Q. WHAT IS THE DIFFERENCE BETWEEN A PSYCHIATRIST AND A PSYCHOTHERAPIST?
A psychiatrist is a doctor who has gone through specialist postgraduate training in looking after people with mental health conditions. Psychiatrists are the only mental health professionals who can diagnose mental health disorders and who can prescribe medication and some other treatments; however, other doctors, such as GPs, are perfectly capable of diagnosing and treating common mental health problems. A psychotherapist is a professional who has undertaken further training in a particular type of talking treatment called psychotherapy, which is usually carried out over the long-term and uses at its centre the patient-therapist relationship as a tool for helping. Oftentimes psychotherapists are psychiatrists or psychologists who have done a psychotherapy training subsequent to their first professional training; sometimes other care professionals such as social workers train as psychotherapists. An important part of psychotherapy training is the requirement for the candidate’s own personal therapy, which in many cases must be undertaken for several years.
Q. WHAT IS A PSYCHOLOGIST THEN?
A psychologist is someone who has done a degree in psychology, i.e. the study of the functioning of the mind. Not all psychologists are clinical psychologists but those with clinical training can work as mental health professionals who treat patients using talking treatments. Individual clinical psychologists may be versed in a number of different “models” of treatment, such as CBT (cognitive behavioural therapy), ACT (acceptance and commitment therapy) or EMDR (eye movement desensitisation and reprocessing). As above, some psychologists go on to do psychotherapy training and can then offer psychotherapy as a treatment.
Q. HOW DOES PSYCHOLOGY OR COUNSELLING DIFFER FROM PSYCHOTHERAPY?
The similarities between psychotherapy, psychology and counselling are probably greater than the differences, in that all three involve speaking with a professional about your mental health difficulties and all three are most effective when the patient feels safe, cared for, listened to and respected. It can be said that there is a general benefit in getting things off your chest, having things detoxified or demystified, and having this taking place within the context of a secure and reliable professional relationship. That said, there are some differences. Counselling is typically more of a shorter-term intervention offering support often around a particular issue or challenge. Psychology work often aims to follow an established programme of treatment and may be focussed around achieving particular goals or changes, and may involve more in the way of guidance or tips. Psychotherapy, on the other hand, is less directed in style. Psychotherapy is typically longer-term and is often considered more intense, deeper, and more about supporting the individual personality to develop and strengthen over time.
Q. HOW DO I CHOOSE A THERAPIST?
Probably the two most important questions to ask yourself are (1) do I feel comfortable enough talking openly with this therapist and (2) is this therapist a safe, well-trained practitioner? The first question might take a few sessions to answer. It is important to trust your gut feeling on the one hand, as you may share things with your therapist that you have never shared with anyone else. On the other hand the relationship doesn’t have to be a “perfect fit” – indeed no therapist gets it right all the time and perhaps it is best to question if the relationship is instead “good enough”. Concerning question two, unlike doctor, psychologist or nurse, “therapist” is not a protected title by law, and so anyone can call themselves a therapist, even if they have very little training or experience. The best way to make sure a therapist is a safe and ethical professional to work with is to check that they are on a reputable professional register, such as the BPC, UKCP or BACP. Being on such a register means the therapist has undergone a recognised clinical training, they keep up-to-date with professional development requirements, and have the necessary supervision arrangements in place to review their clinical practice.
Q. WHAT IS A DIAGNOSIS?
Being given a diagnosis is when a doctor informs a patient that they (most likely) have a particular recognised disease, disorder or condition, for example hypertension (high blood pressure), asthma or diabetes. Within the field of mental health, however, a diagnosis cannot always be considered definite. Mental health diagnoses cannot normally be confirmed or proven with tests; instead they should be viewed as best-guess medical opinions about what might be wrong. For some people, it can be very helpful to be told they have an identifiable condition, to feel they are not alone, to be able to read up online and educate themselves, and to know that there are recognised treatments that have been researched in trials. However, for others it can feel unhelpful to be labelled with something and possibly “pigeonholed”. People are complex, and there is always more to someone’s struggles than just a diagnosis.
Q. HOW LONG DOES IT TAKE FOR PSYCHOTHERAPY TO WORK?
Perhaps the most important thing to state is that psychotherapy is a personal experience and every person’s therapy is different – no-one can really know what it is like without doing it. Some of the benefits of therapy may be noticeable soon after starting, for example, the emotional relief that can be experienced in simply sharing personal issues with an attentive listener and in the feeling that problems, not matter how overwhelming, can be held onto and “contained” within regular sessions with a therapist. Many of the other benefits of psychotherapy, however, may take much more time before you can really identify them, and may even manifest after finishing a period of therapy. People may find themselves “internalising” the experience of therapy over time, such that in the future they might picture themselves talking through something with their therapist even though they are no longer in therapy. Over time people may feel more robust, more at peace with themselves, more authentic, and there can be instances of noticing oneself about to do something automatic yet finding the wherewithal to pause and decide to do something different.
Q. WHAT AGES DO YOU WORK WITH?
As a psychiatrist registered to practise in Spain I can see and treat patients of any age, including children. Seeing children requires the written consent of both parents/guardians. It is unlikely I would recommend psychodynamic psychotherapy as a first approach for a child or adolescent. Instead I would be more likely to use an integrated and collaborative psychological approach, depending on the particular issues.
Q. WHAT ARE YOUR PRICES?
For Spain-based work, my fees are as follows:
Psychiatry first appointment – 200€
Psychiatry follow-up appointment – 120€
Weekly psychotherapy sessions – 90€ (face-to-face or online)
For appointments in Gibraltar at Midtown the fees are in GBP and are paid directly at the clinic.
Q. DO YOU WORK WITH INSURANCE COMPANIES?
For my practice in Spain, no; however, Midtown Clinic in Gibraltar do have arrangements in place with international insurance providers.
Q. DO I HAVE TO COMMIT TO A CERTAIN NUMBER OF THERAPY SESSIONS FROM THE OUTSET?
No. I always encourage people starting up with me to pencil in an initial “trial run” of four consecutive weekly sessions but I do not ask for any fixed commitment. Instead, my suggestion is to allow yourself enough of an immersion in the intensity of weekly sessions to get a feel for what longer-term therapy would really be like for you, before deciding on whether to make a longer-term commitment or not.
Q. HOW CONFIDENTIAL IS THERAPY?
Very. 99% of the time what you share with me is completely private. As with any professional practice, there is a requirement to handle some person-identifying information for communicating and arranging appointments – I have a privacy policy covering this here. Confidentiality can never be absolute, however. Occasionally it can be ethically necessary to break confidentiality in order to protect somebody at risk of harm. This is also covered in my privacy policy.