Dr. Rob,
I'm a sophomore in college and I need to start thinking about my future. I'm pretty sure I want to be in mental health. What is the difference between a Psychologist and Psychiatrist, and what are the benefits of choosing one over the other as a career?
Nicole
While psychology is one of the most popular majors in United States colleges and universities, few go on to actually practice in the field due to the extensive graduate work, so it's great to hear about a future colleague preparing to enter the fold. The differences between psychiatrists and psychologists are vast and important in terms of both training and practice. Psychiatrists are physicians. They complete the traditional medical school training and then study the specialty of mental health, generally from the medical perspective. In large cities like New York, many psychiatrists do also practice psychotherapy (especially Freudian-type psychoanalysis), but over the years more and more psychiatrists have tended to handle solely the medical management of mental health (i.e., drugs).
Clinical Psychologists attend graduate school, as opposed to medical school, studying mental health from a psychological perspective, rather than a medical one. While psychologists are given basic training in medication and anatomy/physiology, their focus is generally on therapy rather than medication. Psychologists also do the majority of psychological testing to address issues such as ADHD, I.Q. scores, learning disabilities and the like.
Broadly speaking, psychiatrists make more money than psychologists. In private practice, psychiatrists complete medication management sessions in approximately 15-20 minutes, whereas a therapy appointment with a psychologist is 45-50 minutes. Over the course of the day then, psychiatrists are generally seeing more people. They also tend to garner more respect from the community because of the fact that they are physicians and can provide you with medication should you need it (there are only a few states that allow psychologists to do this). However, I am told that psychiatrists are at the bottom of the food chain of physicians. Weight loss surgeon Dr. James weighs in:
Don't even get me started. Psychiatry is the easiest residency in the world to get into, no one in the medical field respects them, and if a patient needed help with anything like a broken arm or sore throat, a psychiatrist would be completely clueless as to what to do. And they are so damn weird! You ever notice that? Psychiatrists are possibly the strangest people on the planet, analyzing everything you say, with hardly any social skills. And they are supposed to be knowledgeable about what is "normal?" Please. They need to know how silly they look to their peers.
Psychologists, while not prescription writers, can often get a great deal of credit for not looking to provide the "quick fix" and by not throwing a pill at a problem. This is vital to a large portion of the population that is hesitant to take medication for mental health problems. A psychologist's non-medical position can sometimes help clients be open to understanding themselves fully and to exploring how they've arrived at this juncture in their lives. However, because psychologists often don't get the same respect as our medical colleagues do, many of them have inferiority complexes. A great example of this is our socially phobic psychologist Dr. Pete who is more than happy to chime in, having recently emerged from hiding in a bush so that he didn't have to talk to the mailman:
Most of us [psychologists] go to school for at least six years after college, focusing solely on mental health. I know medical doctors go to school just as long, even longer, but so much of it is spent dissecting cadavers and reading about endocrinology, things that they not only forget, but have no use for in the field. We're the real experts on mental health! Rob, you're not going to print this, are you? My psychiatrist would be furious if she knew I said these things about her field.
In college, I knew that I wanted to be in mental health, but was unsure which direction (psychology or psychiatry) I wanted to go. I wasn't very good at hard science, struggling in biology, chemistry and physics. I also knew that medicine couldn't solve everything, regardless of what the makers of Prozac wanted us to believe, and thought that I would enjoy being a therapist much more. However, I wanted to have the highest level of education in the field of psychology as possible, so I decided to basically throw away my 20's to get a doctorate in the field and claim my "fake doctor" status. Every once in a while I'll look back and think that it might be nice to have a medical education, but certain events remind me why I made the right choice:
When I was in graduate school and told people that I was studying to become a psychologist, I tended to see an expression that was a mix of skepticism, apprehension, and maybe even disdain. I'm sure that my age and baby-face made it difficult for people to believe that I could be a person possessing any form of wisdom or helping ability. And of course there are people who see the treatment of psychological problems as sheer quackery, especially if there is no prescription to write, so these responses made sense to me. However, after a few years of successful practice and a couple of gray hairs on my head, I assumed that my job title would afford me at least a certain amount of respect from the general community.
