A psychologist and psychiatrist are both mental health professionals who can treat schizophrenia. But what’s the difference? Both specialities are commonly referred to as doctors and confusion often results. Today’s episode tackles the differences and touches on what a person visiting with each professional can expect.
People with schizophrenia commonly wonder: How are they similar? Who should they see first? Do they need to see both?
Host Rachel Star Withers, a diagnosed schizophrenic, and co-host Gabe Howard, share their medical health journeys in treatment with numerous doctors and how both psychologists and psychiatrists have played an important part.
Guest John Grohol, PsyD, founder of PsychCentral.com and a psychologist, joins to help people understand the differences between the two.
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Dr. John Grohol is the founder of Psych Central. He’s an author, researcher, and expert in mental health online, and has been writing about online behavior, mental health, and psychology issues since 1995. Grohol has a Master’s degree and a doctorate in clinical psychology from Nova Southeastern University. He sits on the editorial board of the journal Computers in Human Behavior and is a founding board member of the Society for Participatory Medicine.
Rachel Star Withers creates videos documenting her schizophrenia, ways to manage and let others like her know they are not alone and can still live an amazing life. She has written Lil Broken Star: Understanding Schizophrenia for Kids and a tool for schizophrenics, To See in the Dark: Hallucination and Delusion Journal. Fun Fact: She has wrestled alligators.
To learn more about Rachel, please visit her website, RachelStarLive.com.
Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from the author.
To learn more about Gabe, please visit his website, gabehoward.com.
Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Announcer: You’re listening to Inside Schizophrenia. Hosted by Rachel Star Withers, an advocate who lives openly with Schizophrenia. We’re talking to experts about all aspects of life with this condition. Welcome to the show!
Rachel Star Withers: Welcome to Inside Schizophrenia, a Healthline Media podcast. I’m your host, Rachel Star Withers, joined by my wonderful co-host, Gabe Howard. And this episode of Inside Schizophrenia is sponsored by Intra-Cellular Therapies.
Gabe Howard: Hey, Rachel, I’m glad to be here. What’s our topic for today?
Rachel Star Withers: Psychologist vs. psychiatrist, it sounds like we’re going to have a fight, but we’re not. OK, although I don’t know, that might be a pretty interesting, like Internet fight to see, you know.
Gabe Howard: But I think what’s amazing is that most people think that it’s like tomato versus tomato, they think there’s nobody to fight because those are not two unique groups, but they are. They’re very unique groups.
Rachel Star Withers: Absolutely unique groups, and especially if you are newly diagnosed or if you’re a loved one of someone who’s newly diagnosed, those two titles of doctors can be incredibly confusing because it’s like, OK, well, both of them treat the brain, both of them treat schizophrenia. So what’s the difference? Why do I need to see both?
Gabe Howard: I think the other thing that, of course, makes it confusing as well is that they both are called doctors. A psychologist has a PhD, so they are a doctor. A psychiatrist went to medical school. So they are a doctor. And a lot of people will say things like, I need to go see my doctor, just by the way that we sort of talk about it as laypeople. So we want to break that down so that people know what the differences are, who they should see, why they should see. And, of course, do you need one or the other? Both? What’s important?
Rachel Star Withers: And to help us with these differences, later on in the show, we are joined by Dr. John Grohol, who is actually the founder of PsychCentral.com and a psychologist.
Gabe Howard: So, Rachel, let’s break this down, we’ve got psychiatrist, psychologist, a lot of misinformation, a lot of misconception, go.
Rachel Star Withers: Ok, so first off, a psychologist works in psychology, so psychology is the science of the mind and behavior, and that’s going to be the study of the conscious and the unconscious phenomenon, as well as our feelings and understanding individuals, as well as how groups of people react to things. I love it because just the definition of psychology sounds so like smart and philosophical. When you get it, you’re like, Oh, wow, when I say it, I’m picturing like some like super old Roman guy with a big beard.
Gabe Howard: He’s like stroking his beard.
Rachel Star Withers: Yeah,
Gabe Howard: And he’s watching you and he’s like, I know why you do what you do.
Rachel Star Withers: Yeah.
Gabe Howard: And of course, that is a pop culture representation, but it has a little bit of truth in it, right? They’re the ones that study the psychology of human interaction, the psychology of workplace development, the psychology of rioting, or the psychology of so many things. Why do large groups of people behave the way that they do? And it’s one of the things that psychologists are tasked with.
Rachel Star Withers: And then we have psychiatry. Psychiatry is the medical specialty devoted to the diagnosis, prevention and treatment of mental disorders. Now, just the two definitions, Gabe, one of them is kind of very philosophical and the other is like down to earth, OK, we’re treating an ailment. For the longest time, I thought the difference between psychologists and psychiatrists was medication. Is that a psychiatrist can prescribe medication, a psychologist can’t. And that’s actually not correct. A while back, we had an incredible episode that dealt with nurses. And for one, we learned that psychiatric nurse practitioners can actually prescribe medication in certain areas. And certain psychologists, depending on what state, what country they’re in, they can also prescribe. So if you’re out there listening and you’re thinking, wait a minute, I’m pretty sure my psychologist does prescribe. Yes. Depending where you’re located, your psychologist might be able to prescribe medication.
