The fields of psychiatry and clinical psychology over-lap, so it’s easy to get confused in trying to distinguish between them. Here’s a guide to help sort through the confusion.
Clinical Psychology
Clinical psychology is the largest branch of psychology. It refers to the treatment of patients who are suffering from psychological problems or disorders. Treatment usually involves counseling. Most psychologists aren’t allowed to administer pharmaceuticals to patients, so they leave that job to psychiatrists.
Clinical psychology is similar to counseling psychology. The main difference is that clinical psychologists normally treat patients who suffer from more serious disorders than counseling psychologists do.
The first step in treating a patient is to assess the patient’s mental health by means of personality tests, behavioral observations, interviews, achievement tests and neuropsychological tests.
The psychologist then diagnoses the patient and designs a treatment plan, often with the aid of a psychiatrist, especially if pharmaceutical drugs are part of the treatment plan. Treatment normally includes some type of psychotherapy counseling, of which there are many types.
Schools of Thought within Clinical Psychology
There are several schools of thought concerning the theories of psychology, with many of these schools also differing in their prescribed treatment plans. Here are a few of the major schools:
The psychoanalytical school, founded by Sigmund Freud, stresses the importance of the unconscious mind and the libido. It extensively uses free association—a mental process whereby a word or phrase spontaneously calls to mind another word or phrase—to help investigate a client’s unconscious motivations.
The analytical school, founded by Carl Jung, is an offshoot of the psychoanalytic school. The analytic school separates the unconscious into two parts, the collective unconscious (which contains archetypes common to everyone) and the personal unconscious. Jung believed the psyche tends toward wholeness and contains a spiritual aspect, but he claimed there are conflicting drives within people that lead to psychological complexes.
The behavioral school stresses the importance of observing the outward behavior of patients and of re-training improper behavior by re-conditioning the patient, often through a system of rewards and punishments.
The humanistic school is based upon the ideas of Abraham Maslow and Carl Rogers. It stresses the importance of self-actualization, creativity, self-will and human potential.
The gestalt school believes that the whole is greater than the sum of its parts. It claims that breaking the human psyche down into small parts and analyzing them separately is akin to breaking down the letters of a word into separate parts and trying to make sense of them individually.
Psychiatry
Psychiatry is a branch of medicine that specializes in treating patients who suffer from mental, emotional or behavioral disorders.
Perhaps the biggest difference between psychiatry and clinical psychology is that all psychiatrists go to medical school and become MDs, while psychologists don’t. Because of this, psychiatrists are able to prescribe pharmaceuticals, while most psychologists can’t.
Another difference is that psychologists are more apt to administer psychological tests than psychiatrists are. Because of the extra training clinical psychologists receive in counseling patients and because psychiatrists’ fees are also generally higher than psychologists’, clinical psychologists tend to spend more time than psychiatrists in counseling clients.
Psychiatrists and clinical psychologists who work in hospitals or mental institutions often work together in treating the same patients, with the psychologists specializing in psychotherapy counseling and the psychiatrists specializing in prescribing medications and treating any medical conditions that might accompany the mental or emotional problems.
Here is a small sampling of the many specialized branches of psychiatry:
Holistic psychiatrists believe that the body, mind and emotions are interconnected and that psychologists need to examine the total picture rather than just look at the psychiatric symptoms. Holistic psychiatrists examine a patient’s diet, physical condition, emotional health, lifestyle and mental health before recommending a treatment plan.
School psychiatrists specialize in treating students from kindergarten to college. Because many schools need to have both a mental health specialist and a physician on hand, school psychiatrists kill two birds with one stone by serving as both. School psychiatrists are trained to help students and their families with a wide variety of problems pertaining to school and family life. They are qualified to test and counsel students for drug use and are equipped to handle overdoses.
Sports psychiatrists specialize in treating athletes, helping clients with problems like drug addiction and mental blocks. Sometimes a sports psychiatrist doubles as a client’s general physician; but other times, the psychiatrist is part of a team that might include a sports psychologist, masseuse, physical trainer, physical therapist or neurologist.
Youth psychiatrists specialize in treating teenagers with problems like learning disorders, hyperactivity, language disorders, depression, bipolar disorder, bulimia and obsessive-compulsive disorder.
