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Integrated Christian Counseling
Dr. Brian Campbell, 2014

Psychiatrists vs. Psychologists

"There are different kinds of working, but the same
God works all of them in all men. "
(1 Corinthians 12:6 NIV)

 

Developing an integrated Master's level counseling practice will involve reaching out to other professionals in the community.  For example, many of your clients will have medical/medication needs; therefore, it will be important to develop a working relationship with professionals who can consult with you to address these "flesh"  needs.  Personally, I have developed close relationships with a number of  psychiatrists in my local area to help address my client's physical/medication needs.


In addition, you may find that some of your clients present with psychological problems that are well beyond your level of professional training and expertise, or that require specialized psychological  services.  In such cases, finding a Christian psychologist in your area may also help enhance the services you can provide to your clients.  Remember, providing integrated Christian counseling services involves addressing the needs of your client in terms of body, mind, and spirit.  


In this article, I will provide basic information about the education, training, and the role of psychiatrists and psychologists.  It is my hope  that this information will help you "reach out" and effectively utilize other professionals to meet the needs of your clients.


The Psychiatrist: 

Psychiatrists are professionals who train to be doctors and then choose to specialize in psychiatry.  Most of them have received training in traditional psychoanalysis.  Unfortunately, psychoanalysis has not stood the test of time in terms of empirical research.  In addition, it has not stood the test of third-party reimbursement. 

My first predoctoral internship was in psychoanalysis.  I spent a year training in this modality and became quite skilled in the techniques used in this approach.  However, as I look back on my experience, I see that most of it was wasted studying  this particular theoretical approach.  The techniques of psychoanalysis are not used to any great extent in our current society.  Unfortunately, the psychiatrists who were trained in this modality have become “dinosaurs,” with nowhere to turn, except to their medical training.


Today, very few psychiatrists actually practice psychoanalysis.  In fact, I think you would be opening yourself up to lawsuits if you did treat someone with psychoanalysis.  In my opinion, this would be equivalent to a doctor treating someone with a medical procedure that has not been found to be effective. 

Because most psychiatrists have all but abandoned psychoanalysis, almost all of the psychiatrists simply prescribe medications; they do not provide any counseling.  Basically, they do an initial diagnostic interview, and then prescribe medication.  After the medication has been prescribed, the client is scheduled for a 15 minute follow-up medication check.  Actually, my patients tell me that the follow-up often lasts less than 10 minutes.  Medications are adjusted, and then the client is sent on his/her way.  Almost of all of the discussion during these sessions focuses on medication and side effects; there is little or no “counseling.”

With regard to diagnosis, you should know that psychiatrists receive very little, if any, formal training in psychometrics and standardized assessment.  As part of their diagnosis, they typically give a little checklist, or something like the Beck Depression Inventory, but they are not qualified to administer or interpret psychological tests that utilized by psychologists.


Therefore, if you want a thorough diagnostic workup of a client, it is best to send him/her to a psychologist who has been trained in techniques of assessment.  Almost all licensed psychologist receive such training as part of a doctoral degree in clinical psychology.  As part of my responsibilities at Nova Southeastern, I taught “Techniques of Assessment,” so I have a great deal of expertise in this area. 

Now, there is something you should know about psychometric tests and assessment tools.  There are “projective tests,” and there are “standardized” tests.  I trained in projective tests, such as the Rorschach, during my predoctoral internship.  These projective tests are typically based on psychoanalytic constructs.  The Rorschach is very complicated to score, and is really more of a projective test of the examiner than it is of the client.  I would never use it in private practice.  (Learning to interpret the Rorschach was another six months of my life wasted).


There are literally hundreds of standardized tests that psychologists can use to help diagnose and treat their clients.  In my opinion, the most important are the Minnesota Multiphasic Personality Inventory (MMPI) and the Millon Clinical Multiaxial Inventory-III (MCMI-III).  There are different versions of the MCMI for preschool children and for adolescents.

In private practice, the MMPI is not as useful as the different versions of the MCMI.  The MMPI is more useful when used with inpatient psychiatric clients.  The MCMI is especially helpful and relevant for use with outpatient clients who are not as seriously impaired, and who may have underlying personality disorders (Axis II). 

Personally, I feel that MCMI should be administered to everyone who enters counseling.  This is the equivalent of doing “blood work” before starting cancer treatment.  You should not start treatment without undertaking a proper differential diagnosis.  The MCMI is, without doubt, the single most important tool I use at the onset of counseling.  This test is administered in my office after the first counseling session.  It is computer scored and interpreted.  I utilize the information from the MCMI, together with my initial diagnostic interview, to arrive at a tentative differential diagnosis. 

Unfortunately, the MCMI is not available for use by Master’s level practitioners.  Therefore, I would strongly recommend that you establish a relationship with a clinical psychologist in your area, and refer clients for a diagnostic workup.  Almost all clinical psychologists take third party insurance reimbursements, so it may not be an incredible burden on the client to get this assessment done.  After the assessment, the client can be “returned” to you for therapy.