Gabe Howard: From a layperson’s perspective, I can see how we get here. Many people see a psychiatrist because that’s the specialist for mental illness, like an oncologist is the specialist for cancer. Right? There are other people who can prescribe medication. But if you have severe and persistent mental illness like schizophrenia, more often than not, you’re seen by a psychiatrist who is the specialist in schizophrenia, who prescribes the medication. And the psychologist is providing therapy, coping skills, helping you adapt, get back to work, learning to manage symptoms.
Rachel Star Withers: Let’s focus on psychologists first, because I know, Gabe, when I tell people about my treatments in the past, that’s where I always get tangled up because I’ll be talking more like, oh, well, I know I went to this counselor or I went to this therapist and some say, OK, well, what were they? Like what was their actual title? And I’m not 100% sure. And that is something I want mental health professionals out there, I think it’s good for you to be clear. I do wish more professionals kind of said, hi, I’m Dr. So-and-so. I’m a blank, blank, blank, because one of my best therapists I ever had and I say therapist, because looking back, I’m not 100% sure what he was, worked for the college I was going to and he was great working with me. I don’t know, though, was he actually a psychologist? Was? I just called him a school counselor.
Gabe Howard: It’s very complicated because there’s so many options. Typically for people living with schizophrenia, we’re seeing a psychologist for therapy hard stop. So the psychologist that we see specialized in counseling or one possible, you can specialize in many things. It can be organizational psychology. It can be counseling. It can be diagnostic psychology. It can be there. There’s too many to list. And different programs are popping up all the time. And licensure works differently in every state. It works differently in other countries as well. So to your point, Rachel, it is important to sit down with your psychologist and say, hey, what’s your experience? What’s your training, what’s your specialty, what are you most experienced in? And make sure that aligns with your goals so that you and your psychologist are on the same page.
Rachel Star Withers: And to my medical professionals out there, I do wish that more often they would say, oh, and by the way, I’ve studied this, I do think as a person with schizophrenia that would kind of reassure me more, to know that you have some experience with serious mental disorders. I’ve definitely had the opposite where I’ve gotten a therapist who said I’ve never even met anyone with schizophrenia. I didn’t know they could talk. And I’m like, what? Because I figured, right off the bat, this is not going to be a good session. OK, well cool. So it’s funny because I feel so many of the professionals I’ve met with in the past are real quick to tell me that they’ve never worked with a schizophrenic. They’ve never worked with anyone who had electroconvulsive therapy before. For some reason, they always told me that. And I’m like, OK, that does not gain my trust. Awesome. But I rarely have anyone say, oh, I actually did my internship at such and such a mental hospital. I actually worked with different people. I feel like I would like to hear that side of people’s backgrounds more. Like that might make me feel like, oh, OK, I’m not the first person with schizophrenia they’ve met because that that’s can be a little alarming.
Gabe Howard: And Rachel, not to throw you under the bus here, it would, of course, be nice if our psychologist or psychiatrist and all of our medical providers volunteered all the information that we didn’t know that we wanted to know. I completely agree with that statement. But it’s also important that we as people living with mental illness and seeking out the care of these providers, that we ask them better questions and we can know what questions to ask by educating ourselves.
Rachel Star Withers: We’re talking about a psychologist, they don’t have to be a doctor. So you can get a master’s in psychology and become a licensed professional counselor. One reason I want to hit on this, Gabe, is that, again, I’m from a very religious background and I’ve been to many, many religious counselors. I’m kind of like looking back in the past, wondering especially them, what were their credentials? Because I did get some spotty information many times from people. So this is just, you know, a warning out there for my fellow people who are getting therapy, ask about people’s credentials, like feel that you can speak up and be like, hey, have you ever worked with anyone with a serious mental disorder before? And I’m not saying that, you know, it’s bad for, let’s say, a marriage counselor to work with someone who has schizophrenia, but they might not have as much experience. And now we go back to my university. Like I said, he was there working with college students. And then I walked in and it just so happened that he had a side interest in serious mental health disorders. And he actually left our college to work more specifically with serious mental disorders at a different place. So I’m not saying that you have to have a doctorate to be a great psychologist. You do not. But I think it’s important. Ask about what different credentials are. Ask, hey, what is your experience treating people like myself?
Gabe Howard: So to sum this all up, Rachel, psychologists, are, they’re skilled professionals that worked very hard, have a lot of schooling, are licensed and have done a lot of things before they can practice at all. So while we certainly want to find a psychologist that fits with our needs, as far as the patient, we should know that, of course, just by being a licensed psychologist, they have come well-prepared and they’ve been put through a lot.
Rachel Star Withers: Now, psychiatrists, they also have went through so much schooling, Gabe. To become a psychiatrist here in the US, you are actually licensed as a medical doctor. OK, so you have to become a normal, quote unquote, medical doctor first. Then you would focus more on the brain and understanding the psychiatry part on top of the normal medical license. And the great thing about going to a psychiatrist is that they can also use that knowledge to rule out other issues that might not be brain related. So, for instance, maybe depression that you have could be related to hypothyroidism or it could be related to another physical ailment going on inside your body. They’re more likely to think about those possibilities because, yes, they’ve had all that training, also. They’re more likely to, as they’re prescribing medications to hopefully pay attention to how that medication affects your whole body, not just your brain. And Gabe, you’ve been on many, many fun medications, as have I, and that is part of managing a serious mental disorder, is keeping up with your medications and keeping up with the side effects. Just because an antipsychotic is working for, like my brain, I still have to then many times adjust my exercise. I have to adjust other things in my life because that medication changes other things in the body sometimes. Ideally, a good psychiatrist is taking all that into account when they’re treating you.
