What’s The Difference Between a Therapist & a Psychiatrist?
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If you’re just starting your mental health journey and you’re not sure what each of these professions offer to you, this post is designed to provide some insights on where to start and what you might want to look for.
First, lets start with what each profession means. Psychiatrists- In Illinois, a psychiatrist is a doctor of medicine that has continued additional training, residency, and become board-certified to work in the mental health field. Every two years they are required to complete 24 hours of approved continuing education in the mental health field. A psychiatrist can prescribe medication if needed, provides diagnoses and strategies, provide testing and forms for work or school mental health requirements, and may discuss types of therapies to seek out as part of your treatment plan. Each psychiatrist can have to their own style and way of working with their clients, but you may generally find in an outpatient setting (meaning not during any hospitalization or residential program settings) that after an initial intake, you may meet weekly or monthly, depending on your needs, to monitor any medication prescribed and current symptoms. These sessions can become less frequent and last for a shorter amount of time as medication is established, symptoms are stable, and a client needs less monitoring. So after your initial assessment sessions, your future sessions could begin to be 15-20 minutes every 4-6 weeks, but again it depends on your provider and your needs. Not all psychiatrists work with children or adolescents, so if that is a need of yours you’ll want to check ahead. Please note that a psychologist is not the same as a psychiatrist. In Illinois, a psychologist can not prescribe medication unless they have completed continued psychopharmacology education and are licensed to be a ‘prescribing psychologist’.
Many times a psychiatrist may recommend that a client also begins to meet with a therapist to provide more frequent interventions or to address a specialized form of treatment, like trauma therapy or couples counseling. Therapists- as a therapist myself, I’m able to speak a little more to this side of things. In Illinois, a therapist is a licensed (clinical) professional counselor or social worker. They have a master’s degree in psychology or social work and passed testing for state certification as a Licensed Professional Counselor or Licensed Social Worker. When they receive enough experience and supervision as required by the state, they can then test to become an Licensed Clinical Professional Counselor or Licensed Clinical Social Worker. Every two years they are required to complete 30 hours of approved continuing education in the mental health field. A therapist can provide diagnoses but can not provide medication. They provide treatment through therapeutic interventions. Many therapists commonly work with disorders such as anxiety and depression, but a therapist can continue training for certification in specialized areas such as Substance Abuse, Trauma, ADHD, EMDR, Integrative Health, Eating Disorders, and more. Not all therapists work with children, couples, groups, or families so you will want to check a provider’s website for the specializations and types of services provided by each of the therapists on staff and their areas of study (often in a Meet Our Team/Therapists Section) or you can easily inquire as you call to schedule an appointment for a specific need.
A therapist in an outpatient setting will often meet more frequently than a psychiatrist in an outpatient setting, once or twice a week depending on your needs. For example, someone leaving a hospitalization or residential program may need to meet more frequently than someone who has mild or moderate symptoms or needs. Therapy sessions are often 45-60 minutes and they stay that length throughout therapy unless otherwise discussed with you. It is very common for a client to be working with a psychiatrist and a therapist, but it is not required. Many individuals may not need medication so they may not need to work with a psychiatrist or an individual who is working with a psychiatrist may not yet feel comfortable talking for longer periods of time with a therapist as well.
If you are working with both you can decide if you want to allow your therapist and psychiatrist to collaborate to provide your treatment goals by signing a release of information with both parties. Therapists working with children may meet individually with the child as well as provide parental check-ins or family sessions as needed based on the child’s treatment goals and age. Therapists working with couples or families may also recommend some of their clients to meet with another therapist for their individual needs, especially if it is out of their area of specialty, like substance abuse or trauma treatment. What your overall treatment plan and team may look like will vary based on those needs and your provider, but you ultimately lead those decisions.
How long counseling treatment lasts depends on the severity of your symptoms, your engagement in therapy, and the modalities used by your providers. While your sessions may start weekly, the ultimate goal of therapy is to provide you with the tools and strategies to reduce how often you need to meet with your therapist as you ultimately work towards ending services. If you complete therapy and find you need services in the future, this is not any form of failure on your part. It can be common for a mental illness to require a future check-in with your therapist as your life stressors, habits, contacts, circumstances, triggers, and biochemistry continue to change. Those future sessions may be much more brief as strategies are reinforced and thought distortions may be re-evaluated.
