difficult cases, which include patients who have psychotic symptoms, may
require hospitalization, or have unusual responses to psychoactive drugs. Of
the maladies we have discussed, bipolar disorder and medication-resistant
depressions are likely to need psychiatric management.
People seeing psychiatrists should also be seeing a therapist, and
should have a regular primary care physician. All the professionals should
maintain contact with one another, because what each one does affects
the work of the others. Always insist on regular contact, and sign the appro-
priate releases at each doctor’s office. Patients should not be carrying
messages from one doctor to another; there’s too much chance for distortion.
Psychiatrists are usually quite busy and schedule appointments far
in advance. They often spend an hour or two with patients in the initial
evaluation, followed by 15 minute sessions to manage medication.
Psychiatric Nurse Practitioners
Psychiatric nurse practitioners are trained in prescribing psychoactive med-
ications. Their skill level falls somewhere between primary care physicians
and psychiatrists. They generally take more time with patients and are
more available than either.
Psychologists
Psychologists have a Ph.D. (Doctor of Philosophy in Clinical Psychology) or
Psy.D. (Doctor of Psychology) degree and a state license. Some states license
at the master’s level, but usually with a number of restrictions. Psycho-
logical specialties include testing and diagnosis, and, of course, talk therapy.
Being a psychologist myself, I am biased in favor of my own profession.
I think there are two things that set us apart from other people who do
therapy. The first is rigid, written ethical standards and, in most states,
licensing boards that aggressively police those standards. The second is
extensive training in research. In mental health, more than most other
fields, it’s easy to get lost in the internal world of therapist or patient. What
feels good or fits people’s expectations may not be the best or most appro-
priate treatment. Psychologists are taught that controlled studies are nec-
essary to tell which therapy works best for which disorders, that the phrase
clinically provenis an oxymoron. Psychological training pounds respect
for research into the heads of practitioners. Not that we always remember.
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