Gabe Howard: Rachel, you mentioned medication side effects because medication impacts our bodies, it’s a physical thing that’s going into our physical bodies, that produces a physical result. Now we want those physical results to be good. So obviously, we want a doctor who specializes in knowing both good outcomes and bad outcomes, the bad outcomes so that they can fix it and move us more into the good category. And that’s why a psychiatrist has gone to medical school. That is why there is the focus on our physical bodies, because, again, if the medication is capable of giving us positive benefits, that means it’s also capable of giving us negative consequences. So a psychiatrist is up on all of those. That is their field of study.
Rachel Star Withers: So let’s talk about how do these two doctors specifically help people with schizophrenia, Gabe. How does that affect me? A diagnosed schizophrenic? Obviously, when we’re talking about antipsychotics, usually that’s going to be, again, through a psychiatrist and hopefully they’re helping you monitor all of that. When you have a mental disorder and you’re looking to be diagnosed. I thought this was interesting, Gabe. So a psychiatrist or a psychologist, all of them can diagnose you, but how they go about it can be different. The tests that a psychologist uses are going to be different than the tests that a psychiatrist used to diagnose you. A psychiatrist also has the ability to order CT scans and MRI, things like that, to rule out, you know, maybe a brain tumor or other issues that could come up. I remember when I was first fully diagnosed and I always say fully because I went to one person, but I kind of like, you know, I was afraid to say everything. So I just told him a little bit. I feel like they gave me a little bit of a diagnosis, but that’s what I gave them to work with. But after that, I got much worse. I then went and I went to my normal doctor. They referred me to a psychologist. I went to that psychologist. They did lots and lots of testing. I remember it being like a few hours of testing I had to do. And I came back the next week and they told me the results. And I have all of this stuff and it came up with paranoid schizophrenia. And then he referred me to a psychiatrist. But it was the psychologist who originally diagnosed me with schizophrenia. When I went to see the psychiatrist, he then he had changed my diagnosis. And then it was like a few months where they went back and forth between the two doctors. And I just remember being, like, so lost in the middle, like, OK, well, who do I believe?
Gabe Howard: The reality is schizophrenia is severe and persistent and like you said, it is diagnosed by self reporting from the patient who may or may not be compromised or who may not have words to describe what is happening in their lives. I mean, you and I are professional podcasters and describing schizophrenia to those who have never experienced it is a challenge. Illness, by its very definition, is unusual. So it’s not a surprise that it takes a medical team to not only diagnose but care. And it’s also not surprising that sometimes things change, especially when you get a medical team working together on a single patient and observing that patient over time. In some ways, I feel like this episode is making it sound like this is all so confusing. And how can anybody ever get well? This is so impossible. So I just want to take a little moment to point out that having so many specialties with such a diverse background really gives the patient the best opportunity for care, because for some patients, a psychiatrist might be able to, you know, notice things and test for things and see things and aha, that leads to the best care. But for other patients, it might be a psychologist and even for other patients, it could be another member of that medical team, whether it be a case manager or a nurse practitioner. It’s a complicated illness that needs many people all working in concert.
Rachel Star Withers: And when you think there’s so many things that could be affecting your brain, you don’t necessarily always want someone to right away diagnose you with schizophrenia. It could be something like a brain tumor or other issues. There are many things that do cause hallucinations. There are many things that do cause, you know, changes in the way we think. I don’t ever want to put down having different diagnoses because, yes, sometimes it’s good to have a doctor who questions and says, well, let’s look a little bit more into some of these symptoms that you said. Let’s make sure that this is what you have so that we can treat you the right way. Let’s put all this, though, into play, Gabe. Like let’s give the listeners an example of how having a psychologist and a psychiatrist would work for a person with schizophrenia. Gabe, as you know, just from being my friend and I’ve mentioned on the podcast, I had a very, very rough last year. Towards the end of last year, it got to the point where I was going through some experimental treatments and different things just because I was having such a hard time. So let’s talk about that. I have diagnosed schizophrenia and I’ve been managing stable for many years. And towards the end of 2020, you know, right in the pandemic and stuff, I was starting to self isolate more and more. I wasn’t coming out of my room. Even though I live with my family, I was just pretty much staying in my room. Everyone noticed. My parents noticed. I noticed. And the more I isolate, I become weird. I just, my thoughts start to spiral. I hallucinate more. As I get depressed, my hallucinations and my delusions do become darker and more aggressive. How did we manage this? Well, I talked to my psychologist/counselor.
Rachel Star Withers: She said, OK, let’s do a checklist every day. You need to do this, this and this, certain activities. So pretty much a therapy kind of system that she set up for me and I had to check in with, like my different family members. I had to go on a walk every day with my brother or my mom. I had to make sure I was eating with my dad. So I just little things like that. So she helped set up that therapy for me. Very basic things, but therapy. But she also said you have to talk to a psychiatrist about this because there’s clearly something has shifted in your brain. Something has changed. It could just be your symptoms getting worse. But something caused this sudden shift over the past few months. So I had to then meet with my psychiatrist. And when they looked over my medical history, when they looked over my medication history, there was the chance that maybe I was having an issue with serotonin syndrome. Where you’re on the same medications, a lot of them, and you get too much serotonin. And so the psychiatrist pulled me completely off one of the drugs. Not abrupt, but but pretty quickly. And then they’ve been slowly lowering my dosage of one of the other medications I was on. There was some family dynamics and things that were happening, and the therapy definitely helped deal with those. And world of difference, Gabe. Just feeling so much better. And my brain was able to think clearer. That would be a psychologist and a psychiatrist working hand in hand to help someone with schizophrenia get the best possible care.
