What is a therapist?

A therapist is a general term and one, that in most states, is not “controlled” by the government (e.g. by law). Almost anyone can call themselves a therapist while only licensed therapists can use certain terms such as psychotherapist, psychiatrist, psychologist, Marriage and Family therapist, Professional Clinical Counselor, Social Worker, etc.

You must first differentiate between “licensed” therapists and those that are not licensed. I assume your questions are about licensed therapists, and my responses are based on that assumption.

What is a psychiatrist?

A psychiatrist must have a medical degree (MD; DO). Psychiatrists are medical doctors, and therefore, allowed to prescribe medication (as far as I am aware no other “therapists” are permitted to prescribe medication although some states may allow it). In general, a psychiatrist’s specialty is in the diagnosis and treatment (through medication) of psychological disorders. Some also offer therapy, but that is the exception and not the rule.

What type of training do psychiatrists receive and what treatment can they offer?

Generally, a psychiatrist has internships and/or residencies in medical settings such as hospitals and clinics. A psychiatrist must pass a national medical licensing exam and meet specific state requirements.

As for treatment, as noted above, for the most part, they are trained to diagnose and prescribe medication. While they can provide psychotherapy, most are not trained (adequality, if at all) to do so. If you want therapy, in general, a psychiatrist is not a good choice.

What’s the difference between a therapist and psychiatrist and how can someone decide when to see one over the other (or to see both)?

Academic Differences:

            Psychiatrist: Must have a medical degree (MD)

            Psychologist (Clinical and Licensed): In most states must have a doctoral degree (PhD or PsyD

            Marriage and Family Therapists, Clinical Social Workers, Licensed Professional Counselors have at least a masters degree, and occasionally some have                        doctoral degrees.

Training Differences:

A noted above: Psychiatrists generally, have internships or residencies in medical settings such as hospitals.

Psychologists, in most states, must have 3000 hours of supervised clinical experience as required by the state board. These hours are accrued in any setting where psychotherapy is provided including mental health clinics, university counseling centers, private practices, and medical settings such as hospitals. They must also pass a national licensing exam and often additional exams required by the state. They must also meet other licensing requirements of the state where licensed. Psychologists may also offer psychological testing if they are trained to do so.

Marriage and Family Therapists, Clinical Social Workers, Licensed Professional Counselors have similar experience requirements to psychologists. Note that each state has its own specific training requirements. Generally, this includes 2,000-3,000 hours of supervised experience.

Practice Differences (I know this next section is a bit repetitious)

Psychiatrists generally diagnose and prescribe medications. That is what they are mostly trained to do. In general, they are not trained (or minimally trained) in psychotherapy although some do get limited therapy training. From a practical standpoint it is too costly for a psychiatrist to offer therapy. A one-hour therapy session would replace perhaps 4 psychiatric assessments in that same hour.

Psychiatrists are licensed to do most activities that a psychologist does (as long as they are trained to do so; although they rarely are trained to provide testing) AND also prescribe medications which is their primary function. Psychologists (in most or perhaps all states) cannot prescribe medication.

Psychologists can practice psychotherapy (for which they are extensively trained), teach, train, consult, assess, diagnose, and treat all mental health disorders for which they are trained. They can also provide psychological testing.

If you want a qualified psychotherapist, see a psychologist or other licensed mental health counselor (as listed above). If you want a qualified diagnostician and medication provider, see a psychiatrist.

How can someone decide when to see one over the other (or to see both)?

Clearly, if the need is for medication someone would see a psychiatrist. Often medication is a quick fix or long-term management but does not generally offer a “cure” to the psychological distress.

If someone wants psychotherapy, then a licensed professional such as a psychologist (or a Marriage and Family Therapist, Clinical Social Worker, Licensed Professional Counselor) is a far better option for two reasons. First, as mentioned, psychiatrists are, for the most part, not adequately trained in psychotherapy. Second, it is too costly for psychiatrists to offer psychotherapy. In psychotherapy they see one patient per hour and in diagnosing and prescribing they can see about four patients per hour.

If you’re seeking care for anxiety, should you see a psychiatrist, therapist, or both?

The answer to this question is much more complex than you would imagine. However, I will try to give it a brief explanation.

Fundamentally, do you want to manage your anxiety or cure it? While a psychiatrist prescribing medication can help a patient to relieve feeling anxious (temporarily), it is a management strategy and not a cure strategy.

With psychotherapy and a motivated individual, most anxiety can be cured. Most anxiety is caused by the way one thinks. This is VERY easy to demonstrate even when someone indicates that their anxiety happens without explanation. With therapy, a skilled therapist can help a client to see the cognitive cause of feeling anxious even when not cause is apparent. Most anxiety clearly does not have a biochemical cause although it can have a biochemical (medication) treatment. This is very easy to demonstrate but too detailed for this discussion.

A problem with anti-anxiety medication is that, while it does relieve the symptoms of feeling anxious, it teaches the patient that whatever fear is activating being anxious is indeed scary and requires medication. For many, if not most, this makes the anxiety disorder worse.

However, for those patients who claim they cannot tolerate feeling anxious, medication with therapy can be effective. I often work with clients who carry their medication, but learn how to tolerate the distress without mediation. Tolerating anxiety along with adjusting negative thinking eventually leads to complete relief. The medication serves as a safety net while the client is learning that they do not “need” the medication. This causes a shift in the client’s thinking and fear which then relieves (and cures) anxiety.

Why would a therapist refer you to a psychiatrist?

The main reason as suggested above is for the client to be assessed for mediation. A secondary reason might be that the therapist is seeing a complex client, is not clear about the diagnosis of the client, and wants a second opinion. As noted above psychiatrists are trained to be master diagnosticians.