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JackieTreehorn

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If there doesn't appear to be something medically wrong with someone, but they are still having personal problems, do they still see a psychiatrist or a psychologist?

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Of course, there are many reasons why people go to see a psychologist (MA, PhD, PsyD, etc.) or a psychiatrist (MD). (There have been many debates about the roles of mental health professions here on this thread - I will ignore all of those issues in this reply). I personally like the American Psychological Association's answer about seeing a psychotherapist:

Why do people consider using psychotherapy?

Psychotherapy is a partnership between an individual and a professional such as a psychologist who is licensed and trained to help people understand their feelings and assist them with changing their behavior. According to the National Institute of Mental Health, one-third of adults in the United States experience an emotional or substance abuse problem. Nearly 25 percent of the adult population suffers at some point from depression or anxiety.

People often consider psychotherapy, also known simply as therapy, under the following circumstances:

- They feel an overwhelming and prolonged sense of sadness and helplessness, and they lack hope in their lives.
- Their emotional difficulties make it hard for them to function from day to day. For example, they are unable to concentrate on assignments and their job performance suffers as a result.
- Their actions are harmful to themselves or to others. For instance, they drink too much alcohol and become overly aggressive.
- They are troubled by emotional difficulties facing family members or close friends.

http://www.apahelpcenter.org/articles/article.php?id=52
 
Such a person would probably see a psychologist.

Psychologists deal with non-diagnosable issues all the time (especially ones that work in student psychological/counseling centers). They get stressed-out students, breakups, worry about the future/career choice, procrastination, interpersonal problems and a litany of other "adjustment" issues that might not get a label, but are interfering with their social or occupational functioning.

There are also psychologists that work with people who don't even necessarily have a concrete problem to "fix" (e.g. executive or life coaching), but want to improve themselves or do personal development work. For example, a CEO who wants to be a more effective leader, or a retiree who wants to find more meaning and joy in their life. Michael Frisch is one such clinical psychologist at Baylor University who has manualized this into what he calls "Quality of Life" therapy.
 
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I'd probably say psychologist. (just for clarification, the term clinical psychologist implies doc. level training, so MAs can't be psychologists), though they can see a psychiatrists. Many carry private practices and are open to helping people improve their day to day lives, and not just specific conditions.

-t
 
The person should see a psychiatrist for initial evaluation. Although the original question was assuming that there was nothing medically wrong with the patient, it leads to another question: who decided that there was nothing medically wrong with the patient? Many primary care doctors are inexperienced or uncomfortable with ordering the laboratories and imaging studies necessary to rule out Axis III disorders that can masquerade as Axis I diagnoses.

If, after seeing a psychiatrist, the patient has been medically cleared, then the discussion can start about following up with a psychiatrist or a psychologist. It is true that a clinical psychologist is considered doctorate level, but psychologists can have as little as a bachelor's degree to work in a number of settings, ie schools, community centers.
 
It is true that a clinical psychologist is considered doctorate level, but psychologists can have as little as a bachelor's degree to work in a number of settings, ie schools, community centers.

Not to nit-pick, but for the sake of education, this is wrong. The term "psychologist" is a protected title, and defined by each state's licensing board. One cannot represent themselves as a psychologist unless they are licensed by the state, and the large majority of states require a doctorate as a pre-requisite for licensure (among a host of other things!).

Bachelor's and master's-level individuals may call themselves "counselors" or "therapists" or the-even-more-confusing-to-the-public "psychotherapist," but they are not psychologists.
 
You said it best in your own post. It's defined by each state's licensing board. There are a number of states where a person with a bachelor's degree can lawfully identify him or herself as being a psychologist.

This still doesn't take away from the fact that a person with mental health concerns should see a psychiatrist first before considering other options.
 
This still doesn't take away from the fact that a person with mental health concerns should see a psychiatrist first before considering other options.

I don't necessarily disagree with you.

You said it best in your own post. It's defined by each state's licensing board. There are a number of states where a person with a bachelor's degree can lawfully identify him or herself as being a psychologist.

And yes, the final decision regarding title does rest with the licensing boards. But to be honest, I mostly hedged my bets when I posted above... people here are always insisting that there are states that will license a master's or bachelor's level practitioner as a "psychologist" but I have yet to identify which states these are. I have read the licensing requirements for most states, and I have never encountered anything less than a doctoral degree as a requirement.