Forensic psychiatrists specialize in working within the court system or in law enforcement. Forensic psychiatrists commonly evaluate the competency of defendants to stand trial, testify in insanity pleas, advise law enforcement agents and work with patients in prisons.
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What Do Psychologists Do?
Psychologists receive education and professional training to research and apply assessment and treatment methods to help people cope with a variety of cognitive, emotional, behavioral and interpersonal problems. Within the field of psychology, there are several specialties, including clinical psychology, educational psychology, and neuropsychology.
These particular aspects of psychological study are also divided between research and the application of research. That is to say, some psychologists do active research studies, while perhaps also teaching or operating institutes that focus on advancing new ideas in psychological practice. Some psychologists work in applied fields, meaning they directly use what has been studied and published to help people improve their lives.
A few psychologists will work within both areas, either at the same time or at different points in their careers. For our purposes here, we will examine psychologists who work in applied clinical areas, known as clinical psychologists.
Clinical psychologists often earn doctoral degrees, which are typically either a PhD (Doctor of Philosophy in psychology) or a PsyD (Doctor of Psychology). Between postgraduate education and internships, etc., clinical psychologists spend an average of about seven years in training. Their applied clinical skills can include psychological testing and assessment and psychotherapy methods.
Clinical psychologists are licensed and regulated by state boards after they pass a national exam along with their state’s exam. Once they are licensed, psychologists must maintain their licensure through ongoing professional education. Clinical psychology interns who are working towards earning a license are permitted to practice under the supervision of a licensed psychologist. In some places, psychologists may be available to prescribe medications.
Psychologists with the proper education and credentialing can be given authority to prescribe psychiatric medications in Iowa, Idaho, Illinois, New Mexico, and Louisiana, as well as in the Public Health Service, the Indian Health Service, the U.S. military and the territory of Guam. Psychologists who are permitted to prescribe must have advanced training for this purpose or a master’s degree in psychopharmacology, which is the study of psychiatric and other related medications and their effects.
Clinical psychologists can be found in a variety of settings. They often work in outpatient facilities or offices, either as solo practitioners or as a part of a group practice or through telemental health (video conferencing). They also may practice in hospitals, health clinics, schools and universities, rehabilitation centers, community agencies or for businesses and industry. They may work with individuals, couples, families, or groups. They may also provide services for specific segments of the population, such as children and adolescents, veterans, LGBTQ persons, people with learning disabilities, or elderly persons.
Psychologists sometimes focus on specific problem areas, including substance abuse, depression and anxiety, posttraumatic stress disorder, chronic pain, brain injuries, and many others. In short, psychologists can help people from all kinds of backgrounds, with a variety of methods and tools to address the cognitive, emotional, behavioral, social and interpersonal problems that people can suffer in modern life.
Clinical psychologists are trained in psychometrics, which is the study and application of psychological testing. These tests include measurements of IQ and achievement, personality inventories, neuropsychological tests, employment and safety tests, attitude tests, personal interest inventories, screenings for certain psychological disorders, and many others.
Psychologists may meet with an individual and assess for which tests would be appropriate, or may use a battery of tests with which they feel most comfortable under certain circumstances. It may be important to note that not all psychologists use tests in every situation. But many agree that testing can be very helpful in making decisions about a person’s mental health diagnosis or outside of treatment, as in hiring individuals for high-risk occupations.
Psychologists generally agree that psychological tests do not completely offer an exact picture of an individual, their possible treatment needs, or whether or not they would be good candidates for a particular job. Instead, these instruments can provide additional and supportive information in connection with professionally performed interviews, especially for clinical purposes.
In the case of a psychologist assessing an individual’s treatment needs, psychological tests can help reveal such things as the deeper aspects of a person’s fears, personality issues, and the particular ways they may see themselves and the world around them. The information provided to the psychologist from those testing instruments can aid in providing a diagnosis, but perhaps more importantly, alert the provider of psychotherapy services to look for specific problem areas as the treatment progresses.
Understandably, some people might find psychological testing and the overall assessment process a bit intimidating. It may seem like you just answer a lot of questions and respond to items without knowing what it will ultimately say about you and how that information might be used.
