One of the things I'm particularly interested in is trying to clarify the similarities and differences between the practices of a clinical psychologist and a psychiatrist. (It's amazing what different answers I get to this question, from professionals on both sides!) [I'm hoping to avoid a great deal of personal anecdotes about terrible drug-dispensing psychiatrists who don't learn therapy, just for the record!] What I'm asking is more this: imagine that you have two such professionals who each represent all of the best qualities of their fields - they have sought out and studied many forms of psychotherapy, they are great listeners and have wonderful insight, and they do fantastic research. Why might I refer a patient to one versus the other? In what situations would it matter, and in what situations would it not matter? (As one example, my suspician is that it would be totally inappropriate for someone diagnosed with schizophrenia to be treated solely by a psychologist, without ever seeing a psychiatrist - agree or not? Are there other clear examples?)
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Distinctions and similarities
- Thread starter em195
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I think the best distinction is that psychiatrists are best trained to treat serious mental illness, and psychologists are best trained to treat more common emotional, psychological and psychiatric conditions.
I have seen a lot of team settings in the hospital for really complex issues such as autism, eating disorders, schizophrenia etc. where both psychiatrists + psychologists contribute to the care team, so in those contexts I guess the lines blur? - What about in private practice, what would the range of diagnoses/complaints look like for each field? - Oh, and I know that in psych residency you are expected to rotate so that you are exposed to as many different disorders and therapeutic strategies as possible; in clinical psych is there a similar system of rotation or do you spend your training years mroe focused on a certain disorder or therapeutic approach?
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I think the best distinction is that psychiatrists are best trained to treat serious mental illness, and psychologists are best trained to treat more common emotional, psychological and psychiatric conditions.
That's funny because that is the on-paper distinction that is always made to describe the primary difference between clinical psychology (serious mental illness) and counseling psychology (less severe psychopathology). Just goes to show what a complete jumble the whole thing is.
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That's funny because that is the on-paper distinction that is always made to describe the primary difference between clinical psychology (serious mental illness) and counseling psychology (less severe psychopathology). Just goes to show what a complete jumble the whole thing is.
My exact thought.
I think psychologists deal with the severely mentall ill, and typically work in conjunction with a psychiatrist for meds management in the case of a schizophrenic. (This has been my experience)
In the case of a lesser pathology, a MHC, LCSW, etc would be adequate. This is what i'd expect at a general mental health clinic, with the complex cases getting referred out to people who work more specifically with those populations. (Eating Disorders, Schizophrenia, etc) Of course, this is in an ideal case.....and I know that many times the clinics cannot refer out and have to handle the cases the best they can.
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I guess that distinction has left my mind as I have been managing meds for years, and the presence of a psychiatrist has been a luxery but not the norm.
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One of the things I'm particularly interested in is trying to clarify the similarities and differences between the practices of a clinical psychologist and a psychiatrist. (It's amazing what different answers I get to this question, from professionals on both sides!) [I'm hoping to avoid a great deal of personal anecdotes about terrible drug-dispensing psychiatrists who don't learn therapy, just for the record!] What I'm asking is more this: imagine that you have two such professionals who each represent all of the best qualities of their fields - they have sought out and studied many forms of psychotherapy, they are great listeners and have wonderful insight, and they do fantastic research. Why might I refer a patient to one versus the other? In what situations would it matter, and in what situations would it not matter? (As one example, my suspician is that it would be totally inappropriate for someone diagnosed with schizophrenia to be treated solely by a psychologist, without ever seeing a psychiatrist - agree or not? Are there other clear examples?)
IMO psychologists and psychiatrists are the only two doctoral level mental health providers and mentally ill patients generally stand to benefit most from being followed by both since each brings a different but complimentary emphasis to diagnosis and treatment, i.e., psych MD/DO the medical and psych PhD/PsyD the cognitive and behavioral. These two perspectives coalesce into the biopsychosocial model of mental healthcare. Furthermore:
1. Similarity: psychiatrists and psychologist can both provide psychotherapeutic interventions (CBT, DBT, REBT, ITP, psychodynamic/psychoanalysis, etc)
2. Difference: psychologists are much more extensively trained to provide psychological assessment (intelligence, academic achievement, adaptive behavior, forensic, interests and aptitude, neuropsychological, personality, psychopathology, etc) and psychological treatments.
3. Difference: psychiatrists are much more extensively trained to provide medical evaluations and medication management.
As far as referring goes, in general I (currently I'm a psychologist but I have just been accepted to med school and intend to become a psychiatrist, actually I intend to become a PsyD, DO) would refer a patient to a psych MD/DO if I was looking to rule out differential diagnosis that are more medical in nature and for psychotropic eval and mgm-especially for more severe psychopathology, treatment resistant cases, and patients with complex comorbid conditions and I would refer to a psych PhD/PsyD if I was looking for assessment of cognitive function limitations, educational issues, intrapsychic and interpersonal patterns and for empirically validated therapeutic interventions, e.g., CBT for Panic Disorder.
