When people need mental health services, they often experience confusion in deciding who can best serve their needs. It’s hard enough to know what particular mental health issues are at stake, but sometimes even more difficult to understand the various degrees and specialties within mental health practice. In this article, we’ll understand the differences between two important mental health providers, the psychologist and the psychiatrist.
What Do Psychologists Do?
Psychologists receive education and professional training to research and apply assessment and treatment methods to help people cope with a variety of cognitive, emotional, behavioral and interpersonal problems. Within the field of psychology, there are several specialties, including clinical psychology, educational psychology, and neuropsychology.
These particular aspects of psychological study are also divided between research and the application of research. That is to say, some psychologists do active research studies, while perhaps also teaching or operating institutes that focus on advancing new ideas in psychological practice. Some psychologists work in applied fields, meaning they directly use what has been studied and published to help people improve their lives.
A few psychologists will work within both areas, either at the same time or at different points in their careers. For our purposes here, we will examine psychologists who work in applied clinical areas, known as clinical psychologists.
Clinical psychologists often earn doctoral degrees, which are typically either a PhD (Doctor of Philosophy in psychology) or a PsyD (Doctor of Psychology). Between postgraduate education and internships, etc., clinical psychologists spend an average of about seven years in training. Their applied clinical skills can include psychological testing and assessment and psychotherapy methods.
Clinical psychologists are licensed and regulated by state boards after they pass a national exam along with their state’s exam. Once they are licensed, psychologists must maintain their licensure through ongoing professional education. Clinical psychology interns who are working towards earning a license are permitted to practice under the supervision of a licensed psychologist. In some places, psychologists may be available to prescribe medications.
Psychologists with the proper education and credentialing can be given authority to prescribe psychiatric medications in Iowa, Idaho, Illinois, New Mexico, and Louisiana, as well as in the Public Health Service, the Indian Health Service, the U.S. military and the territory of Guam. Psychologists who are permitted to prescribe must have advanced training for this purpose or a master’s degree in psychopharmacology, which is the study of psychiatric and other related medications and their effects.
Clinical psychologists can be found in a variety of settings. They often work in outpatient facilities or offices, either as solo practitioners or as a part of a group practice or through telemental health (video conferencing). They also may practice in hospitals, health clinics, schools and universities, rehabilitation centers, community agencies or for businesses and industry. They may work with individuals, couples, families, or groups. They may also provide services for specific segments of the population, such as children and adolescents, veterans, LGBTQ persons, people with learning disabilities, or elderly persons.
Psychologists sometimes focus on specific problem areas, including substance abuse, depression and anxiety, posttraumatic stress disorder, chronic pain, brain injuries, and many others. In short, psychologists can help people from all kinds of backgrounds, with a variety of methods and tools to address the cognitive, emotional, behavioral, social and interpersonal problems that people can suffer in modern life.
Clinical psychologists are trained in psychometrics, which is the study and application of psychological testing. These tests include measurements of IQ and achievement, personality inventories, neuropsychological tests, employment and safety tests, attitude tests, personal interest inventories, screenings for certain psychological disorders, and many others.
Psychologists may meet with an individual and assess for which tests would be appropriate, or may use a battery of tests with which they feel most comfortable under certain circumstances. It may be important to note that not all psychologists use tests in every situation. But many agree that testing can be very helpful in making decisions about a person’s mental health diagnosis or outside of treatment, as in hiring individuals for high-risk occupations.
Psychologists generally agree that psychological tests do not completely offer an exact picture of an individual, their possible treatment needs, or whether or not they would be good candidates for a particular job. Instead, these instruments can provide additional and supportive information in connection with professionally performed interviews, especially for clinical purposes.
In the case of a psychologist assessing an individual’s treatment needs, psychological tests can help reveal such things as the deeper aspects of a person’s fears, personality issues, and the particular ways they may see themselves and the world around them. The information provided to the psychologist from those testing instruments can aid in providing a diagnosis, but perhaps more importantly, alert the provider of psychotherapy services to look for specific problem areas as the treatment progresses.
Understandably, some people might find psychological testing and the overall assessment process a bit intimidating. It may seem like you just answer a lot of questions and respond to items without knowing what it will ultimately say about you and how that information might be used.
Clinical psychologists can explain the testing and assessment process thoroughly before the assessment begins, along with providing informed consent documents that can be read and clarified, so that individuals know exactly where the information is going, who will see it, and how it will be used. These consent forms allow individuals to provide authorization before testing can proceed. When people are apprised of the reasons and the specific purpose of psychological testing, they tend to cooperate freely, and sometimes even find the process interesting and informative.
As mentioned earlier, not all individuals who seek mental health treatment are subject to psychological tests, but clinical psychologists may decide to use these instruments if needed. In any case, psychologists who provide assessments will conduct a clinical interview for the individual, or for a couple or family who need relationship therapy.
