Questions I am frequently asked.  Please scroll down for answers...

- What is the difference between psychiatrists and psychologists?
- Why should I choose to see a psychiatrist, rather than another sort of mental health professional?
- Why should I choose to have a psychiatrist prescribe my medications, rather than my family doctor?

Q:  What is the difference between psychiatrists and psychologists? 

A:  These specialties have many things in common, but also important differences. 

Psychiatrists are medical doctors (MD’s or DO’s) who, after medical school, completed an additional four years of specialty residency training in psychiatry.  Psychiatrists can prescribe medications.  Psychiatrists are also uniquely qualified to understand the complex interaction and overlap between “mind” and “body” problems.  As residents, all psychiatrists receive broad training in psychotherapy.  In recent decades, managed care has pushed many psychiatrists to focus primarily on medication management; others, such as myself, offer both psychotherapy and medication management.  Psychiatrists typically charge higher rates than other sorts of mental health providers, due in part to the highly competitive nature of medical school admission and length/expense of post-graduate training.  There are currently about 180 psychiatrists in Maine.

Psychologists hold doctorate-level degrees (either PhD or PsyD) in mental health.  Although rightly referred to as “Doctor”, a psychologist does not have a medical degree, and in most states cannot prescribe medication.  Many psychologists have a particular “theoretical orientation” or style of therapy that they favor.  Compared to psychiatrists, psychologists more often have specific training in the administration of particular psychological testing, such as for IQ.  Psychologists fees are typically slightly lower than psychiatrists, but higher than other sorts of therapists.  There are currently about 400 psychologists in Maine.

There are numerous other professionals who also provide therapy of one sort or another:  Social workers (LCSW), licensed clinical professional counselors (LCPC), nurse practitioners (NP), educators (M.Ed), clergy, guidance counselors, “life coaches”, and others.  As the training for these professions tends to be shorter and more specific than that of psychiatrists and psychologists, their fees are often lower.

Q:  Why should I choose to see a psychiatrist, rather than another sort of mental health professional?

A:  Maybe you shouldn’t.  As noted above, psychiatrists are often harder to find and more expensive than other mental health professionals, and in not all cases will this be worthwhile.  A psychiatrist is often the best choice if you know you need medications, or want an opinion about medications.  A psychiatrist may also be the best choice if you feel that a broad medical background is helpful in understanding how the mind works.  Some people choose to see a psychiatrist for their medications, and a different practitioner for psychotherapy; while this is a often a reasonable approach, there are benefits to seeing just one person for both.  The truth about psychotherapy is that its success depends far more on the relationship between you and the therapist than it does on the therapist’s degree, orientation, or even experience.  Finding a therapist who is a “good fit” is a highly subjective process.  While relative affordability, availability, geographic proximity, and other factors will inevitably enter into your decision of who to see, none of these should outweigh the simple matter of whether you and the practitioner are able to develop a strong relationship.

Q:  Why should I choose to have a psychiatrist prescribe my medications, rather than my family doctor?

A:  Maybe you shouldn’t.  If, for example, you have mild depression or anxiety, and are interested in treating it with medications alone, your primary care doctor may be perfectly capable of managing this.  Many people find this an adequate arrangement.  However, you may find that in a purely medical setting you do not have the chance to explore your difficulties in much depth, and that short, intermittent follow-up visits focus more on a checklist of symptoms than on the large picture of your overall well-being.  Years of research also shows that treatment of some issues, such as depression, works best when psychotherapy is used in addition to medication; this is something that most primary care doctors cannot provide.  Finally, many people simply want the additional expertise that a psychiatrist can bring to bear on medication management, whether for efficiency, improved effectiveness, minimization of side-effects, or safety.