So simply put, there are not a "number of states" where a person with a bachelor's degree can identify him or herself as a psychologist. Perhaps it is one or two. Several states have other titles such as "psychological technician" or "psychological associate" for which bachelor's and master's level people may qualify. But by and large - with few exceptions - if a person is going to see a psychologist, they will be seeing someone with a doctoral degree plus clinical internship plus postdoctoral supervised experience.
 
The person should see a psychiatrist for initial evaluation. Although the original question was assuming that there was nothing medically wrong with the patient, it leads to another question: who decided that there was nothing medically wrong with the patient?

It is true that a clinical psychologist is considered doctorate level, but psychologists can have as little as a bachelor's degree to work in a number of settings, ie schools, community centers.

This is a completely overblown assertion. EVERYONE with a mental health issue should see a psychiatrist first? That's pretty ridiculous. There's lots of people who are physically healthy and run into issues with depression and anxiety and can tie it to specific reasons that led them down that path (e.g. husband died, stressed out about med school, etc.).

It's highly unlikely that it has an organic basis whatsoever in these cases. Maybe in theory or utopian society with unlimited resources it would be nice to "medically clear" every single psych patient, but that's not how it works in the real world. Can you imagine if every single student had to see a psychiatrist first before going to student psychological services? The waiting list would be years long (it's already months long as-is) These centers are already stretched thin as it is.

Also, outside of hospital settings, I know very few psychiatrists in private practice or counseling centers that do physical exams or bloodwork on non-severe patients, unless they think there's an actual reason for an organic basis (e.g. patient reports disconcerting somatic symptoms). They diagnose just like we do, on the basis of a diagnostic interview.

Finally, I don't know where these freak exceptions are, but in California, every single clinical psychologist has a doctoral degree. Don't try to disparage psychology as being "lesser" become of a couple grandfathered practitioners in North Dakota might exist.
 
You said it best in your own post. It's defined by each state's licensing board. There are a number of states where a person with a bachelor's degree can lawfully identify him or herself as being a psychologist.

Citation please?

It is in the same vein as someone calling themselves a physician, very much a protected (rightfully so) title.

-t
 
I cut and pasted this from another thread. The message to Therapist4Change is to be careful about what you ask for. You just might get it and be proven wrong.

Not this crap again.....citation please? I asked you about this in another thread, but you conveniently never responded....

Btw...it is a protected term, but I'd love to see your 'evidence'.

-t

Anasazi,

Please note that I was not the one to start using terms such as "crap". I'm making an attempt to keep this civil.

Therapist 4 Change,

You asked for 'evidence' and, in response, I'd like to cite for you the New York State "exemptions" for use of the "protected title" of "psychologist" at the following link: http://www.op.nysed.gov/psych-licques.htm

I've cut and pasted this directly from the above-cited link from the FAQ section of the Psychology Division of the New York State Office of the Professions:

"What are the exemptions where the use of the title and the practice of psychology are permitted?

The activities, services, and use of the title of psychologist, or any derivation thereof, on the part of a person employed by a federal, state, county or municipal agency, or other political subdivision, or a chartered elementary or secondary school or degree-granting educational institution insofar as such activities and services are a part of the duties of the salaried position."

As you can see, these exemptions to protection of the title "psychologist" are quite numerous. These exemptions include essentially any person working for "federal, state, county or municipal agency" institutions. It's no surprise that there are people with associate's degrees working as "psychologists". It's also important to remember that New York state is not alone. I commend California for their rigor but, unfortunately, they are the exception rather than the rule.

Despite the rhetoric of Therapist 4 Change and positivepsych, I don't see how correcting factual inaccuracies constitutes a "bashing" of psychology. It is a fact that individuals with very little training can lawfully (see above) call themselves a "psychologist".
 
I'm reposting this from the other thread, to correct exaggerations:

1) You don't see anyone going around saying "beware of physicians," because there are foreign medical grads in the US with M.S. degrees because they skipped college, graduated from India's med school equivalent, and passed the boards here. These are the exceptions, not the rule. You're trying to insult a profession by talking about freak exceptions. No need to get high and mighty, and make exaggerated arguments that don't apply to 99% of practioners.

2) Furthermore, the exemptions quote that you pasted is actually vague, and makes no indication of how and when exemptions are used in the real world. If you look at the next paragraph, even advanced doctoral-level students in psychology are not allowed to used the term psychologist, and must use "intern" or "trainee" even though they have master's degrees.

