Can psychiatrists prescribe medicine

What They Do, Training & When To See One

Overview

What is a psychiatrist?

A psychiatrist is a medical doctor who’s an expert in the field of psychiatry — the branch of medicine focused on the diagnosis, treatment and prevention of mental, emotional and behavioral disorders.

Psychiatrists assess both the mental and physical aspects of psychological conditions. They can diagnose and treat these conditions.

What is the difference between a psychiatrist and a psychologist?

A psychiatrist is a medical doctor who can diagnose and treat mental health conditions. They can prescribe medications and other medical treatments.

A psychologist has a doctoral degree (PhD), typically in clinical psychology, and often has extensive training in research or clinical practice. Psychologists treat mental health conditions with psychotherapy (talk therapy). A psychologist can’t prescribe medication.

Psychiatrists typically treat more complex mental health conditions than psychologists, especially ones that require medication or medical treatments.

To give another perspective, psychology is the study of the mind, emotions and behavior; whereas psychiatry is the field of medicine focused on diagnosing and treating mental health conditions.

What is the difference between a psychiatrist and a therapist?

A therapist has a master’s degree in a mental health-related field such as psychology, counseling psychology or family therapy. They’re qualified to evaluate a person’s mental health and use therapeutic techniques, such as talk therapy. Examples of therapists include licensed social workers and licensed professional clinical counselors. A therapist can’t prescribe medication.

A psychiatrist is a medical doctor who can diagnose and prescribe medicine and medical treatment for mental health conditions.

What is the difference between a psychiatrist and a neurologist?

A neurologist is a medical doctor who diagnoses, treats and manages conditions of the brain and nervous system (brain, spinal cord and nerves). A neurologist knows the anatomy, function and conditions that affect your nerves and nervous system.

While neurologists and psychiatrists are both doctors that deal with conditions that affect your brain, a neurologist is more focused on the physical aspects and symptoms of the condition, and a psychiatrist is more focused on the cognitive and behavioral symptoms of the condition. Neurologists also diagnose and treat conditions that affect your nerves and spinal cord; a psychiatrist doesn’t work with these kinds of conditions.

Both doctors can prescribe medication, and both doctors may be involved with the management of certain conditions that affect your brain. For example, depression commonly occurs in people who have Parkinson’s disease or who’ve had a stroke.

What does a psychiatrist do?

A psychiatrist assesses, diagnoses and treats mental, emotional and behavioral disorders.

Psychiatrists are medical doctors and can order or perform a variety of medical and/or psychological tests. These tests, combined with conversations about symptoms and medical and family history, allow psychiatrists to diagnose mental health conditions.

Psychiatrists use criteria from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM–5) to diagnose specific mental health conditions.

Psychiatrists also form individualized treatment plans, which can include psychotherapy (talk therapy), medication and other medical treatments.

What conditions do psychiatrists treat?

Psychiatrists can diagnose and treat several conditions, including:

Alcohol use disorder and other substance use disorders.
Alzheimer’s disease.
Anxiety disorders.
Attention-deficit/hyperactivity disorder (ADHD).
Autism spectrum disorder.
Bipolar disorder.
Body dysmorphic disorder.
Depression.
Dissociative disorders.
Eating disorders.
Gambling disorder.
Gender dysphoria.
Hoarding disorder.
Mood disorders.
Obsessive-compulsive disorder (OCD).
Panic disorder.
Personality disorders.
Post-traumatic stress disorder (PTSD).
Postpartum depression.
Schizoaffective disorder.
Schizophrenia.
Sleep disorders.

What treatments do psychiatrists use?

Psychiatrists use and prescribe a variety of treatments, including:

Psychotherapy (talk therapy).
Medications.
Other treatments, such as electric convulsive treatment (ECT) or transcranial magnetic stimulation (TMS).

Treatment for mental health conditions is very individualized and unique to each person. Treatment often involves a combination of therapies.

Psychotherapy

Psychotherapy, often called “talk therapy” or “therapy” for short, is a treatment that involves talking with a trained mental healthcare professional to help identify and work through the factors that are affecting your mental health or may be triggering your mental health condition.

The goal of psychotherapy is to eliminate or control disabling or troubling thought and behavioral patterns so you can function better. Psychotherapy can be short-term or long-term depending on your symptoms and condition.

There are several different types of psychotherapy, including:

Cognitive behavioral therapy (CBT).
Interpersonal therapy (IPT).
Mindfulness-based cognitive therapy (MBCT).
Dialectical behavioral therapy (DBT).
Problem-solving therapy (PST).
Psychodynamic therapy.

