When someone begins to identify a problem and wants to seek the help of a mental health professional, they are often left wondering “Who do I see?”, “Where do I go?” “What kind of practitioner would be best?”, “And what is the difference between a psychiatrist and a psychologist?”… 

To determine the right fit, it is useful to understand the specialized education and training different providers have obtained, where their skill sets overlap and where they diverge.

 A psychiatrist is a medical doctor (M.D.) who has attended four years of medical school after college and then completed a four year residency training program in psychiatry. A child and adolescent psychiatrist has completed a two year fellowship in child psychiatry in addition to the residency. This training involves taking classes and working with supervisors in psychiatric hospitals, outpatient mental health clinics, schools, and therapy clinics. A psychiatrist is trained to evaluate and diagnose behavioral and mental health problems, determine whether or not a medical problem could be causing the symptoms, and to develop a comprehensive treatment plan with behavior modification, therapy, and/or medication.

 Psychiatrists have training both in psychotherapy and in using medications to treat mental health problems. A psychiatrist is a good bet if you need a comprehensive assessment to figure out what is wrong and determine a diagnosis, if you need someone to talk to about private or sensitive problems, or if you or your child have a condition that will respond well to medications such as: depression, anxiety or panic attacks, obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD/ADD), bipolar disorder, schizophrenia, tic disorders (Tourette’s), sleep problems, etc.

 In my practice as a psychiatrist, I work with both adults and youth. When working with a child, I visit with children and parents, review school reports, inquire about medical histories, observe behaviors, and sometimes play and draw to understand what is happening with a child. I look at mood and behaviors, thoughts, sleep and appetite patterns, school and work performance to develop an understanding. I have some patients who come to see me for psychotherapy to improve their mood or behavior, some who were referred by their therapist for me to evaluate and prescribe medications, and others who come for both therapy and medication treatment at my office. As a child, adolescent, and adult psychiatrist I often work with families, too. I frequently collaborate with primary medical doctors, psychologists and diagnosticians, language and occupational therapists, school personnel, and individual and family therapists when it is helpful to have a team approach.

A psychologist completed a graduate (Ph.D.) program in human behavior. Psychologists have specialized training in administering and scoring educational and psychological tests such as IQ and achievement tests, personality tests, etc. They have training in diagnosing mental health problems, developing treatment plans, and providing psychotherapy. Some psychologists primarily conduct testing for learning and personality problems, some primarily conduct psychotherapy and behavioral training, and many do both. If a parent is concerned about a learning disability such as dyslexia, they may seek testing from a psychologist to evaluate the problem. Psychologists will refer clients to a psychiatrist if they believe medication would help with focus problems, mood problems, behavior problems, or anxiety. Psychiatrists often will refer their patient to a psychologist if they suspect a learning problem needs to be evaluated or to receive psychotherapy. 

Educational diagnosticians are also helpful in conducting testing for school and learning problems. Speech and language therapists are helpful in diagnosing and treating language processing problems. 

A therapist (or psychotherapist) may be a psychiatrist or a psychologist, or a therapist may have completed a master’s degree program in social work or counseling and have completed training with a supervisor. A licensed therapist has completed licensure requirements such as a LPC (licensed professional counselor), LMFT (licensed marriage and family therapist), or LCSW (licensed clinical social worker). Because anyone can call themselves a “therapist”, it is important to review their credentials and inquire about their areas of specialty. Therapists can be helpful when a person needs someone to talk to about life adjustments, grief, or promoting positive changes in the future, when one has developed negative or worrisome thought patterns that need to be corrected, when they need help with communication problems or family dynamics, or when they need help with parenting or behavior management. 

To find a provider it can be helpful to get recommendations from friends, school counselors, pediatricians and primary medical doctors, clergy, the internet, etc. For more information about mental health topics or my practice, visit my website at www.drportteus.com

Andrew M. Portteus, MD, MPH, PA