What’s the difference between a Psychologist and a Psychiatrist?
Psychiatrists are specialized medical doctors (must have an MD or DO degree) that have completed a four-year residency in psychiatry. Psychiatrists perform clinical evaluations that consider both mental and physical factors.
Psychiatrists diagnose and can provide both psychotherapy (“talk therapy”) and medications for a wide range of concerns, symptoms, and conditions.
The suffix -iatrist in Psychiatrist identifies a specialist in the field of medicine.
Psychologists are not medical doctors. Psychologists typically have a PsyD or PhD degree.
Psychologists may perform psychotherapy, psychological assessment, or psychological testing (formal, standardized testing that includes “pen and paper” and computerized testing). Psychologists do not prescribe medications.*
The suffix -ology in Psychology means “the study of.”
The suffix -ist in Psychologist identifies “one who does” psychology.
*Clinical psychologists do not prescribe medication under most state licenses. Medical services are considered outside the scope of training and practice of psychologists by most state medical and professional boards. However, there are rare exceptions. See below for more information.
Comparison of Psychiatrist and Psychologist Training and Clinical Practice
Psychiatrists go to medical school like all physicians and surgeons, with the same curriculum and clinical experiences that all medical doctors must receive to be licensed to practice medicine.
To specialize in Psychiatry, a physician then completes a four-year Psychiatry residency where they are supervised by other physicians in diagnosis, evaluation, and treatment of psychiatric disorders through psychotherapy and targeted counseling, medication, and other neuro-therapeutics and interventions. To complete residency, psychiatrists must demonstrate competency in psychotherapies like CBT and psychodynamic psychotherapy. After coursework and didactics on therapy principles, an experienced psychotherapist (usually a psychiatrist or doctoral level psychologist) provides supervision as a psychiatry resident practices psychotherapy. This supervision may last a year or more depending on the residency program. Psychiatry residency requires learning to help patients across a wide range of symptoms and severity of illness, from mild to very severe. While psychiatrists have the training to treat severe illness, they also commonly treat individuals with mild symptoms and conditions.
Psychiatrists may offer therapy, medication treatment, or both.
Once in practice, psychiatrists may choose to focus primarily on providing medication treatment. Many psychiatrists in private practice continue to offer patients both therapy and medication treatment options. More rarely, psychiatrists may choose only to practice psychotherapy, such as psychoanalysts.
While psychiatrists provide diagnoses based on clinical evaluation or assessment, they may use short forms of psychological testing. Most psychiatrists usually do not perform and interpret the longer, more formal psychological testing (such as IQ, difficulties with learning, etc.) that psychologists may perform. Exceptions to this occur when psychiatrists have sought out additional training in formal psychological testing and interpreting the results of these tests, such as during subspecialty fellowship training.
See also “What is a psychiatrist?”
Psychologists typically have a PsyD or PhD degree. This is different than a medical doctorate. A PsyD degree focuses heavily on therapy and clinical care, while PhD training focuses more on original research. Many PhD psychologists are involved in clinical care.
Depending on state requirements, individuals with other non-medical doctoral level degrees, such as those with an EdD, may also have licensure as clinical psychologists. Some states allow master's level psychologists to practice clinical care. However, their practice may be limited to specific services, or they may be required to practice under the supervision of a licensed psychologist.
Psychologists may offer therapy, psychological testing, or both.
Psychologists often specialize in specific forms of psychotherapy, such as existential psychotherapy, EMDR, CBT, or DBT. They may get certified in multiple types of therapy or focus on a specific modality. A patient may be referred to a psychologist for a specialized form of therapy that a particular therapist or physician does not offer.
A psychiatrist may also refer a patient to a psychologist for a specific type of formal psychological testing. Psychological testing includes personality assessments, evaluation for a learning disability, global assessment of cognitive function, clarification in complex diagnoses, and other formal testing. Some psychologists focus just on psychological testing, while others may focus solely on providing psychotherapy. Some offer both psychological evaluation and therapy services. Psychologists, like psychiatrists, can provide diagnosis and perform assessments based on interview and observation. An assessment may include formal psychological testing but takes into account other information as well.
Can Nurse Practitioners Perform Psychotherapy or Counseling?
A nurse practitioner in Kentucky or Tennessee must be first licensed as a registered nurse (RN) and complete a two-year master's degree (in-person or online) and 500 hours of clinical time observing behavioral health providers before treating patients. They do not typically receive the years of longitudinal psychotherapy coursework and formal, observed psychotherapy training (1-2+ years) that psychologists and psychiatrists must receive as part of their core training to provide safe and effective psychotherapy. Psychiatric mental health nurse practitioners (PMH-NP) can be trained in brief psychologically therapeutic interactions and supportive skills that help establish trust and rapport with patients.
Many states do not permit nurse practitioners, including PMH-NP and DNP, to provide or advertise therapy or psychological counseling services unless they have additional credentials such as a licensed clinical counselor, licensed family and marriage therapist, licensed clinical social worker, clinical psychologist, etc. This helps ensure the person providing therapy has had the training and skills to provide safe and effective therapy.
Should I see a Psychiatrist?
You do not have to have a complex condition or difficult-to-treat symptoms to see a psychiatrist.
Psychiatrists can address a broad range of concerns, including providing support and stress management tools when there are changes in life circumstances or a stressful job, addressing grief, healing from trauma and PTSD, weighing risks and benefits of psychiatric medication in pregnancy, and treating a wide variety of psychiatric conditions, including anxiety disorders and treatment-resistant depression. Even if you have never spoken to a doctor about your emotional or behavioral health concerns, you can make a visit with a psychiatrist your first.
Many psychiatrists in private practice offer talk therapy and medication treatment expertise as an option when needed. This allows you to work together in deciding what treatment is right for you. You don’t have to wonder if medication-only or therapy-only treatment is your only option. You don’t have to split your care between medication prescribers and therapists.
This article addresses many common myths and misconceptions about psychiatry.
A Note on Psychologist Prescribing of Medication
In most states, including Kentucky and Tennessee, psychologists are not licensed to prescribe any form of medication. Some states and Veteran’s Administration systems have tried to address the shortage of psychiatrists by making exceptions to allow psychologists to prescribe certain medications. However, because psychologists do not have medical training and instead receive brief coursework to prescribe a specific class of medication, the patient will still need to see a medical doctor for treatment if a patient:
has or has had a significant adverse reaction to a psychiatric medication
doesn’t respond to the type of medication the psychologist is permitted to prescribe
has a medical condition that impacts the choice of psychiatric medication or requires expertise in dose adjustment, including but not limited to epilepsy, diabetes, certain heart conditions, cancer, glaucoma, genetic differences in metabolism, risk of abnormal bleeding, and renal or liver impairment
has an underlying medical condition or non-psychiatric medication causing or contributing to psychiatric symptoms
takes medications that can interact with commonly prescribed psychiatric medications
This includes but is not limited to blood thinners, certain migraine medications, chemotherapeutic agents, lithium, and other psychiatric medications. Some medications can also interact with oral contraceptives and over-the-counter supplements like St. John’s wort.
is pregnant, breastfeeding, or may become pregnant
has history of a condition that requires special expertise in medication selection, including but not limited to mania, catatonia, Bipolar II, and treatment-resistant conditions
has other higher-level needs requiring medical expertise. Some psychiatric medications require expert medical experience for safe use due to potential side effects or other severe and possibly even life-threatening risks. (This includes lithium, TCAs, MAOIs, and anticonvulsants). Appropriate use and medical monitoring by your psychiatrist reduces these risks.