Medications

Psychiatrists can prescribe medications to help treat mental health conditions. These medications work to alter chemical signaling and communication within your brain, which can minimize some symptoms of certain psychiatric conditions.

Psychiatrists often prescribe medications in combination with psychotherapy.

Classes of medications that psychiatrists typically prescribe include:

Antidepressants.
Antipsychotic medications.
Hypnotics.
Mood stabilizers.
Sedatives and anxiolytics.
Stimulants.
Ketamine.

Other treatments

Psychiatrists sometimes use other treatment therapies for certain psychiatric conditions, including:

Electroconvulsive therapy (ECT).
Transcranial magnetic stimulation (TMS).
Light therapy for seasonal depression (seasonal affective disorder [SAD]).

Much less common treatments include:

Vagus nerve stimulation (VNS).
Deep brain stimulation (DBS).

When should I see a psychiatrist?

Determining when to see a psychiatrist often requires a candid self-assessment of your symptoms and day-to-day experiences. While you shouldn’t try to self-diagnose any specific mental health conditions, you can become aware of and note behaviors, emotions and thought patterns that are unhealthy and disruptive to your everyday life.

While it can be difficult and overwhelming to seek help for mental health conditions, it’s essential to do so. Mental health conditions are very common, and your mental health is just as important as your physical health.

In some cases, your primary healthcare provider may refer you to a psychiatrist if you share your symptoms with them. But you can usually go directly to a psychiatrist for a diagnosis and treatment plan if you prefer.

Mental health episodes may happen randomly, infrequently or be constant. The important thing to remember is that if they’re negatively affecting your quality of life, it’s a clear sign you need to seek help.

If you have any of the following symptoms or experiences, you may want to consider seeing a psychiatrist or telling your primary healthcare provider:

Inability to manage or control your emotions.
Continuous or frequent episodes of anger or rage.
Excessive or irrational fears.
Engaging in risky behavior.
Excessive worrying and/or sadness.
Significant changes in sleep patterns.
Substance use.
Eating disorders.
Declining performance in school or work.
Withdrawal from social situations.
Thoughts of self-harm.

Remember, there’s no shame in having or seeking help for a mental health condition. The sooner you seek help and treatment, the sooner you’ll feel better.

What can I expect during an appointment with a psychiatrist?

To get the most out of your appointment with your psychiatrist, it’s helpful to be prepared. Ways to prepare include:

Bring a list of the most important issues you want to discuss with your psychiatrist.
Discuss new symptoms or changes in existing or prior symptoms. Consider keeping a day-to-day journal of your symptoms so it’s easier to keep track of how your symptoms change or affect your quality of life.
Discuss any changes in your overall physical health.
Discuss your family’s history of physical and mental health conditions.
Share with your psychiatrist how others see you doing, especially family, friends and co-workers who really care about you.
Bring a list of all the current medications and substances you take. Include prescription medications; over-the-counter medications; any vitamins, supplements and herbal products; and any recreational drugs.

What questions should I ask my psychiatrist?

It may be helpful to ask your psychiatrist the following questions during an appointment:

What’s my diagnosis and how did you arrive at it?
How much experience do you have in treating my condition?
What are my treatment options?
When can I expect to feel better?
How will I know I’m feeling better?
What should I do if I feel worse?
Who do I contact with an emergency related to my condition?
What are the side effects of my medication?
Will you work with my other healthcare providers?

Frequently Asked Questions

How does someone become a psychiatrist?

To become a psychiatrist, you must successfully complete:

Four years of undergrad education at a college or university, resulting in a bachelor’s degree.
Four years of medical school, resulting in a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree.
Four-year residency program.

After completing residency, most psychiatrists take a voluntary written and oral examination given by the American Board of Psychiatry and Neurology to become a board-certified psychiatrist.

Some psychiatrists also complete fellowship programs to specialize in a particular area of psychiatry, such as child and adolescent psychiatry, which focuses on the mental health in the pediatric population, or consultation liaison psychiatry, which studies the interface of physical and mental health in the medical population.

What are some subspecialties of psychiatry?

Some subspecialties of psychiatry include:

Addiction psychiatry.
Emergency psychiatry.
Forensic (legal) psychiatry.
Geriatric psychiatry.
Pain medicine.
Child and adolescent psychiatry.
Consultation-liaison psychiatry.
Sleep medicine.

A note from Cleveland Clinic

While it can be overwhelming to acknowledge and seek help for a mental health condition, it’s essential you do. A psychiatrist can provide an accurate diagnosis and suggest treatment plans. They’re experts in their field and have up-to-date knowledge on research, medications and other treatment therapies that can help you. Your psychiatrist will work with you to determine a treatment plan that’s best for you.

