Psychiatry vs. Psychology

The field of professional mental health providers unfortunately has inherited and created a confusing terminology when it comes to understanding what types of providers do what.  The most obvious source of confusion arises from the very similar terms, psychiatry and psychology, or the practitioners of those fields–psychiatrists and psychologists.  It is easy to understand how this could be confusing to the lay public.  Aside from the names, these days the distinction is fairly straightforward, however.  Psychiatrists, who are medical doctors (MDs or DOs), tend to prescribe medication for mental illness.  Psychologists, who receive PhDs or another doctorate degree, PsyD, go to graduate school to study psychology to become psychotherapists.  The area has become a little more gray in recent years as some states have granted psychologists the ability to take abbreviated medical courses in order to prescribe a limited number of psychiatric medications.  They may or may not require the supervision of a psychiatrist to do so.  

In previous decades psychiatrists often provided psychotherapy in addition to medication management.  Since approximately the 1980s psychiatry has trended towards what is commonly referred to as the “biological” focus of mental health.  Hence, the tendency for most psychiatrists to focus on medication management.  Some psychiatrists, however, still practice psychotherapy in addition to medication management.  

The field is somewhat more complicated by the fact that for psychotherapists, there are multiple degrees as well.  In addition to the doctorate-level psychotherapists, there are master’s level therapists as well.  The title associated with these master’s programs vary somewhat from state to state, but common ones include Licensed Clinical Social Workers (LCSWs) and Licensed Professional Counselors (LPCs).  There are other types of degrees with more specific areas of focus such as marriage and family therapy, substance abuse, etc.  

In my experience, it is important not to place too much emphasis on the degree your psychotherapist has.  I have met and worked with many LPCs and LCSWs who were profoundly skilled therapists.  Conversely, I have known doctorate-level therapists who were not particularly skilled.  I’ve obviously encountered many highly skilled doctorate-level therapists as well.  The important takeaway is that the degree does not make the therapist.  Clinical acumen in psychotherapy develops from a range of knowledge, skill, and devotion that differs from person to person.  And any specific combination of these factors may or may not work for a particular client.  The ability to form trust and open communication between therapist and client is fundamental.  Like any relationship, how two people go about this and what makes them a good fit is very hard to define.  

Perhaps the best thing that a client can do to see if the relationship might develop is to be open-minded at the beginning and try to give the connection a chance.  It doesn’t always happen right away.  It can take time.  It’s important to be patient.  A fair rule of thumb is to give it at least four sessions.  Therapists are like anyone else.  Sometimes it takes a little while to feel comfortable with them.  Just like other aspects of life, some people who initially don’t make the best impression sometimes turn out to be those with whom we have tremendously close relationships.       

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