Therapy San Diego 101: Should I contact a psychologist or a psychiatrist?

I have been practicing as a Licensed Clinical Psychologist in San Diego for close to 20 years. Over the years, people sometimes mistakenly have referred to me as “a psychiatrist,” or asked me whether I can prescribe medications, like a medical doctor. What is the difference between a psychologist and a psychiatrist after all? In what ways do they overlap and in what ways are they different?

Mental health treatment can be loosely defined as the art of helping people heal from emotional or mental distress, as well as of helping them cope better with life’s challenges. Mental health treatment takes a variety of different forms and is delivered by providers from several different disciplines. When you are looking for a mental health provider, especially while experiencing high distress (either your own or that of a loved one), it may feel overwhelming to try to make sense of the complexity of the field. Let me try to help with some clarification.

“Talk therapy” versus “medication therapy”

For the sake of simplicity, I will divide mental health professionals into those who do “talk therapy” versus those who do “medication therapy.” Talk therapy providers include psychologists, who hold doctorate level degrees, as well as clinical social workers, and marriage and family counselors, who hold master’s level degrees (the list of mental health providers is longer than this, but this suffices for our scope of concerns here). Medication therapy is provided by medical doctors, most often psychiatrists, but also by family doctors or other doctors (MD’s).

Psychologists versus psychiatrists

Both psychologists and psychiatrists require many years of formal education (more than those required for social workers or marriage and family therapists). Psychologists first earn an undergraduate degree and then attend a doctorate level program that can take 4-5 years to complete (either PhD or PsyD). Those who graduate with a PhD in clinical psychology get a stronger foundation in research than those who graduate with a PsyD in clinical psychology. To practice as a psychologist independently, psychologists must be licensed in their State, which requires completing many supervised hours of therapy practice as well as passing State licensing exams. Psychologists’ education focus on interventions via talking and behavioral change.

Psychiatrists are licensed medical doctors with a specialty in psychiatric care. They have completed undergraduate school, then attended medical school to become general doctors, and then completed a residency in psychiatry, which is their medical specialty. They also must pass State licensing exams in order to practice independently. Psychiatrists’ education is focused on medication interventions for treating mental health problems. For instance, they are likely to prescribe anti-depressant medications to individuals who struggle with depression, or anti-anxiety medications to individuals who struggle with anxiety, and so on. Their medical knowledge allows them to consider possible interactions of their patient’s mental health concerns with other medical conditions they might have, or other medications they take. Psychiatrists do get some training in talk therapy, however this is not the focus of their basic training (in contrast to psychologists). Their focus is on medication management as part of the package of mental health treatment.

Psychologists and psychiatrist often collaborate in treating clients. For instance, imagine that as a psychologist, I provide talk therapy to a client who has suffered significant trauma, which also resulted in them experiencing depression and bouts of anxiety. Even though my client feels better after substantial talk therapy, they continue to have significant difficulty falling asleep, and significant anxiety leaving the house. After these problems prove to be impervious to a variety of therapeutic interventions, I may suggest to my client that we consult with a colleague who is a psychiatrist. If interested, my client may meet with the psychiatrist, who would do their own evaluation of the client, and may prescribe certain medications to address the unresolved symptoms. Ultimately, it may be the combination of the talk therapy and the medication intervention that result in the client’s improved mental health.

Conversely, my psychiatrist colleague may treat their patient with medication, and after some time may suggest to their patient that weekly talk therapy may help on top of meeting with the psychiatrist every several weeks. I would then meet with their patient, discuss their treatment goals, and evaluate them. Based on my evaluation, I will devise a psychological treatment plan to augment the benefit gained by the medications.

Should I contact a psychologist or a psychiatrist first?

To answer that question, I would like to make a distinction between your “story” and your “symptoms.” Let’s say that this past year has been a very difficult year. Early in the year you lost your mother after her long battle with cancer. You have spent many hours at her bedside, which affected your ability to focus at work, and also added to tension between you and your partner even though they’ve been trying to be as supportive as they can. Losing your mother was particularly difficult as your relationship with her was never easy and always had been fraught with conflict. You now feel that since she passed, it will never be possible to resolve issues with her and attain peace. This is your “story.”

As far as symptoms go, these may include difficulty sleeping most nights of the week, having suppressed appetite, having low energy and drive when trying to take care of daily tasks, and feeling depressed and anxious.

It's hard to generalize about talk therapy because there are so many variants and therapeutic approaches; however, I would say that on the whole, psychologists would be interested in the “story” and not just the symptoms. I would, being a psychologist. I would work with you on “the meaning” of the loss you’ve experienced, and the emotional complications associated with it. We would explore these, and process them, with the goal of achieving some resolution and emotional relief. That said, I also would a recommend behavioral interventions that may affect the symptoms (e.g., physical activity, mindfulness meditation, journaling), however these would always take the “story” into account. If you are interested in this general approach, I would suggest you contact a psychologist first.

If you are more interested in targeting the symptoms directly, without much discussion or processing of the background story, I would suggest you talk with a psychiatrist first. Their medication intervention would be designed for symptom relief.

And of course, you can talk with both.

Free therapy consultation in San Diego

If you are not sure how to proceed and would like to discuss it further, I provide a FREE 15-min phone consultation. We will briefly discuss your concerns and goals, and I will share whether I can help. This can include a recommendation that you contact a psychiatrist to address your treatment goals. Press here to schedule your free phone consultation or call me at 858-330-0065.