Article written for the Venice Gondolier’s Well Being in Paradise Magazine | July/August 2022

Having been licensed as a psychologist for 36+ years now (since I was five), it’s easy to reflect back on a wonderful career of maintaining interesting and sometimes naughty secrets for the good people of Venice. My current tally is somewhere around 80,000 hours of psychotherapy, with the distinct possibility of having helped a person or two along the way.

Over the years I’ve often been asked, “What is the difference between psychologists and psychiatrists?”

The off-the-cuff response, of course, is probably, “Oh, about $75,000 per year.” But there are certainly other differences of note: a psychologist possesses a doctorate in psychology (PhD, EdD, or most likely, a PsyD-doctor of psychology) whereas a psychiatrist is either a DO (doctor of osteopathic medicine) or more likely, an MD (doctor of medicine).

Stereotypically, psychologists study human behavior, cognitive processes and assessment/testing, (e.g., IQ, learning disabilities, dementia, mental illness) And tend to treat patients with psychotherapy.

Currently, psychiatrists are more inclined to study medicine, psychopharmacology and administer a more biologically-based form of treating mental and emotional disorders. That is, you are more likely to be treated with medication for your issues and symptoms.

So why have in the same office mental health professionals who likely practice from completely different worldviews on how to best treat mental disorders? Isn’t that tantamount to inviting your competition into the practice? Actually, no, not at all.

More than ever before, psychologists and psychiatrists enjoy a professional collaboration, rather than a competition. To wit, research is fairly consistent that the cutting-edge treatment for most mental illnesses and disorders combine the two-pronged approach of psychotherapy (psychology) and medication (psychiatry).

But don’t take my word for it. According to the American Psychological Association, (apa.org, Division 12, Society of Clinical Psychology), “For depression, there is some evidence that combining psychotherapy and medications may be more effective than either treatment alone… for anxiety disorders, cognitive behavioral therapy (written about in this column in the last three articles), anti-depressant medications and anti-anxiety medications have all been shown to be helpful.

Research generally shows that psychotherapy is more effective than medications and that adding medications does not significantly improve outcomes from psychotherapy alone.

Eating disorder? Combining therapy and meds may be the most effective. Schizophrenia or bipolar disorder? Most patients will require antipsychotic and/or mood stabilizing medications, but psychotherapy can improve success rates. Addictions? Again, cognitive behavioral therapy paired with 12-step programs, has proven to be effective. Medication may be used to reduce cravings for severely addicted patients.

What about family issues (parenting, marital strife) or adjustments to life’s challenges? Psychotherapy is deemed to be the first recommendation, in order to learn effective coping skills.

Certainly, medication is not for everyone. But according to The Journal of the American Medical Association (JAMA, 2013), about one in six adult Americans – or 16.7% of the population  – is reportedly taking psychiatric drugs. Three quarters of those are for anti-depressants.

So what about for you? Therapy? Meds? Both? Perhaps the following recommendations are in order: first, recognize that these are personal decisions that are often decided over time on a trial and error basis, after learning what works best.

I understand that a particular medication may be a godsend to your spouse, but disastrous to you, because you have a different bio-chemical make-up. Medications, when helpful, may lose effectiveness overtime and may need to be tweaked, replaced or permanently discontinued.

Psychotherapy can also be increased, reduced or used on an as needed basis. And sometimes, of course, you need a better fit, and should consider trying a different therapist altogether. But in all cases, please consult your doctor(s).

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