What's the difference between a psychologist and a psychiatrist?
That may sound like a setup for a knee-slapper, but it's actually a good question, and many people don't know the full answer.
It's not as simple as who tends to what, like the difference between a goatherd and shepherd. Both kinds of professionals treat people with problems that vary widely by degree and type, from mild anxiety to schizophrenia. Both can practice psychotherapy, and both can do research.
The short answer is, psychiatrists are medical doctors and psychologists are not. The suffix "-iatry" means "medical treatment," and "-logy" means "science" or "theory." So psychiatry is the medical treatment of the psyche, and psychology is the s
cience of the psyche.
Psychiatrists begin their careers in medical school. After earning their MD, they go on to four years of residency training in mental health, typically at a hospital's psychiatric department.
According to Marcia Goin, MD, past-president of the American Psychiatric Association and a clinical professor of psychiatry at the University of Southern California, psychiatric residencies include a range of subspecialized training, such as working with children and adolescents.
After completing their residency, these physicians can be licensed to practice psychiatry.
Psychologists go through five to seven years of academic graduate study, culminating in a doctorate degree. They may hold a PhD or a PsyD. Those who are mainly interested in clinical psychology -- treating patients as opposed to focusing on research -- may pursue a PsyD.
Licensing requirements for psychologists vary from state to state, but at least a one- or two-year internship is required to apply for a license to practice psychology.
As medical doctors, psychiatrists can do what most psychologists in the United States cannot: They can prescribe drugs.
Recently the state of Louisiana allowed psychologists to write prescriptions after consulting with a psychiatrist, joining the state of New Mexico, which allowed psychologists to begin prescribing in 2002.
A common misconception about psychiatrists is that they only treat people with severe mental illness, like schizophrenia or bipolar disorder, diseases for which medication is the mainstay of treatment, leaving psychotherapy to psychologists and patients with less severe problems.
Psychiatrists who work at clinics and hospitals certainly see many hard cases. "The major patients they see are severely mentally ill, but there are others who are not," Goin tells Psych Pedia. She says she practices a lot of psychotherapy in her private office and that most of her patients there are not on medication.
Increasingly, however, psychiatrists in private practice spend their time with medication management and not psychotherapy. Other mental health providers usually do therapy sessions, and when they see a patient who could benefit from medication, they send the patient to a psychiatrist for an evaluation and possibly a prescription.
"It usually is not the psychiatrists' choice to only prescribe medicine," Goin says. But if a psychiatrist participates in a health insurance plan, the plan's fee structure may discourage time spent on psychotherapy.
A study published in the journal Psychiatric Services in 2003 shows that psychiatrists earn less for doing therapy. On average, a psychiatrist who charges for 45-50 minutes of psychotherapy earns $74-$107 less than he or she would for three 15-minute sessions of medication management.
The reason may be that insurers figure that psychotherapy, which is time consuming and may go on for months, should be handled by providers who charge less. "The reality is that psychiatrists' fees are often higher than psychologists'," Goin says.
According to the Centers for Medicare and Medicaid Services, "reasonable" charges for a 45- to 50-minute therapy session are $70-$130 for a psychiatrist and $65-$114 for a psychologist.
These guidelines are based on data from 1988. The 2003 Psychiatric Servicesstudy shows psychiatrists charging an average of $107-$155 per session for therapy.
In addition to psychotherapy and research, psychologists use a variety of tools to examine a person's psychological underpinnings and personality (and how that could affect life experiences).
Psychologists tend to use these tests more than psychiatrists.
Personality tests include the questionnaires such as the Minnesota Multiphasic Personality Inventory (MMPI) and the Millon Clinical Multiaxial Inventory (MCMI), and the famed Rorschach test - where the person is shown a variety of inkblots and asked to tell the therapist what they see. These tests are meant to reveal how people see themselves and how they may behave.
Psychological testing also includes neuropsychological tests, which evaluate brain function to diagnose or assess the extent of damage from an injury or illness.
Another Kind of Therapist
You may be surprised if you're referred to a therapist to find that he or she is neither a psychiatrist nor a psychologist.
Clinical social workers (CSWs) are mental health professionals who have master's degrees in social work and have been licensed to practice psychotherapy after completing at least two years of clinical training.
According to the National Association of Social Workers, 60% of licensed mental health professionals in the United States are clinical social workers.
Like most psychologists, a CSW cannot prescribe drugs, so they refer their therapy patients to psychiatrists to evaluate the need for medication.
"They think in terms of a team ... being part of the treatment team," says Mary Pender Greene, chief of social work with the Jewish Board of Family and Children's Services in New York City.
Whose Therapy Is Best?
Ask any of the three professionals who provide the best psychotherapy, they will all tell you their own specialty is the most skilled.
You could have a great therapeutic relationship, or a bad experience, with any of them.
"The professional credentials alone don't determine that someone would be helpful to any particular patient," says Rebecca Curtis, PhD, a professor of psychology at Adelphi University in Garden City, N.Y., and director of research at the W.A. White Institute of Psychiatry, Psychology, and Psychoanalysis in New York.
Nevertheless, she says experience and training matter at least as much as the therapist's personal qualities and the relationship between the patient and the provider. She advises people to interview a potential therapist carefully. Although you may want to get right to talking about your issues, "ask them specifically about their training during the initial session," she tells Psych Pedia.
"Everybody thinks they can sit down and talk to people and be helpful," she says, "but it really helps to have a lot of experience and training."