. You may also find psychologists and psychiatrists in residential settings, community mental health agencies, and private practice. There are some settings, however, where you may find a psychologist but are unlikely to find a psychiatrist. A psychologist, for instance, may work with clients in their homes or at school (i.e., school psychologists).
Psychologist or Psychiatrist?
Severe Mental Health Problem
Psychiatrists are well-suited for complicated and serious mental health problems, such as bipolar disorder and schizophrenia. Because they are frequently trained and work in hospitals, they often have more experience in severe cases. In addition, a serious mental health issue is likely to require medication. They may refer a difficult case to a psychologist for therapy or testing but a psychiatrist is a good first stop for a serious problem.
Many people have issues that do not fit neatly into one diagnostic category. It can be difficult to ascertain the problem simply by interviewing them. In those cases, it might be a good idea to visit a psychologist for psychological testing. If it is concluded that a client requires medication, they will refer to a psychiatrist or general practitioner for a consultation.
Psychiatrists make significantly more money than psychologists. To put this in perspective, the median salary for psychologists in 2018 was 79,010 per year. The mean annual salary for psychiatrists in May 2018 was $220,380. Not surprisingly, whether someone uses insurance or not, a patient will almost always end up paying more for a psychiatrist per session. For example, it is not uncommon for a client without insurance to pay over $100 more for a visit to a psychiatrist.
The time commitment for going to a psychiatrist for medication is much less than seeing a psychologist. Therapy is a process that may take up to an hour a week for an undetermined period. In contrast, taking a pill takes about a second. What’s more, after the first session, a psychiatrist is likely to see you for no more than 15 minutes each time. Regular sessions with a psychologist usually take 45 minutes to an hour.
Due to the short time they spend with a client, some people do not feel like a psychiatrist truly cares about them. Of course, this is probably not true, but it is hard to give a great amount of personal attention to a patient in 15 minutes. Psychologists who perform testing and therapy tend to spend more time getting to know people and, as a result, clients may feel more understood.
Afraid Of Medication
Some people do not want to take medication. They may not like the idea of a temporary fix or they don’t want to put anything synthetic into their bodies. Age may also be a factor. Giving a child psychotropic medication may raise some alarm bells. After all, no medication has zero side effects.
Afraid Of Therapy
Going to therapy is not an easy decision. As mentioned above, it takes time, money, and effort. It also takes a lot of courage to face your problems. Some people prefer a quick fix without divulging their deepest secrets to a total stranger. For those people, it is advisable to see a psychiatrist and take a pill rather than go through weeks of soul searching with a psychologist.
For many mental health disorders, such as anxiety and depression, it is often recommended that a client receive psychotherapy and take medication at the same time. In fact, there is research to support that the combination of therapy and medication is associated with the most positive outcomes. In those cases, it may be advisable to see a psychologist for therapy and a psychiatrist for medication. Psychologists and psychiatrists often have close professional relationships because they frequently find the need to work together. In most cases, it does not matter who you see first. Most competent professionals will recognize the need to refer out for services that are needed that they do not provide.
Doctor of Philosophy (Ph.D.), Psychology | St. Johns University
Master of Arts (M.A.), Social Psychology | American University
Bachelor of Arts (B.A.), English; Psychology | Washington University in St. Louis
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