Gabe Howard: And this is not unusual in medicine, hard stop. If we take cancer, for example, you’re often diagnosed with a general practitioner because something was wrong. So you usually went to your family doctor and said, hey, I’m worried about X, that family doctor did their battery of tests and determined, uh-oh, you might need a specialist. So they send you on to an oncologist. Now, that oncologist looks you over, a specialist on cancer, and says, OK, well, you have a tumor. Now, that tumor needs to be removed. So you’re going to get referred over to a surgeon. So now you’ve gone, you’re three doctors in. But of course, that surgeon isn’t an anesthesiologist. They’re not skilled at putting you under, making you numb, etc. That’s a whole nother. So now we’re on to our fourth doctor. And then, of course, in between supporting all those people are nurses, orderlies. So in something as quote unquote common and I say common because I think most people recognize that cancer is a common diagnosis. We’re on to, you know, five, six, seven different specialties, depending on how far down the rabbit hole you go and if there’s any consults even among them. So I just want to point this out that for mental health care, people are like, oh, we need two doctors? Well, that’s unusual. No, no, it’s not. It’s not unusual at all. And in fact, this episode is only focusing on psychologist versus psychiatrist. There’s a whole host of other specialties that we’ve barely even touched on. But remember, it’s good to have a robust medical team so that you can get the best care possible.
Rachel Star Withers: If you’re listening out there, my fellow people with schizophrenia, my loved ones, you’re probably starting to get a little overwhelmed because I’m getting overwhelmed. Gabe, how am I supposed to keep up with all these doctors and appointments? Let’s talk about how does this play out? Can I ask you a personal question?
Gabe Howard: Yes, absolutely.
Rachel Star Withers: What does a typical month of your mental health care look like when it comes to like doctors and meeting with people?
Gabe Howard: So for me and I’ve been in recovery for a long time, I see my psychiatrist about every six months, that’s my med management appointment. Usually every other week, you know, sometimes there’s spaces in between, depending on what’s going on in my personal life. I’ll see a psychologist for therapy. I also see my general practitioner to make sure that the medication isn’t causing me to be vitamin deficient or liver damage. And of course, I am approaching middle age. So while it’s not directly related to mental health care, I do want to get a yearly physical. Now, it’s important to note, when I was newly diagnosed, I saw both of those people much more often. Now, while it can be overwhelming, it’s one thing at a time. Right. And there are clinics out there, especially for the newly diagnosed and hospitals and programs that have a care coordinator that helps you put all this together. So, for example, when I was first diagnosed, I went to one clinic and at that clinic, that’s where I got my blood work done. That’s where I saw my psychiatrist. That’s where I saw my psychologist. And that’s very helpful, too. So you don’t 100% have to go through this on your own. And I would be remiss, not to fall down the rabbit hole, at one point in my life, I needed case management to find stable housing, and to get vocational training, you know, to help with just basic everyday things. So you need to find the program that works for you in your area. And again, this is the saddest part, because it’s different in not only every state, but in every city and in every county. But finding a program that works for you is very important to help manage this. Rachel, I want to throw the same question back at you, what is your mental health care like?
Rachel Star Withers: Gabe, I got to throw this pre-pandemic out there because pre-pandemic, it was wonderful. I went to one facility and I met with a therapist there and I met with a nurse practitioner there who did my medication. They were in contact with each other constantly. And usually I would see the nurse practitioner once a month to every two months and I would see the therapist every other week. And it was great. I just went to the same place. They also had me do, I have to have urine tests done monthly for being on different medications. But it was great. I went to one place, bing, bang, boom, no issues. And then that facility closed right when the pandemic happened. So post-pandemic, this is my new schedule, which is really all over the place. It is not fun to deal with, but I telehealth through my counselor twice a month and that is until their office opens back up. Then she will switch to in person and then I have to telehealth my psychiatrist. So that psychiatrist is located in California. Yeah, there will never be me meeting them in person and that’s actually through my insurance. They’re like, no, this is a psychiatrist. This is how we want you to get this medication. The problem being, though, that the psychiatrist requires those urine tests for the medications. So he contacted my general practitioner. So I go to the general practitioner once a month and I do the urine tests there. And then he sends my prescription to the pharmacy. So that is all over the place. Gabe, that one’s confusing. I definitely liked my pre pandemic set up. I looked into it and unfortunately, just where I’m located, like you said, different counties, cities, there isn’t another facility that my insurance takes. I would say treatment wise, I felt more stable before where I where they were all like connected and talking to each other. And I would say it’s not ideal, but that’s going to be the way it has to be for at least for the rest of this year.
Gabe Howard: Actually, look at the difference between us, I live in a more urban setting, and Rachel, you live in a more rural setting and Rachel and I both live in different states. And even though we sit and we talk about living with serious and persistent mental illness and needing the same care, the difference is just from state to state and urban to rural are amazing. The pandemic has changed a lot of things. Coming out of the pandemic is going to change a lot more, but also where you live. So please consider a lot of this general information. You should be able to apply it, but it probably won’t be a perfect puzzle piece fit. You might have to wedge it in a little depending on where you live in that world.