Therapists also work in different modalities and I’ll describe a few common ones. There are a multitude of different modalities and many therapists will blend them to cater to the specific needs of the client. Here are a few of the most common ones:
Cognitive Behavioral Therapy (CBT) focuses on the relationship between your thoughts and behaviors by looking at how dysfunctional thinking can be impacting your feelings, reactions, and mental health. It is a common type of therapy for Anxiety, Bipolar Disorder, Obsessive Compulsive Disorder, Trauma in the form of Trauma Focused CBT, Depression, Substance Abuse, Post Traumatic Stress Disorder, and more.
Dialectic Behavioral Therapy (DBT) is often used to treat severe and chronic mental health disorders by focusing on problem-solving and acceptance-based interventions. It is commonly used with self harming, suicidal ideation, Borderline Personality Disorder, Post Traumatic Stress Disorder, Eating Disorders, and more.
Behavioral Therapy- focuses on changing one’s current unhealthy behaviors and is often used with Substance Abuse, Attention Deficit Hyperactivity Disorder, food avoidance or as a precursor or modified version of CBT if children are not developmentally ready or old enough to address the cognitive approaches for all CBT strategies. Behavioral therapy is a component of CBT.
Psychodynamic or Psychoanalytic Therapy focuses on the impact of our past in our unconscious thoughts and feelings and is often used for Anxiety and Depression.
Client-Centered Therapy or Person Centered Therapy (CCT or PCT) focuses on empathizing with the client and providing subtle encouragement for the client to regain control of their future.
Acceptance and Commitment Therapy (ACT)- focusing on building mindfulness skills for more flexible and resilient psychological responses. It is often used for Anxiety and Depression.
Mindfulness-Based Cognitive Therapy is a combination of ACT and CBT, using mindfulness skill building with CBT tools.
So if you’ve decided that you want to begin therapy or meet with a psychiatrist, where do you start? Contacting your insurance provider can help you get a list of providers already in your network and they can let you know if you’ll need a referral for services. You can also search providers based on your needs and location online and then confirm with the company that they are in your network or that they offer self-pay options if you won’t be using insurance. Websites like psychologytoday.com or goodtherapy.com offers lists of providers that have paid a subscription to be listed, but it is free to you to use and you are able to narrow your searches to insurance, location, specialty, and read a biography of each therapist or psychiatrist. Also, you can check with your local county’s mental health website for behavioral health services that may be free through a nonprofit or offered on a sliding scale.
If you’re unsure whether you should reach out to a psychiatrist or a therapist first, know that you can contact both at the same time. If you’re not sure if you will need or want medication, you can start with a therapist and they will let you know if they would recommend you also meet with a psychiatrist at any point during your therapy services.
So lets say you have an appointment scheduled - what’s next? As a therapist, I always recommend you get in the habit of bringing a notebook with you- it can help you organize what you want to say for each session as well as being a place to write any insights or strategies learned during your sessions. This can be a plain notebook or a therapy-specific book as seen below. If you’re nervous about anyone finding your notebook, you can use a notes feature on your phone instead and delete entries as needed.
Be prepared to talk about your current symptoms and how long you feel like you’ve been experiencing them, it’s ok if you don’t know an exact timeline, we just want to get a feel if this is a new or continuing concern. If you know of any family history of mental illness on your mother’s or father’s sides of the family you can share that as well. All of this information would be confidential.
Finally, don’t put extra pressure on yourself. You’re likely going to feel awkward or anxious going into that first session- it’s completely normal! No, we won’t think you said too much- that’s extremely helpful for us to know more and we can gently redirect you if needed. No, it’s not bad if you weren’t sure what to say, it’s our job to make you more comfortable and find the interventions that best suit you. Keep in mind, if you begin to feel like we’re not a good fit for you, please keep looking for someone else. The goal is for you to feel better- a good therapist won’t take offense and won’t judge you. If we aren’t the person to best help you, then we want you to find the one that is!