The structure of a clinical interview can vary depending on the psychologist, the particular individual(s), and the situation at hand. But essentially, clinical interviews offer opportunities for clinical psychologists to understand the persons involved, their personal, health and family histories, specific symptoms or problems they’re struggling with, and any other questions or issues that are relevant to their needs. It’s also often an opportunity for patients, or their families or caregivers, to ask their own questions about what the psychologist is perceiving about them and their circumstances, and what they may expect about treatment going forward.
As the assessment process finishes, clinical psychologists provide conclusions based on their evaluations, and use their training and experience to form a clinical diagnosis (if appropriate) and other ideas to shape a mental health treatment plan. An important part of training in clinical psychology involves psychopathology, or the study of mental disorders.
Psychologists know how certain behaviors or other information and data they receive can be used to classify particular disorders that may apply to individuals. Formulating a diagnosis helps the treatment professionals involved to know specifically what they are dealing with, and can better plan and anticipate the needs of people in their treatment programs.
One important document used in formulating a diagnosis is called the DSM-5, which stands for the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. This large book holds just about every known psychological disorder, the symptoms of each one, and how to tell one disorder apart from another. Psychologists can inquire about specific symptoms and match those with disorders listed in the DSM-5 to create the most accurate diagnosis.
However, even with all of the tools available to a clinical psychologist, an initial diagnosis may not be entirely clear, or for that matter, all information from the individual may not be immediately available. For example, people with certain disabilities or language and cultural differences may require more time or assistance to complete the assessment process. If so, psychologists can provide initial findings and impressions with caveats to allow for more information as it becomes available.
The total package of information from the initial evaluation can be used for the emerging treatment plan. If the clinical psychologist is a part of the treatment team, then he or she will retain that information for their purposes. But whether or not the psychologist is providing treatment, they will share their findings with any other member of the treatment team, including a treating psychiatrist.
Clinical psychologists themselves can use any number of therapies in which they have specific training and expertise. The most common of these therapies is psychotherapy, which is talk-based, and can involve individuals, couples, families, or groups. In this case, the psychologist may also be referred to as the “therapist” or “psychotherapist.”
Among clinical psychologists who provide therapy, there are often many different approaches and techniques that are used to meet different clinical demands. These include psychodynamic therapy, cognitive behavioral therapy, psychoanalysis, dialectical behavioral therapy, emotionally focused therapy, existential therapy, and several others. Certain psychologists may also provide other psychological treatments such as hypnosis or EMDR (Eye Movement Desensitization and Reprocessing).
Psychotherapy patients often wonder which type of therapy approach is best. And certainly, there can be a lot of controversy among therapists themselves as to what works best. But studies have shown that the type of therapy used is less important to an individual’s overall improvement in well-being than the particular therapist providing the therapy. Thus, no matter what kind of technique is used, it’s the fundamental quality of the therapist and the sense of rapport between therapist and patient that usually determines the best results.
There is no doubt that qualifications, training, and experience are important factors when choosing a therapist for yourself or your loved-one. Understanding their specialties and how they typically provide their services is also helpful in making an informed choice on who you will be entrusting with your mental health care. But it is also important to establish a good sense of connection and affinity for that professional. You may not necessarily experience that immediately with a therapist, but soon enough, having a solid measure of confidence in that therapist will promote successful therapy along the process.
Good therapists, including clinical psychologists, understand this principle, and should invite patients and those who are considering therapy to express openly their concerns about therapy, and promote honest feedback about how the therapist is doing as treatment goes forward.
Clinical Psychologists and Psychiatrists: What’s the Difference?
For people who are seeking mental health services, the various types of providers available to help can seem overwhelming, especially if you’re not familiar with what each mental health specialist does. But among all these professionals, it’s likely that psychiatry and clinical psychology are most often confused. In part, this may be because clinical psychologists who hold either a PhD or a PsyD would be addressed as “Doctor,” just as a psychiatrist with either an MD or a DO.
Psychiatrists are also doctors, but are trained in medical school and receive degrees either as a Doctor of Medicine (MD) or as a Doctor of Osteopathic Medicine (DO). An exception to this is nurse practitioners who can specialize in psychiatry, and thus provide many of the same services as psychiatric physicians. These Psychiatric Nurse Practitioners (PNP) receive their education in nursing school, but then go on to obtain additional training in the practice of psychiatry. In this article, our discussion of psychiatrists will include nurse practitioners.
Between the two disciplines of clinical psychology and psychiatry, there are other similarities, but some important differences, nonetheless.
There is some real overlap between what clinical psychologists and psychiatrists offer. So, let’s first take a look at some of their similarities before we get to the differences. Both clinical psychologists and psychiatrists spend several years in the education and training of mental disorder evaluation and treatment, along with behavioral science. In practice, both can provide assessment, diagnosis and therapy for mental health disorders. When it comes to assessment, they both would conduct the clinical interview to understand a person’s presenting complaints and issues, and personal, health and family histories.
