What's the difference between a psychiatrist and a psychologist?

About a $100 an hour. Seriously, for the consumer the practical difference is that a psychiatrist can prescribe psychoactive medications (for example, an antidepressant or anti-anxiety medication) and a psychologist cannot. The other important difference is that psychologists receive much more training in developing psychotherapeutic relationships than do psychiatrists.

Relative to psychologists, psychiatrists receive very little training in psychotherapy.  Psychiatrists have an M.D. degree; they are generally trained to understand emotional problems in terms of biological functioning and brain chemistry.

A psychologist has a Ph.D. degree and has completed an internship in a clinical setting such as a hospital or community mental health center.  A psychologist's training focuses extensively on understanding psychological problems in terms of a person's perceptions, motivations and emotional conflicts.  A psychologist will have received training about psychoactive medications and can consult with psychiatrists and other physicians about a client's medications.

(In a couple of states psychologists can receive specialized training in psychopharmacology in order to be licensed to prescribe certain psychoactive medications.  California does not currently allow this type of licensure for psychologists)


So what's the difference between a psychologist and a counselor?  Or a therapist and a counselor?  Or a psychotherapist and a shrink?

Therapist, counselor, shrink, psychotherapist  -  these are all generic terms that loosely refer to a mental health professional (or someone who claims to be a professional) who helps others deal with emotional and psychological problems.  Yes, the terminology is confusing.  What these terms means depends on who's using them because these terms have no legal or offical designation.  One way to reduce the confusion about terminology is to think in terms of a therapist's license. 

Here in California a person who has fulfilled specific training requirements may be licensed in one of several mental health disciplines:  psychology (Ph.D.), psychiatry (M.D.), social work (LCSW), marriage and family therapy (MFT) or licensed professional counselor (LPC).   If someone says he or she is a therapist (or a counselor or a psychotherapist), that doesn't tell you what license he or she has received.  In fact, that person may not have a license yet because he or she is still in training.  Or, he or she may not have and may not intend to seek a license.   Be sure to ask a person about their licensing status if their advertising or business card doesn't indicate clearly what it is
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With so many different kinds of therapists, what kind is the best for me to see?

Personally I would not choose a therapist based on his or her professional discipline. Throughout my graduate training and career I have worked with professionals from each discipline whom I respect greatly and to whom I would confidently refer a family member or friend.

On the other hand, I've worked with some highly trained professionals in each discipline to whom I would hesitate to refer someone. In my opinion, what's far more important than a therapist's professional discipline or techniques is how you feel about the relationship you develop with him or her.

However, a psychiatrist's services cost much more than those of other licensed therapists and that is primarily because many psychiatrists prescribe medication more than they do talk therapy.  For the past few decades psychiatric training has focused far more on psychopharmacology than doing psychotherapy. Please see
Choosing a Therapist for more ideas about finding a therapist.
Do you have a specialty?

The mental health professions do not have a well-developed system of certified specialties as does the medical profession. 
An M.D. may have board certification in surgery or obstetrics, but
no parallel system exists in the mental health professions. 

Psychotherapists' specialties are usually self-selected based on interest, training and/or experience.  With a few exceptions, no licensing board or professional association certifies a therapist's competence in  a specialty area.  (One exception is that some professional associations certify special competency in treating chemical dependence or substance abuse.) 

People often wonder if they should see someone who specializes in the treatment of particular symptoms, such as anxiety or depression.  My view is that there are infinite ways that a person can end up depressed or anxious.  How a person resolves depression or anxiety will be a unique blend of his or her life experiences, strengths and goals.  The symptom doesn't determine what that unique blend will be.  Rather, that unique blend evolves (in the context of therapy) as that person and his or her therapist work together to make sense of the person's experiences. In other words, it's not therapeutic techniques that help people heal and grow - it's the therapeutic relationship

That said, my specialty is helping people to understand and accept themselves so they can better enjoy their lives, reduce avoidable emotional suffering and cope better with the unavoidable emotional pain that is part of every life. I help individual adults, teens, couples and families. 

Are you going to tell me everything that's wrong with me?

No. Perhaps you've heard call-in "therapists" on the radio who  aggressively confront callers' behavior or ways of thinking.   Or maybe you've seen television programs or movies in which an all-knowing therapist plays tough and confronts someone with the error of their ways.  In my opinion, that's not therapy.  And I would steer clear of a therapist who assumes they can be an expert and an authority about you and your experience.

Therapy isn't about pointing out someone's "deficiencies" in order for them to "correct" themselves.  In my experience, people usually seek therapy because they already recognize to some degree their patterns of thinking and behaving that harm themselves and their relationships. 

