Basics

Thanks, all, for the great feedback so far about the blog!  I'm having a lot of fun writing, and I've got several posts in the works based on your ideas and suggestions.  Please stay tuned...

For today's post, I figured that the beginning is a good place to start.  Not my beginning (it's spectacularly unremarkable, really - grew up in Southwestern Ontario...same house for 18 years, youngest of 6, blah, blah, blah), but some basic info about clinical psychology.

After more than 10 years in the business, I've fielded a lot of questions.  People are curious.  There's a mystique (some call it stigma) about mental health and what psychologists do.  So here, in no particular order, are answers to the the top 4 questions people ask.  (I know.  "Top 5" has so much more cachet but there are only 4):

1) What's the difference between a psychologist and psychiatrist?

Psychiatrists are trained as physicians.  They typically complete an undergraduate science degree, followed by a degree in medicine (an "m.d.") which earns them the privilege of using the title, "Dr."

Following completion of their medical degree, they undertake extensive (6 years in Ontario) practical training in how to identify and treat mental illness.  Their training is usually hospital-based and, as such, they tend to treat individuals with severe mental health issues.  That being said, some psychiatrists do practice in community-based settings such as clinics and treatment teams.

Because they are physicians, psychiatrists can prescribe medication and they may have "admission privileges" - that is, they can admit individuals to hospital for treatment.  Psychiatrists can also formally "diagnose" individuals with mental disorders (e.g., schizophrenia, bipolar disorder, borderline personality disorder).

Psychologists are trained in a "scientist-practitioner" model.   They complete a Ph.D in clinical psychology which involves extensive research and academic training in mental health issues, as well as intensive practical work with clients.  Most psychologists have completed an undergraduate degree (usually in psychology or a related field) and then a doctoral degree in clinical psychology (5-6 years).  All of this gives them the legal right (in Ontario) to use the title "doctor" and call themselves a psychologist.

Like psychiatrists, clinical psychologists are experts in the assessment and treatment of mental health issues.  Unlike psychiatrists, they do not prescribe medication and they do not admit people to hospital.  Like psychiatrists, they are permitted to formally diagnose mental disorders.  Clinical psychologists typically receive more intensive training than psychiatrists in the process of doing research, as well as the use of the standardized assessment human behaviour (such as thinking, learning and socio-emotional functioning).

Because they are physicians, the services of psychiatrists in Ontario are paid for by the provincial health care plan (OHIP).  The services of clinical psychologists are sometimes covered by OHIP, but only if they work in a publicly-funded institution, like a hospital or community clinic.  Clinical psychologists who work in private facilities charge a fee for service.  Fees are, to a large extent, regulated by their professional college.

So, big difference.  Very confusing.  Call them both doctor.  They've earned it, given the massive student loans they've probably accrued.

These are the basic differences but please keep in mind that there are many more I haven't covered here.  Sometimes the differences arise because of varying provincial and state laws that govern professions.  But, more practically-speaking, psychiatrists and psychologists each tend to have a unique way of seeing mental health and illness, which affects how they approach assessment and treatment.

The best discussion that I've seen about these differing perspectives is Steven Kingsbury's 1987 article in American Psychologist: Cognitive Differences Between Clinical Psychologists and Psychiatrists. Kingsbury is trained as both types of professionals (not sure...glutton for punishment maybe?) so he oughta know.

2) What's a psychological assessment?

A psychological assessment is a process for evaluating facets of human functioning such as thinking, learning, emotional functioning and/or behaviour.  Assessment can include information gained through interviews, observations, review of other documentation and/or the administration and interpretation of standardized tests.

As mentioned above, clinical psychologists are trained extensively in how to use standardized tests.  "Standardized" means that the test is given and scored in the same way for everyone.  It also means that an individual's pattern of responses can be compared to the collective (or "normative") responses of other people of the similar culture, age and (usually) gender.  Standardized assessments are one tool among many that psychologists use to gather information about an individual's current functioning.

Psychologists assess for different reasons.  The reason is usually based on the question at hand, or, the "referral" question.  A 9-year old boy might be referred for an assessment because he isn't doing well at school, relative to other kids his age.  As such, the assessment would involve an analysis of the his learning strengths and needs and, ultimately, recommendations about how his teachers and parents can support him at home and at school.

Similarly, a young woman might be referred because she is feeling down, has lost quite a bit of weight, and is spending increasing amounts of time alone in her room.  A psychological assessment with her might, involve an analysis of her functioning using a combination of clinical interviews (i.e., asking her formulated questions about her history and background and current functioning), her responses to a series of standardized tests, as well as a review of any other available and relevant information.

Reviewing all of this information in context can help the psychologist formulate a better understanding of what is happening for this young woman and what might help her get back to good.  She might, for example, be suffering from clinical depression and, as such, she could benefit from some counselling sessions to help her learn new ways of thinking and coping.  Similarly, it might be beneficial for her to see her family physician to discuss medications that help fight depression.  Maybe both strategies would be helpful.

Psychological assessment is a complex process requiring much thought, experience, expertise and analysis.  Hence the many of years of schooling in order to do it thoroughly and well.

Also.  If you are someone who dreams of dating either of my daughters, (I'm thinking when they reach the age of 30 or so, but I can be flexible), please understand that you will first be asked to submit to a full psychological assessment.

Just sayin'.

3) Are you "analyzing me" right now?

Typically posed at parties.  Makes me want to lie and say that I am a hair stylist in response to "So, what kind of work do you do?"

Short answer?  Nope.  When I'm not at work, I'm just Barb.  Have you tried the dip?

4) What's it like in a psychiatric ward?

The psychiatric wards I have spent time in look much like any other hospital ward you've visited.   There are people milling about, some wearing scrubs and Crocs, some wearing hospital gowns/robes and some wearing street-clothes.  A few wear white coats and carry clipboards.  There's typically a cubicle in the middle where people are typing away at computers and/or talking to each other or on the phone.  From time to time, there's an announcement over the P.A. system paging somebody.

People are not typically violent, per se, but it happens.  You might be aggressive too if your brain was chemically imbalanced such that you couldn't trust your own perceptions and the world was, therefore a chaotic and frightening place.  But aggression is a lot less frequent than you might think.  I found that if someone did become agitated, the well-trained staff (usually nurses and orderlies) functioned together beautifully to help diffuse the situation before it became a crisis.

Sometimes you hear and see odd things.  After all, folks who are admitted to hospital for treatment of mental illness are, by definition, quite ill and sometimes out of touch with reality.  This can lead them to say and do relatively bizarre things.

For example, I was once working away in my office when I swore I heard a monkey in the hallway.  I called a colleague down the hallway.  Luckily, he heard it too so we ignored it and kept working.

There you are.  The top 4 questions and answers.  Now you know.

Be well,

Barb