Psychiatrist or Therapist: Who Should YOU See?

Psychiatrist or Therapist: Who Should YOU See?

If you have a mental health
condition, how do you know if you should see a
psychiatrist or a therapist? That’s what I’m talking about today. I’m Dr. Tracey Marks, a psychiatrist and I make mental health education videos. This topic is based on a
viewer question from JB. JB says. – [Speaker With A Clear Voice] “Dr. Marks, I’ve been feeling depressed
for months and can’t shake it. I thought it would go away
as it has in the past, but this time, it’s
starting to affect my work. I know I need to see a professional, but I don’t know who I should see. Should I look for a
psychiatrist or a therapist?” – Thank you, JB, for your question. I’m going to answer this question in general terms because
ultimately, the decision depends on how severe your symptoms are and what you’re looking
to get out of treatment. For starters though, technically
speaking, psychiatrists are therapists who can
also prescribe medication. Psychiatrists are physicians
who specialize in the area of medicine that deals
with the mind and brain. Brain and body science takes into account how your physical condition
affects your brain, and the science of the
mind involves understanding how what you think affects your behavior and how you respond to
forces in your environment. Aside from the training that
we get in medical specialties like internal medicine and
neurology, psychiatry training includes learning a few therapy modalities like psychodynamic therapy which some people called
insight-oriented psychotherapy. Cognitive behavior therapy,
and supportive therapy. These are only a few of the many psychotherapies
that are available, but many psychiatrists
don’t practice psychotherapy and limit their practices to medication management of
the psychiatric disorders. This is especially the case in large insurance-based practices. Many insurance companies
don’t pay very much for psychotherapy, so practice managers will
limit the psychiatrists work to medication appointments and have the therapist do the therapy, but that’s a choice that the
psychiatrist makes to work in that kind of practice. It’s not because they don’t
know how to do therapy. Therapists is a broad term
that includes a variety of professionals such as
psychologists, social workers, licensed professional counselors, and marriage and family therapists. They provide psychotherapy or talk therapy and cannot
prescribe medication, although there are some states
that allow psychologists to prescribe medication
with additional training. Therapists use psychotherapy
to help you reduce symptoms, identify negative thought
patterns, change behaviors, improve coping skills, be more self-aware and
navigate relationship problems. There are many different
types of therapies out there. Some of the major ones are
cognitive behavior therapy, dialectical behavior therapy, acceptance and commitment therapy, psychodynamic therapy,
interpersonal therapy, problem focus therapy, schema therapy. Then there are the trauma
therapies like EMDR, which stands for eye movement desensitization
and reprocessing, prolonged exposure
therapy, somatic therapy, and inner-child work, and
this is just a short list. It didn’t seem short, but
it really is short compared to all the therapies that are out there and there are too many therapies for one person to be
skilled at all of them. What usually happens is
a therapist will graduate from their program with
training in a few core therapies then get additional training in non-core therapies that interest them and then focus on those
therapies in their practice. Now, getting back to the issue of whether you should see a
psychiatrist first or a therapist. Reasons to see a psychiatrist
are if you’re open to taking medication and you
want to know if you need them, if you have moderate to
severe symptoms that interfere with your daily functioning,
what would that look like? These would be things like
having trouble getting out of bed such that you’re
missing work or school, you’re letting your hygiene slip. Maybe you’re not eating
much or you’re drowning in helplessness and can’t see
a way out of how you feel. If you have any degree of psychosis that includes
delusions or hallucinations, you need to see a
psychiatrist because psychosis is an indication of severe
symptoms that are not going to be talked away with therapy. Another reason to see a psychiatrist is if you have a complicated set of symptoms or other medical conditions that may affect your mental condition. The psychiatrist medical approach may be needed to sort out what’s what. The psychiatrist may determine that you have a condition that can respond to therapy with or without medication. For example, CBT and IPT, which stands for interpersonal therapy
are first line treatments for depression. First line means the therapy can be used as the only treatment without medication, so a psychiatrist can inform you of the therapy options
and maybe even refer you or at least let you know what’s out there. Most people don’t know
from the outset what kind of therapy that they
should be looking for. Some conditions need medication management like schizophrenia and bipolar disorder. Severe anxiety may not respond
enough to therapy alone and may need medication. ADHD or attention deficit
Hyperactivity disorder is a disorder that may or
may not require medication. There are executive function
coaches that can help with things like
time-management, planning, emotion regulation, impulse
control, and working memory. These are functions that
are only marginally improved with stimulant medication. If your ADHD is mostly trouble with focus and concentration and executive dysfunction is
not that impairing for you, then you may do well seeing a psychiatrist or pediatrician if you’re a child for medication to treat the
focus and the concentration. But if you don’t do well with stimulants and many people
don’t, they get depressed or they feel like they
lose their personality, then skills training may
be the way to go for you. It’s not that easy to find an
executive function therapist because it’s pretty niche, and some of the practitioners may be trained as coaches and not therapists, so those are the reasons
to see a psychiatrist. When should you skip the psychiatrist and see a therapist first? If you want help with things like your relationship,
understanding yourself, or especially if you need trauma therapy, these would be reasons to see a therapist. Unless the psychiatrist markets themselves as a trauma specialist, it’s unlikely that they
do trauma treatments. Not every therapist
does trauma therapy, and if you need help healing
from wounds of past trauma, you should seek out someone who says that they have a special focus on trauma. Medication treatment and psychotherapy are
not mutually exclusive. Many people have split treatment where the psychiatrist handles the medication and the therapist does the therapy and this would be the case if the psychiatrist doesn’t do any therapy or doesn’t do the kind
of therapy you need. Also, you don’t have to worry about getting it right the first time. If you go to see a
therapist and the therapist thinks your symptoms are too
severe for therapy alone, they will recommend
you see a psychiatrist. For more on severe depression, watch this video on psychotic depression. Thanks for watching. See you next time.

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Psychiatrist Dr. Tracey Marks delves into the key differences between psychiatrists and therapists, offering guidance on choosing the right mental health professional based on symptoms and treatment needs. The video also explores the range of therapies available and when medication might be beneficial.

Disclaimer: All of the information on this channel is for educational purposes and not intended to be specific/personal medical advice from me to you. Watching the videos or getting answers to comments/question, does not establish a doctor-patient relationship. If you have your own doctor, perhaps these videos can help prepare you for your discussion with your doctor.