A therapist, a psychologist, and a psychiatrist walk into a bar...

In My Humble Opinion
1

Sorry, I don’t have a joke, just a couple of stream-of-consciousness questions that occurred to me regarding these three professions

  1. A number of people have issues going on in their lives that they need help with, so they go see a therapist. Others go to a psychologist. Still others see a psychiatrist. How does a person know which one they need?

  2. I can imagine that after seeing a therapist or psychologist, that practitioner may conclude that a person should probably get medication to help their problem, so they recommend the patient go to a psychiatrist, where they can get another diagnosis and possibly a prescription. Does it go the other way – a person is seeing a psychiatrist, and the doctor then recommends he go to a therapist or psychologist instead?

2

My daughter is unfortunately dealing with this now. She had a bit of a breakdown and was hospitalized (in the psychiatric hospital) and just discharged on Friday. So now the real work begins…

In our case it was a combination of the insurance and her doctors/therapists at the hospital telling her which and who she needs to see. Her therapist is also a psychologist and this is who she will see weekly for actual therapy. But she also has a psychiatrist. The psychiatrist she will see once a month and will not provide any actual therapy or talking about her problems. Her job will be just the medical side of it- she will manage and prescribe the medications (which we are hoping to have her off of within a month- she’s not really that bad and had very bad reactions to antidepressants so she is actually on anti-seizure medication for mood stabilization but that has bad side effects for her too). The psychiatrist will be the one to order and interpret the blood tests and to keep her medically stable through the psychotropic medicine phase of things. I expect she will be seeing the therapist (psychologist) far longer than she will see the psychiatrist.

Our insurance requires any therapist to be a doctor (psychologist) so we had no choice in that part of it and therapist will be the one who decides when she is well enough to wean off the medication and for how long she will need to see the psychiatrist.

3

Depending on how long you go without help, ideally You start with the lowest specialist and work your way up, but sometimes you didn’t go in and it gets so bad you start with the highest level, get meds and work your way down.

4

Pretty much answered above for you, but just echoing the statements:
Psychiatrists can certainly recommend therapists or psychologists, especially if non-pharmacological therapies such as CBT or such may be advisable, and the Doctor feels that they may not be the best person to deliver such a treatment, but rather send the patient to a specialist in that matter (as there are some Psychiatrists who DO therapy and such sessions in a private practice setting usually).

And you get what you need usually by someone else- the psychiatrist is usually encountered by recommendation by another medical professional (ie: a consult for someone in the ER, or by the police discovered the patient- usually a bit more severe, but it can be as simple as insurance issues).

5

. . .and the bartender says: “What is this, some kind of joke?”

6

It can go either way, depending who the patient sees first, because the therapies are usually punted together (i.e. medication + talking about problems = solution).

7

This is a really good question and, sorry, the answers so far seem incomplete to me. Sure, if a person finds themself in a hospital for emotional or psychiatric issues the hospital would guide them on the best steps fromthat point. But what if you know you have problems and don’t know where to start - where do you start?

A number of my family members have had reason to see a professional over the years and it is always a confused mess. One son we had tested for learning problems - the therapists did a few tests, gouged us for a lot of money and were told he was “average”. That was a dead end. My other son tried a psychiatrist because he thought - well, he thought he could get drugs. The Dr. handed him some drugs on the first visit, more on the second and then my son quite because they “weren’t working.”

I’m not blaming (much) the mental health professionals. It is just that the whole thing is such a huge and expensive maze that is is hard to get help or to even find out if there is something wrong.

8

To answer swiftless’s question: I’d say it depends on whether you suspect you are feeling a little bad mentally, or suspect you have a real mental health problem. IF you are just more anxious than usual, or less happy, then a therapist is probably the way to go. If your problems are more severe or of a different type, it becomes more tricky.

First things first: you need to go to whichever will give you a peer reviewed, standardized, full spectrum test. In my experience, this is more likely to be psychologists, but I hear it’s different in different places. While you’re there, get an opinion on how they would treat you. If it’s a psychiatrist, mention using a psychologist, and make sure s/he has nothing against them. Likewise, with a psychologist, make sure they have nothing against medicine. Then ask if they think you need the other. Don’t be afraid to get a second opinion, either.

If you need medicine, I can almost guarantee you you’ll need some sort of therapy, as none of the psychotropic medicines actually cure the problem. However, you may be able to get good help by using a clinic that has mental health therapists and a psychiatrist on staff. If you do not need medicine, you are probably better off going to a psychologist rather than just a therapist, at least at first.

