Psychologist or psychiatrist? How to figure out who to go to? Clinic of Dr. Shmilovich "Re-Alt"

, Doctor of Medical Sciences, doctor of the highest category, head of the Department of Psychiatry and Medical Psychology, Russian National Research Medical University named after. N.I. Pirogova, chief physician of the Re-Alt clinic:

If you are reading this post, then you are interested in the topic of mental health. Perhaps now you or your loved one are feeling bad and you don’t know what to do about it or where to turn. I will tell you what types of psi specialists there are and how not to make a mistake with your choice.

Let's start with the fact that most people do not fully understand the difference between a psychiatrist, psychologist, psychotherapist and psychoanalyst. But which of them you get to first is of key importance. Let's sort it out in order.

Psychiatrist

If a specialist calls himself a psychiatrist, you should understand that you are going to a doctor. He is first of all a physician, just like a surgeon, ENT, gynecologist or ophthalmologist, to whom you contact with a specific complaint: pain in the heart, discomfort in the abdomen, heartburn, double vision, and many other symptoms of the disease.

You expect that such a specialist will listen to you carefully, collect a so-called anamnesis, analyze your medical history and prescribe some examination methods, prescribe medications or refer you for surgical treatment that will relieve you of your illness. It’s absolutely the same story with psychiatry, only they don’t cut anything, there’s no scalpel, unfortunately there aren’t as many instrumental diagnostic methods as in surgery that can visualize the disease on a monitor screen.

However, a psychiatrist has his own advantages and unique diagnostic methods. In a normal dialogue, the psychiatrist conducts a thorough assessment of how you think, how you react, what emotions, feelings, experiences you experience, he tries to record all this, build it into a certain diagnostic structure, in order to further determine your illness and begin to treat it. Or tell you the good news that you are healthy and do not require treatment. So, the main goal of a psychiatrist is to catch the symptoms, diagnose and cure the disease.

Classification of mental disorders

The human psyche requires correction and treatment when its condition differs from normal. At the same time they talk about mental disorder.

According to ICD 10, the following mental diseases are distinguished:

Organic mental disorders. These are mental disorders associated with damage to brain tissue. Its symptoms include affects, decreased cognitive function, dementia, delusions and hallucinations, catatonia, and emotional disturbances.
Schizophrenia and schizotypal disorders. These conditions are characterized by productive and negative symptoms. Productive ones include delusions, hallucinations, and mental disorders. Negative manifestations include poverty of emotions, poverty of speech, lack of will, pleasure, motivation and desire.
Affect disorders. Affect is a person’s expression of his emotions and feelings. The most common affective disorder is depression. It is accompanied by low mood and an inability to get pleasure. There are postpartum, alcoholic, seasonal, melancholic, acute, and minor forms. Other affective disorders include dysthymia (mood disorder) and manic-depressive syndrome.
Manic-depressive syndrome is accompanied by alternating episodes of depression and mania. Mania is the inverse opposite of depression. It is manifested by a pronounced increase in mood, motor agitation and accelerated mental activity. Manic syndrome is also distinguished as a separate pathology.
Neurotic disorders. Reversible changes in the psyche, accompanied by asthenic, obsessive syndromes, hysteria, as well as a decrease in mental and physical activity. These include neuroses, neurasthenia, obsessive-compulsive and anxiety disorders.
Behavioral disorders. This group of diseases includes eating disorders - anorexia, bulimia, sexual disorders, and desire disorders.
Pathological changes in personality and behavior in adulthood. These include paranoid, schizoid, dissocial, emotionally unstable, mixed disorders. Persistent personality disorder, pathology of habits, desire for arson and theft, violation of gender identity and sexual preference.
Mental retardation. It is characterized by a decrease in cognitive functions and manifests itself in mild, moderate and severe degrees.
Mental development disorders. It manifests itself in delayed speech development, counting, writing and reading skills, motor and psychomotor functions.
Emotional and behavioral disorders of childhood and adolescence.

Now a psychologist

This is a specialist with a completely different diploma and a completely different way of thinking. He is not competent to provide medical assistance, he cannot provide treatment, he is primarily determined to study your personality, your psyche and your life in its psycho-social aspect. It is aimed at understanding the structure of your worldview, your principles, to see your temperament, resource characteristics, to evaluate your vision of a particular situation and, through an assessment of your psychological parameters, to help you organize your life in a difficult situation.

This situation may be related to work, family, relationships with friends or enemies, and perhaps only to your internal psychological and mental processes. Or it may be related to illness. But in these cases, the task of the psychologist is to detect this in time and establish cooperation with the psychiatrist, and with the patient to deal not with eliminating this disease, but to find options for adapting to the life that has developed in connection with the disease. This is very important, but not enough to get rid of the disease.

