Do psychiatrists look down on psychologists? or vice versa

[Beckerich]

Before I decided I wanted to do psychology, I was afraid if I did it instead of psychiatry I would be picking a career where I couldnt really help people, but after researching I decided that I wouldnt want to use medication so I figured psychology was the answer.

I'm just wondering if either psychologist or psychiatrist see the other are being less valuable to helping people. Like maybe a psychiatrist says, oh i did medication i have more education, or a psychologist says, well at least I dont drug my patient to the eyeballs.

But now I hear that many psychiatrists do talk therapy too, so isnt that just plain psychology? I mean when you remove the medication, arent they both the same?

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[PsyDr]

you will only get as much respect as you deserve.

every psychiatrist i know looks down on incompetent psychologists, or psychologists who offer nothing to their service (e.g., not answering the referall question directly), and those who speak about things that are outside their scope of practice (e.g., trying to tell teh psychiatrist what to prescribe).


every psychiatrist i know loves useful psychologists.

 

[MaddieMay]

But now I hear that many psychiatrists do talk therapy too, so isnt that just plain psychology? I mean when you remove the medication, arent they both the same?

Well, a psychiatrist could do psychotherapy and prescibe meds at the same time. Talk about a long appointment though, the HMOs are going to have a cow.

I believe there is a pilot program in southern California that trains psychologists to prescribe meds. The lines are getting blurred.

I honestly don't know how much training in psychotherapy psychiatrists get... anyone know?

 

[PsyDr]

it widely varies by the residency program.


what Maddie is referring to is the RxP programs, that allow psychologists to gain an additional masters in psychopharmacology after they get their doctorate. they are tehn elgible to prescribe in Louisiana and Arizona.

there is debate as to whether this liscense will spread to other states or not.

 

[BellaPsyD]

It's New Mexico and Louisiana actually. Arizona and Missouri are close. There is an entire thread on this if anyone is curious

 

[SFPsyd]

As others have stated, competence is the most important thing. An incompetent or closed-minded psychiatrist gets looked down upon by psychologists, just as incapable psychologists are looked down upon by psychiatrists. For the most part, if you're good at what you do and possess good interpersonal skills, there's plenty of respect going both directions between psychiatrists and psychologists. There will always be the occasional jerk, but that's to be expected in any field.

 

[parto123]

I think most people here are being a little naïve and optimistic about this. Ive seen no study or poll, but I know about 4 psychiatrists/residents and all of them look down on and ridicule psychologists (not individuals, but as a profession). Obviously if the psychiatrist knows that the person they are talking to is interested in, or attends school to be a psychologist, they wont go bad mouthing the profession.

 

[Ollie123]

Some psychiatrists look down on psychologists.

Some psychologists look down on psychiatrists.

The issue is what do you want to do with your career, and whether the opinion of members of the other profession is likely to have an effect on it. I've written off people who look down on psychology as ignorant twits, and am taking my career in a direction its unlikely to pose a problem if a few psychiatrsts don't think I made the right call.

 

[erg923]

Speaking for myself only, I do not look down on individual psychiatrists without cause. I am worried however, about the direction of psychiatry as a science and medical discipline, (one poster on the psychiatry board was adamant that we should quit intellectualizing psychiatry, and just do what works") and am troubled by the overarching philosophy and attitudes that it seems to attract and/or produce. One only need to bring up the value of listening and talking to a patient, and the value of rapport on the SDN psychiatry board to see some of the narrow minds and arguments one is confronted with.

 

[parto123]

So what. Almost every psychologist/neurologist/general pracitioner/insert medical specialty here looks down on psychiatrists for one reason or another. So what. Obviously, few will say that to their faces, but you know it, I know it, and what difference does it make? None.

i agree. someone asked a question, and i answered it.

 

[Cosmo75]

Some psychiatrists look down on psychologists.

Some psychologists look down on psychiatrists.

