I could be totally wrong, but in my mind a shrink = psychiatrist = an actual doctor. I’ve never actually worked through problems with a psychiatrist / shrink. They just prescribe medications, and ask if it’s working every now and then.
A therapist = psychologist = more counseling than doctoring.
Ah. This isn’t quite right, actually. A psychiatrist does counseling as much as a psychologist. Basically, psychiatrists are psychologists with an extra tool (medication) at their disposal.
I’m not sure what the advantage of psychologists are… they’re cheaper, maybe? I know they require less school to become certified.
I’m required to see a psychologist as part of the weight loss program that I’m in; they require all participants to see one, just in case your weight issues have a major psychological component. More specifically, a psychological component that a psychologist might be able to help with.
More generally, among me & my friends mental health professionals are just considered another health resource. Our minds are parts of our bodies too, and are subject to pathologies & unhealthy patterns just like the rest of us. But mental health professionals are people you see periodically for particular problems; you don’t usually see them weekly for years on end.
I guess I got lucky – I searched my health insurance’s list of providers by language spoken. In particular, I wanted someone who spoke Hebrew. I do not speak Hebrew, but I thought it would help us get along.
It did. He was an awesome therapist, and I felt like we saw eye to eye.
Follow up question.
Is therapy covered by insurance and if yes, what are the barriers to go (who decides if you need it and is there a limit to number of visits etc.)?
Even though there’s no money out of pocket, I’m the kind of person who only bother with the doctor if I have a specific problem.
Afaik I’d need a referral from her, if I wanted therapy (covered by the State, there’s private practitioners I could go to as much as I liked/could afford). And I think I would need to feel that I had a very specific issue to go to one (like Gav above). So I don’t know if it’s just because of cultural differences or me being tight with my money…
“shrink” = psychiatrist (MD) or psychologist (PhD)
“therapist” = psychologist or in New York, a (licensed) (master) certified social worker
NYS has a lot of therapists… A lot of it b/c insurance health plans are mandated to cover ‘mental health’. NYS medicaid also covers mental health, further increasing demand. Prices vary greatly, from as low as $45/hr for a non-profit MCSW to fancy ball-busting $200+/hr for the therapists my disfunctional juvenile delinquent cousins get sent out for.
This is innacurate, but not grossly so. First, in some states (areas?), a psychiatrist pretty much only dispenses medicine, while psychologists do counseling. In fact, that’s the big issue my wife is facing right now in Ohio. It’s VERY difficult to find someone who does both in our area, which is what she would prefer because that’s what she had back in Alabama. The usual deal around here is that you go to a clinic, and one person does the therapy (usually without a PhD or equivalent) while one does the meds.
Second, there are many different kinds of psychology, some of which specifically target issues that do not require medicine. The advantage is more than financial in such cases. If you don’t need meds, you shouldn’t be on them.
Third, psychologists can get PhDs, too, and many have them. So it isn’t true that the psychiatrists always have more schooling. Of course, you didn’t say they did. You were only talking about certification. I’m just clarifying.
If you are suffering from chemical imbalance issues, you will need a psychiatrist at some point, but he/she doesn’t have to be your primary therapist. If you are not suffering from chemical issues, you probably don’t even need a psychiatrist.
Finally, I feel like your wording is (perhaps unintentionally) disparaging toward psychologists, which is unfair.
um - What?
There is probably a bit of back-story that I am missing, but how does the doctor speaking Hebrew help?
Keep in mind that in America there are a ton of different insurances. Having said that, I think that some form of mental health is covered by most insurances, although how much & what type varies dramatically. I have rather good insurance, so I get something like 8 free visits, and further visits are at half price, or something like that. (My weight loss psychologist visits are included in the cost of the program, so insurance doesn’t come into it.)
As for who decides if we need it, my insurance assumes that if I want to see a shrink, it’s because I actually need one. I don’t know if other insurance plans are as reasonable on this point.
Even though there’s no money out of pocket, I’m the kind of person who only bother with the doctor if I have a specific problem.
This is exactly how therapists are used here. I don’t know of anyone who goes to a therapists for a yearly check-up; we go because of one or more specific problems. If you don’t have any problems to discuss, then by definition you’re OK. The era where therapists dig into your psyche to find “hidden” problems is pretty much over.
Rward, the ability to speak Hebrew may or may not match up to a markedly negative opinion of Nitzsche. Or, fire was having her own personal Francois Dillinger moment. There’s no law that says you have to romaticize the same cultures as everyone else. I for one, find Norwegians highly erotic.
If your insurance doesn’t cover it, it might be cheaper to pay death metal bands to play in your basement, just for you. You can’t understand the lyrics anyway, so just pretend they are telling you what you want to hear.
Wow. That’s… a terrible system. (The Ohio thing, I mean) What we have in Washington is what I described; psychiatrists are psychologists that have also gone to medical school. So they are precisely psychologists with one more tool at their disposal. You’re right that many many people don’t need that tool, so psychologists are just as good for them.
From the way you talk about it, it sounds like in some areas psychiatrists just aren’t that focussed on counseling, in which case psychologists & psychiatrists fulfill different roles. In my area, they fulfill the same role, with psychiatrists in theory able to fill that role more fully.
This doesn’t mean that psychologists aren’t helpful. I’d take a good psychologist over a mediocre psychiatrist any day.
You should seek therapy for that.