3) I challenge you to find someone who claims to be a "licensed psychologist" in NY using PsychologyToday.com's therapist listings, and only has a bachelor's degree. I just ran a search for a Manhattan zip code using "psychologist" as a search parameter, and all had PhDs/PsyDs.

4) You can safely assume, even in New York, that 99% of licensed psychologists who are advertising their services publicly have a doctoral degree. If you're really paranoid and in doubt, just ask. In fact, that's the default state law (from the New York State Psychological Association's website):

http://www.nyspa.org/displaycommon.c...qualifications

Quote:
What are the qualifications of a licensed psychologist?
A doctorate in psychology; two years of supervised training in a specialty and passing the New York State examination for licensure.
 
I'm reposting this from the other thread, to correct exaggerations:

1) You don't see anyone going around saying "beware of physicians," because there are foreign medical grads in the US with M.S. degrees because they skipped college, graduated from India's med school equivalent, and passed the boards here. These are the exceptions, not the rule. You're trying to insult a profession by talking about freak exceptions. No need to get high and mighty, and make exaggerated arguments that don't apply to 99% of practioners.

2) Furthermore, the exemptions quote that you pasted is actually vague, and makes no indication of how and when exemptions are used in the real world. If you look at the next paragraph, even advanced doctoral-level students in psychology are not allowed to used the term psychologist, and must use “intern” or “trainee” even though they have master’s degrees.

3) I challenge you to find someone who claims to be a “licensed psychologist” in NY using PsychologyToday.com’s therapist listings, and only has a bachelor’s degree. I just ran a search for a Manhattan zip code using “psychologist” as a search parameter, and all had PhDs/PsyDs.

4) You can safely assume, even in New York, that 99% of licensed psychologists who are advertising their services publicly have a doctoral degree. If you’re really paranoid and in doubt, just ask. In fact, that’s the default state law (from the New York State Psychological Association's website):

http://www.nyspa.org/displaycommon.c...qualifications

This too is a re-post. Evidently, positivepsych doesn't mind being shown the error of his ways twice.

Anasazi, this thread does not need to be shut down. positivepsych and Therapist4Change simply need to be called to order. Any loss of civility can be directly attributed to these 2 individuals.

positivepsych, having quite a bit of familiarity with Columbia University, I don't see how the title of "Columbia University College of Physicians and Surgeons" supports your claim that PhDs pre-date physicians. Physicians have existed back into antiquity. Hippocrates lived in the 4th century BC. Modern universities did not appear until the Middle Ages (AD, mind you). If anything, it is PhDs who are trading on the names of physicians, commonly referred to as "doctors." It's clear that you need to review your world history.

Speaking of "exaggerated claims," where did you get your data for your two "99%" citations in your last post?

Under New York State Law, since I am part of an educational institution, I can lawfully refer to myself as a "psychologist". And yes, I do have a license. On the other hand, a psychologist calling him/herself a psychiatrist or a physician faces Class E Felony Charges.

Getting back to the OP, do psychiatry. Rather than worry about the protection of your title, you can practice in mental health without restriction. silas has it right pointing out the far greater range of opportunities (earnings, demand, privileges) as a psychiatrist. You can also subspecialize in fertility health. Feel free to private message me if you have questions.
 
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positivepsych, having quite a bit of familiarity with Columbia University, I don't see how the title of "Columbia University College of Physicians and Surgeons" supports your claim that PhDs pre-date physicians. Physicians have existed back into antiquity. Hippocrates lived in the 4th century BC. Modern universities did not appear until the Middle Ages (AD, mind you). If anything, it is PhDs who are trading on the names of physicians, commonly referred to as "doctors." It's clear that you need to review your world history.

You're wrong. And you need a history lesson.

I never said PhDs predate physicians. I said that the use of the title Doctor was used by PhDs well before physicians, and that physicans borrowed the title from PhDs:

Doctor (gen.: doctoris) means teacher in Latin and is a contraction of the Greek διδάκτωρ, didaktōr, teacher, from the verb διδάσκειν, didaskein, to teach. It has been used continuously as an honored academic title for over a millennium in Europe, where it dates back to the rise of the university. This use spread to the Americas, former European colonies, and is now prevalent in most of the world. As a prefix — abbreviated "Dr"— its primary designation is a person who has obtained a doctorate (that is, a doctoral degree), which is the highest rank of academic degree awardable.
 