The issue is what do you want to do with your career, and whether the opinion of members of the other profession is likely to have an effect on it. I've written off people who look down on psychology as ignorant twits, and am taking my career in a direction its unlikely to pose a problem if a few psychiatrsts don't think I made the right call.

I completely agree with this.

In my experience working on the C-L service with all psychiatrists there is some bias, but not from everyone. I also hold some negative views of psychiatry based on some experiences, but I also know some really great psychiatrists who I work with on any med referrals. There will always be a-holes wherever you go. It's really up to you how you react to their nonsense.

 

[sunlioness]

Well, a psychiatrist could do psychotherapy and prescibe meds at the same time. Talk about a long appointment though, the HMOs are going to have a cow.

It really doesn't take much longer, actually. Well, it takes longer than a typical med check appt, but not longer than a typical therapy appointment. HMOs don't have a cow over it, you just get paid less which is why a lot of psychiatrists have no interest in doing therapy themselves. I've actually had this calculated out for me because I am planning to do both therapy and med management. And for every hour of therapy I do per week, I make $5,000 less per year. (I am not complaining about this. Just stating it as fact.)

I honestly don't know how much training in psychotherapy psychiatrists get... anyone know?

It really depends on the residency program. Suffice it to say though that it isn't as much training as psychologists have.

Anyway, as to the original question I agree that some psychiatrists look down on psychologists. Some psychologists look down on psychiatrists. Some psychologists look down on LCSWs. And some LCSWs look down on LPCs. And vice versa for all of that, too. The important thing is to choose your field because you love it and to work with the people in other fields for whom you have mutual respect. There are jerks everywhere, but not everyone's a jerk.

 

[MaddieMay]

It really doesn't take much longer, actually. Well, it takes longer than a typical med check appt, but not longer than a typical therapy appointment. HMOs don't have a cow over it, you just get paid less which is why a lot of psychiatrists have no interest in doing therapy themselves. I've actually had this calculated out for me because I am planning to do both therapy and med management. And for every hour of therapy I do per week, I make $5,000 less per year. (I am not complaining about this. Just stating it as fact.)



It really depends on the residency program. Suffice it to say though that it isn't as much training as psychologists have.

Thank you, sunlioness, I really appreciate the information!

 

[Chimed]

Speaking for myself only, I do not look down on individual psychiatrists without cause. I am worried however, about the direction of psychiatry as a science and medical discipline, (one poster on the psychiatry board was adamant that we should quit intellectualizing psychiatry, and just do what works") and am troubled by the overarching philosophy and attitudes that it seems to attract and/or produce. One only need to bring up the value of listening and talking to a patient, and the value of rapport on the SDN psychiatry board to see some of the narrow minds and arguments one is confronted with.

I know you used the word "some" in the above quote, but I want to stress that the people who post on SDN are an extremely isolated population. To equate one or two posters on SDN as representing the whole of psychiatry is just not reality (I know you're not doing that, but many do). I'm training at a reputable psychiatry residency program, and I can honestly say I've never heard anyone put down a psychologist b/c they're a psychologist or the field of psychology. At my medical center, psychiatrists, psychologists, counselors, and social workers all work very closely together. There is not this big perceived division and competition between the staff that is often suggested on SDN. We all have unique training and backgrounds and work together to come up with comprehensive plan for our patients. We are constantly e-mailing each other and have daily to weekly group meetings to discuss the total care for our patients. Now I realize that my experience doesn't reflect the whole of psychiatry either, but I think that we do a good job following evidence-based practices and any descent program will train their psychiatrist to understand the evidence behind psychotherapy. What I find to be more abusing, is the many negative comments about psychiatrists on this forum....

