It may seem a little strange for me to be writing about two professional designations that aren’t mine. In my years practicing counselling as a registered clinical social worker, I have noticed that psychologist and psychiatrist are frequently used interchangeably or inaccurately. 

This is understandable. There is a lot of confusion about mental health service professionals, including designations in British Columbia.

So, in an effort to clear some of this confusion, it seemed like an article was in order.

I’m limiting my discussion to BC, as this is where my practice is situated. Please note that other regions of Canada, North America or other parts of the world could have different educational and legislative requirements around what it means to be a psychologist or psychiatrist.

I welcome any feedback from any local psychiatrists or psychologists reading this article if there are any errors or omissions in the information presented. And apologies for the length; I recognize that this article will only appeal to those who are searching for more in-depth information about the distinctions between these two professions!

Common Misunderstandings

Themes I’ve noticed:

• Confusion about the difference between psychologists and psychiatrists. Commonly, ‘psychologist’ and ‘psychiatrist’ being used interchangeably or incorrectly.
• ‘Psychologist’ and ‘psychiatrist’ being used tentatively or quizzically, as in “I’m not sure if I’m saying this right…”
• Confusion surrounding psychologists’ and psychiatrists’ roles – Most commonly, “My psychologist prescribed me medications.”
• People addressing me as Dr. Sutherland, when I am not a doctor (I have a Master’s degree in Social Work, not a medical degree or PhD).
• The psychologist designation being applied to any counsellor, therapist or mental health professional (and, as I’ve written about before, anyone can call themselves a counsellor in BC, as “counsellor” is not a legislated profession) .
• Surprise that psychiatrists are medical doctors
• Confusion about some psychiatrists’ practice – Most commonly, shock/anger/surprise when a psychiatrist did not provide counselling or psychotherapy (some do) to the patient who had expected it, or the perception that the psychiatric interview felt more businesslike than therapeutic.
• Confusion about the scope of my practice – Commonly and first, “Do you prescribe medications?” or “Can you recommend a medication?” (The short answer is both is no; social workers are not qualified to prescribe or advise on medications) and second, “Can you make mental health diagnoses?” (The short answer is yes; registered clinical social workers in BC, like psychiatrists and psychologists, are authorized to do so under current legislation).

What is a Psychologist?

The British Columbia Psychological Association defines a psychologist as “a mental health professional trained in the study of human behaviour and in the assessment, diagnosis, and treatment of mental health issues and behavioural disorders.”

Keeping in mind that there are regional variations around qualifications to become a psychologist, or in the case of BC, a Registered Psychologist (R.Psych), let’s look at some of the key requirements in BC; for more comprehensive information, head to the website for the College of Psychologists of BC (CPBC).

Education

According to the CPBC, most registered psychologists in the province have a PhD (Doctor of Philosophy in Psychology) or less commonly, a PsyD (Doctor of Psychology degree); doctoral-level training is the current educational standard for registrants in BC. The CPBC notes that the total amount of years of university study for psychologists is 10 year or more. The CPBC further clarifies that a key difference between the PhD in psychology and the PsyD, is that while both have similar coursework, the former is more research-focused, where the latter is less research-intensive.

Credentialing

In BC, the R.Psych credential is administered by the CPBC, whose mandate is to protect the public. For registrants that have completed a PhD or PsyD at an accredited university, there is a requirement to complete comprehensive oral and written examinations as well as to fulfill other requirements as set out by the College, including select paperwork and criminal record/police checks. Requirements must also be met annually in order to maintain registration (the R.Psych credential) with the CPBC.

Specialization

Because the field of psychology (the study of human behaviour), is broad, psychologists will choose a specialization, which most commonly falls under these categories, according to the CPBC: clinical psychology, counselling psychology, clinical neuropsychology, or educational/school psychology.

