The fields of neuroscience and mental health seem to be on the rise… And if you don’t know all of the fancy-sounding terms that are being batted around, then don’t despair! Most people would be hard pressed to explain the differences between a psychologist and a psychiatrist, much less describe the role of a neuropsychologist. So today, my goal is simply to remove any assumptions and start from the very beginning.
PSYCHIATRY. A psychiatrist is a medical doctor (M.D. or D.O.) who has completed both medical school and a 4-year residency for a specialization in the diagnosis and treatment of mental health disorders. Some psychiatrists seek additional training in psychotherapy (i.e. talk therapy). And some psychiatrists seek even further specialty training to develop expertise in specific fields and/or populations (e.g. children and adolescents, geriatrics, addiction, pain medicine).
What should you expect when you schedule an appointment with a psychiatrist?
Your initial visit with a psychiatrist will be the longest, and should take approximately one hour. Be prepared to discuss the reason for your visit, your mental health symptoms, your medical history, and your family’s medical and mental health history. By the end of this session, your psychiatrist should have a good idea of your diagnosis and (s)he will most likely prescribe a medication to ease your emotional symptoms. While some psychiatrists are willing and able to engage in psychotherapy with you, many of them will refer you to a psychologist. This doesn’t mean that (s)he has given up on you! Rather, research suggests that the combination of medication AND psychotherapy is the quickest and most effective way to reduce mental health symptoms. You should continue to follow-up with your psychiatrist as advised. These follow-up appointments (15-30 minutes) are used to monitor your symptoms and response to treatment, which will inform your psychiatrist whether any adjustments to your medication are needed.
PSYCHOLOGY. A psychologist is a mental health professional (Ph.D. or Psy.D.) who has completed a 4-5 year doctoral program in psychology that includes an emphasis on the diagnosis and treatment of mental health disorders through the use of non-medication based modalities. Clinical psychologists must complete internships while they are enrolled in doctoral school, followed by at least one more year of post-doctoral training to qualify for licensure. Like psychiatrists, psychologists may seek further training to work with special populations and to increase their knowledge about particular fields. Psychologists are frequently involved in research, teaching, assessment, and/or forensics, in addition to providing psychotherapy.
What should you expect when you schedule an appointment with a psychologist?
Your initial visit with a psychologist will involve many of the same questions that are gathered by a psychiatrist. However, psychologists may delve a bit further into the reasons that you are seeking help and ask about any therapy that you’ve had in the past (i.e. what works for you and what doesn’t work for you). A good psychologist is willing to answer your questions as well, and describe his/her treatment plan. Most psychologists favor a certain technique or blend of techniques that could include traditional psychoanalysis, Cognitive Behavioral Therapy (CBT), Behavior Modification, or Humanistic Therapy, just to name a few. Research indicates that some mental health conditions are best treated by a specific technique. For instance, phobias are most likely to be successfully extinguished by Exposure Therapy. Ultimately, however, the type of technique that’s employed is less important than your relationship with the psychologist. What matters most is that you feel comfortable talking to your psychologist and confident about his/her approach in managing your care. Psychotherapy sessions are typically 45-60 minutes in length. The number and frequency of sessions will vary based on multiple factors such as your schedule and availability, the severity of your symptoms, and your health insurance or financial arrangement.
Do I have to see both a psychiatrist and a psychologist? That’s just too many doctor appointments!
No, you don’t have to do anything that you don’t want to do. That being said, this combination is recommended to ensure that you feel better as quickly as possible. Some people’s mental health symptoms are relatively mild and, therefore, treatment with medication is not necessary. In those cases, I would agree that meeting with a psychologist-only is probably adequate. Conversely, some people notice a dramatic improvement and rapid recovery with medication alone. In those cases, it seems perfectly reasonable that you could follow-up with your psychiatrist-only.
Will other people be able to find out that I’m receiving mental health treatment?
If you are using health insurance, then some information must be shared with your insurance provider. Although the specific details about your sessions will never be provided, your doctor is required to submit a diagnosis. Otherwise, be reassured that your family members and friends cannot call your doctor’s office and ask questions about you. Your medical records and mental health information are protected by law. Your doctors cannot confirm that you are a patient or discuss your treatment with anyone (unless you sign a consent form that gives this permission to a specific person or people).
If you are a minor, special arrangements may be made to protect your privacy. Under most circumstances, your parents or guardian must be informed that you are in treatment.
If you are involved in litigation, it is possible that your mental health records will be discovered and subpoenaed. Please know that steps will be taken to protect your privacy to the fullest extent possible.
Can I really tell my psychiatrist or psychologist anything?
Yes. The things that you discuss during your sessions are confidential. Maintaining your confidentiality is important to cultivate trust with your doctor and it’s taken very seriously! There are only a few exceptions that require a mental health professional to breach confidentiality:
It’s normal to think about hurting yourself when you’re depressed. You will be encouraged to discuss these thoughts and feelings with your doctor. However, if you are seriously considering suicide, your doctor will need to take the steps necessary to ensure your safety. This could involve contacting a family member or close friend, designated authority, or even the police.
Sometimes people make threats of violence when they’re angry. Again, you will be encouraged to discuss these thoughts and feelings with your doctor. If it sounds like you truly intend to injure someone or jeopardize someone’s safety, however, then steps must be taken to prevent this from happening.
Mental health professionals are mandated reporters. This means that if you share knowledge about a situation involving the abuse of a minor or a dependent adult, then the authorities will be contacted (e.g. Child Protective Services, Adult Protective Services) and a report will be filed.