Branches of clinical psychology

Psychosomatics. Aimed at identifying the patient’s somatic and psychosomatic problems and their origin. The section studies the relationship between such complex diseases as cancer and the mental factors that provoke them. A psychologist helps prepare the patient for difficult information about the diagnosis, accompanies him throughout the illness, prepares him for surgery, helps with rehabilitation, and so on. In addition, this section is devoted to the disorder - acute chronic mental trauma, which can lead to ischemia, peptic ulcers, hypertension, neurodermatitis, psoriasis, and bronchial asthma.
Psychotherapy is a basic method for psychocorrection. Represents a set of methods and techniques that are used by a psychologist in therapy and in carrying out a number of changes relating to the psycho-emotional sphere of the patient, as well as his behavior and communication skills. Corrective measures are aimed at improving mood, well-being, and adaptive capabilities for development in society. Psychotherapy takes place both in a group and individually.
Neuropsychology is a large separate discipline in science that studies the brain and central nervous system and their role in human mental processes. Includes psychiatry, neuroscience, and philosophical issues in achieving an understanding of how the human mind functions. Studies artificial neural networks, cognitive science. In Soviet psychology, experts considered the issues of cause-and-effect relationships of brain damage, localization of the disorder and changes in the psyche occurring at this time. Neuropsychologists studied such transformations in the functional characteristics of the psyche arising from brain injuries, investigated the location of the leading center of diseases and developed methods of rehabilitation, treatment, as well as the theory and methodology of the foundations for general and clinical psychology.
Psychocorrection is the basis for psychotherapy. It is aimed at directly providing assistance to the patient. Forms not only a psychotherapeutic program, but also subsequent rehabilitation as a systemic medical and psychological activity. Psychocorrection allows you to restore your social status and return to society as a full-fledged member of it, thanks to a combination of pedagogical, medical, psychological and social procedures and activities. This includes mental hygiene, which studies the preservation and support of mental health, and psychological prevention - a set of measures that prevent the occurrence of a mental disorder.

5. Pathopsychology. He studies issues of mental disorders, disorders, violations of the objectivity of perception of the surrounding world, occurring due to destructive processes in the central nervous system. This section explores the patterns of dysfunction of mental processes in various psychopathologies in connection with the factors that contribute to their appearance, and also allows us to find effective methods of correction.

There are also psychotherapists

Officially, such a specialist is primarily a doctor who also has a medical diploma and is aimed at treating, identifying and diagnosing the disease. But he is different from a psychiatrist. The psychotherapist heals with words. He does not use pills, no biological correction methods, he works with the help of words. This word can be wrapped in different shells, in different methods of psychotherapy. There are a wide range of psychotherapists who, having mastered different techniques, can use one or another, depending on the patient’s personality.

However, a psychologist can also be called a psychotherapist. And many psychologists quite rightly call themselves this, although this cannot be officially the case. Nevertheless, we admit the possibility of psychotherapeutic correction by a psychologist, if the goal of this psychotherapy is to heal the soul, but not the disease, not the body. And of course, in this situation, a psychotherapist-psychologist will differ from a psychotherapist-psychiatrist in that his main goal will not be the treatment of the disease, but the correction of the personality.

general information

In the 90s, medical and clinical psychology meant the same thing. Today these are still two different disciplines. They should not be confused with psychiatry. They have similar tasks, but different treatment methods. Psychiatry is aimed at eliminating pathologies and defects that require hospitalization or inpatient treatment. These diseases are schizophrenia, manic-depressive psychosis, epilepsy. Clinical psychology studies the problems of maladaptation and borderline mental states, when a person is not yet pathologically ill, but is no longer normal.

The distinction between pathology and norm is a rather complex process. At the moment, the corresponding norms for age-related development are divided; each period has its own criteria for feeling the world and relating to it. The psychologist assesses how harmoniously developed a person is - how he gets along with himself and others, whether he knows how to be flexible, the ability to think objectively, resistance to stress, the ability to plan and adjust his daily routine, and observe a work and rest schedule. The norm is how a person copes with life’s difficulties, enters society, works productively, and how critically he thinks.

When diagnosing, a clinical psychologist and psychiatrist use their personal experience, adhere to the recommendations of general psychology, as well as information from the ICD and the Handbook of Mental Disorders.

The subject of clinical psychology can be:

Preparation and implementation of psychotherapy methods.
Disturbances in mental development.
The emergence of destructive changes in the psyche.
The use of psychological techniques to influence the patient’s consciousness for the purpose of treatment and as prevention.
Organizing research using specific tools and defining principles for this, methodology.
Finding out how various disorders affect the patient’s psyche.
The role of the psyche in the emergence, progression and prevention of disorders.

So, clinical psychology is a discipline that involves assessing mental health, planning and conducting research in the scientific field to diagnose and identify mental problems.

Psychologists develop and conduct psychocorrection and psychotherapy. They also explore issues of general psychology, compare normality and pathology, study the boundaries of the normal, determine how the social and biological relate in a person, and try to resolve the problem of mental decay.

