Psychological vs Psychiatric Evaluation And Treatment

What's the difference between psychology and psychiatry?

According to the Substance Abuse and Mental Health Services Administration, one in five adults in the U.S. live with a mental health condition. The fields of psychology and psychiatry are both integral to the treatment and evaluation of these prevalent challenges. As we'll discuss in this article, there are a number of differences between psychologists and psychiatrists, as well as differences in their respective evaluations.

The right psychotherapeutic approach for any given individual can depend on their condition, the severity of the psychological condition, their personal preferences, and their geographical area.

Over the course of this article, we'll also see that there are a number of similarities between psychologists and psychiatrists. Both work to help patients overcome mental and emotional obstacles to living happy and healthy lives, and they often work together to achieve this goal.

What is psychology?

The American Psychological Association defines psychology as "the scientific study of the behavior of individuals and their mental processes." In other words, psychology focuses on society as a whole as well as on interactions between individuals.

What is psychiatry?

The American Psychiatric Association defines psychiatry as being "focused on the diagnosis, treatment, and prevention of mental, emotional, and behavioral disorders." In other words, psychiatry is a medical science that considers the social and biological context of individuals.

Similarities and differences 

• Both fields require a doctorate
• Both fields involve intensive study and training
• Both professionals have some of the same diagnostic tools
• Psychologists usually have experience in an array of talk therapies
• In most states, only psychiatrists can prescribe medication
• Psychiatrists can use physical treatments, such as shock therapy
• Psychiatrists often handle the most severe mental health cases

Education and training

Both are doctors who have completed intensive courses combining both education and training. In brief, psychiatrists are medical doctors who have received the distinction of Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.). Psychologists, on the other hand, have completed a doctoral degree that entitles them to be addressed as "doctor" and have received either a Doctor of Philosophy (Ph.D.) in Psychology or Doctor of Psychology (Psy.D.).

Psychiatrists complete the same medical school education as all other medical doctors. They learn all about the different systems in the body, including various illnesses that can affect these systems and how these illnesses can be identified and treated. They take courses in anatomy, behavioral science, biochemistry, neuroscience, and psychiatry, among many other areas. In addition, they're exposed to working in a minimum of six specialist areas. 

To specialize in psychiatry, doctors also spend at least four years focusing on psychiatry in residency training. As part of this residency, they train in a variety of medical settings with patients of all age ranges, gaining exposure to the diversity of psychological conditions that patients face. Upon completion of their residency, most opt to apply for certification with the American Board of Psychiatry and Neurology. 

As mentioned above, psychologists follow a different route. They must first complete doctoral studies, typically earning either a Ph.D. or a Psy.D. Following this, psychology graduates are required to fulfill a one- to two-year residency. This provides the psychologists with a practical setting where they can gain experience in methods of psychological treatment and problem-solving techniques.

Different states have different requirements for psychologists. In some states, they must work an extra one to two years under the guidance and supervision of an authorized mental health psychologist before being fully recognized as a psychologist. 

In summary, when it comes to education and training, the main difference between the two is the focus of their studies. However, both psychology and psychiatry are concerned with why people think and behave the way that they do.

Psychological vs psychiatric evaluation and diagnosis methods

Prior to treating a patient, a mental health professional must conduct a thorough evaluation. There is a vast difference in the way that psychologists and psychiatrists diagnose patients’ mental health challenges, mainly because of the differences in their education and training. Based on their studies, a psychiatrist often looks for physical symptoms or chemical explanations, while a psychologist may look for social or personal explanations. 

The differences in a psychiatric and psychological evaluation are particularly evident in the diagnostic tools each professional can utilize. Psychiatrists are medical doctors who can draw upon diagnostics tests, including medical laboratory tests and computerized tomography (CT) scans. A psychiatrist can also perform a physical exam as part of a comprehensive evaluation. In order to specifically label a psychological condition, psychiatrists rely on the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Within this manual are descriptions of the various mental disorders and the criteria used to diagnose each psychological illness.

For psychological evaluation, both use a variety of tests and assessments. Psychologists, however, usually receive extensive training in administering and interpreting these tests. Psychologists also use the DSM-5 in their work.

Typically, both types of evaluations will involve an interview with the patient. A psychologist or psychiatrist may ask the individual about their medical history, day-to-day life, and family history — as well as the symptoms that caused them to seek psychological treatment. A psychology or psychiatry professional may also choose to speak to other people in the patient’s life, including their partner or other family members. 

Psychological treatment options

In this section, we'll discuss the three most common psychological treatment options. Often, psychiatrists and psychologists work together to create a treatment plan. 

Medication

As trained medical doctors, psychiatrists are legally authorized to prescribe psychological medication. Much of the work they do with patients centers on treating chemical imbalances in the brain and managing medication. Their medical training means that psychiatrists may also take other factors into consideration. Through physical evaluation and possible tests, they try to eliminate other possible causes for a patient's condition before prescribing a course of medication.

In most states, psychologists who want a patient to begin medication or reassess their current dosage must refer the patient to a psychiatrist or another medical doctor. However, there are currently states where psychologists have prescribing powers for certain psychiatric medications. There is also a push for more states to follow suit and widen the scope of treatments psychologists can offer to their patients. Many common emotional and mental psychological disorders are most effectively and efficiently treated with a combination of psychotherapy and medication.

Psychotherapy assessment

Psychotherapy, which is also known as talk therapy, involves talking with patients about the concerns they're facing and helping them to:

• Identify circumstances in their lives (such as divorce or the death of a loved one) that are contributing to their mental health concerns.
• Become aware of any behaviors or emotions that are contributing to their condition.
• Make use of behavior modification techniques.
• Develop healthy coping strategies and appropriate problem-solving techniques.