Psychologist vs. Psychiatrist: What’s the Difference?

The content of this page is only for informational purposes and is not intended, expressly or by implication, as a guarantee of employment or salary, which vary based on many factors including but not limited to education, credentials, and experience. Alliant International University explicitly makes no representations or guarantees about the accuracy of the information provided by any prospective employer or any other website. Salary information available on the internet may not reflect the typical experience of Alliant graduates. Alliant does not guarantee that any graduate will be placed with a particular employer or in any specific employment position.

What’s the difference between a psychologist and a psychiatrist? The question is most often asked by patients seeking treatment, but if you’re considering a career in the field of mental health, it’s an applicable question for you, too. Although the two professions share a lot in common, they also have profound differences that underlie their work. Understanding the similarities, differences and education programs for each will help you determine which career path is right for you.

The Similarities Between Psychologists and Psychiatrists

Just looking at the words “psychologist” and “psychiatrist” tells you that these professions share a common foundation. The root of both words is psy, short for psyche, which is Greek for mind or spirit. Both psychologists and psychiatrists diagnose and treat patients for mental disorders; their work concerns the health of the brain, as well as the thoughts, feelings, and emotions of their patients. Both interview and counsel their patients, and use the criteria from the DSM-V to diagnose mental illnesses such as anxiety, depression, dissociative identity disorder and more.

Educational Background

Both professions require a doctoral degree to practice professionally. The doctoral programs for each profession take very different approaches, however.

To become a psychologist: Becoming a psychologist requires a doctorate in psychology. Two degree options are available:

Doctor of Philosophy (PhD) in Psychology
Doctor of Psychology (PsyD)

If you are looking to work with patients, you will likely earn a doctorate in either counseling or clinical psychology. As part of the doctoral program, you will participate in an internship to get hands-on, real-world experience. A doctorate in psychology program can take anywhere from four to seven years, depending upon which degree option you choose (a PsyD often takes less time than a PhD), and how long it takes you to work through your courses and internship. Upon completion of the doctorate in psychology program, you will need to complete your state’s requirements for licensure before you can practice professionally.

To become a psychiatrist: The primary difference in the educational background of these two groups is that psychiatrists require medical training, whereas psychologists do not. To become a psychiatrist, you will need to attend medical school and earn an M.D. Most medical school programs take four years; following completion of the M.D., you will typically need another four years of residency training to become a psychiatrist. During this time, many candidates choose a subspecialty or concentration area to focus their studies. To work as a professional psychiatrist, you must be licensed as a physician in your state.

Treatment Differences

The differences in education lead to different treatment focuses for each discipline. Whereas psychologists focus on behavioral approaches, using psychological tests and therapy to diagnose and treat patients, psychiatrists treat patients from a medical standpoint, focusing on disorders as a chemical imbalance in the brain.

Psychologists treat their patients using therapy. The word “therapy” – especially in conjunction with the word “psychologist” – conjures up images of a patient lying on a couch sharing their feelings. This is a very limited view, however. Psychologists use a variety of therapies, based upon years of research, to treat patients¹. This variety includes:

Cognitive therapy
Cognitive-behavioral therapy
Humanistic therapy
Psychoanalysis and psychodynamic therapies

Psychotherapy is also a key element in the diagnosis and treatment of a psychiatrist’s patients. However, a psychiatrist has other treatments at their disposal, including medication and hospitalization. Because of their focus and training, psychiatrists often handle patients with more serious mental health issues for which therapy alone cannot help.

Prescribing Medication

The ability to prescribe medication has often been the distinguishing element between a psychiatrist and a psychologist. A psychiatrist can prescribe medication for the treatment of mental disorders, while a psychologist cannot. In the last 15 years, this distinction has started changing, albeit at a slow pace. Since 2002, three states – New Mexico, Louisiana and most recently Illinois – have begun allowing psychologists to prescribe medications in the treatment of mental health disorders.

In many cases, a combination of therapy and medication is the best treatment option. Because most psychologists do not have the authorization to prescribe medication, they often work in conjunction with psychiatrists or primary care physicians to get their patients access to this necessary care. Allowing psychologists to prescribe medication can makesit easier for those patients to get the most effective treatment.

Which Career Path is Right for Me?

In deciding which career path is right for you, consider your interest in the subject. Are you interested in approaching mental disorders from a medical standpoint, as chemical imbalances in the brain? Or are you more interested in treating patients from a therapy standpoint?

