The difference between a Clinical Psychologist and Psychiatrist

It’s not unusual to feel unsure about whether you need a psychiatrist or a clinical psychologist. This article explains the difference between a clinical psychologist and a psychiatrist, so you have a better idea of who to consult.

Some aspects of clinical psychology and psychiatry are the same

Both psychiatrists and clinical psychologists work with all kinds of mental health difficulties, including severe mental illness. Both see patients (also referred to as clients) on a one-on-one basis, although both kinds of professionals may also offer couple, family and group sessions.

The main difference between a clinical psychologist and psychiatrist

Clinical psychologists are specialist therapists who use talk therapy as their main intervention. Meanwhile, psychiatrists are specialist medical doctors who can prescribe medication.

In many cases, these two kinds of professionals work closely together and refer to one another.

Let’s delve into each profession in a little more detail:

Clinical Psychology

The field of psychology can be confusing, because it’s an “umbrella” term with various kinds of specialties. Psychologists are divided into categories, and each category has its own scope of practice (i.e. specific training and experience) and is licensed accordingly. It’s unethical for any psychologist to work with issues outside their scope of practice and a psychologist found to be doing so could risk losing their licence.

The different kinds of psychologists

There are clinical psychologists, *counselling psychologists, educational psychologists, research psychologists, and industrial psychologists. Although all have some aspects in common, the kinds of care they give and the interventions they offer are substantially different. It all depends on their education, training, credentials, and the limitations of their particular licence. For the purposes of this article, I’ll focus on clinical psychology because it’s my specialty and the most likely to be confused with psychiatry.

Clinical psychologists focus on studying the human mind, experience and behaviour.

Clinical psychologists specifically study different kinds of assessment (like systematic, risk, clinical, neuropsychological, and forensic assessment) and varied approaches to therapy to help their patients move towards healing and improve their mental health. They also study neuropsychology, psychopharmacology (how medicines are used) and other clinically-specific subjects.

They’re qualified to diagnose and treat mental illnesses through therapy, not medicine. If a clinical psychologist assesses you to have a clinical disorder of some kind, (s)he’ll refer you to a psychiatrist.

* Counselling psychologists also assess and diagnose, and refer to psychiatrists. The difference is that their studies may be slightly different (less clinical)  and their training is usually in a counselling setting, such as a counselling centre attached to a university, rather than in a clinical setting such as a hospital. In the UAE, counselling psychologists are licensed by a separate body to clinical psychologists.

Clinical psychologists provide Talk Therapy

Clinical psychologists offer talk therapy, of which there are roughly five main types. Each type of talk therapy has a different approach, but research shows that it’s the relationship between the clinical psychologist and their client that’s key in successful psychotherapy.

The academic path:

Clinical psychologists complete graduate school followed by post-graduate study to at least Masters and often Doctoral level. This process takes roughly 6 – 8 years. Once completed, the clinical psychologist completes an internship (Masters level) or post-graduate fellowship (Doctoral level) in a clinical setting, such as a medical or psychiatric hospital. This usually takes another 1-2 years.

Board examination

Clinical psychologists must pass a board exam in each country they want to practice in. Using myself as an example, I wrote a board exam in both my home country and my resident country to qualify as a licenced clinical psychologist in South Africa and Dubai. The entire process from beginning of study to getting board-certified takes anywhere between 7 -10 years.

Ongoing training

Clinical psychologists have to continuously update their knowledge and training to maintain their certification, and usually have to provide annual proof of this training in the form of CME points (Continuing Medical Education) submitted to their professional board(s).

Psychiatry

Psychiatry is a branch of medicine. It’s a medical speciality, which studies science and biology in order to assess, diagnose and medically treat mental, emotional or behavioural illnesses. Psychiatrists study the biological and neurological elements of mental health, and use their deep medical, neurological, and pharmacological (i.e., medicine) knowledge to treat their patients.

They’re fully qualified and certified physicians, with specialist training on top of that, so they understand complex inter-relationships between different kinds of illnesses and clinical history including genetics.

Psychiatrists can conduct full physical examinations and lab tests and will provide several types of assessments in order to reach a diagnosis and devise treatment plans. However, it depends on the individual psychiatrists – many refer physical exams and lab tests to general practitioners.

Psychiatrists primarily use medication to treat patients. They usually offer psychoeducation to help their patients understand their diagnosis and treatment plan. For more extreme cases of mental illness, they can provide ECT (electro-convulsive therapy). Many psychiatrists’ also offer psychosocial interventions (such as family therapy for example), or psychotherapy to their patients, depending on their training.

However, this part of the treatment is often referred to a psychologist. In a case of extreme risk or severe mental illness, such as an actively suicidal person, a psychotherapist will refer the patient to the psychiatrist, who then bears the responsibility of providing their care.

Psychiatry: the academic path

Psychiatrists complete a bachelor’s degree followed by a full medical degree, which includes practical experience in a teaching hospital. This process takes roughly 8 years.

Once fully qualified as doctors, they specialise by completing a psychiatry residency which is typically around 4 years.

Psychiatrists write two board exams

Psychiatrists who qualify as medical doctors must write their board exam before they begin their residency. After four years in specialist training as a resident, they must pass their final written and oral board examination in order to become “board certified”.

The whole process from beginning of study to getting licenced takes about 12 years.

Psychiatrists can specialise further and become board certified in child and adolescent psychiatry, geriatric psychiatry, forensics, addiction, or pain, amongst others – all of which require additional training.

Ongoing training

Psychiatrists are required to continuously update their knowledge and training in order to maintain their licence certification, and provide proof of this training in the form of CME points (Continuing Medical Education) to their licensing authorities/board.  Some countries require psychiatrists to re-certify every 10 years.

It can be hard to tell the difference between a clinical psychologist and psychiatrist because they often work closely together

Ideally, clinical psychologists and psychiatrists see one another as different members of the same team and work together to the benefit of their mutual patients/clients. The psychiatrist provides the medical part of the treatment and the clinical psychologist provides the talk therapy. This is how I work – I deeply value the psychiatrists I work with.

Psychotherapy and medication combined work faster and better for many illnesses

There’s significant evidence that many mental illnesses respond best to a combination intervention that includes pharmacological intervention (medicine) and talk therapy.

Who you should consult first might depend on your insurance provider

In many countries, and particularly in the UAE, who you should consult first depends on your medical insurance. Often, medical insurance will require a psychiatric consultation and referral as a starting point before covering sessions with a clinical psychologist.

If your insurance covers both, or you’re paying for it yourself, you could start by having an initial discussion with a clinical psychologist who will refer you appropriately.

When your symptoms are severe, unusual, or if you’re unable to function either at work or at home, it’s likely you will need to see a psychiatrist early on in the process. If your symptoms are mild, start with psychotherapy (although you might well still benefit from medication, depending on your individual presentation).

If you’re still wondering about whether you need to see a clinical psychologist or psychiatrist, contact me to set up an online consultation.