I know that psychiatrists are medicals doctors who have completed a psychiatric residence and perhaps a fellowship and thus may prescribe; contrariwise, psychologists do not have medical degrees and while they are free to do any of various sorts of talk therapy, they may not prescribe; thus they frequently work in consultation with psychiatrists if a patient needs meds. (Please correct me if I have errered above). But I’m unclear on a few things, which I hope y’all can help me with.
[ol]
[li]Is it correct to say that, in current American practice, psychiatrists rarely, if ever, do talk therapy?[/li][li]Assuming the answer to question 1 is yes, is it correct to say that, in the case of non-institutionalized patients undergoing systematic talk therapy and receiving meds, that the psychologist is operating under the *supervision *of a psychiatrist? (I’m thinking the answer is no–that, rather, the psychologist and psychiatrist are acting as more-or-less equal partners–but I am not a mental health professional. Obviously.)[/li][/ol]
It is not uncommon for a patient working with a psychologist to be prescribed psychiatric meds by a general practitioner or internist rather than a psychiatric specialist. In this case the patient is as likely to start out with one, then be referred to the other in one direction as the other.
As to #1, In my experience, I’d say that yes, it’s more likely that psychiatrists are seen primarily for getting prescribed meds (or evaluated for same), rather than for weekly (or at least regular) therapy. Mainly because they cost so much more that most people wouldn’t consider going to a psychiatrist more than, say, once a month.
That said, there are definite exceptions. In some hospitals’ psychiatric departments, resident doctors pursuing fellowships may be treating patients on a weekly outpatient basis through both talk therapy and medications.
Re: #2, I’d say the answer in general is no, the psychologist (or, very often, a certified social worker) and psychiatrist are unrelated and are working more as a team (and in fact it’s often the case that the psychiatrist doesn’t coordinate with the psychologist at all, aside from perhaps an initial referral from one to the other).
But for a contrary position: in the Karen Horney Clinic here in Manhattan, the therapists – mostly CSWs rather than psychologists – are supervised by the head of the clinic, who is a psychiatrist. Though there’s some sense of a partnership and the CSW has a good deal of autonomy in how s/he treats clients, the head Doctor is the go-to guy for final decisions about treatment.
I guess all this is to say that I think you have the general idea correct in both your assumptions, exceptions notwithstanding.
Psychologists with a Phd can prescribe medication on a limited basis. I’m not sure of the exact perimeters, but I do know that they are allowed to prescribe. The last woman I dated was a psychologist, and she did prescribe.
I think that depends on the state. Heck, in some states, clinical psychologists have to have their doctorate, whether the clinical focused Psy.D. or the research focused PhD.
As for the OP: I find that you will often have therapists (often case workers) working under a psychiatrist, but not a psychologist. If anything, the psychologist refers you to the psychiatrist, or, less often, vice versa.
That said, I’ve had a few psychiatrists that do talk therapy; in my experience, it’s more often the ones who work exclusively with children. And you are more likely to get talk therapy if you can reach the psychiatrist at his actual practice rather than at a clinic.
Also note that psychologists don’t necessarily see patients at all. A psychologist is just someone who studies the mind and/or brain. Many of them just study normal, healthy thinking, and even those who study various mental problems don’t necessarily put their studies to practical use.
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Possibly yes. Don’t know the stats.
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Almost certainly no.
This bears repeating. A “psychologist” studies the mind. It’s a very big tent. When people ask what my field is, I’ve stopped saying psychology due to preconceived notions (I have never and will never see patients). The term for that is “therapist,”
but can also include social workers, other non-PhDs/PsyDs, or crazy “reparative” religious counselors.
It’s like someone who says they are a “chemist,” which could mean they work for a pharmaceutical company, are a professor, do urine tests all day, or run a meth lab.
Skald, here’s a thread I started a while back that is kinda related to this topic:
A therapist, a psychologist, and a psychiatrist walk into a bar…
I don’t think a psychologist, even with a PhD, can prescribe meds. Gotta have an MD.
If a patient is on psychoactive medication prescribed by the Primary Care Provider, and is then referred for counseling, then the PCP will probably be the one to continue the prescriptions.
However, a patient referred to a psychiatrist will be evaluated for medication and prescribed if necessary. The psychiatrist may feel counseling is necessary, and works in conjunction with a therapist. The psychiatrist will continue to see the patient occasionally to monitor medication dosages.
Mental health coverage by insurance is VERY spotty. The insurance may specify that a patient needing therapy must be evaluated by a psychiatrist first.
And outpatient mental health coverage is typically paid at 50%, with a limit on total visits per year. Inpatient coverage isn’t much better.
~VOW
“To date, medical psychologists may prescribe psychotropic medications in Guam, New Mexico, and Louisiana and military psychologists.[67]”
From the wiki for clinical psychologists, with medical psychologists being a specially trained subset of clinical psychologists.
So normally no prescribing, but there are some exceptions.
Otara
The last three psychiatrists I saw, 1980s, were all 50 minute talk appointments but the talk was about neurology medications.
I knew a psychologist in Michigan, and she was prescribing medication.
There are a lot of classes of people who can prescribe medications in various situations in different states. I’ve been given antibiotic and painkiller prescriptions by dentists, veterinarians can prescribe a wide range of medication (for animals, but a huge number of them are the same drugs people use including some of the highly controlled ones), physician’s assistants and certain types of nurses also have limited prescription powers in many places.
I think it is true that only in New Mexico and Louisiana is there a “Medical Psychologist” designation as a path to getting some form of prescription power, but it’s possible a psychologist working in Michigan might have other certifications aside from an M.D. that would allow them to prescribe medication in limited circumstances.
This is not always true. CRNAs (Certified Registered Nurse Anesthetists) have prescriptive authority in multiple states, and they are not MDs. They are, however, more qualified in the field of anesthesia than the vast majority of MDs ever will be, and the only drugs they prescribe are used in their anesthesia practice. (The ones who go on to gain certification in pain management can presumably prescribe in that capacity as well; I don’t know.)
Well, NPs (Nurse Practitioners) and PAs (Physician Assistants) can prescribe as well, but it’s my understanding that on paper, they are under supervision of a MD.
But I think it depends upon the State where licensed.
~VOW
To my surprise, I did research on NPs, and you are correct (on a state-by-state basis, of course). Ditto PAs.
Not true with CRNAs, at least not in the states I’m familiar with where they have prescriptive authority. There are multiple hospitals in Montana at least where there are no anesthesiologists (MDs specializing in anesthesia); all anesthesia is done by CRNAs, and nobody at the hospital is qualified to supervise them. They are not supervised any more than a podiatrist who runs his own clinic is supervised.