Alliant’s Doctoral Programs in Psychology

If you are interested in studying the treatment of mental health disorders from the psychology side, Alliant’s California School of Professional Psychology offers a variety of doctoral programs in psychology, including:

PhD in Clinical Psychology
PsyD in Clinical Psychology
PsyD in Couple and Family Therapy

Alliant also offers a Postdoctoral Master of Science in Clinical Psychopharmacology. Designed for practicing psychologists who live in a state or federal jurisdiction where psychologists are authorized to prescribe medication, this program helps prepare licensed psychologists to safely and effectively prescribe medications in the treatment of patients. Even psychologists who don’t live in a state with this authority can benefit from the program, as it will help them to better answer patient questions about medication and better collaborate with primary care physicians in prescription treatment.

Sources

American Psychological Association, Different Approaches to Psychotherapy, https://www.apa.org/topics/psychotherapy/approaches, Accessed Nov. 29, 2021

What is the difference between a psychologist, a psychiatrist, a psychotherapist - the difference and differences between specialists

Psychological problems happen to everyone from time to time. Someone "can't" forces himself to go to work because of a picky boss, someone worries about a conflict with a spouse or children, someone suffers from unjustified fears, and someone just wants to improve the quality of life, achieve a higher level of harmony in relationships with yourself and others.

It is not so easy to entrust your soul to a stranger, even if this person is a professional with a diploma and work experience. And if you are not sure that you are addressing "at the address", doubts begin to torment even more. Not surprisingly, the most difficult step is usually the choice of the right specialist. nine0003

So who to turn to: a psychologist, a psychotherapist, a psychiatrist? To answer this question, you first need to figure out what problems this or that specialist helps with.

Psychologist

A psychologist is a specialist with a humanitarian, not a medical education. There are many areas in which such specialists work: pedagogical, clinical, general, social psychology, etc. But common to all these areas is that they are designed for healthy or practically healthy people. They turn to a psychologist when they need to cope with temporary difficulties or gain new skills, for example, to learn how to communicate more productively with loved ones, colleagues or clients. nine0003

You should pay a visit to a psychologist if you are worried about dissatisfaction with your life or lack of understanding with your relatives, are at the stage of divorce, separation and other crisis situations at home or at work. A psychologist will help you survive the death of a loved one, recover morally after a major operation, or get rid of a recent anxiety. Regarding children, psychologists are contacted to diagnose the state of the cognitive sphere, assess the child's readiness for school, solve the problems of stuttering, restlessness, increased activity, etc. nine0003

Clinical psychologist

A clinical psychologist also has not a medical, but a psychological education. But he underwent special training, which allows him to work not only with healthy, but also with sick people. He can diagnose mental disorders and, if necessary, refer patients to psychiatrists or psychotherapists. In addition, he has the right to conduct individual consultations and provide family counseling.

A clinical psychologist should be consulted with constant anxiety, obsessions, increased irritability or, on the contrary, apathy, lethargy and loss of strength, as well as with psychosomatic diseases. It should be borne in mind that a clinical psychologist is not a doctor and cannot prescribe drugs. Therefore, if your condition turns out to be too serious and requires the intervention of a doctor and the prescription of medications, you will be referred to another specialist - a psychotherapist or psychiatrist. nine0003

Psychotherapist

A psychotherapist is a specialist with a higher medical education who has worked as a psychiatrist for at least 3 years, and subsequently underwent special retraining. The psychotherapist has the right to prescribe medications and treat patients with non-drug methods - conducting short-term, long-term, group or individual psychotherapy. This specialist has very broad powers and deals with a variety of problems. He treats panic disorders, obsessive-compulsive disorders, depression, post-traumatic stress disorder, eating disorders, and many others. However, a psychotherapist does not treat severe mental illnesses, such as schizophrenia, although he can diagnose such a disorder and refer a person to a psychiatrist. nine0003

Psychiatrist

A psychiatrist is a doctor with a higher education who has a certificate in the specialty "psychiatry". Such a specialist has the right to treat both severe mental disorders and transient conditions, such as depression. He can prescribe medications, conduct official examinations and give conclusions about the state of the patient's mental health, as well as his legal capacity.

A psychiatrist should be contacted if there are suicidal thoughts or intentions, hallucinations, severe anxiety, sleep disturbance, sharp uncontrollable mood swings, if strange or grandiose “ideas” arise, inability to cope with solving current daily tasks, long-term depression of mood. nine0003

Psychologist, psychotherapist, psychiatrist. Whom to choose?