You're wrong. And you need a history lesson.

I never said PhDs predate physicians. I said that the use of the title Doctor was used by PhDs well before physicians, and that physicans borrowed the title from PhDs:

This is yet another re-post since positivepsych isn't so positive.

positivepsych,

How does your cut and pasted reference demonstrate that physicians borrowed the title "Doctor" from PhDs? It says nowhere in your citation that physicians borrowed the title "Doctor" from PhDs. Each post you make is an even more off balance tirade than the last.

I still have my credibility and my medical license. Speaking of credibility, where did you find your cut and pasted entry? It's interesting that you didn't cite your source. Well, I found your cut and pasted entry came from Wikipedia: http://en.wikipedia.org/wiki/Doctor_(title)

If you're going to use sources, you need to use something with a little more respectability than an open-source write-it-yourself internet site like Wikipedia. While it's convenient to look things up, you're not going to sway any REAL doctors with that kind of evidence. Any kid in junior high can do what you just did, but you still haven't advanced your argument one bit.

To the OP, do psychiatry. You've got options that positivepsych could never dream of having. Feel free to private message me. I've got some information that may be useful to you.
 
This thread ought to be closed too.

Its a shame there seems to be this type of anger between both of our fields, and it does point to some of us needing to practice what we tell our own patients to do.

Some of the biggest advances in psychiatry & psychology were accomplished by things going on in the other field. We ought to be working together because our goals are the same--treatment of patients & the advancement of science.

Answering the original post...

Psychology is the study of the entire scope of the human psyche. For that reason, psychologists often have expertise in areas that (in general) psychiatrists do not such as behaviorism, conditioning, biofeedback etc. Several people see psychologists for problems that aren't on the DSM, e.g. personal performance enhancement, work place improvements, psychotherapy, marriage counseling, etc.

Psychiatry is more specialized into treating mental illness, with emphasis on the medical aspects of mental illness.

To give you a real answer--more specific knowledge would be needed. E.g. the severity of the problem, what kind of mental illness is it, etc. I would certainly reccomend a psychiatrist over a psychologist & vice versa--psychologist over a psychaitrist--(all things being equal) depending on the problem. There is of course also some area of grey where both can treat. Managed care also has confused the issue--they won't pay psychiatrists for some of the things that may be needed for therapy, but will pay a psychologist or other therapist, and vice-versa-won't pay psychologists for other things but will pay the psychiatrist.
 
It's like feeding a troll... This is my last post, and I'm done with correcting someone who has a superiority complex and won't listen to reason or substantive evidence.

I agree with you whopper, the animosity is silly, but its only coming from psychiatry towards psychology in this thread. Like I stated earlier, I have tremendous respect for the field of psychiatry. It's too bad the feeling is not mutual amongst some psychiatrists (e.g. PsychMD2100)

If you want a proper citation (and since you only believe physicians are credible), here's a published article by Nicholas Bartenhagen, M.D., published in a peer-reviewed scholarly research journal:

The past participle of Latin docere (to tell, inform) is doctus. Appending the agential suffix -tor leads to the realization that the original meaning of
the word doctor as it entered 14th Century English academia
was: a scholar who had attained a sufficiently high degree of
knowledge in a subject as to be competent enough to teach it.

Medicine, Myth & Metaphor: II. Jason and Medea: Iatros and Medicus
NH Bartenhagen - GUTHRIE JOURNAL, 1999 - becklibrary.org
http://becklibrary.org/GuthrieJournal/68_4_99/141_2.pdf
 
I can tell you of several surgeons, Internal Medicine doctors, ER doctors, etc, that think psychiatrists don't deserve the title of physician.

And while I disagree, when some psyche attendings can't tell (or are too lazy) to figure out the patient is not medically stable with a BUN:Cr ratio of over 30 to 1 or needs to be anticoagulated because they have an artificial heart valve and their INR is below 1, I sometimes agree that the specific psychiatry attending doesn't deserve it either.

I've also seen several good D.O.'s get flack & several good FMGs get flack because of labelling. Pedro Ruiz, M.D. is an FMG & a former president of the AP(sychiatry)A. I'd love to see a psyche resident complain about FMGs in front of his presence.

