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  • Lisa Atkins

The Difference Between a Psychiatrist, a Psychologist, and a Therapist/Counselor


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When people consider addressing their mental health and/or substance use issues they are often confused about the choices professionals in the field. What is the difference between a psychiatrist, a psychologist, or a therapist/counselor? Who do I go to for what purpose? What is the difference in their training? Does it make a difference? This article will elaborate on the difference between the professions, their focus, and their training.

The most significant differences between a psychiatrist, a psychologist and a therapist/counselor are that a psychiatrist is a medical doctor who can prescribe medications; a psychologist specializes in psychological testing; and therapists/counselors specialize in providing talk therapy/counseling. All three professions are equally focused on helping people cope with their mental health and/or substance use disorders utilizing different skills. Let’s dive in.

Psychiatrists

These days psychiatrists rarely if ever provide talk therapy. Their appointments are limited in time and focus to the assessment and diagnosis of mental health and substance use disorders. Psychiatrists then proceed with treating these disorders with medication. When therapy is indicated they typically refer that piece of treatment out to a psychologist or a therapist/counselor to provide the therapy. The main reason for this is time constraints. There are fewer psychiatrists than psychologists and therapists/counselors and they are in great demand. It is not uncommon for psychiatrists to be booked out a couple of months in advance. Psychiatry offices are generally run like medical doctors’ offices with a longer initial appointment and short follow-up appointments as treatment progresses.

A psychiatrist has a medical degree that allows them to diagnose medical conditions and treat mental health disorders with medication and therapy. As said before, they usually refer the therapy piece of treatment to a therapist/counselor and work collaboratively with them for whole person care. Their medical specialty is diagnosing and treating mental health and substance use disorders such as:

· Severe Depression

· Anxiety

· Obsessive-compulsive disorder (OCD)

· Attention deficit hyperactivity disorder (ADHD)

· Schizophrenia

· Bipolar disorders and more.

A psychiatrist can consider a person’s whole health and rule out biological reasons for the symptoms experienced. They are equipped with the knowledge of the relationship between mental illness, physiology, and how that interacts with medical conditions.

A psychiatrist in NC receives the following education:

· 4-year bachelor’s degree

· 2-year master’s degree

· 2-4 year Medical Doctoral degree

· 3-7 years Residency/Fellowship Training

· 12,000-16,000 Hours of Patient Care Training

· 140-180 weeks of Clinical Rotations in Psychiatry

· Passing State Medical Board Exam

· Continued education


Usually, your first appointment with a psychiatrist is limited to a 30-minute evaluation. Follow up appointments are typically 15 minutes in length where adjustments in dosages to prescribed medications are made. The discourse between yourself and your psychiatrist will be limited to how the medication is impacting your symptoms and adjustments will be made in your course of treatment accordingly.

Seeing a psychiatrist may prove to be a necessary component of your wellness plan if therapy alone with a therapist/counselor is not sufficient to treat certain symptoms that have a strong biological component. Severe depression, anxiety, schizoaffective disorder, bipolar disorder, and schizophrenia are examples of disorders that usually require the addition of medications to talk therapy to achieve optimum results. Medications will help stabilize chemicals in the brain that are out of balance due to these disorders. Talk therapy with a therapist/counselor will assist in learning coping skills, behaviors that will restore/improve daily life functioning.

In summary, when you think Psychiatrist think Medication.


Psychologist

A clinical psychologist can provide therapy/counseling but what distinguishes this profession from other therapists/counselors is their ability to provide psychological testing to diagnose clients. A psychologist’s training allows them to administer psychological tests and interpret their statistical findings to assist with the diagnosis of intellectual and developmental disabilities and mental health disorders. Psychologists are not medical doctors like psychiatrists, so they don’t prescribe medications. They are well trained to provide therapy but again it is the use of testing that makes a psychologist stand apart.

Psychological Testing also called a psychological evaluation is particularly useful in determining intellectual/developmental disorders in children as these psychological tests can provide an accurate IQ score. Many people will utilize the services and expertise of a psychologist when they are confirming a diagnosis of:

· Autism Spectrum Disorder

· ADHD

· Intellectual Impairments

· Learning Disorders

· Developmental Delays

· Down Syndrome

· Fetal Alcohol Spectrum Disorder

Psychological Testing results in a Psychological Assessment/Evaluation/Report and these are often utilized to determine needed services and entitlements in the education system; utilized to determine disability for the social security system (going on disability because you are unable to work); and utilized in the legal system to officially assess the mental capacity of a person to stand trial.