Some time ago, a young girl came into my office. I asked, as usual, if she had worked with colleagues before me?
- Worked, - speaks - was at the regional psychiatrist.
- How did it end? I ask.
- Diagnosed and prescribed pills.
- What is the diagnosis?
- Schizophrenia.
I secretly crossed myself and began to ask further, did she have inadequate or obsessive states into which she fell for a long time, hallucinations? The girl replied no. nine0033 - What did you apply for? - He asked in the hope that she would say that she was Hitler's daughter or a messenger from other planets.
- Pulled away from the world and sat at home in a terribly depressed state. I applied with this.
- And what happened to you shortly before that?
- At school and institute I was an excellent student, I graduated with honors, - she answers - after the institute she got her first job, worked there for about a year and then I was offered a "dream job". Excellent position and salary, but a whole sea of unfamiliar functionality and responsibility. The team was also wonderful: everyone tried to support me, but as I immersed myself in work, I realized that I couldn’t cope. In the end, I was fired. It was a blow, after which I plunged into depression. When this condition began to drag on, I went to a psychiatrist ...

From my point of view, the diagnosis seemed far-fetched, if only for the reason that my client's background showed a case of neurosis, but not mental illness. The latter are characterized by more obvious symptoms and totality. Formally, I have no right to judge this, but, in any case, I have the right to write. Partly, the psychiatrist can be understood. As a doctor, he must help. Help for a doctor means prescribing medicines. Medicines can be prescribed only on the basis of a diagnosis. There is only one question - why schizophrenia? Maybe psychiatrists have some kind of performance indicators, such as the crime detection rate of police officers, which they are required to achieve? Otherwise, the diagnosis looked like a sophisticated revenge. By the way, when I asked the girl about the reaction to the diagnosis, she replied: "I burst into tears." nine0003

Any person experiencing psychological problems can face the situation described above. Where to go - to a psychologist, psychotherapist or psychiatrist? I don’t know how often the layman asks himself this question, but I know for sure that the difference between these concepts is little understood not only by him, but also by some of my colleagues.

Let's start with definitions. All of them are excerpts from official reference books and encyclopedias. So…
A psychiatrist is a doctor who specializes in psychiatry. In the training of psychiatrists, preference is given to a biomedical approach to psychological problems. Unlike a clinical psychologist, a psychiatrist can write prescriptions for medications. nine0003

There are three types of psychologists:

A psychologist is a specialist in psychology who deals with the scientific study of the human psyche. Psychologists may work in universities, businesses, schools, or hospitals.

Clinical psychologist - has specialized training in the diagnosis and treatment of mental illnesses and their consequences. Typically, these specialists work in hospitals in conjunction with representatives of other medical specialties.

Psychologist-teacher - has special training in the field of cognitive and emotional development of children. nine0003

Psychotherapist - a trained specialist who is able to diagnose and treat diseases, mainly of psychogenic origin, purposefully using psychological influence as a therapeutic agent. Due to the specifics of psychotherapy, he to some extent brings to the treatment process the originality of his personality, his own system of values, preferred theoretical orientations and psychotherapeutic technologies.

Next, I will give definitions relating to the areas in which our specialists work. nine0003

Psychiatry is a medical discipline that studies the causes and essence of mental illness, their manifestations, course, methods of their treatment and prevention, and the system of organizing care for patients.

Psychology is the science of the patterns, mechanisms and facts of the mental life of humans and animals.

Psychotherapy is currently not an unambiguously understood area of scientific knowledge and practical approaches, but is just their combination and partly interaction and is distinguished by various psychological, medical, anthropological, socio-economic, ecological and philosophical attitudes and an extremely wide range of applications. This is a special type of interpersonal interaction in which patients are provided with professional assistance by psychological means in solving their problems or mental difficulties ...

If one sticks to these de jure definitions, a number of things immediately become apparent.
Firstly, ordinary psychologists should only study the psyche, but not help people. Secondly, psychotherapy is not a branch of medicine, and a psychotherapist, unlike a psychiatrist, treats with “psychological influence”. In turn, the prescription of drugs is a biomedical approach, and therefore is not a psychological or psychotherapeutic effect. And it turns out that only a clinical psychologist can influence by psychological means, and an ordinary psychologist and psychiatrist cannot, because. do not have the necessary qualifications. nine0033 It should be added here that psychotherapy as a system of knowledge appeared in Russia only in the 90s. This was due to the isolation of our psychology from the Western one. We had our own Mozart from Psychology by L.S. Vygotsky and other psychologists who, to one degree or another, developed the theory of activity and domestic psychiatry, but there was no America and Germany with their psychotherapy. As well as sex. Therefore, we did not teach psychotherapy. She began to penetrate to us from abroad and mainly in the form of an additional, unofficial education. nine0033 I will leave for a while the problems of formulations and definitions and pay attention to the essence. A person is interested in having the most qualified assistance in solving his mental problems. At what levels can the impact on the psyche be carried out at all? There are three of these levels.