Regarding the amount of training a psychiatrist gets, it is variable. We are all required get training in psychotherapy throughout our 4 years. At my program we start off in our 1st year getting core lectures about the various psychotherapies (CBT, DBT, IPT, psychodynamic, etc.). We also start learning how to incorporate MI into our patient interactions. It is not until 2nd year that we start receiving supervision (Of course we get supervision in 1st year on interviewing techniques, but not psychotherapy per se, besides MI). In 2nd year we typically pick up 2 cases that we follow through the year and continue getting lectures on psychotherapy as well. During our 3rd year, we work Mon to Friday in an outpatient center and work weekly with about 3 different therapists with different orientations on our cases. We continue this into our 4th year and can get as much or as little training as we want. Our program also works with a local psychoanalysis institute and they offer advanced training for anyone that is interested. We also have opportunities to get certified through the Beck Institute in CBT. So basically, we can get minimal training to pretty extensive (not equal to a PhD/PsyD program, obviously) training. A lot of psychiatrists who do not feel they were adequately trained in psychotherapy as a resident often continue their training after residency, which can easily be done.

 

[erg923]

Yes, you are indeed correct. This is why I specified that I certainly never look down upon a psychiatrist (or psychologist, or any other person for that matter) without just cause. The comment about SDN was due to some of the narrow minds Ive confronted on SDN's psychiatry board. These people would like to think that the patients they see, and the work they do is no different than any other branch of medicine (which, at its core, demonstrates a poor understanding of psychiatry), and assume that psych patients should not expect any more attention, time, or talk, than someone who is going to see their internist. This is obviously the extreme end, but I do maintain that the current training model/philosophy in psychiatry subtly reinforces the ideas that can lead to this extreme end. I do not mean this as a jab, because lord knows we have plenty of problems with training in psychology too.

 

[Chimed]

I do maintain that the current training model/philosophy in psychiatry subtly reinforces the ideas that can lead to this extreme end.

I'm, unfortunately, going to have to agree with you on this... However, after the "decade of the brain" in the 90's, the pendulum is swinging back to a balanced approach and more and more psychiatry residents are demanding greater psychotherapy training. But I think you're right. Part of what you point out is b/c we are trained in the medical model that continues to reduce illness to disease states and fails to put the patient in the context of their environment. But again, although this view continues to be prevalent, even in medical school we were taught more about social issues then our senior physicians.

 

[sunlioness]

Do you really think so (that it's getting better)? I have to say I am so so tired of the biologic/genetic reductionism so prevalent in the field right now. One of our faculty members even announced at one of our grand rounds that she was convinced that someday we would find the "gene for borderline personality." Personally, I think we'll find that gene right after we find the one for tooth-brushing.

Though as far as the original topic goes, I have to agree that in my experience psychologists and psychiatrists have been mutually respectful and happy to work together.

 

[Therapist4Chnge]

Though as far as the original topic goes, I have to agree that in my experience psychologists and psychiatrists have been mutually respectful and happy to work together.

It seems that the people in school are the ones with the most 'issues', and when they get out working it becomes more about 'good' and 'bad' professionals (as individuals), and not about 'good' and 'bad' professions.

I think research will eventually show that everything can't be boiled down to a biological response, but until then...

 

[Pterion]

It seems that the people in school are the ones with the most 'issues', and when they get out working it becomes more about 'good' and 'bad' professionals (as individuals), and not about 'good' and 'bad' professions.

Truer words never spoken.

I think research will eventually show that everything can't be boiled down to a biological response, but until then...

I am confident they already have. Simply too few gene loci to account for literally infinite combinations of expression. There will never be a time when clinical psychology is obsolete or unnecessary.

 

[toby jones]

I think it is fair to say that the average psychiatrist looks down on the average psychologist. how come? professional worries... psychiatry is in the unfortunate position of worrying about professional encoroachment from two sides. neurology on the one hand and psychology on the other.

psychology is in a similiar position, however, with respect to whether their interventions are more effective than those delivered by people with little training.

i think that given the insecurities of both fields (psychiatry being treated as a poorer second cousin that is not worthy within medicine) and withing psychology (prescription envy) there is more than enough in the way of field divisions...

which (IMHO is stupid, really)... but conveying precisely why it is stupid... well... lets just say that one causal factor doesn't exclude another.

