In what area do psychologists have an edge?

[psych84]

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So I'm curious, is there a specific group of patients (child, youth, adult, seniors), or an area of practice (forensic, health, rehab, school), or a certain mental disorder (adhd, borderline personality, etc) that you think psychologists have an edge over psychiatrists? Ie Do psychologists have an edge at first seeing/assesing children because many are reffered while at school? or is there a disadvantage because much of child psychopathology is treated with medications? etc

Love to hear your opinions.

 

[erg923]

So I'm curious, is there a specific group of patients (child, youth, adult, seniors), or an area of practice (forensic, health, rehab, school), or a certain mental disorder (adhd, borderline personality, etc) that you think psychologists have an edge over psychiatrists? Ie Do psychologists have an edge at first seeing/assesing children because many are reffered while at school? or is there a disadvantage because much of child psychopathology is treated with medications? etc

Love to hear your opinions.

What does "an edge" mean? Psychologists and psychiatrists generally dont have the same job description, duties, or responsibilities.

Im sure most would agree that the modal psychologist is better trained in evidence-based interventions than the modal psychiatrist. I also think most would agree that treatment of schizophrenia essentially requires psychotropic medication managment (psychiatry).

 

[AcronymAllergy]

As erg mentioned, it's a tough question to answer in light of the frequently different modal job descriptions.

In general, psychologists will likely have had more experience with evidence-based psychotherapies; conversely, it makes sense that psychiatrists are going to have much more experience/knowledge regarding medication usage and general medical principles. Related to that, psychiatrists are physicians first; as such, they have an intense first four years of general medical training, and often (as far as I know) begin their residency with fairly little exposure to psychiatry/mental health (perhaps a few months). Conversely, psychologists are typically scientist-practitioners (with varying empahses on scientist vs. practitioner), and begin working/training in mental health topics and research methodology from day 1. Thus, the two training paths are very different.

Because of the research background, psychologists generally have more research-related expertise, and can then apply said expertise to a variety of areas--serving as consultants or PIs on research projects, tracking patient outcomes (at the level of their individual clinic, or department/hospital-wide) and relatedly working in program evaluation, etc. As previously mentioned, psychiatrists are expertly trained in medical knowledge/principles, and because of that (and historical precedent), are often tapped to serve in mental health leadership roles in hospitals. However, I've certainly seen psychologists as department heads as well; it's going ot depend on the culture of the hospital and the qualifications of the folks working there. Psychiatrists also see a LOT of patients during residency, and particularly a LOT of severe mental illness, and as such, will likely have more SMI experience and direct patient contact than the modal psychologist. However, psychologists specializing in SMI are going to have unique training in a variety of psychotherapies developed for use with those populations.

Forensics...is it's own area entirely, and whether a psychologist or a psychiatrist will have "an edge" is going to depend in large part on the particulars of the case.

 

[Therapist4Chnge]

Forensics (in most instances)
Research (in the vast majority of instances)

In most other areas the work is quite different, so it isn't easily compared.

 

[WisNeuro]

Definitely depends on the population/disorder. Many anxiety disorders, psychologists have the edge, especially where short-acting benzos just make the problem worse. For anything except severe, treatment refractory depression, CT also has the edge.

We could go on and on, disorder after disorder, just make sure to check the literature. That is actually another area where we have the edge, and why it is important that any reputable psychologist know how to conduct and evaluate literature.

 

[psych84]

Forensics (in most instances)
Research (in the vast majority of instances)

In most other areas the work is quite different, so it isn't easily compared.

Could you go into detail on why in forensics and research? (though the latter is more obvious)

And in regards to other areas the work being quite different, i don't think most people realize this. I think most people assume a person decides to see a psychologist or psychiatrist for a given issue. (and therefore, it is always a battle between the two) Could you explain the differences in these areas?

 

[WisNeuro]

In many hospital settings, psychiatrists are there for medication management.

 

[erg923]

Could you go into detail on why in forensics and research? (though the latter is more obvious)

And in regards to other areas the work being quite different, i don't think most people realize this. I think most people assume a person decides to see a psychologist or psychiatrist for a given issue. (and therefore, it is always a battle between the two) Could you explain the differences in these areas?

That topic is covered ad naseum all over both boards. Use the search function.

Re: Forensics,
Forensic psychiatry's Achilles heel for many years has been its continued reliance on conclusions based on "judgment" alone. Actuarial methods, as Meehl notes, outdo pure clinician judgment every time. That was like, uh, 60 years ago now too.

The biggest reason clinical neuropsychology moved to the forefront in the assessment of malingering/feigning/exaggeration, etc. was largely due to embracing objective asssesment methods of symptom distortion and advancing that science enormously within the past 20 years. If you look back into the 70s and before, this was primarily psychiatry's territory. But that ship sailed long ago, and it aint ever comin back.

 

[PsyDr]

I disagree with research. Psychologist, despite having better training in research, do not have the cache with grants that MDs do.

 

[WisNeuro]

I disagree with research. Psychologist, despite having better training in research, do not have the cache with grants that MDs do.

I think the sentiment was that by and large, your average competent psychologist knows how to conduct and evaluate research better than your average psychiatrist.

 

[PsyDr]

I agree with that idea. But IMO, if an MD and a PhD with equal number of publications with similar impact factors apply for the same grant, the MD will get it hands down 99% of the time.

 

[WisNeuro]

I agree with that idea. But IMO, if an MD and a PhD with equal number of publications with similar impact factors apply for the same grant, the MD will get it hands down 99% of the time.

I don't think it is as simple as that. Maybe for pharma studies, yes. But I think it depends on the area being studied. Any data backing that assertion up?

 

[PsyDr]

Not an assertion. As stated: in my opinion.

 

[WisNeuro]

Fair enough, I just think it is misguided and inaccurate. When I come across various "top XX" lists for nimh/nih/etc grants, it's usually evenly split between PhDs and MD's.

 

[PsyDr]

Unless those PhDs are all clinicians, I believe your representation is inaccurate and misguided.

 

[WisNeuro]

Just one example
http://principalinvestigators.org/special-edition-top-20-nih-ro1-awards-spotlighted/

I am not aware of any data that suggests MD's "win out" on the same grants applied for. I went to grad school at an R1 and our PhD's has several multi-million dollar grants ongoing. Just wondering where the "99% of the time" thing comes from?

 

[PsyDr]

You understand combating an opinion with anecdotal evidence while demanding data is illogical, right?

 

[WisNeuro]

You understand combating an opinion with anecdotal evidence while demanding data is illogical, right?

Quite. Just giving some food for thought. Mainly so others seeing the argument will not automatically see the 99% comment and think that it is valid.

 

[JeyRo]

We don't have an "edge." We're just "edgy."