In NC psychologists require the following training:

· 4-year Bachelor’s Degree

· 2-year Master’s Degree

· 2-3 year Doctoral Degree (PsyD or PhD)

· Passing a State Board Exam

· Continuing education to renew licensure

Like psychiatrists, psychologists are in short supply and may be booked out for several months. Psychologists typically begin with a consultation appointment and then schedule the psychological testing which will likely occur over several appointments. Once those are complete, the psychologist will write the evaluative report and invite you back for another appointment to review the results and make recommendations for ongoing treatment.

In summary, when you think Psychologist think Testing.


Therapists/Counselors

A therapist/counselor is an umbrella term for professionals who are educated, trained, and licensed to provide talk therapy and diagnose and treat mental health and substance use disorders. The various licensures for therapists/counselors in NC are:

· LCSW: Licensed Clinical Social Worker

· LCAS: Licensed Clinical Addiction Specialist

· LCMHC: Licensed Clinical Mental Health Counselor

· LMFT: Licensed Marriage and Family Therapist

All of these licenses require the following training:

· 4-year Bachelor’s Degree

· 2-year Master’s Degree

· 3000 Hours of Supervised Practice after graduation to achieve full licensure.

· Passing a State Board Exam

· 40 hours of continued education to renew licensure every two years.

Therapists/Counselors help individuals resolve issues with their behavior, thoughts, emotions, and relationships. The end goal is to help a person work through their feelings and make skillful decisions in order to solve their own problems with the therapist/counselor acting as a guide. Therapists/Counselors use various evidence-based treatment modalities to help their clients process painful events, learn new coping skills, and achieve goals. You may work with a therapist/counselor to learn to cope with:

· Anxiety

· Depression

· Past Trauma

· Substance Use

· Eating Disorders

A person does not have to have a diagnosable disorder to benefit from talk therapy with a therapist/counselor. Many people may want help dealing with:

· Stress

· Life transitions (empty nest, divorce, job change, or recent move)

· Anger management

· Relationship conflicts

· Grief and loss

· Parenting


Therapy/Counseling appointments generally are 50 minutes to one hour in length. The first appointment is usually longer and consists of an evaluation/assessment to determine your needs. After the first appointment, you may choose to see your therapist/counselor as often as you wish or can afford. Ongoing appointments range from 40 minutes to one hour and can be done either online or in-person. It is up to the individual to choose, as well as the availability of the therapist/counselor. Virtual appointments provide the most flexibility and ease in scheduling with fewer barriers to appointments such as gas prices, transportation issues, child-care and work schedules.

In summary, when you think Therapist/Counselor think therapy/counseling.


Same Goal-Three Different Professions

Psychiatrists, psychologists, therapists/counselors all work with individuals to improve mental health symptoms and substance use disorders. They talk with clients, uncover what is wrong and help clients improve their thoughts and behaviors to live happier, healthier, and more productive lives. The difference is in how these three professions go about it. While psychiatrists use medical treatments, including prescription drugs, to treat mental health and substance use disorders; psychologists are focused on testing to provide accurate diagnosis particularly for the educational, social security, and legal systems; while therapists/counselors focus on talk therapy, coping skills and behavioral changes.

The most effective treatment plans are collaborative in nature. If a psychiatrist is needed for medications, a psychologist is needed for an accurate evaluative report, and a therapist/counselor is needed to spend more time processing issues and symptoms with a client then any or all can provide each other with a broader view of a client’s needs. Each professional can inform the other of the issues experienced by the individual by providing their various expertise to the clinical picture.

It is not necessary to involve all three professions in addressing mental health and or substance use disorders. The main reason to consult a psychiatrist is if medications are being considered. The main reason to involve a psychologist is if their evaluative report is needed for a system involved or if the focus is on a person with intellectual/developmental disabilities.

The best place to start is to begin a relationship with a therapist/counselor. That professional will know if additional expertise needs to be brought in and will make the appropriate referrals for you and collaborate with those professionals in your care.

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