September 18, 2023

How to know whether you need a psychiatrist or a psychologist

Dr. Heather Schultz was interviewed for this Toledo Blade article 

link to the original article


Psychiatrists are medical doctors who have gone through four years of medical school and an additional four or more years of residency.

“Medical students have clinical rotations and they get to experience all of the core medical specialties, so everything from surgery to internal medicine to neurology and psychiatry,” said Heather Schultz, an inpatient psychiatrist and director of the psychiatry residency program at the University of Michigan. “Many medical students, when they come into medicine, don't really know what they would like to specialize in.”


“I refer patients to have neuropsychological testing if I’m worried that they might have an issue with cognition or attention, and just to get more information about how they think, to have assessments done with measurements that I don’t do,” Dr. Schultz said.

Both psychologists and psychiatrists can make diagnoses using the Diagnostic and Statistical Manual of Mental Disorders.

“A psychologist might see someone and be able to really understand that they’re struggling with symptoms of major depressive disorder or symptoms of anxiety, and so would a psychiatrist,” Dr. Schultz said. “If we’re clinical, we’re all trained in assessment and diagnosis.”


Who to see

Dr. Schultz shared tips to determine which type of specialist one should seek out depending on their symptoms.

Some psychiatric illnesses such as schizophrenia or bipolar disorder require medication as a first-line treatment to stabilize symptoms and reduce safety concerns, she said. Suicidal thoughts also require immediate psychiatric attention.

Borderline personality disorder is often better treated with therapy than medication, she added. Someone with symptoms of anxiety might want to start off by talking to a therapist.

Dr. Kazmi also recommended psychotherapy to work through trauma that is affecting one’s relationships or concerns where their everyday functioning is not impaired. The therapist would then recommend further treatment if deemed appropriate.

A primary care doctor can also help a patient identify a specialist that can best treat their symptoms.

If someone has tried psychotherapy but they’re not seeing symptoms subside and still meet criteria for a psychiatric illness, Dr. Schultz said a psychiatrist can look into which medications might be helpful.

In a first appointment with a psychiatrist, the doctor will explore the symptom the patient came in with, as well as get a thorough understanding of their history including family, medical, social, medications, and lifestyle, Dr. Kazmi said.

“At the end of the session, a diagnosis … will be explained to the patient in simple words and how that can be helped with non-medication ways and medication ways,” he said. The psychiatrist may also recommend lifestyle changes, building a strong support network, counseling, or other interventions.

Dr. Schultz said it’s recommended that a patient be on a medication for at least a year. If they’ve done work in therapy, have a strong support system, and life looks different, they can work with a psychiatrist to slowly ease off the medication.

A psychotherapy intake evaluation may focus more on one’s relationships, upbringing, and experiences to determine what coping skills will best help that person modify their feelings or thinking patterns.

“Our goals are often to better understand what the problem is to come up with a diagnosis … and then to think about a treatment approach that would be helpful, both from a medication therapy standpoint,” Dr. Schultz said of psychiatrists.

“The thing that I love about psychiatry is our approach tends to be thinking about all aspects of people’s lives as best we can, and trying to think about how to encourage them … to think about things that they might do on a daily basis that might also be helpful.”