Rachel Star Withers: Another thing to make sure that you look into, if you have schizophrenia, or again, if you are a caretaker, loved one, etc., how many times you can go to the doctor. So my insurance, for instance, I can only talk to my therapist once every other week. Whenever you switch insurances or if you’re just newly diagnosed, look into that. How often is my insurance going to cover me, going to a psychologist, psychiatrist, all that kind of stuff. And I know we’re getting into the weeds of things here, but I feel it’s important to point that out because I’ve been hit with those medical bills. Yeah, you’re already suffering from a mental disorder, which has probably affected your work, school and whatnot. And then on top of that, you get like a bill that sometimes could be in the thousands. I know it shocked me when I got one once for like a thousand something. It was just crazy. And I was in tears. I had to go to my parents and be like, I can’t afford this. They were very awesome and helped me out. But it did take my parents having to be like, OK, Rachel, we need to relook at your insurance and figure out what’s going on here.
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Rachel Star Withers: And we’re back, discussing how psychologists are different from psychiatrists.
Gabe Howard: Rachel and I have been doing our best to describe the differences between psychologists and psychiatrists, but as we alluded to at the top of the show, we actually called in an expert. Dr. John Grohol is not only the founder of Psych Central, but he’s sort of the founder of Inside Schizophrenia as well. We all worked together to come up with a concept for this show, and it is a Psych Central podcast. It was born on PsychCentral.com. He supported it a lot. John himself is a great mental health advocate and he absolutely believes in getting information out to people in whatever way is possible. He was an early adapter on the Internet. He was an early adapter of podcasters. He’s a great friend of the show. And Rachel was very fortunate to be able to interview him for the show. So here we go.
Rachel Star Withers: Today, we’re talking with Dr. John Grohol, who is a psychologist and the founder of Psych Central. Thank you so much for being here today, John.
Dr. John Grohol: Great to be with you today.
Rachel Star Withers: How many years have you been working in mental health?
Dr. John Grohol: So I got my start back in nineteen ninety five. My focus has always been on psycho education, which is a fancy way of saying I like to help spread education and information about mental illness and mental health issues.
Rachel Star Withers: Which is great, because our topic today on the surface, it seems like it’s simple, but it can get so confusing. So right away, can you tell us what’s the difference between a psychologist and a psychiatrist?
Dr. John Grohol: So both professionals are highly qualified to treat mental illness and mental disorders, both have a lot of education and training in helping people with these kinds of concerns. A psychiatrist is a medical doctor. They go to college and get their bachelor’s degree than they do four years of medical school. Then they come out and they do another four years of something called residency. And residency is where they get the specialized training in psychiatry and mental disorders. So that’s where they really hone their skills and get direct patient experience with helping people with different mental mental illness and the treatments thereof. Then they usually get board certified where they take a written and oral tests. And if they want to specialize even further, there are training opportunities to do like in child psychiatry and things like that. There can be additional schooling even after the residency or additional training after the residency. That’s a psychiatrist, a medical doctor, a psychologist also does their four years of undergraduate and get their bachelor’s degree. And then they go on to graduate school, typically four or five year program, where they not only get the coursework, learning about mental illness and disorders and treatments, but they’re also after the first year, they’re doing direct patient contact as well in something called practiums. A lot of times most programs have these. And then in after they’ve done all of their coursework, they’re required to do a one year internship where they are full time help treating patients in actual treatment settings, which are as varied as there are patients. After that, they can sit for their licensure in their state and they can also get additional postdoc training in specialized areas like neuropsychology or things of that nature. But generally you’re looking at five to six years of training versus eight to 10 years for a psychiatrist, but a psychiatrist also. You have to keep in mind the psychiatrist has more training because they’re learning everything about the body and how medications work in the body, because in the United States anyway, most psychiatrists focus and do most of the work in terms of medication prescribing.
Rachel Star Withers: Wow, so much schooling with both of them.
Dr. John Grohol: Yes, yes, it’s a it’s a lot of schooling, it’s a lot of coursework, but also a lot of patient time, a lot of face to face time with actual patients in training environments where they’re being supervised by experienced clinicians and professors. And they’re really getting a hands on education about, you know, how do you do psychotherapy? How do you do good medication, understanding your patient’s needs for different medications? And what happens if they’re having intolerable side effects? And what do you do next and all that? When it comes to psychotherapy and medications and psychiatry and psychology, it’s so much as much of an art as it is a science. There certainly is a lot of research and data to back up the methods that people use to treat people with mental illness, people with schizophrenia. But it’s also so much just listening to the patient and understanding what their individual needs are in the moment.
Rachel Star Withers: As a person with schizophrenia and I go see a psychiatrist and a psychologist, how would those two doctors treat my disorder differently?