I recently attended a wine tasting/social hour, arranged through a local gathering website. "Why You Need Not Fear Bordeaux" was the theme (because, as we all know, Bordeaux is clearly the most intimidating of red liquids that you consume for recreation), hosted by a local sommelier in a downtown loft. Most of the guests in attendance were somewhat older than me, 40's and 50's mainly, and clearly much more well-to-do. Wall Street gurus, plastic surgeons, successful artists were all on hand, wearing Armani and Prada, despite the fact that the flier clearly stated "Casual is fine, I'll love you anyway!" Because love is important to me, I wore jeans and a rugby shirt, both courtesy of The Gap (20% off with coupon).
After chatting with a successful architect for about 15 minutes (i.e., hearing about how awesome he was at basically everything), he asked me what I did for "work or trade," like I could be a plumber who was there to unclog the toilet in my rags that I tried to pass off as clothes.
"I'm a psychologist."
He sort of scoffed/chortled at this. "Oh you are? So if I tell you I'm depressed, which I'm not because I have everything in the world going for me, are you going to write me a prescription for Zoloft or something?"
"No, that's what a Psychiatrist does. I'm a Psychologist."
"So what is it you do then, exactly?"
I began to explain all of the nuances of my job but I got the impression that I was boring him. This astute observation was due to a combination of him staring at his watch, the plasma television, the hostess's butt, his cigarette ash, the smoke from said cigarette, his tie, and his hair in the mirror behind me.
"Right. A lot of people think that stuff is such horse shit. So you just talk to people to help them feel better about mental stuff?"
I began to point out that his take was a bit of an oversimplification, but he wasn't done yet.
"Are you successful?"
"Excuse me?"
"Are you successful? As a psychologist?"
"I guess that depends on how you define success" I said.
"Are you wealthy?"
"No."
"Do you have a booming practice?"
"Booming? No."
"Can you charge above your market's rate and still get clients?"
"Probably not, no."
"Do ladies want you because of your job?"
"Well, I did have a woman tell me that I seem very nice and kind, and that that was probably because I'm a therapist."
"So no then?"
"Right."
"You're nothing like me," he said, obviously pleased with his interrogation. "I'm successful: wealthy, good-looking, with as much female companionship as I want. I design glorious homes for people of extensive means and I make their lives better for it."
"Actually," I countered, "I'm a lot like you then. Sometimes, although not always, I can help a person get rid of intense psychological pain. Pain that they never could have imagined. I've had wealthy clients tell me that they'd rather give up all of the fortune and material possessions to not feel like they do right then. And when I help them, I make their lives better, just like you do."
"Whatever," he said, clearly unconvinced. "Right now you're just some guy with a lot of education who talks to people for a living. A quack, basically. You'd be a lot more successful as a psychiatrist, because then you'd have a prescription pad and could fix a lot more problems."
"I don't know about that."
"How do you figure?"
"Well, if I were a psychiatrist, there's nothing I could write that would stop you from being a narcissistic prick. You'll probably need years of therapy to not be the pretentious and elitist asshole that you are. Here, take my card. I can fit you in next Wednesday. And bring some of your cute little drawings of houses. We can compare them to the ones I did in kindergarten. We can't have enough mansions in the world now, can we?"
Surprisingly, he actually took the card, mumbled something about me being a peasant, and walked away. A few moments later, I was told by the hostess that I was no longer welcome at the wine tasting sessions due to my "coarse language and disregard for the city's high end urban development plan." I left, but was able to get a few more sips of some really expensive Bordeaux before walking out.
And just think: it only took ten years of post-high school education to diagnose that man in less than 20 minutes. It was totally worth it.
Posted by Rob Dobrenski at 3:36 PM