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Psychiatrists go to medical scho...

Posted Sep 12 2008 7:55am

Psychiatrists go to medical school.
I am still struck by how many people have only a vague idea about the distinction. It’s a pretty big one, namely: medical school. Psychiatrists go to medical school. They are trained in the medical model. As a broad generalization, particularly today, psychiatrists probably see more severely disabled patients — people that suffer from what we call bipolar disorder, people that suffer from what we call schizophrenia, people that suffer from what we call major depression. At one time, many psychiatrists did talk therapy, often in a psychoanalytic vein.

Psychiatrists and psychoanalysis.
In fact, until the late 1980’s, psychiatrists had a monopoly on psychoanalytic training. You were not allowed to train psychoanalytically unless you had an M.D. Part of the prestige of seeing a psychiatrist was that they were the only doctoral-level psychotherapists that were trained in psychoanalysis. Things were different then.

If you didn’t have a medical degree and you really wanted that training, you had to sign a waiver saying that you only wanted the training for educational purposes and would never use it to see patients! Now psychiatrists that practice any kind of talk therapy are in a small minority. Psychiatrists now mainly treat through prescribing psychotropic medications. Psychiatrists, being trained in the medical model, tend to be good diagnosticians. They cut to the chase pretty quickly, with seemingly offhand questions they get a quick read on the “diagnosis.”

Psychologists get a doctorate in psychology.
They get this from a university or a professional school. These programs require 4-5 years of graduate school. Psychologists can be psychotherapists, they can be researchers, and some of them are both. All psychologists are expected to be conversant in statistics, research design, biological bases of behavior, social psychology, diagnosis, personality, therapeutic interventions, and psychological testing, among other things.

Psychologists do a lot of different things.
Currently, psychological testing is one thing that distinguishes psychologists from the other mental health practitioners. Only psychologists can legally give personality tests like the MMPI or the Rorschach. Psychologists administer IQ tests as well as neuropsychological diagnostic tests. Some psychologists work in psychiatric settings (i.e., mental hospitals). Increasingly, psychologists are working in medical hospitals. This is referred to as behavioral medicine. Some psychologists work as consultants to corporations.

Academic and research psychology.
Many of the academic or research psychologists are professors. Being strictly on the academic side, they do not need to be licensed as psychologists. Their degree is their credential. A psychologist that does private practice, psychotherapy, either has to be under the supervision of a licensed psychologist, or be licensed as a clinical psychologist.

Clinical psychology.
In California, licensure requires a doctoral degree in psychology from an accredited university or professional school, 3000 hours of supervised experience, and to have passed both the national and state licensing exams. There are also a few continuing education credits that are required.

An important distinction: Human experience.
It may sound quaint, but increasingly in mental health there is less and less focus on people’s actual experience. You are more likely to hear about insurance panels, health care “providers”, and antidepressants. Mental health is rapidly being re-conceptualized as being almost entirely dependent on neurochemical processes, biological generalities, without regard for individuals with unique histories.

Doctoral-level practitioners.
As psychotherapists, psychologists are the doctoral-level practitioners that are trained extensively in thinking about, and working with, the human experience from different perspectives. We are trained to appreciate differences and commonalities in human development, adaptation, life transitions, family systems, and personality styles. Psychologists are also conversant in research methodology and findings. When discussing what interventions are most effective, psychologists are familiar with a body of research that supports their practice.

So that’s a little about psychiatrists and psychologists. Each has their place. They are quite different.

Kalea Chapman, Psy.D.

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