Dr. John Grohol: So psychologist is going to focus on the skills that they have available to them, which is going to be basically psychotherapy. So they’re going to use any number of different techniques and psychological interventions to help you understand how your illness interacts with your life and how you are dealing with your illness in a way in the best possible way. So a lot of times, especially with chronic conditions such as schizophrenia or bipolar disorder, it’s not so much as the active treatment of psychotherapy trying to help you undo the symptoms of schizophrenia because the symptoms seem not to be as as helped by psychotherapy, as medications. But it might be help helping figuring out how to live your best life possible with schizophrenia, with bipolar disorder. Right. It’s helping the person understand the coping strategies and the mechanisms to live that productive and fulfilling life that otherwise they might struggle in certain areas with. Because we aren’t taught a lot of basic things about living in school. It’s not part of the curriculum. And when you throw on top a severe chronic mental illness like it can be for schizophrenia, that can really be challenging for most people. So psychologists is really going to focus on the psychotherapy aspect, the psychology aspect, the living with aspect. The psychiatrist, on the other hand, at least in the United States, is going to focus more on helping find that drug cocktail, that combination of medications that work best for that individual patient in front of them for their symptoms.
Dr. John Grohol: So in schizophrenia, there’s going to be a combination usually of drugs that they’re going to try. And it could be one drug or it could be two drugs. The key here is that every person is different. Every dose that a person might need is going to be different, that there’s no single like, oh, we try everybody on this first. Some psychiatrist might do that. But honestly, most psychiatrists really try and figure out, hey, given this patient’s symptoms and their history and their background and things that they’ve taken in the past and it hasn’t helped or worked, you know, what’s going to be best for this person? They’re going to see the patient initially for a longer consultation to really understand the person and their background. And then they’re probably going to see them every once a month or in some cases once every three months. It really depends on the psychiatrist and their practice and the severity of the symptoms for the the person that’s that’s coming to them with a psychologist and the psychotherapy component. Again, it really varies. Like I said, schizophrenia is a is more of a chronic condition and it’s managed more as a chronic condition. Initially, they might see them every week, but as time goes on, it might be more helpful to the patient not to see them as often and maybe see them once every other week or once a month. So it really kind of varies widely depending upon each individual’s needs.
Rachel Star Withers: Ideally, who would I go see first, a psychologist or psychiatrist?
Dr. John Grohol: You know, I get asked this question a lot, and the answer is it doesn’t matter. The important
Rachel Star Withers: Ok.
Dr. John Grohol: Thing is you go see somebody and whoever you can go see the most quickly, I would say, is the person to go see first. Because if you go in and you can get an appointment with a psychologist in two weeks time and you and the psychiatrist is going to put you off for two months time, I would say get in with the psychologist first and the psychologist is going to do that initial assessment and it’s going to take them usually an hour, hour and a half to understand what that person’s needs are and where they are in their illness. And then if they feel like medication is something that should be considered in most cases with schizophrenia, that’s usually treatment options. So a psychologist is going to say, well, I’m going to refer you to a psychiatrist to explore medication options. And they might even have psychiatrists that they work with on a regular basis and feel more comfortable working with. So the answer is, it doesn’t matter. Whoever you go see first, they will recommend that you see the other kind of professional, if that seems like it’s going to be helpful and needed. And in most cases, that’s almost always going to be a psychiatrist or some other kind of medication provider, like a psychiatric nurse or a nurse practitioner. Or if you see the psychiatrist and they think that you would benefit from having psychotherapy sessions to help you with certain areas in your life, they’re going to recommend that you go see a psychologist. So.
Rachel Star Withers: Now, can both a psychologist and a psychiatrist diagnose people?
Dr. John Grohol: Yes, they are both qualified and have the background, training and experience to offer an official diagnosis.
Rachel Star Withers: Now, when I first got diagnosed many, many years ago, I had a psychologist and that he referred me to the psychiatrist, that he worked with different practices, but exactly like what you said earlier with someone, you know, referring you over. My problem came up when my psychologist and the psychiatrist didn’t agree on my diagnosis or my treatment plan. And I know so many other people that I’ve gotten caught in this web. What is your advice for people like that?
Dr. John Grohol: Yeah, that’s a tough one, right, because when you have a treatment team and it’s made up of different professionals from different disciplines, it can be challenging when they don’t agree on what the best course of action is to help you move forward. And it can be super frustrating as far as the patient caught up in the middle of between two or more professionals when they have that kind of disagreement. There is no simple answer, right. Because you need to kind of figure out like which professional do you trust more or which one do you feel like you have a greater connection with? It really comes down to to those kinds of things, like the trust that you have in the and the relationship with the professional and how much you believe their professional opinion over another professional’s opinion who might not have that same kind of close relationship with you. The trust level may not be there. Unfortunately, there’s a hundred different ways to treat someone with the same diagnosis. And in the case of any individual coming to someone’s office, the professional has one of those hundred different treatment options available to them. And there is no sort of flowchart or diagram that says, oh, well, given this patient’s symptoms we treat this way, it really comes down to their experience in treating other people like you and really listening to what what your needs are, because especially for a person who’s been in treatment before, they have their own preferences about, you know, medications and psychotherapy and all of that. For a newcomer to be put in that position between two professionals, it’s really, really tough. It really has to come down to almost maybe a gut feeling of which course would you rather pursue. I have to say, though, that even if you pursue what turns out to be maybe not the most beneficial course for yourself and your treatment, you can always go back. You can always change course. That’s the thing with treatment, right? Like
Rachel Star Withers: Yes.
Dr. John Grohol: You start taking a medication and a year in that medication is either not working as much or never really worked very well. You can say, look, this isn’t working for me. I need something different. I need something. We need to change our treatment options here. And so you can always revisit that disagreement and go in the other direction if the first one you choose isn’t working.