It's not uncommon for a psychiatrist to refer patients to a psychologist so they may benefit from the other's specific area of psychotherapy expertise.

Types of talk therapy psychologists utilize to support patients

• Psychoanalysis. This method focuses on helping patients to discover, examine, and learn to cope with repressed thoughts and emotions that may be buried deep in their unconscious mind. It's an in-depth method that has been proven effective for patients dealing with depression, personality disorders, persistent relationship issues, emotional challenges, and trauma, as well as self-destructive behavior patterns.
• Cognitive behavioral therapy (CBT). CBT seeks to change the way patients behave in difficult situations by changing their thought patterns. CBT is an approach used to treat current problems patients are facing, such as anxiety, stress, anger, and eating disorders.
• Cognitive analytic therapy (CAT). Using CAT, a psychotherapist aims to help patients identify early experiences that may be contributing to their current mental health challenges. For example, overly controlling parenting often leads to an overly rebellious nature in adolescence or adulthood. Patients in CAT are typically actively involved in the process, helping to develop strategies that will curb their maladaptive behaviors.
• Gestalt therapy. This client-centered form of psychotherapy is often used for patients who are experiencing relationship difficulties, depression, anxiety, and low self-esteem. It has also been shown to have positive effects in cases where patients' emotional stress is manifested physically through migraine headaches and back spasms. Gestalt therapy encourages bringing possibly painful concerns to the surface using methods like drama or art so they can be addressed positively in an environment where patients believe they are safe.
• Hypno-psychotherapy. This approach the clinical use of hypnosis to augment psychotherapeutic interventions. It's meant for the treatment of deep psychological challenges and psychiatric illness through selective attention and suggested experiences. It is also often combined with CBT in a treatment known as cognitive/behavior hypnotherapy (CBH).
• Dance/movement therapy (DMT). This is an expressive therapy, and in some instances, it's referred to as movement psychotherapy. It draws on the well-researched relationship between movement and emotion. Dance/movement therapy is sometimes applied in the treatment of eating disorders and poor self-image.
• Art therapy. This is another expressive form of therapy in which art is used to release patients' emotions. In addition, the art that patients produce is often evaluated by the therapist for underlying signs of a mental health condition. It's often used in the treatment of children and adolescents, but it has also proven effective for adults.
• Integrative or holistic therapy. This is practiced by some psychologists who believe that a fusion of different therapies is the best approach to take with a particular individual.

Physical treatment options

As medical doctors, psychiatrists are trained in a diverse array of physical treatments that can be used with patients. However, these are most often reserved for severe cases of mental illness, and some treatments are known for being controversial.

Treatment and therapy options listed by the American Psychiatric Association

• Electroconvulsive therapy (ECT). Also known as shock therapy, ECT involves the use of electrical currents to the brain to induce seizures in order to treat severe depression, catatonia, and mania.
• Transcranial magnetic stimulation (TMS). This treatment entails the noninvasive use of a magnetic field generator to stimulate certain areas of the brain. It has been used effectively in patients whose severe depression does not respond to medication.
• Deep brain stimulation (DBS). In this treatment, a neurostimulator (i.e., a brain pacemaker) is implanted in the patient's brain. Electrical impulses are then used to treat conditions like obsessive-compulsive disorder (OCD).
• Vagus nerve stimulation (VNS). This is another treatment where electrical stimulation is applied to the brain to treat medication-resistant depression.
• Light therapy. This relatively new technique is used to treat both seasonal and nonseasonal depression.

Psychological or Psychiatric: Which mental health therapy is right for you?

When you're trying to decide between using psychiatry and psychology to treat a mental health concern, there are two important factors to keep in mind: 1) severity and type of mental health condition and 2) the approach with which you’re most comfortable.

Severity and type of mental health illness

Psychiatrists often treat the most complex mental illnesses. These include schizophrenia, severe depression, highly irrational thoughts, and bipolar disorder, as well as conditions that are physically disabling for the patient. Individuals who are suicidal, whether they're having suicidal thoughts or they have attempted suicide, will also usually be treated by a psychiatrist instead of a psychologist. However, in the case of behavioral problems, mild forms of depression, anxiety, phobias, or learning difficulties, the skills of a psychologist may be the most appropriate.

Psychological vs psychiatric evaluation and diagnosis methods that suit you

The difference in the way that both approach treatment means that some people may be more comfortable with one than the other. For instance, people who are cautious about the side effects of medication or about taking medication in general may gravitate toward the services of a psychologist.

Also, treatment by a psychotherapist is usually more time intensive because it often requires weekly sessions, and sessions are normally longer than those with a psychiatrist. Psychiatrists generally see patients for shorter sessions on a weekly or monthly schedule to focus on medication management.

Online therapy with mental health professionals

Unfortunately, many people also make their decision based on their geographic location and ability to pay. Medication is more likely to be covered by insurance. However, there are several talk therapy options (such as online therapy through BetterHelp) that cost about the same as some insurance co-pays for therapy.

If you or a loved one is experiencing a mental health challenge, you don’t have to face it alone. Your course of treatment may involve working with a psychologist, a psychiatrist, or both. If you're interested in talk therapy, consider a service like BetterHelp. Research has found that online therapy is just as effective as in-person therapy in most cases, and it offers the convenience of being able to talk with a therapist from the comfort of your home in a format that you prefer. You can connect with a licensed therapist via phone or video chat, in addition to contacting them in between sessions via in-app messaging.