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  • Q&A with Australian Health Practitioners

    Psychologist or psychiatrist? If someone is depressed, who is better to see? What is the difference?

    I don't understand the real difference between a psychologist and psychiatrist… although I do know that psychiatrists can prescribe medications. In terms of therapy, which is better? Or does it not make a difference?
  • Image of Louise Shepherd

    Clinical Psychologist, Psychologist

    58

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    I am a clinical psychologist with 15 years experience working with all sorts of goals and issues. I love working with people, helping them to ... View Profile

    This is a fairly personal decision and I won't pretend to fully answer this here. I'll just give you a few ideas (my opinion on this!!). 

    A psychiatrist is a doctor with a medical degree who has specialised in psychiatry so they are very highly trained in treating mental illness. And yes they can prescribe medications.

    A “psychologist” is someone who has studied psychology, the study of human behaviour. A “clinical psychologist” refers to someone who has studied psychology at a masters and / or PhD level. They have specific training in “clinical” psychology, i.e. mental illness etc.

    I am biased - let me be clear - so I would say that for a mild or moderate depressive episode a clinical psychologist may be the ideal choice. Antidpressant medication is not the first treatment of choice for mild to moderate depression. Psychiatrists and clinical psychologists and psychologists all differ in terms of the training they have done and the amount of knowledge and experience they have in treating depression. Some, but of course not all, psychatrists may be inclined to prescribe medication rather than engage in “talking” therapies. I find this varies enormously. 

    For severe depression (can barely get out of bed, not showering, very little engagement in the world) antidpressant medication is probably worth considering - at least discussing with a doctor. The best combination may be medication as well as seeing a clinical psychologist to get moving and out and about doing the things you usually care about. 

    And the other consideration is the type of treatment that people use. For depression there are some treatments that we know to be more likely to work than others - such as CBT, IPT and what is called behavioural activation. You can look any of these up and read more about them. Wikipedia is often a good basic resource for doing that. 

    Other treatment approaches that are gaining a lot of interest and can be enormously helpful for many people are Acceptance and Commitment Therapy and Mindfulness Based Cognitive Therapy.

    Long answer sorry - I hope that it helps a little. I think a lot will come down to the individual person - but a bit of knowledge and asking a few questions will make it more likely that you receive the best treatment for your issues. 

  • Image of Carolien Koreneff

    Counsellor, Diabetes Educator, Psychotherapist, Registered Nurse

    18

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    Carolien Koreneff is a Somatic (body-oriented) psychotherapist, Health Coach, Counsellor as well as a Credentialed Diabetes Educator with nearly 20 years experience. She currently sees ... View Profile

    I agree with Louise that the choice between seeing a psychologist or a psychiatrist can be a personal one, and largely would depend on whether medication is required or not. 
    Louise mention a few different modalities that can be used in the treatment of depression, but this was of course an incomplete list.
    It was mentioned that some psychiatrists may restrict themselves to “prescribing medication, rather than engaging in talking therapies”; I would like to add that psychologists can also restrict themselves by choosing a particular modality.
    As a somatic psychotherapist I pride myself in the fact that I was trained in a large number of different modalities. This means that we can choose the one (or a combination of modalities) that best work for you. 
    I tried various modalities myself for the treatment of my depression and found that the best thing was to incorporate both body and mind. I have benefitted so much from this myself, that I dicided to do the training myself, so I can help others in a similar fashion.
    Not many people know about this form of psychotherapy, even though it has been around for decades, probably because it does not currently attract Medicare benefits. But if you are interested in finding out more about Somatic Psychotherapy you can take a look at my website http://www.glebetotalhealth.com.au/somatic-psychotherapy/ or check out the site of the Australian College of Somatic Psychotherapists: http://www.somaticpsychotherapy.com.au/

  • Image of Grant McKell

    Psychologist

    28

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    Grant McKell is a counselling psychologist working in Sydney's inner west with over ten years' experience. He founded HeadsUp Psychology in August, 2011. Having worked in ... View Profile

    I'll jump in here, too, just to add a little more. A clinical psychologist is a psychological specialist in mental health disorders and has studied to a masters or PhD level. Most other psychologists have also studied to a Masters or PhD level as well and many non-clinical psychologists are qualified and able to deliver CBT, IPT and the like.

    The most important thing is to find a therapist who you connect with and whim you find it easy to talk to, whether or not they be a counsellor, psychologist or psychiatrist. If you're not comfortable with the therapist you see, don't stop getting treatment- go and find another.

    The psychiatrist/psychologist difference, which Louise explained very well, doesn't mean that you have to see one or the other exclusively. Psychiatrists are a bit thin on the ground compared to psychologists, especially in regional areas, so many people get their regular therapy from a psychologist with reviews of progress and medication decisions handled by a psychiatrist. This can also be a cheaper option, as psychiatrist fees tend to be a bit steeper than most psychologist fees. In other words, the psychiatrist is often the case manager. Don't be surprised, because of this, if a psychiatrist ends up referring you to a psychologist for regular therapy anyway.

    In terms of therapy, a psychiatrist is not really better than a psychologist and vice versa. The therapies employed by either should be (and usually are) evidence based, so it makes no real difference. As I said before, the thing that does make a difference is whether you connect with your therapist or not. And to reiterare, you'll probably be able to get in to see a psychologist sooner and more regularly than a psychiatrist.

    Something else not mentioned is that to see a psychiatrist, you will need a referral from your GP. You don't need a referral from a GP to see a psychologist, but I would recommend that you get one anyway, as this may allow you to claim some of your psychologist fees back from Medicare if you do.

