Alexandra KordosiCounselling Psychologist / Psychotherapist (MA.,BSc.)

Psychologist or Psychiatrist?

Due to considerable lack of awareness around mental health issues, many people who are in need, do not know where and how they can receive help. For clarification purposes, this section outlines the basic differences between the professions of psychology and psychiatry.

A psychiatrist is a trained doctor, having studied traditional medicine and in addition neurology - psychiatry. A psychiatric evaluation is made on the basis of knowledge on normal brain and body functioning and psychiatric treatment is therefore based on the medical model. This means, that the psychiatrist observes and evaluates the clinical symptoms that deviate from (what is statistically considered) "normal brain functioning" and "normal human behavior" - in accordance with the Diagnostic Statistical Manual for Mental Health Disorders (DSM-V). The Psychiatrist uses pharmacological treatment (that changes brain neurochemistry) as a means of controlling the various symptoms of patients and in this way, helps them to return to a "normal range" of brain activity and behavior. The benefits of pharmacological treatment are evident shortly (from a few days to a few weeks) however the duration of treatment and its progressive termination, should always be closely monitored by the psychiatrist. Pharmacological treatment is highly effective in acute symptoms, however it tends to have short-term benefits if used alone (that is, without psychotherapy). People who use pharmacological treatment for long periods of time, tend to reduce their issues on physical symptoms and complaints and fail to develop a deeper insight on the psychological concerns underlying their symptoms. As a result, there is a high relapse tendency at future periods of stress.

A Psychologist on the other hand, has been trained to adopt an integrative perspective, examining along with the medical model, the cognitive, emotional, behavioral, social, existential and spiritual dimensions of human existence. A Psychologist is not a doctor and therefore does not prescribe medical treatment to patients. If the psychologist considers pharmacological treatment to be a necessity for his client, he will refer him to a psychiatrist, often in parallel to psychotherapy. The psychotherapeutic interventions that the therapist uses vary, depending on individual client needs, the therapist's expertise and other factors. Psychotherapy does not follow a clear-cut course with predictable outcomes at specific time frames – as is the case with drugs. Research however has provided strong evidence that people who have had psychotherapy (even for a short period of time) tend to feel overall better, to have greater self-awareness and display better coping strategies with regards to their issues. Because people who have had experience of psychotherapy have developed coping skills and an ability to think flexibly regarding their difficulties, the benefits of psychotherapy tend to be long-term. The basic psychotherapeutic "tools" that a psychologist uses irrespectively of training orientation, is the therapeutic relationship, communication and dialogue, empathy and a respectful stance towards the client and his unique experiences. The psychotherapist's role is neither to judge and counsel clients based on his views (as is often believed), nor to substitute friendships – as the therapeutic relationship has specificities that make it very different from friendship. A more appropriate statement would be that the psychotherapist's role is to offer a "secure base" which the client can use, so as to gain a better understanding of himself and his experiences. It is a base from which the client can explore his full potential and experiment with new ways of being that feel appropriate to him.

Most services that are publically available in Greece, are psychiatric services, e.g. public psychiatric hospitals (e.g. Aeginition, Dromokaition). Usually people who have suffered from acute episodes of mental health disorders are referred to these hospitals and it is often the case that they have been involuntary hospitalized through police and legal enforcement. In less severe cases, patients are treated in drop-in day centers (Local Mental Health Centers) and are often subjected to long waiting lists. There are limited public services and organizations in conjunction with psychiatric services, that offer low-cost or free psychotherapy to patients and their families. Unfortunately, due to minimal funding that is provided from the government, psychotherapeutic services cover a very small portion of the populations' actual needs. Psychotherapy (short-term or long-term) for people who do not fall under the category of "severe cases" is only available in the private sector (provided from psychologists / psychotherapists in private practice). This is very unfortunate, as there is a large portion of the population that would benefit from psychotherapy and does not appear in the lists of psychiatric hospitals. Psychotherapy is for "people who visit the supermarket" (as a supervisor of mine characteristically commented once), implying that anyone could benefit from psychological support at some point in his / her life.

The prominent psychotherapeutic approaches are:

• Cognitive approaches: focus on cognitive processes (thoughts) and how these influence human emotions and behavior
• Behavioral approaches: focus on human behavior and the conditions under which certain behaviors tend to appear or diminish
• Psychodynamic approaches: focus on unconscious processes and relations with primary care-givers and examine how these are reproduced in the client’s life and in his relationship to the therapist
• Intersubjective approaches: focus on different levels of reciprocity and attunement in primary relations and examine the current quality of interaction between therapist and client.
• Humanistic / existential approaches: focus on authentic expression of the totality of the person and his genuine relating with others
• Systemic approaches: focus on the individual's interrelationship with the wider social environment (the various social systems that he is a part of) and examine his behavior within such systems
• Transpersonal approaches: incorporate the spiritual dimension in psychological analysis, emphasizing the individual's "peak" (transformative) experiences
• Experiential approaches: utilize a variety of expressive art, energy and sensory methods and techniques as an integral part of therapy (art therapy, play therapy, drama therapy, bodywork, breathing and relaxation techniques, hypnosis, guided imagery etc.)

The various therapeutic approaches are not necessarily contradictory with each other. They rather represent different ways of therapeutic work, under the same basic goal: to deepen insight on human experiences and to enhance the individual's quality of life. Consequently, it is often the case that different approaches are complementary to each other in the psychotherapeutic process and therefore, it is often difficult to distinguish which classical approach the therapist is using.

In case you are concerned about someone close to you and you feel that he / she should ask for professional help, you should encourage him / her to contact the professional himself / herself. Reassure this individual that he does not need to continue therapy in case he feels that is not helpful and that he can stop at any point he wants. Let him know however how you feel next to him, how you experience his problems and insist in asking for professional help – regardless of the outcome. Having the opportunity of reading a mental health leaflet, or checking a mental health website (as is this one), or just by having the professional's contact number at home, is enough sometimes for someone to make the responsible decision of seeking help.

In case however someone close to you expresses (usually "out of the blue") bizarre or dangerous behaviors and you feel that is impossible for him to be aware of his need for professional help, it is probable that it is an acute episode of a mental health disorder. In such case, you should contact a psychiatrist and possibly, psychiatric hospitalization will be necessary. Moreover, in case the person in question is imminently dangerous to himself or others, an involuntary psychiatric hospitalization might be necessary through police enforcement.