I empathize with you, and agree that it is difficult to find a good therapist. I don’t know of a way that works other than trying out as many as necessary to get a good fit. In many studies of psychotherapy, the relationship between a therapist & client accounts for more of the outcome (i.e., more versus less symptom reduction) than factors like the type of therapy, the degree of the provider, and the specific techniques used. I mentioned the importance of the relationship in a thread last year. It’s worth the time to find a good match, although it can be discouraging if you have limited providers, or if you’re struggling with stuff like depression, which decreases motivation to begin with.
I’m 99% certain you are incorrect. If you are correct, Washington’s system is different than that of Michigan, Minnesota, Ohio, & Oklahoma.
A psychiatrist is a licensed medical doctor (M.D.) that specializes in mental disorders. They can prescribe medication. Most of their training is in standard medical rotations; they have specialized residencies where they get more practice with psychiatric meds & psychotherapy. Med school is 4 years, & I believe most psychiatry residencies are an additional 4 years.
Folks who can advertise as psychologists are people with doctorates (Ph.D., Psy.D., maybe Ed.D.) in clinical/counseling/community psychology or social work licensed to practice in the state. Less common are Ph.D.'s in family studies or Ed.D.'s in school psychology or counseling. In most states, they can’t prescribe medication. Most Ph.D. training is in various areas of psychology (e.g., clinical/applied, biological, cognitive, social), with emphasis on mental disorders, and in scientific methodology & research methods. They will also have internships & practicums where they practice psychological assessment & psychotherapy. It typically takes 4-5 years to get a Ph.D., & the internship (like a residency) is 1 year.
Most states also have a limited mental health practitioner license that is geared towards master’s level folks; many M.S.W.'s (social workers) get this license. The limited license means there must be at least one Ph.D. or M.D. supervising the facility where the limited license person works. These folks have less overall training (usually 2-2.5 years, academic & applied combined), but nearly all is focused on psychotherapy practice.
The reality is that M.D.'s cost more than Ph.D.'s, who in turn cost more than master’s level people. In most managed care systems, psychiatrists are expected to see 4 people an hour, which effectively makes them medication specialists. After clients get stabilized on effective medications, they’ll usually only meet with their psychiatrist every 3 months for a check-up. Ongoing therapy (e.g., a session every week or two) is usually done by master’s level folks, or maybe a Ph.D., because they cost less per hour.
In theory, psychiatrists have equivalent levels of skill in psychotherapy as Ph.D.'s. In practice, many psychiatrists will do very little psychotherapy after their training is completed, instead getting more experience with medication. Ph.D.'s are more likely to continue their one-on-one clinical work, & therefore obtain more therapy experience. In my experience, Ph.D.'s generally have similar training to M.D.'s in psychotherapy, and have much less training in general medicine & psychiatric medication. Ph.D.'s typically have more training than M.D.'s in evaluating research, and in psychological assessment.
Yes, that’s certainly what we are encountering in Ohio, Sidd. However, in Alabama, my wife went to a psychiatrist for therapy AND medication. She did both, with counseling sessions lasting about half an hour once routine. In fact, when my wife talked her about the system here in Ohio, she seemed surprised. So I suspect there may be big regional differences. However, the system could be basically the same in Alabama, with a few exceptions, and my wife happened to have found one.
You seem to know the field better than I do, Sidd. At the same time, I’ve briefly seen a psychiatrist for a mental health issue, and a friend of mine saw a different psychiatrist for a longer period of time. In both cases, the psychiatrist acted only as a therapist; no medication prescriptions were involved. And both the psychiatrists & the psychologist I’m currently seeing (through the weight loss program) agreed that the only difference between the two professions is that one can prescribe medicine, while the other can’t. Of course, it’s entirely possible they dumbed it down for me, the layman. shrug
I hope you’re kidding. You’re kidding, right?
I see a psychiatrist once every 3 months or so for meds and then a therapist once a month or so. The psychiatrist reviews the therapy sessions. Not sure if it is free because of BC/BS of Alabama or if it is somehow supplemented by the state as there are offices throughout the state. The meds are totally not free, but BC/BS picks up 80% or so.
It looksh like thish is my lucky day! I’ll take “The Rapishtsh” for $200, Alexsh.
Well, I guess it depends what you mean by “benefit.” I actually am of the mind that therapy should be problem-focused – the goal is to sort your shit out and then not have to be in therapy anymore. I mean, if you don’t have any specific (or even generalized) issue that you’re working on, then why are you paying this fucker to talk to him? Don’t you have life partners, friends, forum people, etc. for that?
I went to therapy for several months at one point when I was in a relationship with a borderline woman and needed some sanity checks. I was also working on some substance abuse issues at the time. My wife also has a therapist that she goes to occasionally when she gets too stressed about being a stay-at-home mom. So I know there is value in therapy. I just can’t see myself wanting a permanent therapy relationship, though… I’m a big fan of cognitive therapy and other how-to-feel-better action-oriented therapies, so that’s probably just my bias.
Therapy should be problem-focused but aren’t depression and anxiety often symptoms of a bigger problem? It seems like that stuff should come out on its own when the client feels it’s right and not at the request of the therapist on day one. I would have been put off if my therapist had come right out and asked me for a diagnosis.
I feel like a better way to go about it would be for the therapist to just ask why you’re there, what you hope to gain from therapy, etc and then take it from there.