Psychologist versus Psychiatrist: Who should I see?

Okay, I’m totally going to put my foot in it here and offend someone I’m sure but I assure both professions that I mean no harm. I am a psychologist but I work closely with many psychiatrists and have a great deal of respect for the work that they do. Let me explain quickly what the difference is between psychologists and psychiatrists and compare the training of these professionals.

Psychiatrist: Is a medical doctor and in Australia this means they have studied a minimum six year Medical Degree. Then, in addition to this they have studied a specialised program in psychiatry beyond their hospital internship. They are highly qualified as you can tell. They can prescribe medication and for the most part hold a predominantly medical perspective of your mental health. I’m not saying that they discount psychological and psychosocial factors, they just specialise in the medical field and so they bring this philosophy to their conceptualisation of you.

Psychologist: A psychologist has completed a minimum of an undergraduate degree of four years and two years of at work training before they can become registered. Some psychologists (including myself) have completed an additional 2 years of postgraduate Masters degrees in a specific area such as clinical psychology, educational psychology, or counselling psychology. These specialisations don’t necessarily dictate the type of practice they have adopted though their training likely influences their philosophies and conceptualizations of you (and therefore also your treatment).  

So… The sorts of things you may want to ask yourself are;

Do I want a pharmacological  treatment approach to my issue I am facing (do I want to take medication?)? If so, then a psychiatrist is your best choice but it may not be your first choice. Many psychiatric illnesses can be treated with psychotherapy alone and in other cases a combination of psychotherapy and medication are a better option than just medication alone.

Do I want a diagnosis? Is so, a psychiatrist again is the practitioner you need to see to get a formal diagnosis. This said, psychologists are well trained in the DSM (diagnostic manual) and can provide you with insight and a plethora of information without formal diagnosis. Their diagnostic conceptualisation of you ultimately often guides them in their treatment approach.

What type of therapy do I need? There are lots of different therapeutic approaches. Some demonstrated as being more beneficial for certain issues people are facing. You may have heard of some. If not, check here for some examples…. Some therapists have specific additional training (beyond university) in certain treatment modalities. Find out this info…

What does the presentations does the therapist have a particular interest in? If you have an eating disorder for example, find a therapist who states they have an interest in this area. If you have been given a possible BPD diagnosis, you might like to find a practitioner with an interest in personality disorders (me for example :o))… Practitioners with particular interests keep up to date with the latest research in their area of interest and so are likely well equipped to help you with what you are dealing with.Psychology today is a great website to search for practitioners.

Now, throw all of this information on the sidelines for a minute and I’m going to tell you the single biggest contributing factor to your improvement in your mental health. What do you think it is??

Okay, well, I’m here to tell you that it is not the practitioner’s training. It is also not the type of therapeutic model they adopt. It is also not the number of years they have studied. Research has demonstrated repeatedly that the single biggest factor to your improvements in therapy is the quality of your relationship with your therapist. That’s right!!! The quality of the rapport that you have with your therapist.

So…. Research your therapist choice. Read what they have written, check out their blogs, look at their website, check out their profile photo, arrange a brief phone call, stalk them on facebook (LOL). All of the above. This will give you more knowledge than any letters they have by their name whether they are the right therapist to help you.

Peace and happy journeying….

If you’ve liked what you read here and think I may be a good fit for you, you are welcome to send me an email or call me with any questions you may have.

Worth reading and simply written article on managing depression....

So you’re depressed. You know this because a health professional has told you so, or you’ve been depressed before and there is no mistaking the symptoms. Or perhaps you just suspect that you’re depressed – you’ve used an online screening questionnaire that suggests the diagnosis, and just need to see a health professional to confirm it. What now?

First stop: talking therapies

Psychotherapy remains the cornerstone of treatment. Cognitive behavioural therapy (CBT) is the most studied of the therapies, but other forms are effective too. CBT works by addressing the thoughts and behaviours that act to entrench depression.