BTW, I’m using the terms as I assume the OP was: a psychologist is a therapist with a doctorate, while a therapist has only a masters, perhaps even in social work. I’m also assuming you don’t have the better psychiatrists, which are actually psychologists as well. If you can find one of those and keep them, they are the best of both worlds.

9

What is this - is this a pencil and paper test? Are there examples on the internet?

10

There are two mental health professionals in my county that my insurance will pay for. He’s a psychiatrist, she’s a psychologist. They are husband and wife. When I signed up, his waiting list was much longer, so I went to her. She recommends which drugs she thinks will help, and my primary care doc writes the scrips.

If I’d had more drastic problems, I might have been recommended to him, but I would have had to wait 9 months to see him.

There are lots of other shrinks here, but the insurance won’t pay for them.

11

For many, this too is dictated by the insurance. In our case we are required to see our primary physician for any of it, then she will make the referral for whichever she feels is appropriate (psychologist or psychiatrist).

Given options (or self pay) I believe most people should (or would) start with a therapist (psychologist or equivalent) who would then refer them to a psychiatrist if necessary (and if medication was required). Although there would be nothing stopping them from going straight to the psychiatrist who may or may nor refer downward as needed. My daughter’s psychiatrist does no therapy, ever. So unless one needed medication and nothing else, they are unlikely to be solely her patient (they would have therapists of some sort as well) but some do therapy too and could be a one-stop mental health provider.

12

The person that needs to work the hardest in any of those relationships is the patient. Most people that get nothing out of therapy aren’t working at it, and expect the professional to have all the answers after a couple of visits.

13

“Therapist” is a vague term. Anyone doing therapy with you is your therapist. (More specifically, anyone doing psychotherapy is your psychotherapist. There are also physical therapists, of course, but I assume you aren’t asking about those.) “Counselor” is even more general. Anyone helping you with just about anything can legitimately be called your counselor. States will have specific laws about who can hang out a shingle calling themselves a “counselor” or “therapist” but in many states it’s absolutely anybody. That is certainly the case in my state of Colorado, although you have to register as an “unlicensed psychotherapist” so the state can record complaints against you. (That part is unique to Colorado, I think.)

Most (all?) states also have one or more specific classifications for mid-level practitioners who have been licensed by the state. Colorado has “Licensed Practical Counselors” (LPCs). I believe the equivalent in most states is “Licensed Family and Marriage Counselor” or “Marriage, Family and Child Counselor.” These require a Master’s Degree, usually in Counseling, in addition to the state’s licensing requirements. I believe all states also recognize counseling and psychotherapy to fall within the scope of practice of a Licensed Clinical Social Worker (LCSW). A Master of Social Work is a prerequisite for becoming an LCSW. I believe LCSWs are more commonly accepted by insurance companies and other payers and are generally regarded as having a slightly higher qualification than LPC/FMCs.

To further complicate matters, there are also Certified Addictions Counselors, who are licensed to do drug and alcohol counseling. In Colorado, the lowest level of certification, CAC-I, doesn’t even require a bachelor’s degree. (But many have Master’s degrees.)

Most or all states require someone licensed or working as a psychologist to have a PhD in Psychology or a PsyD (Doctor of Psychology). Psychologists are very highly trained (but of course may still be crap at doing psychotherapy.) Psychologists are often trained primarily as scientists, and may only do research and little or no counseling of patients. Others work primarily as psychotherapists and have done little or no research, even in school. Most fall somewhere in between. Besides psychotherapy, many clinical psychologists perform psychological evaluations and other testing, which can only be performed by a psychologist, so an LCSW, LFMC, or MFCC may refer you to a psychologist if they want some specific testing done.

A psychiatrist is a medical doctor who, following completion of their MD, performed a residency in psychiatry. Most psychiatrists specialize in prescribing psychiatric medications, and if you see a psychiatrist it will almost always be because a family doctor or a therapist (of whatever qualification) referred you. Some psychiatrists also do psychotherapy, however.

There isn’t much difference in the psychotherapy done by each type of practitioner, although each practitioner will have their own style and may specialize in certain types of afflictions, and their educational background may influence how they see various mental health issues. Also, each one should have additional knowledge and skills beyond psychotherapy that may be useful. An LCSW, for example, should have at least some knowledge of how to work with schools to deal with emotional or psychological problems, while a psychiatrist should be skilled at recognizing other medical conditions such as autism or thyroid problems, which may affect mood and behavior.