Scope of Practice

In describing what psychologists do, the CPBC states, “psychologists are trained to assess and diagnose problems in thinking, feeling, and behaviour as well as to help people overcome or manage these problems.” The CPBC adds that psychologists also use psychological tests to help with assessment and diagnosis and employ a range of psychotherapies to help people with their life difficulties. Psychologists are not authorized to prescribe medications but are authorized to make mental health diagnoses.

Access

Psychologists work in both the public and private sectors. In the public health care system, psychologists can be found in hospitals, mental health clinics/teams, schools, prisons, rehabilitations centres and more. Private settings include but are not limited to self-employed psychologists in private practice and those working in specialized clinics.

Title

Psychologists may use the title “Dr.” before their name.

Cost

Unless you are being seen at a publicly-funded clinic, hospital, community agency, government facility or company where psychology services are covered, psychologists are hired privately.

Often professional associations will recommend a particular rate schedule, however I was not able to find official confirmation of this online. A survey of several private psychologists in Vancouver report that the current recommended hourly rate is $200/hr.

Unless part of a government-funded program, psychologist fees are not covered by the Medical Services Plan (MSP), although for those with an extended health plan through their employer, fees for a registered psychologist may be covered, or partially covered, up to a certain annual maximum.

What is a Psychiatrist?

According to the BC Psychiatric Association (BCPA), “psychiatrists are medical doctors who specialize in treating mental illness such as depression, mania, anxiety, psychosis, and addiction.”

Education

To become a psychiatrist, the BCPA advises that after the completion of a university undergraduate degree, the next step is to attend four years of medical school at an accredited university, followed by five years of specialist medical training in psychiatry, or what is known as “residency.” Psychiatrists are medical doctors with a specialization in psychiatry.

Credentialing

All psychiatrists in BC are regulated by the College of Physicians and Surgeons of BC LINK whose mandate is to protect the public. Psychiatrists, like all physicians, are subject to a strict regulation process which includes, but is not limited to, educational verification, training, practice experience, references and a criminal record check.

Specialization

As with psychology, a psychiatrist may choose to specialize; for example, child and adolescent psychiatry, geriatrics, mood disorders, psychotic disorders, forensics, etc.

Scope of Practice

Psychiatrists can and frequently do provide mental health diagnoses. 

As medical doctors, they may also prescribe mediation and are responsible for monitoring the effects of medications on their patients and are trained to understand how medications may interact with other body systems. While most do prescribe medications, some psychiatrists may choose not to do so.

Some psychiatrists may also provide counselling and/or psychotherapy as part of their practice, while others do not. For potential patients in Vancouver seeking counselling or psychotherapy from a psychiatrist, I could not find any information or resource lists that could direct them.

Access

To access the services of a psychiatrist in BC, patients will need to be referred by either their family doctor, a GP at a walk-in clinic or sometimes, a mental health program.

For psychiatric emergencies, there is typically an on-call psychiatrist or resident at the emergency department of the hospital. Psychiatrists and psychiatric residents also provide treatment in psychiatric inpatient units.

Psychiatrists can also be found at local outpatient mental health teams and some mental health programs.

Title

Psychiatrists may use the title “Dr.” before their name, and typically do.

Cost

In British Columbia, there is no cost to see a psychiatrist; psychiatric services are covered by the Medical Services Plan (MSP).

In Summary – Main Points

Education

Psychologist – PhD or PsyD following master’s and undergraduate degrees

Psychiatrist – Undergraudate Degree; Medical school; Specialist Residency

Professional College Regulated

Psychologist – Yes

Psychiatrist – Yes

Mental Health Diagnosis

Psychologist – Yes

Psychiatrist – Yes

Prescribe Medications

Psychologist – No

Psychiatrist – Yes

Counselling / Psychotherapy

Psychologist – Usually

Psychiatrist – Sometimes

Title

Psychologist – “Dr.”

Psychiatrist – “Dr.”

Cost

Psychologist – Usually private pay or insurance

Psychiatrist – Covered by MSP

Access

Psychologist – Usually self-refer

Psychiatrist – Referral through GP