When people are depressed they tend to withdraw from their social networks. They no longer enjoy social interactions and think they’re unappealing company. By spending more time alone, and less time around people whose company they would usually enjoy, the depression gets worse, leading to even more time spent alone, and so on.

CBT and most other therapies act to break this feedback loop by challenging the thoughts and behaviours that reinforce social isolation, and getting people engaged again.

How do you find a therapist?

Your GP should be able to recommend one, or you can find names in the directories at the Australian Psychological Society and Royal Australian and New Zealand College of Psychiatrists. If you’re between 12 and 25, headspace is a good option.

Most therapists are psychologists or psychiatrists, but some have backgrounds in occupational therapy and social work. There is actually no need for a formal qualification to work as a therapist; my five-year-old daughter could put up her shingle. But it becomes important for claiming rebates, as well as feeling confident you’re seeing someone with a degree of competence.

The Medicare Better Access scheme provides rebates for up to ten sessions of therapy a year to see a psychologist, social worker, or occupational therapist.

To access it you need a GP referral, and the amount of the rebate you get will depend on the qualification of the therapist. It might cover all of the therapist’s fee, or there might be a gap.

You can get a higher rebate still if you see a psychiatrist, who can offer up to 50 sessions of therapy a year. Their fees are likely to be higher, though, meaning a bigger gap between what you pay and the rebate you get.

CBT aims to break unhelpful thinking patterns. Photographee.eu/Shutterstock

The funding for ten sessions per calendar year for non-medical therapists introduces an oddity to the process. If you start seeing a therapist towards the end of the year you can get 20 continuous sessions (ten in one year and ten in the next). But if your depression hits at the beginning of a calendar year you will be cut off after ten.

There are other options, though: you might be eligible for rebates from your health insurance fund and of course, if you can afford to, you can pay for the sessions yourself.

Then there is online therapy, which research suggests is very effective. There are a number of options available in Australia, including MoodGYM, e-couch and This Way Up. They are worth investigating.

Antidepressants

Medications for depression have got a lot of bad press in the past few years, with suggestions that pharmaceutical companies have exaggerated their effectiveness by burying equivocal or negative results.

A fair assessment of the evidence suggests that overall they are effective: only modestly so, but taking an antidepressant medication is, on average, more effective than taking a sugar tablet.

Antidepressant medications might be considered when therapy hasn’t been effective, when it isn’t wanted (not everyone wants to see a therapist), or when the depression is severe.

One of the problems with antidepressant medications is they’re often not well-managed. Too often doctors write a script and the person stays on a low and ineffective dose of the medication without review for many months, even years.

Antidepressant use should be closely managed. Photographee.eu/Shutterstock

Antidepressant medications take four to six weeks before they start working. If there hasn’t been any effect by then, something needs to happen. In the first instance that is usually a dose increase.

But if the medication still hasn’t had any positive effect after another six to eight weeks, another medication should be considered. You need to get to this point before you can determine that a medication hasn’t been effective, but beyond this point there seems little sense in staying on a medication that hasn’t helped.

Any decisions about stopping medication, or changing dose, should be made in consultation with a doctor. Not only can they discuss the options, but they can also monitor your mood while changes are made.

Diet and exercise

People with depression are increasingly told that doing more exercise and eating better – the contemporary version of pulling their socks up – will alleviate their symptoms.

The science shows people who eat well and exercise regularly have lower levels of depression. Good physical health is associated with good mental health. Whether or not interventions that aim to improve diet or increase physical fitness are effective treatments for depression is, however, less certain.

The main problem with these prescriptions, as anyone who has been on a diet or joined a gym will know, is that filling them is hard.

It is always good to be fit and eat well, and doctors should more often recommend that these can help depression. But at this stage, while we work out how best exercise and diet can work as interventions, they should be seen as adjuncts to the more established treatments: pursue them, but in addition to psychotherapy, not instead of it.

Author

1. Christopher Davey

   Consultant psychiatrist and head of mood disorders research at Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne

https://theconversation.com/youve-been-diagnosed-with-depression-now-what-44976