What is the difference between a Psychologist, a Psychiatrist and a Psychotherapist?
  • A Psychologist is not a doctor. A Master’s or Doctoral degree in Psychology is obtainable through various university faculties. Psychology with its various sub-sections is required for each year of study in the 7 year qualifying program. Two to three years of practical work through a licensed institution (like a mental hospital or university clinic) is required for registration. Psychologists are limited by law to practise only what they have specifically been trained to do. Previous classifications of, for instance, Counselling / Educational / Industrial / Clinical Psychologists are not always applied anymore and the client should ensure that the psychologist they consult is properly trained in the type of intervention needed. Generally psychologists may not prescribe medication although some are choosing to add an additional qualification to allow them to do so.
  • A Psychiatrist is a medical practitioner who has specialised, after completing his/her general medical training, in the field of psychiatry. Their specialisation field includes the diagnosis and treatment of all mental states and disorders. They can also prescribe medication or provide in-hospital treatments of various kinds. Some psychiatrists specialise, after further training, in specific forms of psychotherapy.
  • Psychotherapists can be psychologists or psychiatrists (or other medically registered persons, like social workers) who have received specific training in one or more types of psychotherapy. They have been tested through examination and practical supervision and are licensed by the medical board (in South Africa this is the Health Professions Council, or HPCSA) to practise as psychotherapists. It is illegal for unqualified persons to use this title.

You are entitled to view the licensing and training certificates of any health practitioner you consult. Concerns may be addressed to the HPCSA and its various Professional Boards: Contact details are on their website www.hpcsa.co.za

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Does everyone need psychotherapy?

Given the long list of symptoms and mental disorders that can be the focus of psychological intervention these days, it might seem as if we imply that all people need psychotherapy. And because of the time lag of certain parts of our physiological functioning that appear to to be better suited to more primitive rural societies than to modern industrial and urban life, I think that many people in modern society to in fact need additional therapeutic relationships. However, a therapeutic relationship does not have to be defined as a professional relationship with a psychotherapist only: Mentors and psychological sponsors of many different kinds can help us on our journey of psychological healing or personal growth. A psychotherapist is, however, professionally trained to help people in modern society effectively and the professional relationship is carefully schooled to facilitate this journey safely.

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Which kind of psychotherapy should I choose?

We are privileged today to be able to access hundreds of different kinds of therapy in some of the larger cities in developed countries. The choice can indeed be difficult. They are even books written with titles like “Uncommon Therapies”! From the last part of the twentieth century the main choices appear to be:

  • various forms of psychoanalytically-orientated psychotherapy, including Freudian, Kleinian, or Jungian Psychoanalysis, and Self Psychology;
  • Client-centered psychotherapy;
  • cognitive-behavioral psychotherapies of different kinds;
  • different kinds of counselling;
  • group psychotherapies of different kinds;
  • various kinds of hypnotherapy;
  • inter-active therapies like Psychodrama, Art therapy, Biodanza, Sand box therapy, etc.;
  • “encounter” types of therapy, like Wilderness experiences, and various men’s or women’s encounter groups.

Find out what is available in your community by consulting, for instance, your house doctor, a university Psychology department, telephone directory services such as “yellow pages” (under headings like “psychologists registered with…”), or even use the Internet to search.

Some kinds of disorders or symptoms appear to respond better to specific types of therapy (see the article on “Panic Attacks”, for instance). Don’t be afraid to ask for information before you make choice.

In South Africa there are parent organisations who can help you find a therapist skilled in particular types of therapy: SASCH or the South African Society for Clinical Hypnosis, have their own website and also publish directories with names, contact details, and fields of specialization or interest, of their members. (See Links.)

If you are suffering from a disorder like severe depression, you may also have to consult a psychiatrist if, for instance, you need specialized medication: your house doctor or a psychologist can advise you in this regard.

I would like to point out that in most developed countries there are a multitude of different Support Groups for various kinds of disorders or symptoms. Such groups are invaluable support and can be effective sources of information and referral. Sometimes major university hospitals have psychiatric departments who can also give information about support groups and other organisations who can help you find an appropriate psychotherapist.

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What does psychotherapy cost?

This depends on many factors: the type of therapy, the type of problem or therapy goal, availability, financial resources, etc.

While some medical Aids to give partial or full financial support for psychotherapy, it really depends on the particular contract you have with your medical Aid. You need to consult your rule book, or the client services department of your medical Aid to ascertain the level and extent of your coverage.

Psychiatrists’ fees are determined by the Medical Association of South Africa, MASA. Some psychiatrists will agree to work according to these fees whereas others may charge more and some may even charge less, for instance if clients will agree to a cash per session payment. For the year 2003 MASA rates were R544.30 per 60 minutes session. Like all other fees, these would increase annually; it is wise to budget for at least 10% increase in rates.

Psychologists’ fees are determined by the Psychological Society of South Africa, PsySSA. While these are much lower than psychiatrists’ fees, they are still somewhat higher than what medical Aids are prepared to pay for psychological services. In 2003 PsySSA rates were R347.30 per 60 minutes session, of which medical Aids giving full coverage would reimburse the medical Aid rate of R253.60. Again, you should budget for at least a 10% increase per subsequent year.

Some psychotherapists agree to work according to a sliding scale, so that people with limited resources may be allowed to pay a much lower rate.

If the client contracts to attend psychotherapy regularly and over a prolonged period, some psychotherapists will agree to a set fee per session which may be lower than even the medical Aid rates, to allow the client to engage in effective longer-term psychotherapy.

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How long does psychotherapy take?

Again, this depends on many factors: the type of therapy, the type of problem or therapy goal, availability, financial resources, etc.

Psychotherapists tend to differ in their approaches to method. Even words like “Brief” can have totally different meanings according to various schools of psychotherapy: If the therapist uses an effective tool (like EMDR), even severe single-event Trauma may remit in 1 to 3 sessions of between 100 and 60 minutes each; this would be “brief” trauma-de-briefing. In Psychoanalytic terms, “brief psychotherapy” may refer to approximately 20 sessions of about 50 minutes each. Some types of therapy, for instance, various kinds of group therapy, like psychodrama, or stress management, will be offered on a set contract of a specific number of sessions of a specific length, for instance, six sessions of 90 minutes each for the course.

Generally, the term “Long-Term Psychotherapy” is used to denote either Psychoanalysis, psychoanalytically-orientated psychotherapy, or Client-Centered Therapy. But even here there are variations: In traditional Freudian or Kleinian Psychoanalysis a client might be invited to attend psychotherapy on a daily basis for several years or even decades; in Jungian analysis, or Psychoanalytic Self Psychology, for instance, the client might be invited to attend sessions twice or more times a week, for two or more years, and such analysis may last more than a decade. Similarly, couples’ therapy in the Psychoanalytic approach may be presented over a longer contract period than some other forms of couples’ therapy.

Cognitive-Behavioral therapists tend to help the client to set specific goals to be worked on and often a specific number of sessions is set as an initial contract for a specific goal.

Are many persons choose to attend psychotherapy over a longer term, for instance, for personal growth, really effective work can also be done in just a few sessions, as many clients have found out when using the limited resources of for instance, the work’s Employees Assistance Programme, or EAP.

It is best to make prior telephonic inquiries as to the approach followed by specific psychotherapists. Indicate clearly if you wish to have only limited number of sessions, or have limited resources, or want to deal with a specific problem: The psychotherapist may then refer you to someone who prefers to work according to your needs, or may invite you to attend a few sessions so that s/he can advise you as to the most effective course of therapy for you.

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