Rachel Star Withers: Yes, that’s a very good point. Now, again, we’re talking here in the U.S., so other countries, people who might be listening to your health care systems are different. But talking about here in the US, it can be very frustrating and costly sometimes to see multiple doctors. So what comes up a lot is as a person with schizophrenia, do I have to have both? Do I have to go see both people, a psychologist and a psychiatrist?
Dr. John Grohol: No, absolutely you don’t. It’s entirely a personal preference and a personal choice, even if you go see a psychiatrist first and they put you on medication and they recommend you go see a therapist to get psychotherapy at the end of the day. That’s a recommendation. It’s ultimately each individual’s choice as to whether they want to follow that recommendation or not. The psychiatrist might might feel like this is a part of the treatment that they really like to see you be a part of in terms of your treatment plan and the things that you’re agreeing to. But they can’t force you to go into therapy if you’re not ready or you don’t want to. That’s always your choice. And the same is true with medication. Like if you go in and you start seeing a psychologist at the onset and he or she says you really should be on some type of medication as well, and you say, I don’t like medication. I’ve had bad side effects in the past with it. I’m not ready for medication at this point. Ultimately, therapist is going to have to respect that decision and try and work with you despite your decision.
Dr. John Grohol: And maybe it’s just a matter of getting more comfortable with the professional and and feeling like their recommendations. You can trust when you first go see a psychologist or psychiatrist, you don’t know them and they don’t really know you. So it definitely takes some time to build up that relationship. And so a lot of people are often at times a little wary of just diving all in on all the treatment recommendations. They’re kind of testing the water lot of times, especially first timers. They need to understand, like, how is this process going to work? Can I trust this professional? I’m not going to go see two or more professionals if I can trust and get used to working with one professional. So let me take it one step at a time and go slowly. I think that’s perfectly all right. And professionals just need to adapt to that kind of of way of working with a person and respect the person’s boundaries, respect the person, can’t always do everything that a psychologist or psychiatrist would like their patient to do immediately. So.
Rachel Star Withers: Just to be clear, is a therapist the same thing as a psychologist?
Dr. John Grohol: There are lots of different types of therapists and psychologists are one of them, but there are a lot of other different degrees and professionals that also provide psychotherapy. The psychologist is usually the most experienced and trained at providing psychotherapy. They have the deepest background in science and research and understanding different psychotherapy techniques. But that doesn’t mean that other therapists don’t treat schizophrenia. There are a wide range of professionals who actually do offer psychotherapy to people with schizophrenia.
Rachel Star Withers: Let’s say that I have not been diagnosed yet, but I am worried that I might have a mental disorder. Who do you think I should go to first? Like what? I just go to my normal doctor and tell them and they would suggest someone or should I bypass a normal doctor? It goes straight to a psychiatrist or psychologist. What is your opinion on my best like route of action there?
Dr. John Grohol: That’s a great question, Rachel. It comes down to a lot of times a mental health professional, whether it’s a psychiatrist or psychologist, they want to sort of rule out any kind of medical problem that might be causing the symptoms, because there are a lot of medical conditions that go on diagnosed that kind of look like a mental illness. And it could be a tumor in the brain. It could be some other sort of trauma in the body that’s just undiagnosed and because it doesn’t hurt like a regular physical injury. So a lot of times one of the first things a mental health professional will do is say, hey, have you been to the doctor recently? Have you had a regular checkup? Can you go and get one if you haven’t, to make sure just to ensure that the symptoms that they’re seeing, that they’re hearing from you aren’t better explained by an actual medical condition or some sort of medical disease. It might be beneficial to first see your general practitioner or your family doctor or something and say, look, I’ve been having these symptoms that don’t make sense to me. And I’m wondering if you have any ideas. Could this be something related to mental illness or is this something else? I don’t know. A lot of times, though, people are a little uncomfortable talking to their family doc about symptoms of depression or symptoms of anxiety or schizophrenia. These, especially if they are maybe more severe symptoms, they can be a little scary. But so it really comes down to each individual and what they’re most comfortable with when it comes to something like schizophrenia.
Dr. John Grohol: And you feel like you’re slipping in a way that just doesn’t make sense to you that you’ve never experienced before. I think the, you know, going to see a mental health professional, the first one that I can get you in as quickly as possible is probably the best course of action, because the important thing is to get a diagnosis and to get an accurate diagnosis as quickly as possible so treatment can begin as quickly as possible. And the longer that that is put off, whether it’s just difficulty getting an appointment, you know, professionals all booked up or you can’t go and see your GP or whatever, then I just say, you know, find a professional that you can see that has some experience with schizophrenia.
Rachel Star Withers: Would that be the same advice for someone who is in crisis mode? Like they’re having a detachment from reality psychotic episode, do you still say just whoever you can get them into the quickest or.
Dr. John Grohol: Yeah, I mean, if you’re in crisis mode, unfortunately, our health care system doesn’t really have a lot of good options for that. Right. And that’s the worst part about health care in the United States. The only crisis option we have is the E.R. in the E.R. is really one of the worst places to act. I have to go visit if you’re suffering from a mental illness or a crisis associated with a mental illness. But sadly, that’s usually the place where most people end up because other kinds of offices aren’t set up to take people in immediately. So you can call around the mental health professional or even call your GP’s office. But the possibility of getting in immediately is usually not too high. So I don’t think it hurts to try and go down that route first, because I think the kind of care and treatment that you’re going to receive from either even just a family doctor or mental health professional psychologist or psychiatrist is going to be far superior to any kind of treatment you’re going to receive in the E.R. It’s important that you see someone as quickly as possible. Right. So if that is the E.R., then go to the E.R. because seeing someone is going to be better than trying to deal with it on your own and maybe go down a road that you can’t recover from.
