What is the difference between a psychologist, psychotherapist, psychiatrist, and psychoanalyst?

In the U.S., psychologists are doctors and experts in the field of psychology. Clinical Psychologists are also experts in psychological testing. Psychologists receive their respective doctorates in Psychology (Psy.D.), Philosophy (Ph.D.), or Education (Ed.D.) and will list these credentials after their name. Doctoral psychology programs are typically 5 years long and include 1 or 2 years of postdoctoral residency. Once a psychologist is licensed with their respective state’s board, they may treat patients (or “clients”) for mental health problems and psychiatric conditions. Some states allow psychologists to prescribe psychiatric medications after completing an additional Master’s degree in psychopharmacology, though this is not the norm.

In the U.S., psychotherapists must hold a minimum of a Master’s degree in psychology or a respective mental health or counseling field (such as Marriage and Family therapy). All clinical psychologists are trained to be psychotherapists, but not all clinical psychologists practice psychotherapy. Licensed psychotherapists have credentials following their name, such as “LMHC, LMFT, LPC,” etc. If you see an “A” next to someone’s credential, this means they are still in training under a fully licensed supervisor.

In the U.S., psychiatrists are medical doctors (M.D. or D.O.) who completed 4 years of medical school and 4 years of postdoctoral residency in their respective specialty (psychiatry). Their focus is on prescribing medication for biological and psychiatric conditions - they are trained to offer psychotherapy. Freud and Jung were psychiatrists who invented the first psychotherapy called psychoanalysis (or Jungian therapy). Roughly 2% of modern-day psychiatrists follow this tradition to be trained in psychoanalysis as well.

Psychoanalysts are uniquely trained Master’s/Doctoral mental health professionals who specialize in treating the unconscious mind, the oldest form of psychotherapy. Today, psychoanalysts are required to complete 2-5 years of additional training in psychoanalysis, and clients usually commit to long-term or lifelong therapy with their analyst.

There are other providers who treat mental health problems like LCSWs and PsycNPs, though these folks typically have much less training in psychotherapy compared to those listed above.

What do psychologists do that masters-level mental health providers cannot do?

Psychologists are the only professionals who are trained to administer psychological testing, including neuropsychological evaluations and personality tests (e.g. ADHD, Autism, Personality Disorders, etc.). They may also be doctoral-level researchers, doctoral-level professors, and doctoral-level psychotherapists. In addition to clinical interviews and observations, clinical and school psychologists are qualified to differentiate between diagnoses through psychological testing, which significantly improves the accuracy of the diagnosis.

Some people consider psychologists to be “experts in therapy” because they are required to complete more years of therapy training under a licensed therapist than other mental health providers. However, it is important to remember that achievement (e.g., holding a doctorate in psychology) does not equate to higher-quality care or improved treatment outcomes. Genuine care for people, specialization, evidence-based treatment, outcome measurement, and higher-quality training are usually better indicators of whether someone is a “great therapist”.

How does therapy actually work? Can it really help me?

Psychotherapy (aka “therapy”) works similarly to other types of therapy (physical therapy, OT, etc.) in that a person is guiding you towards your personal health goals or treating a diagnosis you hold, using their expertise. Specifically, a psychotherapist explores their client’s mental, emotional, and relational challenges, identifies a treatment plan that aims to improve their life, regularly collaborates with the client to determine what is working vs what is not, and applies tools and techniques that “adjust” both themselves and their client to meet treatment goals. The primary tool that a good psychotherapist will use is the therapeutic relationship itself. The highest-quality studies on therapy effectiveness show that the safety and quality of the “therapeutic alliance” is the best predictor of treatment outcomes, so how you feel about your therapist and how they treat you, is a crucial factor in whether therapy will be effective for you. Other very popular tools psychotherapists use include mindfulness training, exposure, cognitive reframing, somatic experiencing, and psychoeducation.

I tried therapy before - it didn’t help me. Should I try again?

Like in all professions, not all therapists are “made equal”, and the quality of treatment fluctuates based on individual differences, relationship “fit”, the provider’s training quality, attitudes towards the field and clients, and many other important factors. It is always important to find a therapist you feel safe with and someone you believe can help you. Not every therapist is made for every client either. Just like in dating or friendship, sometimes finding the right therapist is about not giving up on your search, staying open, and getting clear on what you want out of that relationship.

Hope is a significant factor in seeing progress, so if you don’t have hope that your specific therapist can help you, it would be a good idea to raise this issue with your provider to give them a chance to explore this with you (and change what they can), or to help you find someone who is a better fit for you (if you would like their help).

How do I find a therapist that is a “good fit" for me? How will I know they're right for me?

To start, you'll want to get clear about what you hope to change or improve. You do not need to get your own diagnosis correct, such as “I'm stuck in addiction” or “I have ADHD”, you just need a sense of what is hurting or causing distress that you want help resolving.

If you are being asked to go to therapy by a partner, parent or adult-child, you may not get the most out of therapy. Good therapy requires am eager buy-in from the client to go on a journey of curious self-exploration and uncomfortable transformation. If you are only in therapy because someone else wants you to change, you will likely find your sessions unhelpful or wasteful. Pyschotherapists are not magicians and psychotherapy is hard work when it's done “correctly”. If you are unwilling to do “the work” (i.e., coming prepared to explore your self and try new things), you may not be a good candidate for therapy at this moment.

If you are ready to find a therapist, most people begin by using a search engine like Google or therapist registry like Psychologytoday.com to find a mental health professional in their zipcode or state. There are lesser-known sites too, like therapyden and goodtherapy. ChatGPT is also a good option if you need help pinpointing a therapist for your specific needs, or you can ask your GP/PCP for a referral. Within these registries, you’ll be able to “filter” for specific needs or preferences you have.

I like to filter by the primary issue, modality, training, and location when helping someone find a “good fit”. Ask yourself, do I need a “hands-on” approach like in Somatic Experiencing or art therapy? Is my condition severe or complex, requiring a trained specialist, like in cases of trauma, Anorexia Nervosa, or debilitating OCD? If yes, look for therapists who specialize in this “primary problem” rather than trying to filter for every issue that you want help with. If no, consider what else may be important to you - such as a holistic approach to mental health, or a therapist who is/is not religious, etc.

Most importantly, read the therapist’s bio or website, and then schedule a consultation with the potential provider to get a feel for them as a human being. If you are in crisis, a “good enough” therapist may be the right decision for you until the storm blows over. If you can tolerate searching for a “great fit,” - this is often worth the effort and time.

Be wary of providers whom you do not feel safe with, such as someone who gives you a cold or dismissive attitude, or behaves inappropriately. If this happens, I recommend continuing your search for a “safe, hopeful” relationship.

Should I do in-person or online therapy? Which is better?

Studies examining treatment outcomes and satisfaction of online vs in-person do not show significant differences, and thus, it is really about your personal preference and circumstances. I prefer to see folks in person whenever possible because I get better data doing in-person sessions, especially when I am first getting to know a client. I strongly encourage client’s to begin with in-person for at least the first 6 sessions before they consider moving online.

If you want to expand your therapist options, filter for “Online Therapists” to cast a net as wide as your state. Some states only allow you to see a therapist located in your state, so always ask your online therapist if they are all allowed to see you based on where you reside.

Online coaches are not legally limited to state or country restrictions. Today, many psychotherapists have a life coaching business in addition to their therapy practice, which allows them to offer non-clinical services and support across time zones.

Feel free to send me a message with more questions you have! Text 512.957.9628 or email dryuliashtarev@gmail.com