Without the use of the MCMI, it is virtually impossible (even for someone who is as experienced as I am), to properly diagnose complex personality disorders.  Even with my experience, I would “miss” a lot of problems that would be crucial for treatment.  For example, individuals with Narcissistic Personality Disorder often present with very few obvious symptoms, and they are very reluctant to admit any shortcomings.  Interestingly, the MCMI usually clearly identifies their NPD.  In fact, the MCMI is very difficult to “fake,” or undermine.  There are clever checks and balances in the test that make it very difficult to “fake good,” or “fake bad.”

Since narcissists typically believe that there is nothing wrong with them (it’s always someone else’s fault), I especially like using the MCMI with them as an adjunct to therapy.  You see, if they try to look “too good,” the MCMI catches these attempts.  They are almost always “found out,” by this diagnostic tool.  Since effectively confronting a narcissist is important to treatment, I take some secret delight in showing the NPD client the results of the MCMI.  I can tell them, with a great deal of certainty, that they qualify for a diagnosis of NPD.  In my experience, people with NPD are often very bright, and are clever at trying to “dodge” the diagnosis.  Having the data from the MCMI is typically very helpful in getting the process of treatment started.


For example, not long ago I diagnosed a very intelligent man with NPD, based on the MCMI.  When giving him feedback on the test results he wiggled and squirmed, but I kept holding up the MCMI and repeating that “I didn’t take this test, you did, and it definitively indicates that you suffer from NPD.”  After several attempts to blame everything on his wife, he finally conceded in a most unusual and funny fashion.  He admitted, “Well, maybe I am a narcissist, but I bet you I’m the best narcissist you’ve ever treated.”  I laughed, and treatment commenced.


The Psychologist:  
                    

In case you didn’t know, I will tell you the general training that clinical psychologists receive.  First of all, there are two types of degrees:  Ph.D. (Doctor of Philosophy), and Psy.D. (Doctor of Psychology).  The Ph.D. is focused on research and a scientific approach to assessment and treatment.  Students in this program study statistics, experimental design, etc.  Their Ph.D. dissertation is research-based and students conduct actual experiments with subjects.  The Psy.D. program (Doctorate of Psychology), involves much of the same information as the Ph.D., but the expectations for the dissertation are not as rigorous and, traditionally, there tends to be more of a focus on treatment, as opposed to research. Also, there tends to be more of a focus on psychoanalytic psychotherapy.

Both the Ph.D. and the Psy.D.  programs typically take three-four years to complete, plus a one-year predoctoral internship.  The internship involves 2000 hours (one full year) of supervised training in a program approved by the American Psychological Association.  The Ph.D. and Psy.D. programs both require a dissertation, that must be “defended” in front of faculty members.


I completed my predoctoral internship at the Veteran’s Hospital in Pittsburgh, Pa.  During the course of the training, my treatment of clients was very closely supervised by trained psychologists.  I mainly treated Vietnam veterans.  I was involved in family therapy as well as individual therapy.  As I mentioned elsewhere, the orientation of the program was basically psychoanalytic. 

I also completed a postdoctoral fellowship at the Center for Reproductive Medicine and Child Neurology, at the University Affiliated Program of Brown University.  There I trained under a radical behaviorist, and worked mainly with developmentally disabled/mentally retarded, violent and aggressive individuals.  We set up a behavior-training unit and I worked with individuals who were self-injurious and behaviorally disturbed.  By the way, this postdoctoral fellowship was entirely optional.  I was paid a small stipend while undertaking this 2,000 hour (one year) postdoctoral fellowship.  Psychologists are required to accumulate a total of 4,000 hours of supervised training before sitting for the licensure exam.  I obtained 2,000 during my predoctoral internship and 2,000 during my postdoctoral fellowship.


The course work for the Ph.D. and Psy.D. involves training in assessment and treatment.  There are courses on psychometric testing (i.e., how to administer and interpret psychological tests).  There are also courses on child psychopathology, adult psychopathology, personality, human development, behavior modification, cognitive therapy, etc.

As mentioned above, after successfully graduating from a doctoral program, psychologists have to obtain an additional year (2,000 hours) of supervised training under a licensed psychologist.  During this year of postdoctoral supervised training, individuals practice psychology under the title of “intern.”  Finally, after the academic training, the predoctoral internship, and the postdoctoral supervised training, psychologists are then required to take and pass a national licensing exam. 

As you can see, the standards for obtaining a license as a psychologist are very high.  By the way, did I mention that it is extremely difficult to get accepted into a doctoral program in the first place?  There is a tremendous amount of competition for these programs and only a limited student enrollment. 


Finally, I want to mention that psychologists do not receive medical training and are not able to prescribe medications.  However, as part of their training, they do receive education and training in medications, and they often work in settings along-side psychiatrists who are prescribing medication.  Personally, I received a great deal of knowledge about medications during my predoctoral internship at the Veteran’s Hospital.


I hope that all this information will help students at LU understand the basic roles and training of Psychiatrists vs Psychologists.

Dr. Campbell

P.S.  For additional information on the training of a psychologist, you might want to look at the university in which I used to teach.  I was an associate professor of clinical psychology and taught in our two doctoral programs (Ph.D. and Psy.D.).  Click here.