More needs to be known about the differences between two types of healthcare professionals, and it would be worthwhile for everyone to be on the same page regarding understanding.

A friend recently told me he had to change his therapist because the therapist was going to a new job. He had no choice in who would be his next therapist at that institution, which might I say is an enormous place, but he assumed it would work out smoothly. His assumption, unfortunately, was premature.

At his first therapy appointment, the woman behind the desk asked about his health and medication. After about 15 to 20 minutes, she indicated that they would have another appointment in 2 months. He was more than shocked and amazed since he had been seen weekly for therapy sessions.

When he asked the young woman, "But you are my therapist, correct?" She responded in a nonplussed manner, "No, I am a psychiatrist, and I don't do therapy." So, he had not been seeing a psychiatrist all along? Clearly, he hadn't, and he had been seeing either a psychology intern or a social work intern—information that nobody had ever given to him. He just assumed something that was patently incorrect.

The world of mental health has undergone seismic changes in the last 30 years or even more. Originally, psychiatrists went through a period of psychoanalytic training, which was the norm. Once biopsychiatry began to make its place in the world of healthcare and backed up its conclusions with hard data rather than dream analysis, training programs dropped psychoanalysis altogether.

I can remember being at a large hospital in a major East Coast setting, where a young psychiatrist in training felt abandoned. His program was no longer continuing his psychoanalytic training but biopsychiatry instead. He was well into his training and didn't know what he was going to do.

At that point in his career, he felt that his work would always include psychoanalysis, but now it wouldn't. I never discovered how he resolved his dilemma, but I imagine he had to transition to biopsychiatry and abandon psychoanalytic training or leave the program, and who leaves a residency in the middle of a program?.

Anyone wishing a bit more background, or should I say backstory of psychoanalysis, should read “The Assault on Truth” and “Freud and His Followers” and “Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness.” I would also suggest reading one of Freud’s works, “Moses & Monotheism.”

The Testing Divide

Nowhere in their training are psychiatrists trained to administer psychological tests other than the brief checkmark forms developed by pharmaceutical companies for their research protocols. Personally, I have had an interaction that pointed up how this can affect a psychiatrist's work.

While working at a facility as a consulting psychologist and being paid far less than psychiatrists who were doing the same work as I, a psychiatrist came over to me and asked me to interpret psychological testing that had been given to him and on which he was to write a report.

He had no idea how to do an IQ test or what each of its scales would indicate about an individual. In truth, he was asking for a mini-seminar that could not possibly provide him with the information he would've gotten had he been trained in psychological testing. I couldn't make up for that lack, but I tried to give him a quick overview, and I assume he used that in everything that he evaluated in the future. For me, I didn't think he had sufficient training or experience for the reports, but people's benefits were based on his reports. It was an ethical conundrum.

Medicine, Psychiatry and Psychology

Separating both the physical and the mental into two different areas, to me and too many other people, doesn't make much sense. They both work in concert, and all of us need to be familiar with everything. We cannot seclude ourselves in our own little area of one profession. I can remember when a psychologist asked me for information on Xanax because one of her patients, who had an alcohol problem, was taking it.

I expressed serious concern since I knew that Xanax (a benzodiazepine) is a potentiator when used with alcohol and can be quite dangerous. She had no idea because she had almost no training in biology and knew nothing about psychiatric medications.

I wondered how she could consider herself working in an ethical manner if she didn't increase that knowledge now that I had brought it to her attention. This was an individual who had at least five or six brass plaques on her door, indicating that she had additional training in specific areas of therapy. In a word, ego was stronger than ethics.

The healthcare situation has become a bit more muddled for some because MDs are no longer the only specialists in healthcare permitted to prescribe. Now, nurse practitioners and psychologists who have taken specific courses to obtain pharmaceutical licensing privileges can write prescriptions. States may have particular requirements for other-than-MDs to prescribe, and anyone wishing more information is advised to go to their local state's website to do further research on this.