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Psychiatrists, Psychologists and Counselors: What’s the Difference?

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Based on the frequency of calls I get with people wanting a prescription, it seems that not everyone is clear on the distinctions between psychiatrists, psychologists, and counselors. I thought I’d address that here.

A psychiatrist is a medical doctor, just like your family physician. However, instead of specializing in family medicine, a psychiatrist has specialized in treating mental concerns. Family doctors can and do prescribe medications like anti-depressants. In fact, a huge percentage of people see their family doctor for depression and anxiety instead of a psychiatrist. I recommend a psychiatrist because that’s their specialty. They are current on the latest research and they can provide more nuanced treatment when it comes to prescriptions. For example, ADHD is one place where it pays to see a psychiatrist. There are a variety of stimulant and non-stimulant medications used to treat ADHD. And on top of that, there are various formulations of those stimulants: extended release, quick release, liquid, capsule, etc. And each is going to have a slightly different effect. In addition to this, some medications may be combined for an extra bit of punch. When one dose of medication isn’t quite enough but the next dose higher would be too much, a second ADHD medication might be added to help hit that sweet spot. Psychiatrists may also offer therapy. Many do not because the insurance reimbursement rates are too low for psychiatrists, especially when compared to what they make for a 15-minute medication management appointment. However, some do provide therapy in addition to medication management.

Psychologists are therapists. In some states, psychologists are able to write for certain prescriptions. Missouri and Kansas are not among those states which allow psychologists prescription privileges. Most psychologists have their doctorates (PhD or PsyD); although there are some master’s level psychologists, they aren’t as common. Some psychologists also specialize in testing, such as IQ tests, tests for ADHD, etc. Only someone who is licensed as a psychologist may claim to be a psychologist.

Professional counselors, which is what I am, marriage and family therapists, and social workers are other therapists. There are doctoral degrees available in these professions but often times these therapists have a master’s degree. There are distinctions between psychologists, social workers, marriage and family therapists, and professional counselors that matter professionally but generally wouldn’t be important to the person seeking therapy. For instance, the focus or philosophy of each is a bit different. Counselors approach mental health from a wellness perspective, wanting to strengthen and support wellness rather than focus on what is wrong.

You might be wondering about coaches. Coaches are not therapists although they often offer services that approach the line to counseling and may sometimes cross that line. Unlike the therapists, coaches at this time are not regulated by the state and there are no minimum requirements in education and training and no board to address someone who may be causing harm or acting unethically. Anyone can be a coach if they declare themselves to be one. There are training programs that offer certifications, but these are nothing compared to the education that therapists undertake. My own master’s degree was a three-year full-time endeavor and included hundreds of hours of supervised work as a therapist.

So in Missouri or Kansas, when you are seeking medication for help with a mental health issue, you will need to see a doctor. I recommend seeing a psychiatrist. (Note that it can take 6 or 8 weeks to have your first appointment with a psychiatrist, so if you are even considering it, go ahead and schedule the appointment even if you aren’t sure you want to keep it. You can always cancel it closer to the date). For therapy, you have a lot of choices and what is most important is that you find a therapist who you feel listens to and respects you.

I’m currently accepting new clients. If you’d like to schedule a session or a free 30-minute consultation, you can book one yourself using the “schedule appointment” button at the top of each page or you can text (816-226-4678) or email me.

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