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Psychiatrist / Psychologist - What's the Difference?

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Sunday, November 9, 2014
Mental Health Professional with Patient

When I meet someone new I am almost invariably asked, “So what do you do for a living?” Technically I am a psychiatrist, child and adolescent psychiatrist as well as a forensic psychiatrist. However, this is a really long answer to a short question so I usually just say “I’m a psychiatrist”. If a person wants to know more specifics about my career then I elaborate from there. Either way, almost every single person responds with some variation of, “Oh – you’re a psychologist. Interesting.”

I stopped correcting people long ago that I am in fact not a psychologist but a psychiatrist. Correcting them only seems to cause confusion in casual conversation and some people are simply put off when they are “corrected”. Frequently, people will ask for more details about my career if they learn I am a forensic psychiatrist. They may even say something like, “Oh, so you’re a forensic psychologist – now that’s really interesting”. I agree forensic psychology is interesting, although that does not make me one. "I am a forensic psychiatrist for crying out loud," I want to tell them. I don't like to split hairs unless it is absolutely necessary, so I typically just smile and politely answer their questions about testifying as an expert witness.

Similarities between a psycholgist and psychiatrist

Although there are many differences between psychologists and psychiatrists, there are also many similarities. In most cases both psychologists and psychiatrists hold some type of doctoral degree. Both tend to have significant training in the diagnosis of mental health conditions and the rendering of psychotherapy.

Differences between a Psychologist and Psychiatrist (Educational)

Psychologists typically hold either a doctorate of philosophy (Ph.D.) or a doctorate of psychology (Psy.D.). This is a 5 to 7 year process after undergraduate school. Some states require psychologists to complete a 1 or 2 year practicum after they finish their schooling before becoming fully licensed. Psychologists can also sub-specialize, including but not limited to the fields of child psychology and forensic psychology. Sub-specialization typically involves further education.

Psychiatrists are physicians holding either a doctorate of medicine (M.D.) or a doctorate of osteopathy (D.O.). Either route is a 4-year process after undergraduate school. However, neither of these doctoral degrees comes with any type of specialization and an entirely separate education is required on top of the doctorate. This is traditionally referred to as residency, and in psychiatry it lasts 4 years. It therefore takes a general psychiatrist 8 years to complete the educational requirements after college. Sub-specialties require fellowship training. For example, child and adolescent psychiatry sub-specialty training is a 2-year program and forensic psychiatry is an additional 1-year program.

Differences between a Psychologist and Psychiatrist (Clinical)

Psychologists’ training focuses heavily on the diagnosis of mental illness and treatment with psychotherapy. Psychologists are often highly trained in the administration and interpretation of complex psychological testing, such as the Minnesota Multiphasic Personality Inventory (MMPI). Psychologists also tend to be trained in a number of other psychological tests, including a variety of testing methods to measure a person's intelligence quotient (IQ).

Psychiatrists’ training also focuses on the diagnosis of mental illness and treatment with psychotherapy. However, psychiatrists are also trained in the more traditionally termed “medical” modalities of diagnosis and treatment. These medical treatments may include the prescribing of psychiatric medications, the prescribing of medical devices such as a vagus nerve stimulator or other medical procedures such as electroconvulsive therapy (ECT). Unlike psychologists, psychiatrists' training in psychological testing is often not as thorough. Having said this, some sub-specialties, such as child/adolescent and forensic psychiatry, frequently offer psychiatrists additional training in psychological testing. Such sub-specialty training adds years to a psychiatrists' training, which is why my academic career spanned some 14 years much to my wife's chagrin.

In addition to prescribing medically-based treatments, psychiatrists differ from psychologists in their ability to order medically-based diagnostic tests to look for underlying medical conditions that may outwardly appear to be “mental illness.” Such tests include any number of blood tests, brain imaging (such as CT or MRI scans) or even brain wave tests (EEGs).

The Big Picture

Psychiatrists and psychologists are both highly trained professionals. Although it takes a number of years longer to become a psychiatrist, there are certain areas in which psychologists may have more training than psychiatrists. This generally involves administration and interpretation of certain types of psychological testing. On the other hand, psychiatrists are medical doctors and may be more adept at uncovering underlying medical problems that present with symptoms of depression, anxiety, or any number of other seemingly "mental" problems.

Finally, it is my opinion that psychiatrists and psychologists should frequently work together as a team. In my private practice, for example, I often hire a consulting psychologist to conduct and/or interpret psychological tests. Such testing can prove extremely helpful in evaluating an individual either clinically or in a forensic setting.

-Dr. Tim