To narrow the difference down to prescribing is reductionist and insulting to both parties.

it’s just toppings on a pizza, guys. psychotherapy is perfect for some people, just as psychiatry is necessary for others.

let me give an example – an 8 year old girl who pees her pants every day at school. parents don’t know why, etc. she doesn’t need anti-diuretics, because that would be the ‘greenhouse effect’ – a cheap plastic cover to your crops, until the everyday weather breaks it down again, and exposes even more destruction.

in this case she needs psychotherapy – help with trauma, domestic voilence, all that tedious, hands-on intervention shit that psychiatrists are not too good at.

now, in another case, a man walks in the therapy room, and complains that his room-mates have inserted a chip in his brain, and that they work for the MI5. and you guessed it folks, it’s psychiatric time, because severe, biological mental illness as such is so fragile it needs MEDICAL attention – not heart-and-soul intervention, because that just ain’t gunna cut it.

toppings on a pizza, guys – stop discriminating each other. and for all those scientifically-correct folks – chemicals make the world go round, but heart and soul, and all those things you deem as insignificant – are the output product, whether you like it or not.
for you see, those of us who actually work in the industry, know there is no better cure than an all-in-one facility that caters for every type of anything – referals are common, and communication a must.

i mean even the referal thing – i have seen it so many times… big shot psychiatrist, thinks he can do everything, then realises he needs psychotherapeutic assistance. yeah guys – it all sounds so good on paper, doesn’t it? gotta love the rookies…

My personal opinion is that the evidence of CBT being effective, shows that 6/12 months down the line patients are less likely to have relapsed than through taking drugs, (but this is not difficult given how ineffective most mental health drugs are!) There is still a significant relapse rate. CBT is also being used for pain and a whole host of other psychological disorders. I think the NHS think CBT is a panacea for all ills. However if you have lost your job and been struck down by M.S., I don’t believe any amount of CBT or talking is going to make you better! Some peoples mental disorders are caused by the fact that line is genuinely rubbish. (Schizophrenia and BP are triggered and maintained by stress). Therefore the Human Givens Approach is more effective.

Psychiatrists need to do less drugging and locking people up and Clinical Psychologists need to do less ‘talking’. They both need to do more DOING.

In my experience all of these things are ALOT more effective: exercise therapy, therapeutic gardening, art therapy, hypnotherapy, Human Givens Approach, Buddhist meditation on loving kindness and impermanence, yoga, singing, EFT, acupuncture, massage involving acupressure points, tai chi, British herbal and Chinese herbal remedies, NLP techniques, solution focused therapy (Shazer & Berg), guided visualisation and breathing techniques, taking vitamins and sourcing organic food (where possible).

(I write this as someone who has had major depressive disorder for over ten years as a result of getting M.E. and has extensive experience of receiving medication, counselling and a considerable amount of CBT).

There needs to be more willingness for psychiatrists to prescribe or pack people off for these therapies and for Clinical Psychologists to learn some of these these skills (namely SFT, HGA, hypnotherapy, NLP, meditation).

Unfortunately there is an unwillingness in the mental health system to INNOVATE and do what ACTUALLY WORKS. As a trained scientist also, I find this incredibly frustrating!

So in answer to the question psychiatrist or clinical psychologist… I would say neither! People would be better off teaching/helping themselves in the above techniques.

Some Psychiatrists are trained in giving ‘old school’ psychotherapy, however most of them (the ones I have observed in the NHS) can’t be bothered. They just assess someone using the DSM criteria, a simple tick box exercise and then pack them off to someone else to do the hard work of therapy (a ClinPsych, counsellor, mental health nurse or IAPT practitioner). Psychotherapy does not have any evidence base, I am not saying it doesn’t work, I am just saying there isn’t any evidence for it. I am not aware of any psychiatrists who have any training in CBT (which is supposedly evidence based). I think ClinPsychs are more ‘useful’ as they have training in CBT, systemic therapy, family therapy and psycho dynamic therapy as well as ‘old school’ psychotherapy. They are trained to take into account the whole person i.e. the person in the context of their environment and a range of reasons for why individuals are ill and what could be maintaining their illness.