I was actually somewhat anti-psychology for a few months, mostly because of the issue of psychologists getting power to prescribe meds. Dr. Ruiz was the guy who put me in my place and gave me a lot of interesting data on the issue that showed me that seeing it as an us vs them thing is really looking at it the wrong way.

Richard Contrada, Ph.D.--a psychologist has made several advances in medical care--and not with mental illness. E.g. Type A behavior and correlations with cardiovascular disease, quality of life relationships with positive outcomes post CABG. I did research with the guy in college & he was a great teacher.

Heck, a large amount of data that we study as psychiatrists came from psychologists. If we're going to do the best we can for our patients, we need to work with them, as much as we'll need an internal medical doctor for the things we don't specialize in.

OK--that's it, I'm keeping my mouth shut on this. I suggest this thread be closed.
 
> The earliest use of "doctor" in WRITTEN English was in 1303, but the term applied to "doctors of the Church," meaning "learned men in the scriptures."
It was not until 1377 that it was used in the sense of "medical doctor," or one who treats illnesses or diseases.

(OED)

doctor c.1303, "Church father," from O.Fr. doctour, from M.L. doctor "religious teacher, adviser, scholar," from L. doctor "teacher," from doct- stem of docere "to show, teach," originally "make to appear right," causative of decere "be seemly, fitting" (see decent). Familiar form doc first recorded c.1850. Meaning of "holder of highest degree in university" is first found c.1375; that of "medical professional" dates from 1377, though this was not common till late 16c. Verb sense of "alter, disguise, falsify" is first recorded 1774.

Mwah haha! I win
(Being an academic philosopher)
;-)

(Though to be fair took a bit before philosophers became distinguished from theologians)
 
Sorry folks - I just found the other thread. I don't really have a desire to keep conflict going... Just got interested in the question (hey, if it is one thing we can say as philosophers its usually 'WE were around (formally) well before YOU')

But all in good fun, of course.

Psychology (as it is known today) wasn't invented until the 1900's. I'm fairly sure the birth of psychology (experimental psychology as an academic scientific discipline) is traced back to round abouts... Wundt. Wasn't his big claim to fame having the first psychology laboratory?

But... Nobody is interested in that really...

I'm reading Roy Porter's "The Greatest Benefit to Mankind: A Medical History of Humanity From Antiquity to the Present" at the moment. Interesting read...

:)
 
It's like feeding a troll... This is my last post, and I'm done with correcting someone who has a superiority complex and won't listen to reason or substantive evidence.

I agree with you whopper, the animosity is silly, but its only coming from psychiatry towards psychology in this thread. Like I stated earlier, I have tremendous respect for the field of psychiatry. It's too bad the feeling is not mutual amongst some psychiatrists (e.g. PsychMD2100)

If you want a proper citation (and since you only believe physicians are credible), here's a published article by Nicholas Bartenhagen, M.D., published in a peer-reviewed scholarly research journal:



Medicine, Myth & Metaphor: II. Jason and Medea: Iatros and Medicus
NH Bartenhagen - GUTHRIE JOURNAL, 1999 - becklibrary.org
http://becklibrary.org/GuthrieJournal/68_4_99/141_2.pdf

Neither individual who has just posted has substantiated the claim that physicians borrowed the title "Doctor" from PhDs. No one is disputing the emergence of the term for PhDs in the 14th century AD. However, not a single person has shown that PhDs existed in even the first millenium AD. Hippocrates existed in the 4th century BC and, in case you didn't know, he didn't use English as his native tongue.

Both posters have tried to show that "Doctor" was used sometime in the Middle Ages by PhDs with the rise of the university. The gaping hole is that they haven't supported the original claim that physicians adopted the term from PhDs.

I would hardly consider The Guthrie Journal to be a well-known psychiatric journal. Also, I never once hinted that I "only believe physicians are credible". If you're going to make claims, you've got to use the words that I've used--not put words in my mouth.

Both posters need to review their history and their forensics before posting. I don't think this thread needs to be closed. I think better arguments and better evidence need to be presented.
 
I would hardly consider The Guthrie Journal to be a well-known psychiatric journal. Also, I never once hinted that I "only believe physicians are credible". If you're going to make claims, you've got to use the words that I've used--not put words in my mouth.

How about.....THIS?

The vast majority of the psychological literature is trash. Your claim about psychological literature, especially as it relates to Dx, is laughable.

Your words.

-t
 
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