P is for Psych
There are so many different designations and levels of training that a therapist can have. It’s overwhelming. So here, albeit briefly, I outline the differences, to the best of my knowledge and broad experience.
First, psychologists. They have a PhD. They are not medical doctors, and thus, can not prescribe medication for you or your loved one. They can counsel you, as in, do therapy with you, or they can diagnose a condition. That’s their job. They also often refer you to a psychiatrist if they suspect medications might be helpful.
Psychiatrists hold an MD. They can diagnose you AND they can and often do prescribe medication. There are conflicting things out there about the difference between a psychiatrist and a psychopharmacologist.
In my extensive experience, the psychiatrist who specializes in medications for psychiatric disorders kind of by definition IS a psychopharmacologist. The words are sometimes used interchangeably. I can’t really speak to the subtle differences between them, because, I’m hoping, that if you are a psychiatrist, you’re well-versed in medication administration. There could be some psychiatrists who don’t know meds as well, and who generally just evaluate and diagnose people. I couldn’t say, because I’ve been on medication in two countries and too many cities to count, and anytime a psychiatrist has given me medication, it’s because they evaluated me and considered my needs based on their experience. And I’ve gotten some fun diagnoses along the way.
I currently have a psychiatrist, who is a super star, and he is both an MD AND a PhD, so he does counselling as well. But I can’t afford both, so I stick with the meds. It can be very hard to find someone to responsibly prescribe medication. There can be waiting lists, or denial of insurance. Word to the wise: if you don’t have a good experience with your first psychiatrist (or anyone working with mental health issues) then find a second opinion/option. You may have to ask around, and wait awhile to get an appointment, but having someone with whom you feel comfortable is extremely important.
And as a final comment on the psychopharmacologist/psychiatrist duality, I just look at it this way: every psychiatrist worth their salt keeps up with new research, and can evaluate and prescribe responsibly and systematically. So they’re automatically one and the same. (As far as I know.)
One thing I’ve noticed is that of the many psychiatrists/psychopharmacologists I’ve had, they’ve all but one been arrogant males who don’t listen super well. I’ve lived in a lot of places over the years, so my continuity of care SUCKS, and so each time my family and I end up moving, I have to start again. And usually, the psychiatrist is irked at whatever I’ve been prescribed, and insists I need it all needs to be changed. But do NOT be afraid to ask questions. They are not better than you because they hold a graduate degree. They are there to help YOU, not the other way around. There’s a certain amount of casual hubris you find in doctors who are literally playing with your brain chemistry. (The only one who isn’t arrogant is the wonderful one I have now. And my insurance doesn’t cover him. But I see him anyway, because he’s saved my life once already and could again.)
Finally, psychotherapists. They hold an undergraduate degree in psychology, then take a master’s in psychotherapy. Simultaneously, they have to obtain hours and hours of clinical experience, So these folks are well trained.
But wait, aren’t there many more kinds of therapists?
Why yes. It’s seemingly endless. And yet, as recently featured in The Wall Street Journal, it is extremely difficult to find a clinician who can see you within a month, or months, even. It can also be quite tough to find anyone taking new patients. Or taking your insurance. Or both. Many therapists have found that it’s easier and cheaper for them to bypass all of the paperwork and take no insurance at all. (That’s what happened to me with my former therapist.) But these factors added together make it challenging to find any viable therapist, let alone one you feel good about. So be aware that this is a long journey, and it may take some time to get things into a healthy routine for you or your loved one. It’s worth pursuing.
The fact that mental health support is so fractured, weak and prohibitively expensive in this country is the worst. I’m lucky; I have insurance. And I live in a large metropolitan area. But if I’m living in a rural town where there’s only one pspychiatrist within a 60 mile radius, and I don’t have insurance (not that they’d necessarily take it anyway) then what the actual fuck am I supposed to do? Write in my damn dream journal and hope for the best?
Yes, I’m expressing vexation here, people. I’ve tried to remain neutral-ish in these pieces, but we all know that’s only moderately successful. I’m sharing my outrage and you should be outraged, too. 20% of adults in this country have a mental illness. It is downright inhumane bullshit that so many people struggle to get even a modicum of healthcare that they desperately need.
(Is the coast clear? Is she done ranting? Phew. Okay. Back to information in the calm, cool light of day.)
A few more people who can help: Licensed Master Social Workers (LMSW) have been certified by the state, and they can do therapy in various professional settings within state boundaries.
Marriage and Family Therapists (MFT) can also help. They do exactly what you’d expect. I’ve only experienced one, and she was excellent.
Both the LMSWs and MFTs take much less time and training than psychologists (5+ years for a PhD) and psychiatrists (Med school), and psychopharmacologists can go beyond the MD with specialization, but that’s as far as I can go on my knowledge.
So, the sequence of events if you’re having an evaluation for a mood disorder should generally flow like this:
- Ask your doctor for a referral to a psychologist.
- See the psychologist. Possibly get a diagnosis.
- Ask for a referral to a psychiatrist.
- See the psychiatrist.
- Hopefully get a diagnosis.
- Take meds as prescribed by your doctor, if applicable.
- Find a good therapist: ask the professionals you are already seeing for references, preferably (crucially) covered by your health insurance (if you have any)
What you need to remember is that ANYONE can put up a shingle (virtual or literal) and can call themselves a THERAPIST. It does not mean that they have any training, insight, or experience. They might be helpful, they might be dangerous. Be very careful and check out the background of your potential medical professional by looking for someone affiliated with a hospital, mental health clinic, or through friends you know and trust. Look for the degree the potential psych professional holds. It should be graduate work at the minimum. There’s just too much to learn about mental health and illnesses to have less training than at least a master’s. I have a horror story for you when we get to the letter T about therapy gone very wrong by someone incredibly charismatic but totally unqualified to help patients in distress, especially those on medication, about which she knew NOTHING.
And on that tantalizing note, we move on to Q.