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Psychology vs. Psychiatry: Which Is Better?

Confused by the difference between a psychiatrist and a psychologist? WebMD explains who does what and how that affects treatment.

Fees

"It usually is not the psychiatrists' choice to only prescribe medicine," Goin says. But if a psychiatrist participates in a health insurance plan, the plan's fee structure may discourage time spent on psychotherapy.

A study published in the journal Psychiatric Services in 2003 shows that psychiatrists earn less for doing therapy. On average, a psychiatrist who charges for 45-50 minutes of psychotherapy earns $74-$107 less than he or she would for three 15-minute sessions of medication management.

The reason may be that insurers figure that psychotherapy, which is time consuming and may go on for months, should be handled by providers who charge less. "The reality is that psychiatrists' fees are often higher than psychologists'," Goin says.

According to the Centers for Medicare and Medicaid Services, "reasonable" charges for a 45- to 50-minute therapy session are $70-$130 for a psychiatrist and $65-$114 for a psychologist.

These guidelines are based on data from 1988. The 2003 Psychiatric Services study shows psychiatrists charging an average of $107-$155 per session for therapy.

Psychological Testing

In addition to psychotherapy and research, psychologists use a variety of tools to examine a person's psychological underpinnings and personality (and how that could affect life experiences).

Psychologists tend to use these tests more than psychiatrists.

Personality tests include the questionnaires such as the Minnesota Multiphasic Personality Inventory (MMPI) and the Millon Clinical Multiaxial Inventory (MCMI), and the famed Rorschach test - where the person is shown a variety of inkblots and asked to tell the therapist what they see. These tests are meant to reveal how people see themselves and how they may behave.

Psychological testing also includes neuropsychological tests, which evaluate brain function to diagnose or assess the extent of damage from an injury or illness.

Another Kind of Therapist

You may be surprised if you're referred to a therapist to find that he or she is neither a psychiatrist nor a psychologist.

Clinical social workers (CSWs) are mental health professionals who have master's degrees in social work and have been licensed to practice psychotherapy after completing at least two years of clinical training.

According to the National Association of Social Workers, 60% of licensed mental health professionals in the United States are clinical social workers.

Like most psychologists, a CSW cannot prescribe drugs, so they refer their therapy patients to psychiatrists to evaluate the need for medication.

"They think in terms of a team ... being part of the treatment team," says Mary Pender Greene, chief of social work with the Jewish Board of Family and Children's Services in New York City.

Whose Therapy Is Best?

Ask any of the three professionals who provide the best psychotherapy, they will all tell you their own specialty is the most skilled.

You could have a great therapeutic relationship, or a bad experience, with any of them.

"The professional credentials alone don't determine that someone would be helpful to any particular patient," says Rebecca Curtis, PhD, a professor of psychology at Adelphi University in Garden City, N.Y., and director of research at the W.A. White Institute of Psychiatry, Psychology, and Psychoanalysis in New York.

Nevertheless, she says experience and training matter at least as much as the therapist's personal qualities and the relationship between the patient and the provider. She advises people to interview a potential therapist carefully. Although you may want to get right to talking about your issues, "ask them specifically about their training during the initial session," she tells WebMD.

"Everybody thinks they can sit down and talk to people and be helpful," she says, "but it really helps to have a lot of experience and training."

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