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Clinical Psycologist, the difference between clinical psycology and psychiatry

Jun 29, 2010, 1:50 PM | Article By: Dr. Lamin Sidibeh

Many people, including university students, lawyers and others from the public have asked me about the difference between clinical psychology and psychiatry. Some people are confused about the difference and the confusion is understandable as both clinical psychologists and psychiatrists are involved in analyzing and treating psychological disorders. Although some overlap do exist between the two professions, the training and educational requirements for the two are quite different.

Clinical psychologists goto graduate school to earn a doctoral degree in order to have full status in their profession. They are concerned with the evaluation (assessment) diagnosis and treatment of individuals with psychological disorders as well as the treatment of less severe behavioural and emotional problems. Their main activities include interviewing clients, psychological testing and providing group or individual psychotherapy.

Psychiatrists on the hand, attend a medical school for their post graduate education where they receive general training in medicine and earn an M.D. degree. They then specialize by completing residency training in psychiatry at a hospital. They are physicians who also specialize in the diagnosis and treatment of psychological disorders. Many psychiatrists also treat everyday behavioral problems. It should be understood that psychological disorders included problems related to the brain and mind and behavioural disorders.

Whereas the clinical psychologists study human behaviour and mental processes and undergo psychotherapy training (often rigorous) which takes a longer duration, the psychiatrists psychotherapy training occurs during their residency, because the required coursework in medical school is essentially the same for everyone whether they are going into surgery, gaenocology or psychiatry. In rendering therapy, psychiatrists increasingly emphasize drug therapy (medication) for disorders such as anxiety, depression and psychosis. Drug therapies can be effective to some extent especially in dealing with symptoms short-term, nonetheless they are controversial. Critics of drug therapy have raised a number of issues such as: they produce short-lived curative effects, for example valium does not really solve problems with anxiety, it merely provides temporary relief from an unpleasant symptom but cannot deal with the underlying anxious problem, relapse rates are substantial when medication regimes are discontinued, the damaging side effects of therapeutic medications are often underestimated by psychiatrists and these side effects can be even worse than the psychological problem itself. The critics further state that many of these drugs are over prescribed and many patients overmedicated.

Clinical psychologists are qualified psychologists, specializing in mental health, just as the psychiatrists are medical doctors specializing in mental health. The clinical psychologists however take a nonmedical approach to mental disorders. Psychologists receive most of their training in universities or independent professional schools. They then serve a one-year internship in a clinical setting, such as a hospital, clinic or mental health center. This is usually followed by one or two years of postdoctoral fellowship  training especially in clinical practice. Psychologist mainly apply insight or behavioural approaches to treat mental disorders, they attempt to work on the underlying factors that cause a disorder, bearing in mind both the behaviour, cognitive and physiological processes (i.e. the biopsychosocial approach).

Forensic Psychological Services

Two critical assessments that both Clinical Psychologist and Psychiatrists are asked to make in our contemporary society are whether certain people accused of crime are competent to stand trial and whether they were sane at the time the crime was committed. The Psychologists and Psychiatrists actually do not make the final judgement about any dispensation of people accused of crime, they only make recommendations to the court. One of the fundamental principles of law is that in order to stand trial, accused people must have a rational understanding of the charges against them and the proceedings of the trial, and must be able to participate in their defense. Incompetence may involve impairment in several capacities, including the capacity to understand information, to think rationally about alternative courses of action, to make good choices, and to appreciate ones own situation as criminal defendant, tends to have lower level of education, poor and unemployed. Impaired competence may be a common problem in society or in the prisons but only a handful of defense lawyers refer their clients for formal evaluation.

The word "forensic" means pertaining to or employed in legal proceedings. Psychologists and Psychiatrists may be called on by courts, corrections and attorneys involved in the criminal justice systems to offer expert opinion on some matter. The main differences between the forensic and general clinical practices is that in the forensic situation, the Psychologist or Psychiatrist is not serving the patient but a third party, such as the court or  a lawyer. Another difference is that the client is consulting the Psychologist or Psychiatrists, not for therapy, but for help in dealing with the third party, It is therefore possible that the accused person will "pretend" or will not be "truthful". As a result, it is Imperative that the assessor rely not only on the assessee's representation but on all other documentation such as police reports and interviews with persons who have pertinent knowledge.

Should the assessment of an accused person for murder for instance, show that the individual is incompetent to stand trial, this person may nevertheless be dangerous to himself, herself, or to others.

This professional determination is indeed a legal cause to deprive that individual of liberty. The person so judged will undergo psychotherapeutic intervention, typically in a secure treatment facility until such time that he or she is no longer judged to be dangerous. This is because the state has a clear and compelling interest in protecting its citizens from danger. The determination of dangerousness is ideally made on the basis of various acts, previous attempts to commit the act and the method by which the violent act was done. The therapeutic intervention in a secure treatment facility due to dangerousness involves a thorough diagnosis and a treatment programme at the secure treatment facility. Treatment can include both short-term medication and long-term psychological treatment depending on the nature of the mental disorder.

It is crucial that legal practitioners are abreast with the roles of clinical Psychologists and Psychiatrists described above as well as the critical role they can play especially in Forensic Services. Unfortunately, it seems to me that only a handful of legal practitioners have some adequate knowledge about Forensic psychology and its importance in legal systems. The psychology unit of the University of The Gambia has therefore developed a detailed course description and outline for its law students inorder to enhance their knowledge and skills in Forensic work in due course. The possibility of extending such an opportunity to interested lawyers already in practice is also being looked into.