What is the difference? Psychotherapy, psychology, psychiatry
It can be difficult to understand exactly what each of these titles mean when it comes to searching for help. Navigating the mental health sector and searching for help in times of stress or crisis can be overwhelming and confusing. I have been frequently told by families that it feels as though the onus is on them to do the hard work or research, despite the consistent messaging out there to "just ask for help". The question becomes "where?", "ask who?", "how am I supposed to know what will be most helpful?".
To assist in the search, I will attempt to outline broadly the approaches of each discipline. This may provide some further understanding about which approach may be best suited for you and your family. I also offer free initial phone consultations during which I am happy to further discuss whether or not child psychotherapy may be suitable for your child and family.
A psychiatrist is a medical doctor who has trained to become a doctor, then further specialised in the field of psychiatry. This is a lengthy process which equips psychiatrists in understanding medically what may be occurring.
Psychiatrists are able to prescribe medication and a formal mental health diagnoses which may reduce the effects of mental illness and distress. Psychiatric care is often the first port-of-call in crisis situations, as it rapidly addresses the risk at hand to reduce overwhelming or dangerous distress. Contact with psychiatrists is often brief and clinical, requiring ongoing revision to discuss whether or not the medication provided is having a good effect.
Psychiatry may be useful for those with diagnosable mental illness. Resolving debilitating symptoms or immediately reducing distress can be necessary to maintain safety. Some people find that psychiatric medication can give them a much needed 'break' from their symptoms, allowing space for other healthy habits such as exercise or socialisation to re-emerge in their lives.
People can often feel, however, that the medication alone is not able to fully address the whole problem despite sometimes addressing the presenting symptom. Distinct from other forms of medicine in which a problem can be accurately addressed following clear protocols, psychiatric medicine is an ever-evolving practice in which there is not often a single or clear diagnostic pathway. That means, that although one psychiatrist may prescribe medication A to address one problem, another psychiatrist may prescribe medication B to address another which they think is more pressing. This trial-and-error process can leave families feeling hopeless and helpless, as though those in a position to help are not willing to 'do much' to really get to the root of what is going on.
Psychology is a behaviour-oriented, therapeutic practice which is often used in conjunction with psychiatry to provide both symptom management, and therapeutic input. Psychologists are often versed in a number of standardised techniques (like CBT or mindfulness) which map and address patterns of behaviours which need to be altered. Psychologists utilise a mixture of these techniques in a combination which feels most useful for their client. Some psychologists are able to give mental health diagnoses (like depression, or ADHD) however are not able to prescribe medication.
Advice from a psychologist can often involve a range of suggestions or templates which families can take home and attempt to integrate into their lives. This may include changes to routine, thinking or discipline. Psychologists are well versed in child development, which allows them to identify abnormal behaviours and teach coping mechanisms.
Psychology can be useful for those who want an answer to a problem. This can, however, feel as though it is too rigid. People often associate psychologists with 'homework', that is, they feel they are given many tips or suggestions of things they can do and are then expected to return home and practice these things. There is an element of truth to this; healthy habits are indeed conducive to health. However, at times of struggle, disconnect or overwhelm it can feel difficult to keep up with these practices. Psychologists can also practice psychotherapy and then work by integrating the two practices, but must complete separate trainings to do so.
Psychotherapy is a relational practice which provides another form of therapeutic contact which is different to psychology. The stereotypical image of psychotherapy that people are familiar with, is the classical 'laying on the couch' method which is often depicted in film.
This method has developed considerably since its conception however, and utilises a broad range of theory. For children, the development of play therapy is perhaps most significant.
Psychotherapy is often bought in at a time where other methods have been attempted and failed. Psychotherapy is an approach often utilised when situations are confounding, confusing or unclear. This may be because psychotherapy looks towards the sometimes concealed, or unconscious, aspects of communication to better grasp what is occurring. This is done through the relationship, in which the therapist and client gradually come to understand the patterns of how the client relates to, and interacts with the world through their contacts together. In work with children this has become intensely important due to their limited or sometimes compromised abilities to accurately explain in words how they are feeling, why they are feeling this way, and what might make them feel better.
Psychotherapists are generally not able to give formal mental health diagnoses, however are equipped to understand diagnostic criteria. This means, for those who may come with a historical diagnosis, the therapist is able to understand how this generally presents. Psychotherapists may be able to provide diagnostic material to psychiatrists where necessary, which can be used to build into their understanding of the client. Psychotherapists are not able to prescribe medication.
The play therapy technique invites children to use a range of play materials (dolls, sand tray, art) to assist them with expressing parts of their inner world. Over time, the therapist is able to weave together what is observed in the styles of play with understanding given by the child's parents. This can then be communicated back to the child, to assist in managing their responses to what is going on. The strength of this approach is that it works at the child's pace, in a communicative style that matches their level of functioning. Over time, a process emerges in which the child is able to experience the therapy (and therapist) as a safe space to communicate what is needed in order to relieve distressing feelings. Psychotherapy is a rigorous and in-depth approach which seeks to locate the root of familial disharmony.
The difficulty in this approach is that it can be at times confronting for families to go into deep detail about what is occurring in their family. It can also be difficult to 'trust the process', as psychotherapy can be felt to be slow moving and arduous. This is particularly present in the case of child psychotherapy, which follows the lead of the child. Some parents may feel worried or curious about what happens inside the sessions, unsure of what the child may be saying or doing. Others may feel worried about what the therapist might 'see' in their child or family system.
Psychotherapy, however, is a non-judgemental approach which recognises that there are times of difficulty and disconnect in nearly every family. The therapist seeks to understand how people have found themselves stuck in a way of relating to each other, and assist in providing a space to explore new ways of being together. Psychotherapy is an approach which thrives upon authentic experience; a state which cannot be forced, hurried or duplicated.
The varying approaches to mental health are paradoxically, complimentary and contradictory in their own ways. The takeaway, however, is that each family should be supported to find what works for them regardless of whether or not that is what works for others. The wide spectrum of approaches goes far beyond the practices of psychiatry, psychology and psychotherapy.
My parting advice for those seeking to help their child is to hold on to hope throughout. It can take time to land on a therapist or approach which feels best suited to your family. As a parent you are within your rights to explore different options and shop around. Many practitioners will be happy to answer questions about their approach and how it works. Ultimately, as parents and caregivers, you have the best sense of who your child is and what they are needing. Trust that understanding of them throughout this process - your insights into who they are will ultimately be key to assisting them through difficult times.