What can a psychiatrist do that a psychologist cannot

Short answer is that psychiatrists are medical doctors and (more often than not) medical researchers, and thus psychiatrists themselves often do not practice psychotherapy.

Psychiatrists

Psychiatrists are physicians, which means they have received a medical degree (M.D.) and have completed medical training, along with an additional four-year residency in psychiatry. Some psychiatrists pursue additional fellowship training after their residency. Thus, it takes at least twelve years of practice to become a psychiatrist.

Psychiatrists are legally allowed to prescribe psychotropic medications to patients. This is because they are medically trained to do so, having completed a medical degree and medical training. A large portion of this medical training is dedicated to learning how psychotropic medications work in the brain and in the body, particularly in those of patients with mental illnesses. For this reason, psychiatrists are generally more aware of the physical symptoms of illness (much like a doctor would be) as well as the mental symptoms, and thus must make an informed evaluation to determine whether the patients' symptoms are due to physical or mental factors (or both).

Though psychiatrists can perform psychotherapy, the vast majority are purely medical researchers. A psychiatrist may thus refer a patient to a clinical psychologist or a specifically-trained therapist for their individual psychotherapy needs. A physician or psychiatrist (both trained in psychopharmacology by definition) who both practices psychotherapy and prescribes psychoactive medication may refer to themselves as a "psychopharmacologist", though this is more of a distinction than a formal occupation.

Clinical psychologists

Clinical psychologists are PhDs who have received several years of graduate training in the science and theory of psychology-based dysfunction and mental illness. They do not receive medical training, but they do undergo 2-4 years of supervised clinical practice before they are licensed as clinical psychologists.

A clinical psychologist's job description is a bit more broad than that of a psychiatrist. While many provide psychotherapy to patients suffering from mental illness, other clinical psychologists may opt to teach, administer psychological testing, conduct research, work with administrators, develop treatment and prevention programs, or work as psychological consultants.

Though there is very little that a clinical psychologist can do that a psychiatrist simply can't do, a clinical psychologist is trained in mental health and well-being first and foremost, and thus is typically called on to perform tasks related to mental health (such as psychotherapy or psychometric testing). The difference may be comparable to that of a professor versus a teacher. Though the professor typically undergoes more training, they split their focus between their research and their students (and may prioritize research first), whereas high school teachers are often teachers through-and-through, and thus their primary focus is on the students. Thus the teacher role is a bit more interpersonal.

And that’s just the first step. The next question is: “What kind of doctor should I see?”

You could see your primary care doctor. Many people do. Of the 8 million appointments for depression, about half of them are made with primary care physicians, according to a news story on PBS.com.

If the primary care doctor route is not for you, you are then faced with another choice: should you see a psychologist or a psychiatrist? How do you know who is right for you?

What’s the Difference Between a Psychiatrist & a Psychologist?

Before we explore the difference, you should first know that many psychiatrists and psychologists work closely together.

The primary difference between the two types of doctors comes down to medication: a psychiatrist can prescribe it, while a psychologist cannot.

In addition to offering treatment through medication, psychiatrists will often conduct talk therapy, cognitive behavioral therapy or other forms of treatment. They may also make referrals to counselors or therapists (like psychologists).

According to Psychology Today: “Psychiatrists receive the same medical school education as any other medical doctor, such as an internal medicine physician or a pediatrician and, therefore, hold a doctor of medicine degree (M.D.).”

When to Choose a Psychologist

A psychologist doesn’t hold an M.D. degree. Psychologists will assess patients and treat them through counseling or talk therapy.

Talk therapy is a method of treatment that helps patients re-evaluate their feelings and attitudes, creating healthier behavior according to the American Psychological Association. The Association states that psychologists are “highly trained professionals with expertise in the areas of human behavior, mental health assessment, diagnosis and treatment, and behavior change.”

Applying scientifically validated procedures, a psychologist will work with a patient to help them identify and isolate a problem, recommend potential behavioral changes, and determine the best course of action.

Marian Margulies, PhD, a psychologist in New York City and candidate in psychoanalysis at the Institute for Psychoanalytic Education at the NYU Medical Center, said talk therapy is important because you aren’t just treating the symptoms – you are finding out what’s causing the pain.

“If you’re not getting to the cause of the pain, you’re essentially chained to the past,” Dr. Margulies told Forbes. “Psychotherapy gets to the root.”

When to Choose a Psychiatrist

Even if psychotherapy is getting to the root of the problem, you still may need additional help.

With a medical background, a psychiatrist can review your complete medical history. Understanding the full picture is important because some mood disorders may be caused by physical conditions like hormonal changes (pregnancy or thyroid disorder), according to the Mayo Clinic.

“Because we learned how the body interacts with the mind, we can rule out physical disorders as a cause of mental illness. This is important, since a person may have a hyperactive thyroid, for example, which can trigger panic attacks, anxiety, insomnia, or anorexia. We can look at thyroid blood tests or have a patient consult an endocrinologist if we suspect the problem stems from thyroid disease,” Carol W. Berman, M.D., a clinical assistant professor of psychiatry at NYU Medical Center in New York City, wrote in the Huffington Post.

If depressive symptoms are significantly impacting your body and daily life, a psychiatrist can help determine if medication will help. Importantly, a psychiatrist can consider drug-drug interactions if you are already taking medication for other conditions.

If a patient needs it, a psychiatrist has the authority to recommend hospitalization. However, Dr. Berman writes that hospitalization is often a last resort:

“The most common types of psychiatric hospitalizations are for suicide attempts, detoxifications from drugs or alcohol, psychotic episodes caused by mania or from schizophrenia. Most psychiatrists use hospitalization sparingly as a last resort if no other treatment will work.”

Choosing A Provider who is Right for You

If you feel you may be experiencing depressive symptoms, a good way to start is to talk to your primary care physician about a referral. This way, the physician who sees you the most can determine which type of mental healthcare provider you should see based on your medical history.

Our articles are for informational purposes only and are reviewed by our Medical Information team, which includes PharmDs, MDs, and PhDs. Do not make any changes to your current medications or dosing without consulting your healthcare provider.

The GeneSight test must be ordered by and used only in consultation with a healthcare provider who can prescribe medications. As with all genetic tests, the GeneSight test results have limitations and do not constitute medical advice. The test results are designed to be just one part of a larger, complete patient assessment, which would include proper diagnosis and consideration of your medical history, other medications you may be taking, your family history, and other factors.

If you are a healthcare provider and interested in learning more about the GeneSight test, please call us at 855.891.9415. If you are a patient, please talk with your doctor to see if the GeneSight test may be helpful.

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