    Hope we're making it all a bit clearer for you!

     

  • Image of Dr Carla Rogers

    Psychologist

    11

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    Are you ready to make some changes?  I don't have a magic wand, I can't fix all your problems, and when we work together you're ... View Profile

    Well said Grant!  I strongly believe (and research has shown) that the client-therapist relationship is actually the strongest predictor of therapy success.  So definitely find a psychologist/psychiatrist with whom you connect well.  this is hard sometimes as I know how difficult it can be to make that first step in seeking therapy… so having to start again if you don't connect with the first one is difficult but well worth it.  Once you've found someone that you are comfortable with, the entire process will flow a lot more smoothly for you.  Good luck!
    Carla

  • 10

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    My research interests include immunology and the mechanisms of amyloid formation. The latter has implications for people who are dealing with Alzheimer's Disease, Parkinson's Disease ... View Profile

    I think that (if possible) it is best to have access to *both* a psychiatrist and a clinical psychologist, working togther as a professional team.

    That has been my experience - I am in remission from Major Depressive Disorder thanks to a combination of my hard work and help from my care team.

    I am now on a “care and maintenance” basis with both - I see them every six months for a quick chat and (in the case of my psychiatrist) to also pick up scrip for my anti-depressant.

  • Image of rakesh saw

    Healthshare Member

    5

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    Hi,
    A psychiatrist is a doctor with a medical degree who has specialized in psychiatry so they are very highly trained in treating mental illness. Today's world every people suffer with some mental problem and undergo depression. At this time Psychologist is there to solve the problem.

    http://www.coursesinindia.co.in/careercounselling/diff-between-psychologist-psychiatrist.php

  • Image of Jade Worthington

    Healthshare Member

    6

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    The best person to see depends on whether it is a psychological or psychiatric depression.

    The DSMV categorises mental illness along the lines of Axis 2 and Axis 1.  Axis 2 conditions are more likely to be psychological in nature.  Psychological issues can be deconstructed and resolved by new ways of thinking and acting - and a psychologist is the best person to help one to approach life differently in order to get better outcomes.  The good news about psychological depression is that if one is prepared to change oneself, one will usually have a very good prognosis.  

    Axis 1 conditions are more likely to be psychiatric in nature.  Psychiatric depression can occur regardless of how healthy one's thinking style may be.  Psychiatric illness is chemical in nature and has a very physical impact on the brain and body.  Symptoms can be catatonia, numbness, extreme emotional suffering without basis in life situation and acute suicidality.  There can also be psychotic symptoms.  Psychiatric illness needs to be treated by medication.  Sometimes in extreme cases, that don't respond to medication, electo-convulsive shock therapy can be used.  (It is like a defibrilator for the brain that attempts to reset the brains chemistry to relieve very distressing, life threatening symptoms).  Often high level psychiatric intervention is nothing to be afraid of if one is suffering acute psychiatric illness.  One's acute symptoms can so debilitating and involve so much suffering that the treatment, (no matter how scary it may appear to be), provides much needed relief from symptoms and helps to save lives.

    It is possible to have acute depression without having an Axis 1 condition.  Nevertheless, acute depression is often best managed with therapy and medication in conjunction.  There is no blanket rule about how to treat major depression.  It's about identifying what is the most effective course of treatment for each individual, as a unique being that they are, in their own particular circumstances.

  • 5

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    I am a Consultant Psychiatrist and Psychoanalytic Psychotherapist who specialises in Adult ADHD, Jungian Psychotherapy, and the Psychological Medicine aspects of Chronic Pain conditions. View Profile

    When a person is depressed, the starting point is to obtain a professional assessment from the most qualified and experienced mental health professional available. Consultant Psychiatrists and Clinical Psychologists are the most appropriately qualified professionals in our community to provide such an assessment, although Consultant Psychiatrists, by virtue of their preliminary medical training prior to Psychiatry training, are also able to routinely assess for medical and physical causes of depression beyond the psychological and social domains. 

    Treatment recommendations follow assessment. 

    The skilled clinician will be aware that depression arises in a context, and attempt to identify and address this often hidden, or unrecognised, context. 

    Sometimes this previously unrecognised context will be a biological one, such as an undiagnosed medical condition (obstructive sleep apnoea, thyroid disease, cancer, anaemia, dementia, chronic pain disorders, etc). Sometimes the context will be psychological, such as a previously unrecognised underlying mental disorder (Bipolar Disorder, Lifelong Attention Deficit Disorder, Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, etc,etc). Sometimes the context is a previously unrecognised, unaddressed social one, such as grief and loss, relationship issues, workplace stress, etc

    As regards treatment, the key is for the assessing clinician undertaking the initial assessment to be a member of a mental health team capable of addressing not only the depression, but also the underlying context, working with members from a diversity of professional backgrounds (psychology, social work, psychotherapy, mental health nursing, general medical practice, psychiatry) with additional training in a range of therapies, including individual therapies, relationship and family therapies, pharmacotherapies, and hospital base therapies like intensive group therapies, TMS and ECT. In this team context treatment recommendations and implementation can be tailored to individual patient needs, rather than dictated by an individual clinician's particular training background.

    A reminder that many Consultant Psychiatrists are trained in a range of psychotherapies, beyond simply pharmacotherapies, and that psychologists usually do not have extensive training in pharmacotherapies, in TMS or ECT or Psychoanalytic, Family or Group psychotherapies.

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