What’s the Difference Between a Psychologist and Psychiatrist?
Psychologists, psychiatrists, and social workers, oh my! Understanding the health care system is hard enough—choosing a mental health provider complicates matters even more. By request from listener Diane, a who’s who in mental health and how to find a provider the perfect fit for you or someone you love.
Ellen Hendriksen, PhD
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What’s the Difference Between a Psychologist and Psychiatrist?
When it comes to mental health, the answer to “Who you gonna call?” isn’t so straightforward. How to know if you, or someone you love, needs a psychologist, psychiatrist, counselor, coach, or someone else? Let’s clear up the confusion once and for all.
Rather than reading off a list of job descriptions, instead we’ll play a choose your own adventure and see where you land. In general, the two paths are therapy or medication (though it’s been shown over and over that the most effective treatment is both together).
So while the one-two punch of therapy and medication is your best bet, different professions provide each. And, trivia night bonus: oddly, the first and most famous mental health professional who started it all, Freud, love him or hate him, was none of these—he was a neurologist.
Who Primarily Does Therapy?
Since I’m biased, we’ll start with psychologists. Psychologists have a doctoral degree and have passed a national licensing exam, kind of like the bar for lawyers or the boards for physicians. There are two paths to being a psychologist, but each one teaches diagnosis and treatment of almost any psychological problem.
Seventy-five percent of psychology doctorates still earn the traditional Ph.D. You get a kind of three careers-in-one training in a psychology Ph.D. program: there’s a heavy emphasis on research training, but you also learn how to teach and, most importantly, how to treat patients. It’s the broadest and, arguably, the most versatile degree.
But about 40 years ago, a new psychology degree was pioneered: the PsyD, or Doctor of Psychology. It was conceptualized as a professional degree like the M.D. or the J.D. and was focused on working with patients, not statistics or undergrads. Indeed, until the Psy.D. came along, an aspiring psychologist who wanted solely to be a therapist had to pretend they liked research until they graduated and could burn their statistics textbook with impunity. Admittedly, Psy.Ds still fight for legitimacy (it’s hard to compete with the Ph.D., which has been around since the year 1150), but their numbers are growing quickly.
Other licensed mental health professionals who provide therapy include Licensed Clinical Social Workers (LCSWs) and Marriage and Family Therapists (MFTs). Don’t let the titles throw you: these Master’s-level clinicians often specialize in therapy and are not just restricted to marital counseling or family therapy.
But here is the most important part: no matter who you choose, look for someone who uses “evidence-based practices,” also known as techniques that have actually been shown to work in scientific studies. Unfortunately, there are a lot of ineffective therapists out there. Not all types of therapy work—empathetic support is necessary, but not sufficient. If you feel like you could get the same support from a close friend, you’re not learning to challenge your thoughts or your actions, or you’re simply not getting better, it’s probably time to switch. Beware therapists who say, “I just do whatever works,” or worse, “Let’s see what comes up.” A good therapist will stay focused on a particular problem and will teach you skills with the goal to make him or herself obsolete, not to keep you in therapy forever.
Who Primarily Prescribes?
Psychiatrists will be your best bet for psychiatric medication. A psychiatrist is a physician who went through four years of medical school and four more years of psychiatry residency, and maybe even additional years of subspecialty fellowship training. Psychiatrists diagnose, rule out other medical illnesses, prescribe, and monitor medication. Some also do therapy, and many would like to do more therapy, but the modern medical system often doesn’t allow time to do so.
Other professionals who can prescribe are nurse practitioners (NPs) and physician assistants (PAs). Plus, if you’re lucky enough to live in New Mexico or Louisiana, a psychologist with additional medical training can also write you a prescription.
There are other professionals I’m leaving out: licensed counselors, school counselors, psychiatric nurses, and more, all of whom are licensed or otherwise have to have certain credentials to claim their title.
Regardless of whom you choose to see, keep the following four tips in mind:
Tip #1: Get recommendations. No matter what kind of mental health professional you plan to see, ask around. Many clinicians have small private practices and rely on reputation. If you hear rave reviews from someone you trust, make the call.
Tip #2: Value experience, but don’t be afraid to see a student. The next thing to consider is experience. This can go either way, so let’s look at both sides of the coin.
First, trainees like students, residents, interns, or post-docs often have more energy, are up-to-date on the most recent techniques, and are, let’s face it, more earnest and less jaded. So don’t shy away from seeing a trainee—they’re always supervised by a licensed professional, so you’re getting two brains thinking about your problems rather than just one.
On the other hand, so much of being a good therapist is gained not through school, but through showing up to work every day … for years. Learning doesn’t stop at graduation. If you can find someone with extensive experience but without burnout, you’re golden.
Tip #3: Don’t insist on seeing the head of the department. Around the water cooler, those of us who do this for a living assume folks who demand to see only the head honcho should be diagnosed as narcissists. In all seriousness, you probably don’t want to see the person in charge; he or she often has a primarily administrative role and may not have done therapy or written a prescription in years.
Tip #4: If you’re going through a tough time but don’t have a diagnosis, you have many options. If you’re dealing with a life problem that’s not actually a diagnosis—you’re getting divorced, are coming out after decades in the closet, or want to change careers mid-life—you can see the professional of your choosing. Shop around until you find someone competent you like and trust.
However, buyer beware: anyone can call himself a “counselor,” “therapist,” or a “life coach.” Those titles aren’t regulated. Some life coaches are awesome and go through training or certification, but many don’t—indeed, you could hang up a shingle and declare yourself a coach right now.
And finally, don’t be afraid to shop around. Your mental health is vital—you trust your mental health provider with your quality of life, if not your literal life, so only settle in with someone who works for you.
For more, check out 5 Therapy Myths and Fears Busted and How to Encourage Someone to Go to Therapy from the Savvy Psychologist archives.
Image courtesy of Shutterstock.
About the Author
Dr. Ellen Hendriksen was the host of the Savvy Psychologist podcast from 2014 to 2019. She is a clinical psychologist at Boston University’s Center for Anxiety and Related Disorders (CARD). She earned her Ph.D. at UCLA and completed her training at Harvard Medical School. Her scientifically-based, zero-judgment approach is regularly featured in Psychology Today, Scientific American, The Huffington Post, and many other media outlets. Her debut book, HOW TO BE YOURSELF: Quiet Your Inner Critic and Rise Above Social Anxiety, was published in March 2018.