What helps more than confrontation is exploring why they feel the need to react in these ways.  This patient exploration not only deepens self-understanding; it also fosters receptiveness to new and more adaptive ways of thinking and behaving.  (In those instances in which a person does not or cannot see how their reactions are harmful to themselves and their relationships, aggressive confrontation usually lowers a persons' self-regard and their openness to change.)

Very often people actually don't recognize their strengths and positive qualities. Indeed, they may even view them as weaknesses or as part of the problem.  One of the consistent outcomes of successful therapy is deeper self-understanding and, consequently, enhanced self-esteem.  One of my rewards for doing my work is helping a person learn to like and appreciate themselves and then seeing how that benefits all of their relationships.  
How long will therapy take?

In my experience, it takes as long as it takes.  It's impossible to reliably predict a length of time that would apply accurately to every person. 

The reasons that a person begins therapy are unique to that individual regardless of their symptoms.  For example, let's say someone seeks therapy because they're experiencing depression.  Here are just a few of the many factors that influence how long therapy will take: how long the person has been depressed, how severe the symptoms are, what life events triggered the depression (for example, loss of a job vs. death of a loved one), whether the person abuses substances, whether physical health problems contribute, how much social support the person receives from others, the presence of a family history of depression (possible hereditary predisposition to biological depression).  Finally, as a person begins to understand their problems and to make connections they hadn't made before, their goals for therapy often change and evolve.  They may begin to see possibilities for a better life that had always seemed out of reach and thus choose to continue therapy longer than they originally planned.

Now, take all those factors and add in the well-established research finding that the outcome of therapy is determined largely by the therapeutic alliance - an academic term for how well two people establish a relationship of trust, openness and colloboration.
Perhaps now you can appreciate how difficult it is for a therapist to forecast how long therapy will take.


Will I have to spend months or even years dredging up childhood problems or analyzing my relationship with my parents?

Not necessarily; there's no set agenda of topics that you'll need to discuss in order to resolve your problems. Media stereotypes about therapy give the incorrect idea that therapy follows a set pattern of uncovering forgotten memories, particularly about one's parents. I've worked with people who spent little or no time discussing the past; they made very significant changes in their lives.  I've also worked with others who didn't plan to talk about family relationships; but as we explored their problems they realized they wanted to talk about family relationships, both past and present.  Ideally, you'll feel free to set the pace and direction of what you talk about with your therapist.  If therapy is going well, you'll likely become curious about things you'd always taken for granted about yourself and your relationships. 
How can I know whether therapy will work for me?

First, it depends a lot on what you hope to get from therapy. In your first few meetings you'll need to clarify what you want to accomplish. But the only way to find out whether therapy will work is to try it. I know of no tests or questionnaires or personality characteristics that can accurately predict whether therapy will work. So much depends on the collaborative relationship that develops between you and your therapist. Again, I think the Consumer Reports study ("Mental Health: Does Therapy Work?") mentioned above offers very useful ideas if you're unsure whether therapy will work for you.

If you've been in therapy once before (or even more than once) and you felt it didn't work for you, it's still quite possible that it could work for you now.   You and/or your life circumstances may have changed since then in ways that would enable you to get a lot more out of therapy.  It's also possible that you and your previous therapist weren't the best fit.  In fact, trying a few sessions with a new therapist could include discussion of what did and didn't work for you in therapy before - and that could make just the difference for you to have a better experience.

Do you accept insurance?

After many years of dealing with multiple insurance companies' paperwork systems, unneeded and sometimes harmful meddling by "managed care" overseers and long delays in receiving payment, I decided to not participate in insurance, preferred provider or managed care programs. 

Your insurance company most likely has an "out-of-network" benefit. That means you could receive services from me and also be reimbursed partially by your insurance company for payments you've made to me.   You would simply submit to the insurance company the billing statement you receive from me.  That statement contains the date and type of service along with a diagnosis code (required, unfortunately, for you to receive reimbursement). 

Keep in mind that in the opinion of many mental health professionals the benefit provided by many insurance companies is barely adequate at best.  Yes, your benefit may include 10 sessions per year within your network, but it may cover only $25 of the total cost of each session. 

One way to reduce your out-of-pocket cost of therapy is to use (if your employer offers one) your medical spending account.  With such accounts (they go by many names) you can set aside pre-tax dollars that are designated for medical expenses, including psychotherapy. Also, your company may offer an Employee Assistance Program (EAP) that includes confidential short-term counseling.  Earlier in my career I worked for an EAP sponsored by El Camino Hospital in Mountain View.   For some types of problems EAP services can be just right.
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