How to Tell if You Should See a Psychiatrist Versus a Psychologist
As a general rule, television shows and movies completely screw this up.
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Ask the average person the difference between a psychiatrist and a psychologist, and you’ll likely hear a mixture of impressive-sounding blather—most of it culled from medical dramas on TV, and most of it wrong. If you’re likewise unsure of the difference, don’t feel bad: “The media as a general rule completely screws this up,” says Michelle Newman, a professor of psychology at Penn State University. “Every single television show or movie I have ever seen suggests that if you want therapy you should go to a psychiatrist,” Newman says. And that's just not correct.
What's the difference between a psychiatrist and a psychologist?
At the highest level, a psychiatrist is an MD who can prescribe medication. “Psychiatrists attend a four-year medical school after obtaining an undergraduate degree, and their training is in the full range of all branches of medicine,” says Katherine Brownlowe, a psychiatrist at Ohio State University’s Wexner Medical Center. “After graduating medical school, a psychiatrist attends a residency program specifically in psychiatry, in which they learn the practice of assessment of mental illness as well as medical treatments of mental health problems.”
A psychologist, on the other hand, is someone who has earned either a PhD or PsyD degree depending on if their specialty is likely to be research or clinical practice, respectively. “A psychologist is trained on how to deliver evidence-based psychotherapy and to conduct psychological assessments,” Newman says. This training typical spans ten years and is focused solely on identifying and treating mental health disorders using non-medical means (i.e., talk therapy, not drugs).
It’s common for people to juxtapose psychiatrists and psychologists as MD/drugs versus PhD/psychotherapy. But the reality is messier than that. For example, there are some situations in which a psychologist can write drug prescriptions, says Gerard Sanacora, a professor of psychiatry at Yale School of Medicine. “There are also many psychiatrists that mainly specialize in psychotherapy and do not regularly prescribe medications,” he adds.
Spend some time chatting with psychologists and psychiatrists, and you’ll hear some professional pride mixed with some (very mild) sniping. “It is harder to gain admittance to a clinical psychology PhD program than it is to get into medical school,” Newman (a psychologist) says.
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Meanwhile, Michelle Riba—an MD, psychiatrist, and clinical professor at the University of Michigan—points out that both psychologists and psychiatrists are trained to provide psychotherapy. But while psychologists focus on behavior, “psychiatrists focus on the whole person, taking into account biology, neurochemistry, psychosocial history, and other medical problems and treatments the patient might be undergoing.”
When should you see a psychiatrist versus a psychologist?
So which one should you see? “If you know you want or need medication, you should go to a psychiatrist,” Newman says. “If you are interested in psychotherapy, a psychologist may be preferable.” She adds that psychotherapy “requires motivation to change and a willingness to work hard on one’s problems.” Medication, on the other hand, requires little effort but also comes saddled with more side-effects. “Also, if you stop the medication, the problems recur,” Newman adds, “whereas psychotherapy is meant to teach people skills that they can continue to use after the treatment has ended.”
Asked what conditions tend to warrant a trip to a psychiatrist as opposed to a psychologist, she says that severe mental health problems such as bipolar disorder, psychosis, or schizophrenia require medications as part of treatment. On the other hand, depression and anxiety are two conditions that often don’t require drugs, and for which psychotherapy may be more beneficial, she says.
But these are broad generalizations. Sanacora points out that most mental health illnesses are considered “diagnoses of exclusion,” meaning there’s no sure-fire test that can determine if a person’s symptoms are 100 percent the result of a specific mental health disorder. “Many of the same symptoms that we see with depression could be caused by hypothyroidism, some cancers, infectious processes, or some other neurological disorders,” he says. Someone who is trained to identify and differentiate among these underlying factors—a psychiatrist, for example, but also a physician or general practitioner—may be a better person to see first when trying to determine a problem’s cause, he says.
Brownlowe agrees. “When a patient has a complicated medical history, neurological problems, or is acutely ill and possibly in need of intensive treatment, a psychiatrist will be the best place to start,” she says. Psychologists, on the other hand, tend to have more training in assessing and diagnosing illnesses that are strictly mental or psychological, she says. “Psychologists also provide couples, family, and group treatment, which psychiatrists do not specialize in,” she adds.
To sum all this up, a psychiatrist is an MD who can prescribe drugs and who has broad medical training. A psychologist is a PhD or PsyD who has more focused training in diagnosing mental health disorders and treating them with non-drug therapies. If you’re still not sure which one is for you, find an office that houses both. “Psychiatrists and psychologists typically work in collaboration, and can also refer to each other to incorporate many methods of treatment into a particular patient’s plan of treatment,” Brownlowe says. In other words, whichever you choose to see, you’ll likely end up in the right hands.
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