Let’s
recap from last time: although each province is governed by their own
acts for health professions, on the whole physicians and psychologists
can both diagnose mental health conditions and can both be doctors even
though they differ in their training. So why would you choose to go
to one over the other to obtain a mental health diagnosis? Let’s
tackle that question in this instalment…
But first,
I again offer my disclaimer. Psychiatrists (or other Physicians) and
Psychologists are both well trained and qualified professionals –
this article should NOT be perceived as an attack on one profession
versus another, or an attempt to show the superiority of one to the
other. They are, though, different disciplines. Given an individual’s
needs and situation, a person may prefer going to one type of professional
versus the other then. ALL I hope to accomplish in this 2-part article
is to make you a more informed consumer by giving you enough information
to make the choice that is best for you. Having said that though, despite
an honest effort to be fair and accurate this article may be ‘lop-sided’
in that I simply know more about what Psychologists have to offer. Perhaps
in the future a Physician counterpart will continue what I’ve
started by offering a more thorough look at ‘their’ side,
giving you the most complete picture possible.
Deciding whether to go see a Physician or Psychologist for diagnosis
purposes largely comes down to circumstances. Physicians are covered
by provincial health insurance plans (i.e. THEY ARE FREE!), but therefore
require a referral (often from another physician – typically the
family doctor). Speaking in generalities, family doctors typically have
not received much training in recognizing or treating mental health
conditions (if any at all) as they did not choose that stream as their
specialty. Leaving them as both the front-line and gatekeepers to appropriate
services, then, seems somewhat unfair (to both them AND the consumer)
and can at times lead to problems. Over the years many parents have
shared horror stories of hindered or erroneous referrals and diagnoses.
Finally, because in Canada health care is a public (and publicly funded)
service, wait-lists can be formidable.
On the
other hand a private practice Psychologist does not require a referral,
and the wait-lists (if they exist at all) are often short. The major
shortcoming here is that Psychologists are not covered by all provincial
health insurance plans, although most work insurance policies include
at least some (and sometimes excellent to unlimited) coverage for Psychologists.
Psychologists
are trained extensively in assessment skills. Like medicine, there are
many types of psychology to choose to major in (industrial-organizational,
developmental, cognitive, and behavioural neuroscience, to name only
a few). Unlike medical students, psychology students choose the stream
in which they are interested as soon as they are finished their undergraduate
degree. As mentioned last time, it is in the later stages of their training
where physicians choose their specialities.
The advantage
to the Psychologist route, then, is that those who are working in the
assessment, diagnosis, and treatment of mental disorders (called ‘clinical’
psychology) receive training particular to this specific area for their
entire 5 years (or more) of graduate schooling. Physicians, as mentioned
last time, don’t have that luxury – they also need to learn
about how the rest of the body works, how it can fail, and how to fix
it.
It certainly
does not take that long to learn how to actually PERFORM an assessment
– to learn to administer the various tools of our trade. In fact,
probably just about anyone could eventually be trained in it. Of course,
likely the same could be said about the steps of a surgical technique
too. Does this mean you would want just anyone to be in charge of your
operation though? Obviously not. You still want someone with the background
necessary to intuitively read certain situations, and the repertoire
to flex and compensate if everything doesn’t go by the book. A
Physician, better than anyone else, can do these things in the operating
room; rather than woodenly executing a set procedure without deviation,
(s)he has the knowledge base to adapt to each individual situation.
So it is with Psychologists in the mental health assessment room.
This is
why oftentimes even though a Physician may be the team leader in mental
health facilities or hospitals, Psychologists are frequently delegated
the responsibility of the assessment. Both the Physician and Psychologist
play essential roles on the team, but a recognition of which disciplines
can fulfill each team expectation the best will make that team as efficient
and effective as possible.
Another
advantage Psychologists have because of this intense focus on the mind
and brain is that we have the luxury to go beyond the organic –
to look at the psychological and sociological aspects of various conditions
along with their physiological aspects. In other words, rather than
working from the ‘medical’ model, Psychologists work from
what’s called the ‘biopsychosocial’ model.
By doing
so, this aids us in understanding the bi-directional influence of psychology
and neurology. We spend time learning how our neurology influences what
we learn and how we act, think and feel. But we also spend time learning
how psychology influences our neurology – something that most
people aren’t aware happens as well.
Those
who have seen my presentations may have listened to me applaud the importance
of including “significant distress or impairment” as a criterion
in the diagnosis of mental health disorders. I believe impairment is
a crucial component of diagnosis, because my training has shown me that
the presence of a brain abnormality alone is not sufficient to explain
the problems that drive people to seek help. Consideration of the environment
in which a client finds him/herself can add insight into understanding
certain behaviours and modes of thinking, and guides treatment. This
insight can be missed when one considers the neurological issues in
isolation.
The best
work in mental health is done when disciplines come together though
– when Physicians and Psychologists pool their repertoires the
result is greater than the sum of the parts. My Incidental Associations
Model of Tic Formation (written for my Ph.D. defence and available for
download on my website) is an example of this. By introducing certain
learning principles and models from the psychological discipline into
the excellent brain imaging work done in the medical field, comprehensive
explanations for the origin and maintenance of certain aspects of TS
can be attained. From the medical or psychological perspectives alone,
these explanations are out of reach. Put together the things that Physicians
and Psychologists each do best, however, and we see further than either
could hope to alone.
As of this writing I am in possession of a Certificate of Registration
Authorizing Supervised Practice as a Psychologist. You can recognize
a registered Psychologist in Canada by the addition of the abbreviation
“C.Psych.” (registered Psychological Associates put “C.Psych.Assoc.”)
following their name and highest degree. Others may simply put “Dr.”
in front of their name (if they have a Ph.D.) and “Psychologist”
after it, for ease of public comprehension. Since these are all restricted
titles you can trust in the credentials of that individual when you
see them. Note that my new letters are followed by “(supervised
practice)”. Until I am designated ‘autonomous’ as
a practitioner (scheduled for December 2003), I will need to add this
qualifier to indicate that my work is done under another College member;
until then the clients I see are theirs and I am not permitted to take
my own.
We’ll
continue on this topic of ‘who can offer what the best and when’
again at a future date. Having thoroughly covered diagnosis, though,
when we next pick up this topic again we’ll move on to the area
of intervention.
Cheers!
B. Duncan McKinlay, Ph.D., C.Psych. (supervised practice)