Both sets of professionals would also use the information and guidance of researched sources, such as the DSM-5, to develop a diagnosis, and begin to construct an appropriate treatment plan. Clinical psychologists and psychiatrists could include consultation with family members or other professionals involved in that person’s life and care. They both could also offer psychotherapy services along with their specific training and expertise to do so, along with other specialized services to improve social, occupational and interpersonal functioning.
Now let’s look at the differences, and why someone might be seen by either a psychologist or a psychiatrist. With respect to training, psychiatrists receive the great part of their education and experience in medical studies. Like other physicians, they are immersed in understanding human anatomy, physiology, medication diagnostics, and diseases and how to treat them. They graduate from medical school just the same as any physician, or nursing school in the case of nurse practitioners, and then go on to complete their specialty (a “residency”) in psychiatry.
This training after medical school provides them with a unique insight into mental disorders by studying brain and central nervous system functioning, and pharmacology, which is the study of medications and their effects on the body. Because of their larger knowledge of medical practice, they are in position to know how other diseases, including endocrine and metabolic disorders, poor nutrition, drug or alcohol abuse, or brain injuries can affect the mind and behavior.
They also can understand medication interactions, so that prescriptions for psychiatric disorders can be provided safely. During their residency program, most psychiatrists also get training and education in therapy styles and techniques.
Clinical psychologists typically do receive some training in understanding how the body—especially the brain—affects behavior, but it’s not their specialty. The emphasis for psychologists is on mental processes, including cognition (thoughts), mood and emotion, and behavior, along with understanding people in the context of the world around them, especially in their interpersonal interactions.
Psychologists offer focus on how the thoughts and behaviors of an individual can be changed to improve functioning, or how their deeper or repressed thoughts and emotions can be brought out and clarified for better understanding and awareness.
Psychiatrists generally do not provide psychological testing as clinical psychologists do, but they often work in collaboration with psychologists in the total assessment and diagnostic process of an individual, couple or family. Psychiatrists can also use the data from certain tests provided by psychologists to help determine what course of treatment may be most appropriate for any given psychiatric patient.
And while psychiatrists have the background to understand the intricacies of the brain and its effect on cognition, mood and behavior, some psychologists known as neuropsychologists focus on how the brain influences these areas of functioning, as well. Clinical neuropsychologists can provide specialized tests to assess how certain areas of the brain that are not functioning optimally due to disease, damage or developmental problems affect the daily lives of those individuals. Neuropsychologists may then work to provide therapies to address these problem areas, or provide test results to psychiatrists, along with neurologists or other therapists in a collaborative approach to care.
One obvious difference between psychiatrists and clinical psychologists is that psychiatrists can prescribe medications for mental disorders (although there are some exceptions as mentioned above). Psychiatrists generally provide a medication evaluation as a part of their initial assessment process. This is to see first if a person’s psychiatric condition might benefit from medications.
Not everyone who goes to a psychiatrist for an assessment might be appropriate for meds, but many people find relief from psychological symptoms with the aid of medication. If it is determined by the psychiatrist that a medication or combination of medications can be helpful, then a prescription would be suggested and provided, along with any additional treatment recommendation, often including psychotherapy.
It is then customary to schedule follow-up sessions with the psychiatrist to manage the medications and address any problems or issues as treatment progresses. This is often the primary role of a psychiatrist in mental health care. If he or she is not providing any therapy services beyond medications, the psychiatrist will often allow the patient to work with the therapist, such as a clinical psychologist, on their deeper and more complex life issues, while making sure the medications are effective, and offer little or no side effects.
Again, not every person seeking mental health services may require medication. Generally, psychotherapy is considered the treatment of choice, with or without medications involved. But when medications are indicated, the psychiatrist and therapist can provide a dual treatment approach that can offer the best outcomes. And there may also be instances when therapy is concluded, but the need for medication continues. In this case, medications may be renewed and occasionally monitored by the treating psychiatrist after meetings with the psychologist is no longer needed.
Clinical psychologists and psychiatrists can provide similar mental health services in similar settings, but also work from different perspectives, as well. The services they both provide include the assessment and treatment of mental disorders, including mood disorders and depression, anxiety, psychosis, substance abuse, traumatic brain injury, and many other conditions.
They can also both offer psychotherapy services, as well as other novel treatments for these afflictions, and can collaborate with other professionals as needed. But the main differences between psychiatrists and psychologists typically involve important aspects of their training, the specific tools of how they assess patients, and what areas of treatment they typically focus on. Psychiatrists generally assess and diagnose mental disorders from a medical and psychological point of view.
They can then provide treatment recommendations, but typically rely more on their own role as a medication provider. Once medications are prescribed, psychiatrists will follow the medication management of their patients as long as they are needed. Psychologists also assess and diagnose, but may use psychological testing instruments to provide a broader and often more accurate portrayal of individuals with mental health conditions and the particular struggles they may be experiencing.
From there, clinical psychologists can provide various forms of psychotherapy services depending on the needs of the individuals, couples or families involved. Both psychiatrists and clinical psychologists can provide vital mental health services while collaborating together to insure an optimal level of well-being and success.