Clinical psychologists can explain the testing and assessment process thoroughly before the assessment begins, along with providing informed consent documents that can be read and clarified, so that individuals know exactly where the information is going, who will see it, and how it will be used. These consent forms allow individuals to provide authorization before testing can proceed. When people are apprised of the reasons and the specific purpose of psychological testing, they tend to cooperate freely, and sometimes even find the process interesting and informative.
As mentioned earlier, not all individuals who seek mental health treatment are subject to psychological tests, but clinical psychologists may decide to use these instruments if needed. In any case, psychologists who provide assessments will conduct a clinical interview for the individual, or for a couple or family who need relationship therapy.
The structure of a clinical interview can vary depending on the psychologist, the particular individual(s), and the situation at hand. But essentially, clinical interviews offer opportunities for clinical psychologists to understand the persons involved, their personal, health and family histories, specific symptoms or problems they’re struggling with, and any other questions or issues that are relevant to their needs. It’s also often an opportunity for patients, or their families or caregivers, to ask their own questions about what the psychologist is perceiving about them and their circumstances, and what they may expect about treatment going forward.
As the assessment process finishes, clinical psychologists provide conclusions based on their evaluations, and use their training and experience to form a clinical diagnosis (if appropriate) and other ideas to shape a mental health treatment plan. An important part of training in clinical psychology involves psychopathology, or the study of mental disorders.
Psychologists know how certain behaviors or other information and data they receive can be used to classify particular disorders that may apply to individuals. Formulating a diagnosis helps the treatment professionals involved to know specifically what they are dealing with, and can better plan and anticipate the needs of people in their treatment programs.
One important document used in formulating a diagnosis is called the DSM-5, which stands for the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. This large book holds just about every known psychological disorder, the symptoms of each one, and how to tell one disorder apart from another. Psychologists can inquire about specific symptoms and match those with disorders listed in the DSM-5 to create the most accurate diagnosis.
However, even with all of the tools available to a clinical psychologist, an initial diagnosis may not be entirely clear, or for that matter, all information from the individual may not be immediately available. For example, people with certain disabilities or language and cultural differences may require more time or assistance to complete the assessment process. If so, psychologists can provide initial findings and impressions with caveats to allow for more information as it becomes available.
The total package of information from the initial evaluation can be used for the emerging treatment plan. If the clinical psychologist is a part of the treatment team, then he or she will retain that information for their purposes. But whether or not the psychologist is providing treatment, they will share their findings with any other member of the treatment team, including a treating psychiatrist.
Clinical psychologists themselves can use any number of therapies in which they have specific training and expertise. The most common of these therapies is psychotherapy, which is talk-based, and can involve individuals, couples, families, or groups. In this case, the psychologist may also be referred to as the “therapist” or “psychotherapist.”
Among clinical psychologists who provide therapy, there are often many different approaches and techniques that are used to meet different clinical demands. These include psychodynamic therapy, cognitive behavioral therapy, psychoanalysis, dialectical behavioral therapy, emotionally focused therapy, existential therapy, and several others. Certain psychologists may also provide other psychological treatments such as hypnosis or EMDR (Eye Movement Desensitization and Reprocessing).
Psychotherapy patients often wonder which type of therapy approach is best. And certainly, there can be a lot of controversy among therapists themselves as to what works best. But studies have shown that the type of therapy used is less important to an individual’s overall improvement in well-being than the particular therapist providing the therapy. Thus, no matter what kind of technique is used, it’s the fundamental quality of the therapist and the sense of rapport between therapist and patient that usually determines the best results.
There is no doubt that qualifications, training, and experience are important factors when choosing a therapist for yourself or your loved-one. Understanding their specialties and how they typically provide their services is also helpful in making an informed choice on who you will be entrusting with your mental health care. But it is also important to establish a good sense of connection and affinity for that professional. You may not necessarily experience that immediately with a therapist, but soon enough, having a solid measure of confidence in that therapist will promote successful therapy along the process.
Good therapists, including clinical psychologists, understand this principle, and should invite patients and those who are considering therapy to express openly their concerns about therapy, and promote honest feedback about how the therapist is doing as treatment goes forward.