Rachel Star Withers: And my last question for you, could someone, a doctor, be both a psychologist and a psychiatrist?
Dr. John Grohol: Yeah, absolutely, it’s not common, but it does happen where medical doctors go on and get a PhD or PsyD to become a psychologist and vice versa, that some PsyD and PhD psychologists go on into medical school to become a doctor or M.D., a medical doctor. And there’s been some innovations in degrees and prescribing in certain states, like, for instance, in some states, psychologists that have had additional training can actually be prescribers as well. Unfortunately, in the United States, there is a great lack of psychiatrists. Doctors, medical students aren’t choosing psychiatry as much as we need them to. So we have a huge, huge lack of psychiatrists and numbers of psychiatrists in the United States. And it can be very challenging to see a psychiatrist and to get in as a new patient too for a psychiatrist appointment. And there’s no, unfortunately, there’s no simple answer or solution to that problem. We just need more medical students to choose psychiatry. It’s a great profession. It’s one of the few professions of being a doctor where you can help people, you know, over the course of a long, longer period of time. You see a patient, it’s OK to serve once a year or something. It’s much more frequently. And you really get to help and see and know your patients a lot more than most doctors ever do.
Rachel Star Withers: Well, thank you so much for talking with us today, Dr. Grohol. How can our listeners find out more about you?
Dr. John Grohol: They can go on PsychCentral.com, it’s a great website, I love it. It’s everything that you need to know about mental health. That’s the place to go.
Rachel Star Withers: Very true. Well, thank you so much for talking with us today.
Dr. John Grohol: My pleasure. Thank you.
Gabe Howard: It’s great to hear Dr. John’s voice. Rachel, of course, a great interview, as always. Do you have any takeaways?
Rachel Star Withers: My biggest thing when he was talking was that he stressed finding a psychiatrist, psychologist that you’re comfortable with and that works for you. It’s good to hear that coming from another professional, because it’s one thing if I say it, Gabe, where I’m just like, you got to find someone who helps you. But when you hear someone else in the medical community say, look, you need to find there’s plenty of doctors out there, if one isn’t working, try and find another one. That’s really great advice.
Gabe Howard: Rachel, I’m glad that you highlighted that because it shows that medical professionals, they believe this, too. It’s easy to become overwhelmed by our medical team, whether they’re a psychologist, a psychiatrist or otherwise. But listen, they have the same goals as us, which is they want us to be well, that is their goal. We need to have a partnership. We need to talk to them. We need to find medical practitioners that do the best for us so that we can lead our best lives.
Rachel Star Withers: I actually met John a few years ago, Gabe, and one of the coolest things was that he set up Psych Central, founded Psych Central connecting mental health and the Internet very early on. Right there, that’s a medical professional connecting with patients. And that is so cool. More and more. I like seeing that, Gabe. You know, I like seeing someone kind of like you said, an authority actually reaching out and wanting to connect with the people they’re treating. We’ve had, you know, some amazing doctors from different backgrounds on this show. And I’m always so taken with how passionate they are about working with people with schizophrenia, not just seeing us as, you know, just like a chapter in a book. But, hey, as an actual person and wanting to help our lives be better, wanting to help us manage our schizophrenia.
Gabe Howard: Completely agree.
Rachel Star Withers: The bottom line for this entire episode, whether we’re talking about psychiatrists, psychologists, nurses, counselors, therapists, all these different mental health professionals, they all are there to help you. They have some different backgrounds. But what makes them all similar is that they’re part of your health care team to help you manage schizophrenia, to help you with managing big things like hallucinations, delusions, to the smaller things, like building relationships, getting friends, you know, being able to live on your own, like being able to hold down a part time job. I know to my fellow people with schizophrenia out there, it can be overwhelming when you’re like, oh, my goodness, there’s so many doctors. Just think of it as so many people who want to help you have an incredible life. The bottom line is psychiatrists and psychologists are two types of mental health professionals. And while they may have several similarities, they play different roles in our health care settings. Both treat a variety of mental health care conditions like schizophrenia, but they treat it in different ways. While psychiatrists can use a mixture of therapy and medication, psychologists focus on providing therapy, helping us in our everyday lives.
Gabe Howard: And the important thing to remember is that you, as the person seeking their services, are ultimately in charge, so the way that you interact with them is ultimately up to you. The best care is a good partnership between you and your mental health team.
Rachel Star Withers: Thank you so much for listening to this episode of Inside Schizophrenia, please, like, share, subscribe and rate our podcast, and we’ll see you next time here on Inside Schizophrenia.
Announcer: You’ve been listening to Inside Schizophrenia, a podcast from Psych Central and Healthline Media. Previous episodes can be found at PsychCentral.com/IS or on your favorite podcast player. Your host, Rachel Star Withers, can be found online at RachelStarLive.com. Co-host Gabe Howard can be found online at gabehoward.com. Thank you and we’ll see you next time.