The level of causes - the impact is carried out directly on the psyche, i.e. to the cause of the problem. For such an impact, a specialist must have the skills and practical methods of psychotherapy. nine0033 Let me give you a favorite example from the practice of the famous American psychotherapist K. Whitaker. At the dawn of his career, a boy was sent to him, who refused to talk. The boy had to come to his office several times a week for a month. The first sessions Whitaker tried to talk to the patient, however, starting from 3 or 4, he realized that his attempts were unsuccessful. The rest of the time they spent as follows: at the appointed time, the boy came into the office and silently spent an hour in it, while Whitaker was nearby doing his own business. nine0033 At the last meeting, the boy left the office without starting to talk, and Whitaker began to write a letter of resignation. However, in the evening he received a call and was told that the boy had spoken.
From the point of view of psychotherapy, as I see it, Whitaker influenced the psyche of the boy by inaction. He did what others did not do - he allowed his symptom to be. Whether Whitaker himself was aware of it or not, he treated the symptom as a need that had to be satisfied. The boy was satisfied with silence to the full, after which he became "normal". Well, among other things, the main thing that the therapist provided the boy was acceptance. If there had been someone else in Whitaker's place who would have pulled the poor child by the testicles, then perhaps the symptom would have become even more entrenched. Of course, Whitaker acted intuitively, like any great psychotherapist. nine0033 In fact, there are a lot of techniques that work at the level of causes. The most striking result of the work that is possible at this level is insight. The so-called insight, which is a consequence of psychotherapeutic work. In the moment of insight, the client instantly and clearly senses the multiple connections that led to the existence of his problem. He receives new information about himself, but not with the help of understanding, but rather with the help of feeling. Insight cannot arise on the basis of a diagnosis, it is an “inner truth” that a person does not question because it originated in himself, and did not come from outside. A vivid realization, after which he can no longer remain the same. nine0003

The next level is the problem mechanism level. If it is impossible to get to the bottom of the causes, or the impact on the psyche does not give a result, then it is carried out at this level in order to destroy or eliminate the elements of the mechanism. In principle, working on it is less effective than working on the level of causes, however, in many cases it is the only possible way of working, because. the psychotherapist cannot work with the client's psyche directly.
After all, the impact on the psyche is always mediated by many factors, and most importantly - by the client himself. His psychological defenses, energy level, character, temperament and many other features. The most important thing is that by influencing the mechanism of the disease, in any case, we influence the psyche, thereby healing it. nine0033 The case of working with the mechanism of the problem can be described on the example of the practice of my supervisor, a wonderful psychologist Efremova D. N. While studying, he always laughed at her lectures. Once, a patient approached her and reported that in the morning an eye appeared on the wall opposite her bed, which began to watch her incessantly.
- What do you do in this case? Efremova asked.
- I jump up and go to the wall, but the eye disappears at that moment. This is how I spend part of the early morning getting up and going to bed. nine0033 Why do you think this eye is watching you?
- I have no idea.
- Good. Let's do an experiment. The next time the eye reappears on the wall, try not to move and observe it yourself through squinted eyelids.
The next time the patient came to Efremova, the situation changed. Some time after she, following the recommendations, began to follow the eye on the wall, it disappeared, and she fell asleep safely. nine0033 This example shows how the therapist affects the mechanism of the problem, eliminating its elements.
Obviously, the woman's anxious behavior reinforced the mechanism of affect, which in turn aggravated the course of the disease. Eliminating the elements of the mechanism, we eliminate the problem itself in fragments. It can also be said that in this case, by encouraging positive forms of behavior and eliminating negative ones, we are working at the behavioral level.

And finally, the last level is symptomatic. The impact here is carried out exclusively on the symptom of the problem, as a factor that prevents a person from living. Of course, in this case, there can be no question of any elimination of the cause or destruction of the mechanism. This is the level of psychiatry, and therefore the biomedical approach - prescribing drugs. nine0033 The vast majority of mental problems are based on the fact that in childhood and early adolescence a person had a neurotic relationship with his parents and “absorbed” their negative ways of behavior. And it's pretty silly to think that any chemical drug will help get rid of these problems. Its appointment stops the symptoms, thereby maintaining a satisfactory standard of living, but the problem itself remains the same.
This does not mean that drugs do not help. They help to restore contact with the environment at a time when the symptoms interfere with this, and therefore partially destroy the neurotic mechanism. We can say that competent appointment begins to work at the second level. nine0033 Returning to the example of the girl who was diagnosed with schizophrenia, I want to note that the appointment helped to eliminate most of the symptoms, finally get out of the apartment and, ultimately, put social life back on track. But on the other hand, symptom relief is a deal with the devil.

