Psychologist or psychiatrist — who do I need?

A psychiatrist is a medical doctor who can prescribe medication. A clinical psychologist is not a doctor of medicine and cannot prescribe; they assess and deliver therapy. Many people need one, some need both, and either can tell you which.

A psychiatrist trains first as a doctor of medicine and then specialises in psychiatry. The route is a medical degree, then general medical practice, then specialist psychiatric training. That is why a psychiatrist thinks about the brain and the body together, can consider whether a physical illness or a medication is contributing to what you are experiencing, and can prescribe.

A clinical psychologist trains in psychology — the study of how people think, feel and behave — and then specialises clinically, through a postgraduate degree followed by a long period of supervised clinical practice with real patients. That supervised period is the part that matters and the part nobody outside the profession ever asks about. At PHC every psychologist holds a minimum postgraduate qualification in clinical psychology and over 800 supervised clinical hours, and several hold several thousand.

Neither training is shorter than the other. They are simply pointed at different things: one at diagnosis and medical treatment, the other at assessment and psychological treatment.

The difference people actually notice is time.

A psychiatric appointment is often shorter and is structured around symptoms, history, physical health, medication and how you are responding to it. A psychiatrist may see you for a longer first appointment and then briefly at intervals to review.

A psychology session at PHC is 50 minutes, and it continues at that length for as long as the work continues. It is a working conversation. Depending on what you have come with, it might involve looking at patterns of thinking, practising something between sessions, working through a memory carefully and slowly, or — for a young child — using play rather than talking, because a six-year-old cannot narrate their own distress and should not be asked to.

Psychologists also carry out formal psychological assessment. That is the structured, standardised testing that produces a written report: IQ and learning assessment, neurodevelopmental assessment for ADHD and autism, personality assessment, neuropsychological assessment. Psychiatrists generally do not administer these; psychologists do.

A great many people see a psychiatrist for medication and a psychologist for therapy at the same time, and the two working in parallel is a well-established way to be treated rather than a sign that something has gone wrong.

What matters is that they know about each other. If you are seeing both, tell each one. A psychologist who does not know what you have been prescribed is working with a piece missing.

PHC is a practice of clinical psychologists. We assess, we deliver therapy, and we do not prescribe.

Every route into PHC starts with an initial session whose job is to work out what is actually happening rather than to begin treating it. If that session concludes that what you need is psychiatric input, we will tell you so directly and work alongside a psychiatrist rather than around one. If it concludes that what you need is not us at all, we will tell you that too and point you somewhere else. That answer is free and it is the honest use of a first appointment.

If what you are dealing with is low mood, anxiety, trauma or a child's difficulty at school, those pages set out how PHC assesses and works with each, and the assessments section sets out what each formal assessment measures and what its report contains.

• What happens in a first session
• Is therapy confidential?