Psychiatrist vs. Psychologist
Judging by how often I’m asked this question, there is a lot of confusion out there about the differences between psychiatrists and psychologists. For a lot of people the two professions are synonymous.
There is overlap between the two roles, and both professions deal with a similar group of patients; we both work for the well being of patients who have problems concerning their mental health or behaviour (or both). There are however a large number of differences.
Firstly, psychologists and psychiatrists have different training. A psychiatrist goes to medical school and, in the UK , will have spent at least a year working in physical medicine. A psychologist starts their training with a psychology degree, going on to higher degrees and has no medical background.
This leads us to the really big difference: psychiatrists can prescribe medications for patients (as ever there are exceptions to this – nurses can take a prescribing course, but their remit would mostly be restricted to commonplace short term medication, for example night sedation) and psychologists do not. Psychiatrists therefore spend a lot of their time initiating and monitoring pharmaceutical treatments and assessing patients’ mental state in the light of this.
In contrast to the psychiatrists’ focus on medication as a treatment for mental illness, a psychologist’s approach focuses extensively on psychotherapy and treating emotional and mental suffering in patients with behavioral interventions. This might involve problem solving techniques or identifying and tackling dysfunctional behavioural patterns perhaps via psychological therapy such as CBT. Psychologists are also qualified to conduct psychological testing, which is important in assessing a person’s mental state and determining the most effective course of treatment.
One final difference is that psychiatrists are also involved in involuntarily detaining patients on psychiatric wards when it is felt that a patient is at risk to themselves and/or others and cannot be treated in the community; this is not part of psychologist’s remit.
So, as a simple example, let’s say that a person is referred to a mental health team because of severe anxiety. Their psychiatrist would consider prescribing them anti-anxiety medication. A psychologist will be more focused on behavioural intervention. This might involve CBT or, with a phobia, graded exposure.
People also mix up the role of psychiatrists and psychologists with that of psychotherapists/psychoanalysts. Again there is overlap between this profession and psychiatry - but it’s a story for another day.
Added 14 June 2008
Here’s what ‘Psychology: A Very Short Introduction’ has to say on the subject.
‘There are some fields with which psychology is frequently confused - and indeed there are good reasons for the confusion. First, psychology is not psychiatry. Psychiatry is a branch of medicine which specialises in helping people to overcome mental disorders. It therefore concentrates on what happens when things go wrong: on mental illness and mental distress. Psychologists also apply their skills in the clinic, but they are not medical doctors and combine with their focus on psychological problems and distress a wide knowledge of normal psychological processes and development. They are not usually able to prescribe drugs; rather they specialise in helping people to understand control or modify their thoughts or behaviour in order to reduce their suffering and distress’
Added 13 August 2008
And in 1980 under Mao psychology was condemned as being
‘90% useless’ and ‘10% distorted and bourgeois phoney science’
Source: Bond M.H. 1995 Beyond the Chinese Face: Insights from Psychology
Via Affluenza by Oliver James page 128
If you enjoyed this post you can buy me a coffee!
March 13th, 2008 at 10:23 pm
As a trainee clin psy I was flinching a bit before reading this post, given the old tension between the professions. But I reckon it’s a good fair assessment of the difference between psychiatrists and clinical psychologists. As you say main difference is prescribing. I’d add salary to that as well as caseload and possibly working hours! Psychiatrists prob have greater levels of all three.
I think the rest is fairly blurry now though - esp the idea of clinical responsibility. Even responsibility for sectioning is increasingly a multi-disciplinary task. I can think of several wards where, for example, a clin psy’s integrative formulation (CAT, attachment and/or CT) of the function or otherwise of serious self-harm would determine whether to admit to the IPCU under section - esp. with more ‘interpersonally challenging’ clients.
On the other hand clin psy’s argue their key skill is ‘formulation’ as opposed to diagnosis - but psychiatrists and other professionals are quite rightly laying claim to this as part of their approach. Most psychotherapies including those that use formulation were devised by psychiatrists in the first place!
Putting aside things like salary, respect and power which are always going to divide professions, I’m increasingly thinking that the important divide (the one that matters to me anyway) lies between those clinicians who are good and those who are not - regardless of professional background. By good I mean those who take a thoughtful, philosophical, intelligent, scientific and respectful / ethical approach to aiding people in distress, and by ‘not good’ I mean those psychologists, psychiatrists and others who just see ‘pathology’ and ‘disease’ and diagnose and ‘treat’ accordingly (ie neoKraepelinians) - be that with CBT or meds. Also ‘not good’ are those at the other extreme - those who are so seduced by social constructionism that they refuse to say (or do) anything lest they take an ‘expert position’. Heaven forbid.
March 27th, 2008 at 9:40 pm
From my experience people still seem to expect doctors to take more responsibility than other allied professions. In my last job I was often asked to do risk assessments for patients so that ‘a doctor had seen them’. Perhaps the new mental health act which allows people other than psychiatrists to be RMOs will change this.
April 12th, 2008 at 5:02 pm
perhaps this is naive of me but would it not be better if psychiatrists studied more psychology & were therefore able to offer both therapy & drugs, a more comprehensive service for the patient?
Clinical psychologists don’t want to be put out of a job… from my lowly perspective it does seem a bit duplicative to have these two roles. Do we really need them both?
April 13th, 2008 at 10:30 pm
A slightly controversial stance medically_brunette!
There’s an interesting discussion going on at
http://lakecocytus.blogspot.com/2008/04/what-do-doctors-do.html
On similar.
I’m currently working in child psychiatry and the psychologists there certainly do a lot of things (assessment of learning difficulties, diagnosis of autism) that I wouldn’t feel qualified to do. There is a lot of job overlap within (mental) healthcare provision, and I think that this is no bad thing, especially if it means I can stay in bed whilst on call.
This is my current thinking: there are lots of parts of my job that people could be taught to do in about ten minutes. Which is fine, but when something slightly difficult comes up, then they’d have to ask someone (probably me). So, the reason I can justify my salary is that I’m able to use my knowledge and to apply it to situations I’ve not seen before.
What I’m trying to say, is that if someone else’s job looks easy, it may well be, but they’re really there waiting for it to get difficult.
May 14th, 2008 at 2:39 pm
I am currently in medical school and in our neuroscience and psychiatry module, we had a bunch of psychologists come speak to us about the most useless topics. Topics included sex, personality disorders, etc. Seemed as if most of the stuff was made up and a waste of my time, a person very interested in the study of medicine.
May 15th, 2008 at 12:44 pm
In my local boozer, we’d describe that as ‘fighting talk’. You haven’t given us much to go on with regards to why you consider the entirety of psychology to be ‘made up’ and a ‘waste of my time’. Tell us more….
Never mind though, if medicine in its narrowest sense, i.e. internal medicine, is your bag then the closest you’ll have to come to a psychiatrist or a psychologist is calling them on the phone to come and see one of your patients when you can’t be bothered to talk to them yourself!
September 24th, 2008 at 3:15 am
Psychiatric and Mental Health Care work best through the collaborative efforts of an interdiciplinary team. As an APRN, I can provide therapy and presribe medication. However, my care would not be complete without psychologists, psychiatrists and social workers! We are all trained differently but we are treating the same population.
October 7th, 2008 at 8:31 pm
Are there not psychiatrists that do the same things as psychologists but also prescribe medication? I realize this is controversial, but I have spoken to some in the field who say if you’re interested in becoming a psychologist, you may as well become a psychiatrist.
My point: I always thought of psychiatrists as having the same essential training as psychologists, with the addition of the ability to prescribe medication. Is it possible for a person to gain and implement both sets of skills? Is this common?