Psychologist vs Psychiatrist – What’s the difference

November 8, 2013 by  
Filed under Psychology

Psychologist vs Psychiatrist – What’s the difference? This is something I am often asked to explain so it seems sensible to set out some of the key differences for you here.

Psychologist-vs-Psychiatrist
But first:-

The old joke goes

What’s the difference between a psychiatrist and a psychologist? Answer: about £100,000 per year.

Psychologist vs Psychiatrist: What is a Psychologist?

Chartered Psychologists have completed an undergraduate degree in psychology and then completed at least a further postgraduate degree that constitutes their clinical training (usually a doctorate).

Psychologist vs Psychiatrist: What is a Psychiatrist?

By contrast, a psychiatrist has undergone medical training and is first qualified as a medical doctor. They then go on to specialise in psychiatry and eventually become qualified to practice.

Both professions are sensitive to the complex origins of mental health problems although it is also the case that the emphasis in training is different between these professions.

Psychologist-vs-Psychiatrist-talking
A psychologist will usually take a psychological view of problem origins and therefore psychologists offer psychological solutions to problems like depression and anxiety. These days the most common treatment strategy is likely to be cognitive-behavioural therapy (CBT). It is an effective and relatively short  term treatment and patients often like the experience of understanding their own thought processes and learning how to make them more useful.

In general psychiatrists have been trained to place more emphasis on the genetic and biological basis of mental health problems and therefore usually offer a pharmacological treatment for them. Psychiatrists also commonly refer to psychologists to provide CBT therapy in addition to drugs or instead of them.

I have now answered the question I set myself without, I hope, upsetting too many people by misrepresenting them.

I hope you can now see that broadly psychologists and psychiatrists have differing views of how mental health problems are created, maintained and what constitutes treatment for them. We often have somewhat contradictory theories of mental health problems. A good example is depression.

Psychologist vs Psychiatrist: What causes depression?

The most complete answer will probably include a multitude of possible things, genetics may play a role for some people, social settings may be important, employment, relationships, adverse life events or trauma and sometimes there does not seem to be any reason that can be found.

Psychologist vs Psychiatrist: The real differences between psychiatry and psychology

This is where the differences between psychiatry and psychology kicks in and can affect the patient. I have never seen a depressed person, in my clinic, who did not appear to be overly negative (compared to the average) about their history, life chances, and their potential future. I know this because in therapy I hear it.

I consider this overt negativity a facet of their overall psychology being expressed. The beliefs they have about themselves, the world and their future are a window to how they think about themselves and their capabilities.  I consider this to be the stuff of psychology.

Psychologist-vs-Psychiatrist-negativity
When these overtly negative beliefs are challenged and changed (because they are always inaccurate) the patient’s mood lifts, they feel better and they go back to their normal life.  Therefore I see depression as a predominantly psychological problem that responds well to a psychological treatment.

I have seen this hundreds of times over the years, the research on CBT and depression confirms this and I have received many emails from patients thanking me for helping them get their life back on track.

Psychologist vs Psychiatrist: The psychiatric view of depression

I don’t want to mis-represent psychiatrists but in general they will tend to accept the view that mental health problems are largely caused by genetic or biological processes gone wrong. Why else would they prescribe a pharmacological solution?

Antidepressant meds cannot change a personally held belief but it can lessen the impact of that belief and that seems to me to be the sum total of the effectiveness of antidepressants.

Psychologist vs Psychiatrist: Symptoms and Problems

Perhaps psychiatrists help manage symptoms while psychologists help resolve underlying problems.

Maybe the outcome of treatment from psychology and psychiatry look similar but the focus is different.

Psychologist-vs-Psychiatrist-focus
The trouble is that in the topsy turvey world of medical interventions for psychological problems most treatments are medical in nature (drugs) and relatively few are psychological although there is something of a change occurring albeit a modest one.

Psychologist vs Psychiatrist: My View

If the entire system worked well that would be okay. But I have several criticisms I would like to express.

Dr Purves leads CBT Therapy
The common mental health problems like the depressive disorders and the anxiety disorders are overwhelmingly treated with pharmacological medications and yet these problems continue to increase.

Furthermore once antidepressant medication is stopped relapse rates are high. In fact anti-depressants give no protection against further occurrence of depression and some commentators consider that anti depressants make relapse more likely. In practice this often necessitates someone being on an antidepressant for many years if not their whole lifetime.

Hence my view that antidepressants and anxiolytics treat the symptoms of a mental health problem but not the problem itself, once the symptom relief is stopped the problem is prone to re-emerge (sometimes worse than before).

The biological explanations for why mental health problems arise has little evidence to support it and little to recommend it. And yet ‘patients’ often report they have been told they have ‘a chemical imbalance in the brain’. When in reality they don’t because the ‘chemical imbalance’ story is just that, a story! So, despite the vast commercial and research effort in trying to find them, biological explanations are as rare and as valuable as dragons eggs.

Psychological therapies, on the other hand, are the most effective treatments for psychological problems. Treatments like Cognitive behaviour therapy (CBT) give good treatment outcomes and give enhanced protection against relapse. Hence they are recommended as the first line of treatment for the depressive disorders and the anxiety disorders.

Psychologist vs Psychiatrist: Medical treatments

Why are medical treatments still used for depression and anxiety?

Pharmacological treatments manage the symptoms of depression and anxiety without the sufferer having to do anything other than take the pill and tolerate the side effects. For many people this is all they want or can tolerate. A treatment like CBT takes some time and effort and costs much more than a medication. Furthermore CBT is considered to be an effortful therapy and not everyone has the resources to put effort into their own treatment, or even wants to. Not everyone can find a good therapist and not everyone has the funds for private therapy. In many parts of the world CBT is very scarce.

Psychologist vs Psychiatrist: In Conclusion

Psychologist-vs-Psychiatrist-room-for-both
So there remains the need for both psychologists and psychiatrists. I will just say that I have seen quite a few people, over the years, whose lives appear to have been blighted by long term use of psychiatrist prescribed medications and I think that is a terrible thing.

And I have seen many more whose use of antidepressants appears to be on a life-long trajectory.

It makes me wonder if we, as a society, have put too much faith in modern medicine to provide medical treatments for what are essentially psychological problems.

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Comments

3 Comments on " Psychologist vs Psychiatrist – What’s the difference "

  1. Veloni Amsberry on Sun, 17th Nov 2013 9:04 am  

    I’m currently being treated for depression,PTSD, and personality disorder. I’ve learned that CBT works when I have been triggered. Its not fun.CBT has helped me get back to a state I feel a little better. You have to learn how to apply the thoughts with the emotions and learn why we think the way we do.

  2. Arden on Fri, 25th Sep 2015 8:44 am  

    You really make it appear so easy with your presentation however
    I to find this topic to be really something that I feel I might never understand.

    It kind of feels too complex and very wide for me.
    I am taking a look forward for your next submit, I’ll
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  3. Healing Resource: A quick introduction to Dr David Purves | Healing Hub on Sun, 17th Sep 2017 6:35 am  

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