Psychologist vs Psychiatrist: Which is best?

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As I've mentioned in a previous article, I'm from NYC; a town where it's highly common for people to have a shrink -- and most of us have no problem with saying we do. I've been to a number of psychologists and psychiatrists in the last few decades in my quest to find a good one (of either variety) and I've come to notice a few traits that seem to apply to either group.

Some of these traits are quite off-putting to me, and so I've drawn my own conclusions about which type of therapist is more appropriate for my needs. Your mileage may vary, and you might prefer the other group. So if you're looking for a good therapist to help you sort something out, take a look at these observations and they may be able to help you choose between the two camps -- cos they are really quite different groups of people.

Psychiatrists

  • A psychiatrist is a medical doctor who specializes in psychiatry. Obviously! This means they view themselves as more distinguished than their psychologist colleagues, and I suppose they have the right to do so based on their education, but this doesn't necessarily make them better at being a shrink. The psychiatrists I've seen have always behaved the same way a GP would -- they try to observe your symptoms and then fix you with something traditional. I suppose this might work for some, but it has never worked for me, and I find it very condescending. They aren't all like this, but those I've known have been. Even those I've had as friends or colleagues.

  • Many psychiatrists are stuffy and formal and they will treat you like a sick person who needs some kind of treatment, just as your GP would if you showed up with a case of tonsillitis. Some people respond well to this dynamic, but some (like me) do not. If I'm paying someone to work with me on something, I deserve to be comfortable with the process. If you are comfortable with this, more power to you. If you're not, try someone else.

  • Psychiatrists are usually more expensive than psychologists, but your insurance may cover a certain number of sessions. Then again, if you claim these expenses on your insurance, you lose some degree of privacy in doing so, because your employer may be made aware that you are in therapy with a psychiatrist.

  • Psychiatrists are MDs and MDs are taught that illness is cured with medicine. This philosophy is not one that I agree with, and this alone is one of the main reasons I don't care for psychiatrists. This is not to say I'm opposed to medicating a true schizophrenic or psychopath, but I am strongly opposed to writing scripts for every person who shows up complaining of depression or something like it. Then again, some people really want to be medicated, and if that is the case, only a psychiatrist is going to be able to sort that out for you.

Psychologists

  • Psychologists often have a PhD in psychology, but at the very least they ought to have a Masters. Licensing requirements can vary depending on the country you live in -- my psychologist doesn't have a PhD, but does have a Masters, and he's quite adept at his job (far more so than other PhDs and MDs I've seen). This is what matters to me. If you prefer a certain level of education, simply ask what they've accomplished beforehand, as that is a perfectly reasonable question. There are other types of counselors out there as well with other qualifications, so you may want to look into those as well.

  • Most psychologists are far, far more laid-back than psychiatrists. I prefer my therapists to talk to me, and not at me, and IME psychologists are far better at this than psychiatrists. Psychologists are perfectly capable of diagnosing issues or even mental illness, but they seem to be less inclined to shove patients/clients into text-book compartments that would see everything as black and white.

  • Psychologists tend to be cheaper than Psychiatrists, and that might be a big factor in your decision to choose one or the other. It is also worth noting that many psychologists will work with organizations that offer reduced-rates to those who can't afford the full price.

  • Psychologists cannot prescribe medication and this is a good thing. It has become too easy today to medicate people for every little issue and I think this practice is morally reprehensible. That said, psychologists do usually have a psychiatrist they consult with who can prescribe something if there is a need for it. But psychologists will rarely suggest medication unless it's really justified.

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