An example from my practice. A woman came to me with a condition she called "protracted depression." As it turned out, the reason is that a few years ago she discovered her husband's infidelity. Everything happened due to a certain negative scenario, which does not make sense to consider here. Having discovered the betrayal, again due to the peculiarities of the psyche and the script, she chose not to say anything to her husband. He continued to change, and she - to receive indirect confirmation of his betrayals. nine0033 This situation eventually led to the emergence of many symptoms, including paranoia, with which she turned to a psychiatrist. The psychiatrist prescribed treatment. As a result, she spent the next couple of years in limbo, in fact, preventing herself from responding naturally to the situation.
It is clear that family or individual psychotherapy would be more appropriate. It is also clear that the psychiatrist could not engage in psychotherapy with her, but did what he had to do - prescribed treatment, but it only delayed the solution of the problem. nine0003

By the way, after a couple of sessions with your obedient servant, she tripled her husband's showdown, including her mistress. A couple of weeks later, she evicted her husband from her apartment and ... stopped providing. For the last year and a half, the faithful lived at her expense. In the end, she thanked me and was perplexed by the realization of the fact that she had spent several years of her life in a dream.
What did I do? For a couple of sessions, he constantly and subtly ridiculed her sacrificial role. The question of the success of our interaction was the following - can I anger her in such a way that she does not become depressed, but feels new forces in herself? nine0033 Concluding the story about this level, I want to note that, in principle, most people tend to solve problems on it, because. the previous two require independent action and, ultimately, a change in life. And, of course, symptomatic treatment gives a guaranteed result, unlike psychotherapy, which may be more long-term and ambiguous.

Now back to the situation with the competence of psychologists. It is clear that they were indignant (together and each separately), because they asked themselves the following question: “Why can we explore the psyche, but we cannot help people?” nine0033 If psychotherapy is not a medical field, then why does it need a clinical education to practice it?
Why can psychiatrists with no knowledge of human psychology help, but we can't?
Asking yourself these questions was additionally stimulated by the fact that the activity of a psychologist is not licensed, because. is not medical.

Then they made a very simple thing. They came up with a new term - psychocorrection. This is an activity aimed at forming in a person the necessary psychological qualities to increase his socialization and adaptation to changing living conditions, as well as correcting the characteristics of psychological development if they prevent a person from achieving his goals. As you can see, they seemed to say: okay, since we cannot treat the psyche, then we will adapt a person to living conditions, by forming the necessary qualities. The attentive reader will realize that this is only one of the many definitions that can be given with equal success to psychotherapy. nine0033 Psychocorrection arose from the activities of domestic psychologists who studied child development and helped them socialize and grow up. In the future, these developments served as the basis for the theory and practice of working with adults.
By adding here a completely broad term - psychological counseling, psychologists received the right to engage in psychotherapy, only under other names. The debate about whether psychocorrection and psychotherapy are synonymous is still going on, but most likely they are led by those people who either have nothing to do in this life, or they are overly involved in the process that I will describe in the next paragraph. nine0003

There is a professional anecdote. An old psychoanalyst dies and calls his sons to his deathbed.
- To you, - he says to the elder, - I give my house.
- To you, - he says to the middle one, - I give all my money.
- And to you, - he says to the youngest, - I give the most precious thing - my clients.

The main thing we are fighting for is the flow of clients to our office. This desire is hidden under the sauces of "concern for the safety of the client and the guardian of the foundations of professional ethics", but in fact it is a simple competition. Yes, most of us have our own moral principles, which more or less coincide with general notions of ethics. But you don't have to lie. We compete for work and its results - the number of positive reviews that give us self-esteem and money. But regardless of these factors, every psychologist, psychotherapist and psychiatrist considers himself the best, and his services - the most effective. nine0003

How to stand out? The surest way is to say that others are crap and you are sweet. They are fake and you are real.
Colleagues who have had the opportunity to study psychotherapy abroad like to stand out here. These went to many years of training, advanced training, went to symposiums, passed supervisions and, in the end, received diplomas and certificates of international level.
The system of professional training and selection is designed to protect the client from unprofessionalism and protect him from the neurotic or mental problems of the therapist, but, of course, this does not work. nine0033 There is a good article - "Profanation of psychotherapy", which was written by psychotherapist A. Varga. There she writes about a classic procedure that separates the wheat from the chaff and keeps our clients safe.
Among the comments I found one particularly cool one, from a colleague who worked abroad - where strict standards are maintained. I quote: “However, only during my residency at the University of Toronto in the mid-70s, the “Chief” psychiatrist and psychoanalyst of all Canada, president and chairman of the Canadian Psychiatric Association and the Psychoanalytic Society and an honorary member of all possible international trade union organizations, Dr. S.G. contacted his client and flew from all his posts. One of the doctors who supported me, for which I am grateful to him, who was in charge of the education of residents, as I later learned, was at the center of the scandal by seducing wards of both sexes. And my personal supervisor, Dr. D.F. - an alcoholic whose lectures were sometimes difficult to understand. Even though I learned a lot from him.” nine0003

