3 differences between a psychiatrist and a psychologist
One of the most common questions I am asked in my role as a psychologist is how my job differs to that of a psychiatrist. This post highlights the top 3 differences between psychologists and psychiatrists working in Australia.
Difference #1: The medical model Vs case formulation
Psychiatrists who I have worked with in Sydney carry out an assessment session that aims to understand the interaction between the biological, psychological and social factors that go into an individual's well being. They typically end the session with a tentative diagnosis. They may make a decision to prescribe a medication based on both the diagnosis, treatment guidelines for that diagnosis, and the biopsychosocial factors going on for the person.
Psychologists will use an assessment session to develop a case formulation. Psychologists are not medically trained and do no prescribe medication. Instead they are trained in the interaction between behaviours, cognition (one's internal world of thoughts, memories and attentional processes), coping strategies an individual employs and the problems they are facing. They make plans for how time in sessions and out of sessions can be best utilised to make changes in behaviour patterns, thinking patters, attentional processes, or how one manages their emotions.
Difference #2: Training and studies
Prior to undertaking specialist psychiatry training, Psychiatrists complete a degree in medicine, and practice as a medical intern as well as a medical resident. Once their medical training is completed, they carry out specialist training as a psychiatry registrar for at least five years before reaching the status of consultant psychiatrist. Psychiatrists in Australia are generally members of the Royal Australian and New Zealand College of Psychiatrists - the acronym RANZCP in their list of qualifications will signify that.
Registered psychologists carry out an undergraduate degree in psychology or behaviour science. They must complete a research dissertation in their fourth and final year of study. Psychologists are then required to complete at least two further years of training, honing their clinical skills in assessment and treatment. Many carry out postgraduate training for at least four years in a specialisation. This is somewhat similar to the psychiatry registrar program, since it involves an intense period of practical training, exams, completion of a research thesis, and extensive coursework. Psychologists who are advertised as clinical psychologists, neuropsychologists, or organisational psychologists have completed this training. The acronym MPsych or DPsych in a psychologists list of qualifications indicates specialist postgraduate training has taken place.
Difference #3: The way they address mental health in day to day work
In the Australian system, a psychiatrist in private practice tends to manage a number of facets of one’s mental health. They will tend to make decisions on what medications a patient is taking. They provide opinions on changes to medication and supplements to medication. They provide guidance on psychological and lifestyle factors in a patient’s life. Some will provide ‘talk therapy’ or counselling, but most tend to refer to psychologists, counsellors or social workers to address that area in full. Psychiatrists often act as the ‘manager’ of the treatment process, communicating with gp’s and and psychologists about treatment planning.
Many psychiatrists also do ‘consultation’ work in hospitals and community health services around Australia, providing treatment decisions for patients staying in hospital for an inpatient stay or visiting as outpatients. There are other roles a psychiatrist may engage with, but this is what I have observed to be the core business of most psychiatrists’ day to day work in Australia.
In private practice, most psychologists are carrying out assessment, case formulation and talk therapy. The talk therapy will differ depending on the modality the psychologist uses, and the form of therapy utilised can often be easily found via a web search of the psychologist's profile information. Most sessions are somewhere between 45 to 60 minutes. Given psychiatrists generally see more severe cases on the spectrum of mental health compared to psychologists, if a person’s situation is particularly complex or requires a review about the suitability of medication, a psychologist will often start to work in tandem with a psychiatrist. That is, the psychiatrist will manage the biological aspects of treatment and the psychologist will manage the social and psychological aspects.
Psychologists are also trained in psychometric testing, and often there are some psychologists working in private practice who specialise in this area. This will include testing to determine learning disabilities, neurological functioning, concentration issues or memory difficulties. It is good to speak to a GP about these issues before seeing a psychologist for testing.
How do I know if a psychologist or psychiatrist is right for me?
I would always advise people facing this dilemma talk to their GP about this. GP referrals are necessary for both psychologists and psychiatrists if you wish to have medicare rebates for consultations. You cannot see a psychiatrist without seeing a GP first. Don’t be afraid to see at least two to three professionals if you think you haven’t found the right fit or you don’t feel comfortable with the treatment.
How do I find a psychologist or psychiastrist that treats a specific problem?
For psychiatrists, head over the the RANZCP website which has an option to Find A Psychiatrist here https://www.yourhealthinmind.org/find-a-psychiatrist
For psychologists, head over to the Australian Clinical Psychology Association website which has an option to Find A Clinical Psychologist https://acpa.org.au/find-a-clinical-psychologist/ or to the APS Find A Psychologist Page.
Sources of information
Patrick Sheehan is a clinical psychologist who works with adults and adolescents in his private practice located in Glebe, Sydney. If you want to enquire about an appointment, please head over to the contact page.