WHAT IS THE DIFFERENCE BETWEEN A PSYCHOLOGIST AND A PSYCHIATRIST?

Psychiatry

Psychiatrists have earned a Doctor of Medicine (MD) en route to more specialized training in psychodiagnostics and the treatment of mental illness using psychotropic interventions - medication that affects mental activity, behavior, perception, or mood. While most psychiatrists receive some training in psychosocial interventions including psychotherapy, such training tends to be more limited in comparison to their medical expertise and more narrow in scope when compared to the psychosocial training of psychologists. As a result, most psychiatrists will tend to view psychological issues from a "medical model" of practice and psychopharmaceutical interventions are more likely to be entertained as a possible solution to a patient's psychological issues. Initial appointments tend to be quite detailed and typically involve a thorough investigation of presenting symptoms, medical, and psychosocial history. After an initial appointment, face-to-face contact tends to be brief (unless engaging in therapy), and usually consists of monitoring adherence to medication, perseverance of symptoms, and the discussion of possible side-effects.

Since a psychiatrist is a physician, their services are covered under Nova Scotia's Medical Services Insurance (MSI). At the time of this writing, psychiatric referrals in Nova Scotia are limited by a shortage of psychiatrists relative to demand; it is not uncommon for first-time non-emergency patients to wait months before an initial appointment. It is therefore unsurprising that in both Canada and the United States most psychiatric medications (e.g. anti-depressants & anxiolytics) are prescribed by family physicians.

Psychology

Psychologists take a path of graduate training that does not involve a medical degree, but rather a Masters or Doctoral degree in Psychology. They are not physicians and are therefore unable to prescribe medication. Their psychological training enables them to specialize in psychodiagnostic assessment, psychosocial theory, and therapeutic intervention - primarily by means of behavioral interventions or "talk therapy." While some psychologists will also adopt a "medical model" of practice (perhaps more so in the public sector where such philosophies are ever-present), most will be more inclined to conceptualize an individual's presenting issues in terms of problematic patterns of thinking, feeling, or behavior, in the context of broader interpersonal, environmental, or cultural factors. Psychologists tend to believe that such issues are often treatable through psychosocial, rather than medical interventions, and their approach often allows them to better conceptualize a therapeutic treatment plan tailored to the individual, versus their psychiatric diagnosis.

The philosophical differences between psychologists and psychiatrists are also somewhat reflected in the language used by each profession. Psychiatrists, in the medical tradition, will refer to those who seek treatment as "patients." This term implicitly suggests that the disempowered individual will play more of a passive role in the treatment process, while the expert physician draws upon their superior knowledge and expertise to prescribe an active form of treatment (e.g. medication). In comparison, psychologists will usually refer to those who seek treatment as "clients," a term which tries to put the individual on more of an equal footing with the psychologist, while acknowledging that the person seeking treatment will play an active role in the collaborative therapy process and must also share some responsibility for resolving the core issues they are looking to address. Thus, the psychologist in the role of therapist is not so much an "expert," but rather a knowledgeable guide.

I hope that the above gives a sense of how the role of psychologist and psychiatrist are different, while also acknowledging the obvious areas of overlap. Even in the course of therapy there can sometimes be a role for medication and for a good psychiatric consultation. In these situations, a psychiatrist and psychologist would ideally consult with one another about clinical progress and areas of concern.