At this point in time I'm actually disillusioned with respect to psychiatry's status as a science. Mostly because... They don't seem to answer to the same standards of evidence based medicine as everyone else. Don't get me wrong, the standards could use some tweaking...

But when 'professional experience' outweighs the experience of patients with respect to such things as ECT... I can't help but think that really psychiatry deserves its bad name.

Psychological interventions have never been subject to *such* controversy...

 

[Chimed]

I think it is fair to say that the average psychiatrist looks down on the average psychologist. how come? professional worries... psychiatry is in the unfortunate position of worrying about professional encoroachment from two sides. neurology on the one hand and psychology on the other.

The "average psychiatrist" does not look "down on the average psychologist." It is really tiring to keep hearing people say this. I don't know what mental health center you work at, but this is just not true. Also, believe me, we are not worried about neurologists. I don't know where you're getting that from. The average neurologist has absolutely no interest in treating psychiatric patients and this will never be an issue in the future. While it is reasonable that one may argue that psychiatry may eventually merge into more a a neuropsychiatric model and may look different in the future, there will never be day when the field of psychiatry will just disappear (I know you didn't say that, but the implication of why a psychiatrist would feel threatened is that they are worried about neurologists taking over the field...And that is incorrect).

 

[Therapist4Chnge]

I've been lucky enough to work with multi-disciplinary teams for a few years now, and I've never seen a problem, as each role has been pretty well defined. The psychologists at my current place are primarily supervisors and secondarily therapists (MA/MS do most of the therapy), while the psychiatrists primarily do meds management, and work in conjunction with nursing to handle the medical side of things. I think what really helps is that we understand what the other roles handle because we talk about things in our meetings, so everyone is on the same page. I can see things possibly being harder when there are referrals involved and distance (as paperwork can sometimes be done poorly, poor communication, etc), but in the end if you are good at what you do, then you'll be respected.

 

[toby jones]

I said 'I think it is fair to say'. You can disagree if you like, but I'm not hearing a reason why your experience should be taken to be more representative than mine. It is indeed something that you often hear...

There is something of a literature on whether psychiatry will remain autonomous from neurology / neuroscience or whether it will become subsumed within it with future neurological / neuroscientific advances. Some theorists are indeed arguing that psychiatry isn't a distinct field from these disciplines and that in the future psychiatry will be merged rather than independent. I guess you hadn't heard of that literature...

> The average neurologist has absolutely no interest in treating psychiatric patients and this will never be an issue in the future.

Paresis (resulting from syphilis) used to be regarded as psychiatric. Psychiatrists no longer treat this - other specialists treat that. Epilepsy used to be regarded as psychiatric. Psychiatrists no longer treat that, either. One might this think that depression, psychosis etc will similarly be handed off to alternative specialities once we have developed more effective treatment for them. That might not happen - but it doesn't seem to be a particularly stupid position. I don't think it will happen - but it is a position that many theorists (including some psychiatrists) feel strongly about. So... There could be a day when there isn't any psychiatry anymore.

If the neurological disorders are treated by neuroscientists / neuropsychologists / neurologists and the cognitive disorders are treated by therapy then what is psychiatry's distinctive place again? I think that there is a great deal of concern about the future of psychiatry from within psychiatry. That explains why psychiatrists tend to be more defensive than, say, surgeons, or whatever...

 

[73BARMYPgsp]

... (masters level providers and professional schools weaken psychology).

The opportunity to squeeze this comment into as many posts as possible is never overlooked by you.

What do you think is the reason for the slowing economy? "Professional schools suck"

Why are people being slaughtered in the Sudan? "Professional schools suck"

How many fingers am I holding up? "Professional schools suck"

What time is it? "Professional schools suck."

What did you have for breakfast? "Professional schools suck."

 

[Therapist4Chnge]

"In Fighting" is problematic for both psychology and psychiatry.

Now to get back on track........

