What is the Difference?

It has come to my attention that many people do not know the difference between a psychologist, clinical psychologist, psychiatrist, psychoanalyst, psychotherapist, or counsellor. Some people seem to think they are interchangeable. Some people think that it's hierarchical with psychiatrists being "better" than counsellors. It's easy to understand the confusion, especially when so many of these terms are unregulated with many competing vested interests.

Anyone can call themselves a psychoanalyst, psychotherapist or counsellor, and some psychiatrists and clinical psychologists actually call themselves "psychoanalysts" or indicate having undergone extra post graduate psychoanalytic or psychodynamic study when really, they may have completed an 8 week introductory seminar series or 4 weekend courses spread out over a year or two. I heard quite a number of chilling tales of people who had highly destructive and damaging therapy with various psychiatrists who called themselves a psychoanalyst and insisted that their patients undertake a 5 days a week Kleinian analysis without having any training in psychoanalysis, let alone, any scholarly study in Melanie Klein. So, let me try and break it down for you:

PSYCHOLOGIST: is someone who has a 4 year psychology degree, which involves research and study in the scientific theories of human behaviour. There is no clinical or mental health training in this degree. Some psychologists have completed a post graduate training in mental health, psychotherapy, or counselling, and undertaken a certain number of hours of supervision to register with a recognised psychotherapy board such as PACFA. Others have learnt on the job and had clinical supervision or mentoring. In Western Australia, clinical psychologists but not 4 year trained psychologists are able to work in health department mental health services.

CLINICAL PSYCHOLOGIST: is someone who has completed a 4 year degree in psychology and at least a 2 year Master's degree in Clinical Psychology. The master's degree provides training in the assessment, formulation, and treatment of mental health disorders, primarily, from a medical model of symptom diagnosis and treatment of symptoms via cognitive behavioural therapy. In Western Australia, there is a further 2 year full time registration period where clinical psychology registrars need to meet specific board requirements in order to pass and call themselves a clinical psychologist. In the East Coast of Australia, there was no post graduate registration requirement until more recently. In order to raise training standards to international levels, the East Coast is now adopting a model of training similar to that of WA under the change to national registration.

PSYCHIATRIST: is someone who is a medical doctor and has specialised in psychiatry, an additional 5 years of training, which includes training in the diagnosis and treatment of mental health disorders from a biochemical, physical, medico-legal, and medical point of view. There is little training in the psychotherapy process or emotional or psychological development in the personality as the focus is primarily a medical understanding of mental health and mental health disorders. Psychiatrists are the only mental health professional able to prescribe specialised psychiatric medication and have the authority to schedule someone under the Mental Health Act.

PSYCHOANALYST/ PSYCHOANALYTIC PSYCHOTHERAPIST: is someone who has completed a psychoanalytic training, which is a highly rigorous, emotionally, intellectually, and financially taxing training that specialises in a method for understanding how our present is shaped by our past experiences in a developmental context and that all behaviour has meaning and a pattern, even if unconscious. There is usually a 1 to 2 year infant observation training followed by a concurrent, tripartite training model of training cases and supervision, scholarly seminars, and the trainee's own analysis. This usually takes between 4 to 10 years to complete. When the trainee has passed, the longest training case is presented to the society to be approved to join and register with the member association of the Psychoanalytic Psychotherapy Association of the Australia (eg, APPWA, NSWIPP, QPPA, VAPP), or the Confederation of Psychoanalytic Psychotherapy, or the Institute of Psychoanalysis.

The ethical and continuing professional development requirements to maintain registration far exceeds that of psychologists, psychiatrists, counsellors, and clinical psychologists.

COUNSELLOR: the only way the public could know whether a counsellor has had adequate training and supervision in a specific counselling method is if they are registered with an appropriate board such as PACFA. Trained counsellors focus on a well being model rather than a mental health model and provide guidance and advice rather than psychotherapists, who tend to focus more on helping the client to understand themselves and their situation.

This is only a superficial overview but I hope helpful in beginning to understand some of the differences between providers of mental health and psychological services.