What Is the Difference Between a Psychologist and a Psychiatrist?

This is a confusing question for many people, but also a very important one, as people seek out help with mental health issues.  Do they need a psychiatrist, or a psychologist, or a social worker, or a licensed professional counselor?  Some states have other licenses and certifications as well (such as marriage and family counselor).  I'm just going to deal here with the distinction between a psychiatrist and psychologist.

There is a basic difference in training and in method.  In the beginning of psychiatry (early 20th century or late 19th century), there was a beginning in medical research, neurology, and Freudian theories.  In the beginning of psychology, there were laboratory studies of animal behavior, study of child development, and school psychology.  These two different beginnings led to two somewhat different perspectives on human behavior, each valid and useful.

In addition to there being differences in perspective, there are differences in training.  A psychologist gets a four year bachelors degree, then four to six more years for a Ph.D. and a year for internship.  Sometimes there is an additional year or two of a postdoctoral fellowship.

A psychiatrist gets the four year college degree, then four years of medical school, and then four years of residency.  If they are a child psychiatrist, there are two more years of residency for that specialization.

Then in addition to differences in training, there are differences in treatment methods.  Both psychologists and psychiatrists can do psychotherapy.  However, in the United States, psychiatrists often see patients for 10-20 minutes for medication treatment, leaving the psychotherapy for non-MDs.  Psychologists, on the other hand, spend most of their time doing psychotherapy, usually 45-55 minutes at a time.  Psychiatrists can prescribe medication and order laboratory tests and interpret them.  Psychologists cannot.  And while theoretically psychiatrists can do some basic psychological testing, it is not really part of their training, and they usually do not attempt it beyond short questionnaires.  Psychological testing is often a major part of a psychologist's training.

Oftentimes, a psychiatrist and a psychologist will refer patients to each other and have a close working relationship.  For some professionals, however, there is more of an antagonistic relationship, which is unfortunate for patients.  Much of the research literature suggests that combined psychotherapy and pharmacotherapy is a superior treatment to either alone.  So it is usually in the patient's best interest to have the option of seeing both a psychiatrist and a psychologist.

If you are seeking out treatment, you may want to consider seeing both a psychiatrist (or some other physician) and a psychologist (or some other non-MD psychotherapist).  But which one do you go to first?  The answer is generally that the more severe the symptoms are, the more logical it would be to start with a psychiatrist.  If there are hallucinations, delusions, or an inability to go to work, then medication is generally  necessary.  However, if the issues are milder, or if there are family or relationship problems, then starting with a psychotherapist is generally a good idea.