 

[Therapist4Chnge]

*MOD NOTE: Last warning, anything else off topic and I'm locking the thread. -t*

 

[socialcog]

...and when they get out working it becomes more about 'good' and 'bad' professionals (as individuals), and not about 'good' and 'bad' professions.

This statement sums up my experience as an MFT and by my observation is more or less true. Other variables weigh in your evaluation from other disciplines such as the quality of work you provide to your patients, which over time equates to how reputable you become in your community. Furthermore, how well you collaborate with those other disciplines will bolster your professional image...over time.

Not to say that I haven't been on the recieving end of many disparaging remarks because I am an MFT. It's going to happen.

 

[toby jones]

I wonder how much of the professional envy has to do with the differences in pay scale.

Fact: The average psychiatrist earns more per hour than the average psychologist.

I wonder how much of the professional envy has to do with the differences in pay scale.

Fact: Psychiatry is one of the lowest paid medical specialities.

I wonder if the compatative $$$ (read: value(?) ) has something to do with the comparative defensiveness?

Everyone is worried about being considered a 'second rate' something else. Psychiatrists are concerned about being considered 'second rate' doctors / medical practitioners, and psychologists are concerned about being considered `second rate' psychiatrists, and councellors are worried about... Etc etc etc...

 

[73BARMYPgsp]

I wonder how much of the professional envy has to do with the differences in pay scale.

Fact: The average psychiatrist earns more per hour than the average psychologist.

I wonder how much of the professional envy has to do with the differences in pay scale.

Fact: Psychiatry is one of the lowest paid medical specialities.

I wonder if the compatative $$$ (read: value(?) ) has something to do with the comparative defensiveness?

Everyone is worried about being considered a 'second rate' something else. Psychiatrists are concerned about being considered 'second rate' doctors / medical practitioners, and psychologists are concerned about being considered `second rate' psychiatrists, and councellors are worried about... Etc etc etc...

So true. Some call it the "missing tile" syndrome. "If only I was a ______ then people woule respect me/think I am valuable/my life would be better." The grass is always greener, I guess.

 

[JockNerd]

I wonder how much of the professional envy has to do with the differences in pay scale.

Fact: The average psychiatrist earns more per hour than the average psychologist.

I wonder how much of the professional envy has to do with the differences in pay scale.

Fact: Psychiatry is one of the lowest paid medical specialities.

I wonder if the compatative $$$ (read: value(?) ) has something to do with the comparative defensiveness?

Everyone is worried about being considered a 'second rate' something else. Psychiatrists are concerned about being considered 'second rate' doctors / medical practitioners, and psychologists are concerned about being considered `second rate' psychiatrists, and councellors are worried about... Etc etc etc...

Eh, I don't know about this one. I think this would only be an issue when two people in different professions are doing exactly the same thing... corporate lawyers make more money than any of us, but I don't envy them.

I do think one additional factor may be that many of us actively chose against the other professions... I chose to go to grad school, not med and psychiatry, and not social work grad school and I think my reasons are great. Most psychiatrists could probably have gotten into psychology grad school, but chose med for their own reasons. I think some people are unable to separate "my reasons" from "others' reasons" and can't see why someone would choose to do x profession. That goes for divides in psych between researchers and practitioners too. Seems pretty immature to me, but that's the impression I get.

 

[parto123]

Eh, I don't know about this one. I think this would only be an issue when two people in different professions are doing exactly the same thing... corporate lawyers make more money than any of us, but I don't envy them.

I do think one additional factor may be that many of us actively chose against the other professions... I chose to go to grad school, not med and psychiatry, and not social work grad school and I think my reasons are great. Most psychiatrists could probably have gotten into psychology grad school, but chose med for their own reasons. I think some people are unable to separate "my reasons" from "others' reasons" and can't see why someone would choose to do x profession. That goes for divides in psych between researchers and practitioners too. Seems pretty immature to me, but that's the impression I get.

Well, he didn’t say that everyone is worried about being considered a second rate EVERYTHING else.

People’s professional insecurities/envy comes from professions that are very similar to their own and that may be compared to or confused with their own.