Psychoanalyst

This is a specialist who may be a psychotherapist or a psychologist-psychotherapist. Psychoanalysis

is a well-known technique that has existed for many decades and has long established itself as an absolutely proven technique in both psychiatry and psychology. Modern psychoanalysis can be called an independent discipline, based on the key principles of the architecture of the human psyche, discovered by Sigmund Freud and his followers and based on the theory of the unconscious. Once you see a psychoanalyst, you will have the opportunity to discover a lot of new things in the content of your mental life and direct its course in a direction that is comfortable for you.

History of appearance

Clinical psychology began to develop at the turn of the 19th century by French researchers and Russian psychiatrists. Among the French we can single out J.-M. Charcot, R. Ribot, P. Janet, I. Taine. Russian scientists include V. M. Bekhterev, S. S. Korsakov, V. Kh. Kandinsky, I. A. Sikorsky and other prominent psychiatrists of those years.

Thus, V. M. Bekhterev founded the first psychological laboratory in Russia in 1885. It is on the basis of the Psychoneurological Institute named after. A large number of studies have been carried out on Bekhterev.

I. P. Pavlov, V. P. Osipov, V. N. Myasishchev, G. N. Vyrubov influenced the direct development of Russian clinical psychology. A special role in psychology in general was played by L. S. Vygotsky, and then his ideas were supported and continued by A. R. Luria, P. Ya. Galperin, A. N. Leontyev and others.

During the Second World War, all famous psychologists, the best of them, were sent to military hospitals and learned the basics of medical psychology in practice. Among them were B.G. Ananyev, S.L. Rubinstein, A.N. Leontyev, A.V. Zaporozhets, B.V. Zeigarnik. This entire galaxy of scientific minds helped soldiers cope with injuries, stress, and survive brain damage. It was this practice that allowed them to formulate the first provisions of clinical psychology, since unique extensive material was collected on mental disorders that are associated with localized brain disorders.

So we figured out what kind of specialists these are. So, what is next?

How can I understand whether I’m sick and I need to see a psychiatrist, or whether it’s just a life collision and I should see a psychologist? Most people think like this. I’ll go to a psychologist first, listen to what he says, try his therapy, and if it doesn’t help, then I’ll go to a psychiatrist. Or, on the contrary, I’ll go to a psychiatrist, find out what the doctor says, and if anything happens, then I’ll refuse his treatment and go to a psychologist. This tactic seems logical. I'll try one thing, if it doesn't work I'll go do something else. But unfortunately, most often this path is never completed. And it turns out that a patient in need of medical psychiatric help receives only psychological support for a long time, and a mentally healthy person who most needs psychological support and psychotherapy comes to see a psychiatrist and does not receive qualified psychological help.

The only correct move in such a situation is to kill two birds with one stone and sign up for a joint consultation with two specialists.

You will immediately receive an answer to your main pressing question, whether you are sick or not, and you will immediately find out with whom you need to deal with your complex life problem.

What is a joint consultation between a psychiatrist and a psychologist?

This is what most progressive psi specialists around the world strive for. Unfortunately, it is not always possible for psychiatrists and psychologists to find a common language, to find a consensus, because these, as you already understand, are completely different people, from different planets, who think and see people differently. Therefore, almost all attempts at professional interaction, unfortunately, turn out to be short-lived, often end in a break, and in the end, psychiatrists go to their lair, psychologists to theirs, and only occasionally transfer patients to each other. And, of course, this does not always benefit patients.

In 2015, we decided to realize our dream and unite specialists from two different areas in the Re-Alt psychotherapeutic center. And we did it! Ultimately, over the years, very good connections have been developed, very interesting interactions; our psychiatrists and psychologists have formed professional duets and always work together at the initial appointment.

Patient coming to appointment

, sits down at the same table with such a pair of specialists and begins to communicate with them at the same time. Each of them asks their own questions. After such communication, the specialists leave the patient alone in the office for a few minutes with a cup of coffee, while they themselves go into the next room, discuss what they heard and return to report their judgment. The doctor reports his diagnostic conclusion, the psychologist talks about his psychological vision of the situation in your life. And the patient who comes to the appointment for the first time ultimately receives the most important information for himself: what is happening to him.

If the patient is mentally healthy

, but the problem still exists, then the psychologist takes the reins into his own hands and then the person understands that he does not need to be treated by a doctor and calmly continues to work with a psychologist or psychoanalyst.

If the doctor understands that the patient is seriously ill

and he now needs medical care with obvious dominance, then a psychiatrist begins to deal with this patient in the future, he prescribes medication from the very first dose and offers options for dynamic observation on an outpatient or semi-inpatient basis, and sometimes in an inpatient setting.

Or, as most often happens, both a psychiatrist and a psychologist find something different and offer therapy in parallel.

The psychiatrist meets with the patient as a doctor, monitoring his drug therapy, assessing his health, and the psychologist conducts sessions with him, solving other problems.

The effectiveness and practical advantages of such a union

We have learned from many years of experience. It is in this tandem of work of two different specialists that the effectiveness of the care provided to the patient doubles, if not triples, and we arrive at the desired result much faster.