What is better, a psychologist or a psychiatrist?

Neither is “better” for everyone. However, one might be better than the other because of your unique needs. You want a psychologist if you want counseling alone or special counseling. Psychologists can specialize in behavioral therapy for obsessive-compulsive disorder (exposure and response prevention is one example), and behavior therapy for borderline personality disorder (dialectical behavior therapy). And there are special counseling strategies for post-traumatic stress disorder (response prevention), attachment issues, and addictions.

A psychologist will talk about their specialty on their website. Then, they look for testimonies in online reviews to see how their patients performed in that specialty. The same can be said for psychiatrists.

Why would you want to see a psychiatrist?

Many people ask that question because little is known about what psychiatrists do. That’s because they often don’t talk about themselves and resist that in their work with their patients. That’s how they are trained based on backward assumptions that date back to the early 1900’s. In those days, Freudian Analysis was popular. In that approach, the patient lies down and says whatever is on their mind. The doctor is not supposed to talk about themselves, so the patient then can talk about their impressions of the doctor–and it is understood that didn’t come from the doctor-patient communication–because there wasn’t much in that regard.

For instance, the patient might say, “I think you don’t care about me.” But then can’t say what it was the doctor did for the patient to get that impression. Then, the patient can learn they were “projecting” their internal impressions (people don’t care about me) onto the outside world (“the doctor doesn’t care about me”) even though there was nothing the doctor did to merit that reaction! While that might have been a valuable tool back then (it was the only counseling approach available), it is an old habit now. Some old habits die hard, even among mental health professionals.

As noted above, a psychiatrist can prescribe medicine and do counseling. That unique set of skills will allow you to work with one person to do both things. What are people’s experiences like when they see a provider who does both? I review over 100 examples of people overcoming problems with the help of a psychiatrist in the book, “Prescription For Positivity,” which is for sale on Amazon. That approach also can save you money.

Another reason to work with a psychiatrist is that the person who is prescribing you medicine is the best one in a situation to help you potentially get off a medication. They have seen perhaps hundreds of people on a certain medication and are familiar with what it is like to decrease the dose of a medication. They can speak to those issues, such as insomnia. Going down on sleep medicine might leave a person having difficulty sleeping at night and overthinking things that happen during the day. The psychiatrist then could inform you about different techniques you can do to take the place of a percentage of that sleep medication.

Unfortunately, there is a trend nowadays for psychiatrists just to do medication management or just do online visits. Check for online reviews to see how that is going for people.

If there is an extreme chemical imbalance in the brain, such as due to anxiety, depression, or insomnia, medication is often needed to get things on the right track. Then, with less of a “chemical imbalance, “ a person’s brain is better positioned to respond to the new thinking and actions learned in counseling. Counseling works better when the medicine is working to calm down the chemical imbalance.

You would want to work with a psychiatrist who knows how to prescribe medicine for anxiety and depression if you have those issues. This would be evident in the online reviews and with what is written on their website.

So, psychologists are the best choice when there are only psychological issues. They may be simple or deep, but they are psychological issues. Psychological issues cause personal distress but do not affect sleep, energy, appetite, attention, motivation, or follow-through. These are markers of a “biological” condition or an issue that is likely to not get better with counseling unless medication is also used at the same time as the counseling.

A psychiatrist is what you’re looking for when the emotional issues become biological. This is often a difficult thing to call. But if the chemical imbalance in your brain interferes with sleep, you’re tired all day, that is a biological marker. Or if it is a great struggle to get out of bed in the morning and stay focused at school or work. Suppose you’re getting bad feedback on your performance at school or work, and applying the new thinking and action strategies you’ve learned in counseling isn’t helping. In that case, you should start thinking about seeing a psychiatrist. Some chemical imbalances in the brain are so bad that all the counseling in the world won’t help, and you don’t want to let it go to the point where you start failing in school or getting bad reviews at work. So, in summary, it’s often hard to tell what is best, but those are some pointers.