Here I will not consider the desire for improvement as a sign of pathology, I will only note that immersion in study and work is hardly possible without prejudice to the rest of life.
In general, when I hear from a psychologist that he is passionate about his work, I internally tense up. There is some trick here.
It is only life that is really worth getting involved in, and it consists of many spheres. To the place of the words of Freud, who said: “The best psychotherapists become not doctors themselves, but in collaboration with them, writers, teachers, lawyers or social workers. They understand human nature, are more connected with people and ideas, and did not agree to spend their entire youth only on acquiring a specialty. nine0003

Everyone knows that it is possible to teach a person the technique of drawing, but he will not become an artist. He can learn to draw, but the works will be "dead". They will not have a spark of the divine idea that distinguishes true art from craft. Therefore, psychotherapy differs from fakes by the ability of a psychologist or therapist to improvise based on the sensory perception of the client and the context of working with him. And sometimes, as in the above case with Whitaker and the boy, the result is actions that are not obvious to the therapist himself. nine0003

That is why psychotherapy, also known as psychocorrection, is an exclusive product. Sometimes they write that, they say, a psychotherapist should have the maximum number of techniques, then he is a master.
This is probably true, but only from one end. At the second end is the following statement - the result of psychotherapy is not the result of the application of a particular technique and not even a strategy for choosing them.
The key factor is the personality of the psychotherapist. In some way, he must demonstrate with his life and its conditions the goal that the client wants to achieve in changing his own. nine0003

The text is already quite large, so I'll start with the recommendations. How to “competently” choose a psychologist or therapist for someone who wants to start working on himself?

First, psychotherapy is a service. If you want to get a haircut, then it’s stupid to choose the first hairdresser you come across. It is better to go to two or three and choose the one who will make the most beautiful haircut.
If you carefully read the text, you understand that the effectiveness of psychotherapy as a service depends on two factors: professional skills and personal qualities of a specialist. At this stage, you cannot avoid the activity that will be the key to success. nine0003

The biggest mistake is to become a hostage to the first specialist you have an appointment with.
At the first meeting, you need to actively get to know him in order to understand how ready you are to trust him with your life? Look at what the one you came to looks like? Excess weight, a wrinkled face, bags under the eyes, an untidy appearance or a style of clothing from the last century - all this should lead to disturbing thoughts. Ask a specialist about his life, hobbies. Can you ask if he is married? Who does he live with? What books are your favorite? What movie is he watching? Try to find out about the identity of the one you came to. Remember, with this person he will treat you. If the specialist seems “strange” to you, then it is better to say goodbye and leave. nine0003

How do you know that a therapist has knowledge and can apply professional techniques? There must be dynamics. Ideally, after each new meeting, you should endure something new for yourself. When a client comes to me for another session, I usually ask: “What has changed since our last session?”
“I feel terrible… things just got worse,” the saddened client says.
- Fine, - I exclaim, catching his surprised look, - this is dynamics! It is really sad if a person does not change, because this indicates three possible reasons, which I will point out below. nine0003

In America, there is a practice in which the services of a psychotherapist are paid for by health insurance. As far as I know, no more than 12 sessions. If you want to keep walking, then pay out of your own pocket. It is obvious that these figures are not taken "from the bulldozer". I’ll add on my own that, in my opinion, if in 6-8 meetings you have not made progress in solving the problem with which you came, then one of 3 reasons takes place:
- they do not engage in psychotherapy with you, but simply talk;
- the personality of a specialist and / or his approach does not suit you; nine0033 - you have too high a level of psychological defenses that you cannot overcome.

Personally, the statements “I went to a psychologist once a week for a year, all this time we talked about my childhood” scare me. Obviously, the only thing you have succeeded in this time is in feeding said specialist and his family. And the responsibility for this lies entirely with you, because we are the hostages of the client. Yes, it is embarrassing to know that a client is wasting time with you and not tell him about it, but it is impossible to know in advance how many sessions he needs to become more aware. I already wrote about this. nine0003

These reasons may not be equally objective for you and your specialist, because in some way, you are still on opposite sides of the barricades.

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