What's the difference between a psychologist and a psychiatrist?
If you've ever tried to figure out who to call when you're struggling — a psychologist or a psychiatrist — you're not alone. The titles are easy to confuse. Both involve mental health. Both require years of rigorous training. But they are different in ways that matter, especially if you're trying to figure out who might be the right fit for you.
You’ll learn:
How their training differs
Prescribing medication — who can, and who can't
What each one actually does in practice
How each approaches mental health
When you might see one versus the other
How their training differs
The most fundamental difference is this: a psychiatrist is a medical doctor. A psychologist is not.
Psychiatrists attend medical school and complete a residency in psychiatry where they work with patients in a variety of clinical settings such as psychiatric inpatient units in hospitals, outpatient clinics, emergency psychiatry, and consultation services. It is in these settings that the budding psychiatrist comes to learn and understand the usefulness of psychiatric medicines and how to prescribe them. Being able to do this also requires an education and understanding of human brain functioning and the ways in which psychiatric medicines pharmacologically impact the brain. Psychiatric residency also includes extensive training in psychotherapy and psychological theory so the newly minted psychiatrist is clinically able to treat psychological distress by way of both therapy and psychiatric medicines, if the latter are warranted.
Psychologists follow a different path. They earn a doctoral degree in psychology, either a Ph.D. or a Psy.D., and are trained in behavioral science, psychological theory, and clinical practice. It is a rigorous education and training but it lacks the scope and breadth of that seen in psychiatry.
Prescribing medication: who can, and who can't
Psychiatrists, as medical doctors, can prescribe psychiatric medications. They're also trained to monitor side effects, manage drug interactions, and consider how a psychiatric medication fits into a patient's overall treatment plan. Not everyone is a good candidate for medication therapy, and I take into consideration the patient’s ability to adhere to a medication regimen, along with other biological, psychological, and social factors in order to yield the best chance for achieving my patients’ goals.
In most states, psychologists cannot prescribe medication. Their work is focused on non-medication approaches, such as therapy, behavioral interventions, and psychological assessment.
If medication is something you're considering, or something you want to thoughtfully rule out, that conversation belongs with a psychiatrist.
What each one actually does in practice
Psychiatrists are often associated primarily with medication management, yes, that's a significant part of what many psychiatrists do. But it isn't the whole picture. Many psychiatrists also provide psychotherapy — including psychodynamic therapy, CBT, DBT, and psychoanalysis. The range of what a psychiatrist offers depends significantly on their training and the kind of practice they've built.
In my own practice, for instance, I work with patients seeking therapy, medication, or a combination of both. Some people come in specifically wanting to avoid medication, and that's a completely valid starting point. Others need medication to create enough stability that therapy can do its work. Many benefit from both, thoughtfully combined.
Psychologists, for their part, focus primarily on psychotherapy.
How each approaches mental health
Psychiatry is about diagnosing and empathizing with another in regard to the psychological symptoms and suffering they are experiencing. One avenue of treatment to address these problems are the psychiatric medicines that can help control depression, anxiety, mood instability, disruptive emotional outbursts, and other problems.
Another approach a psychiatrist may take here would be psychotherapy, commonly known as therapy. Rooted in conversation, therapy is a process of talking to obtain relief from one’s distress. During appointments, I listen closely and attentively to you and try to help you explore the trouble you are going through. Over time, this process leads to insight into your difficulties that enable you to change your behavior and lead a better life.
I am also a psychoanalyst. Psychoanalysis, also rooted in conversation, is an altogether more intensive form of therapy that attempts to understand the unconscious mind, in addition to the conscious mind. Many patients can benefit from psychoanalysis. It helps one understand the complicated and confusing parts of the self that are often behind repetitive self-destructive behavior and emotional states. Understanding the deeper parts of ourselves leads to less harmful behavioral patterns, a greater sense of contentment, and overall better choices in life.
I have also done graduate study in neuroscience. Integrating all of these various treatment modes enables me to offer my patients a form of comprehensive, personalized care that reflects my patient’s needs.
So, psychiatrists like myself in general bring to bear a medical and biological background that provides a fuller form of treatment compared to psychologists, who are fully competent clinicians whose focus is strictly psychological.
When you might see one versus the other
You would want to seek out a psychiatrist if you think medication might help with what’s troubling you, or you want a professional who can thoughtfully evaluate that question with you. Another reason to seek out a psychiatrist is that you are primarily seeking therapy but you also want access to medication if it ever becomes relevant. Also, you might want to consult with a psychiatrist if you are dealing with a complex problem that you would like to be evaluated from a psychological, biological, and social perspective.
Psychiatrists and psychologists both offer therapies that were mentioned earlier, but if you are interested in doing a deeper type of psychotherapeutic work, psychoanalysis is available in my practice. As a word of caution, it does involve a significant time commitment.
Lastly, my background in neuroscience, along with my training in psychiatry, psychology, and psychoanalysis, enables me to offer an integrated form of biopsychosocial care that is comprehensive enough to meet any patient’s needs.
A psychologist may be a particularly good fit if you're specifically seeking therapy and have no interest in a medication conversation, or if you're already working with a prescribing physician and want a dedicated therapy relationship alongside that.
In the end, the most important thing is finding someone whose training, approach, and way of working with you adequately fits your needs.
If you've been trying to figure out which direction makes sense for you, I'm happy to talk it through. I offer a brief, no-fee introductory conversation for that exact reason. You can schedule yours here.
~ Dr. Wasik