mental health

When should I see a psychologist? Or a psychiatrist? Or both?

Steph Arnaldo
When should I see a psychologist? Or a psychiatrist? Or both?

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Seeking help is the first step to getting better. But what's the difference between a psychologist and a psychiatrist? Here's a simple guide.

When I could no longer eat, sleep, work, and take care of myself, that’s when I knew I needed help.

I woke up one February morning with my heart hammering against my chest, my breath short, chest tight, and nausea in full swing. Was this just another bad case of anxiety? My grandmother had just passed away and I was going through health-related worries, so I chalked my sudden symptoms to that, coupled with the constant stress of a prolonged pandemic.

Hardly a stranger to anxiety and overthinking, I thought that this was something my usual arsenal of coping mechanisms could fix – maybe it was time for some deep breathing, meditation, a walk, self-help quotes, tea, and a chat with my loved ones, and then I’d be okay.

But night came, and things got worse. For the first time, I experienced insomnia – I regretfully watched the sun rise as I tossed and turned in bed, trying so hard to grasp what was happening to me. I tried to take in my morning coffee and some bread, but I found that I had also lost my appetite completely, and as a ~foodie, this was what drove me off the edge.

My sleep-deprived brain was fuzzy, my hands were trembling, and I was filled with a surge of inexplicable fear. I couldn’t even leave my condo unit to do errands or stand up to cook myself a meal; all I could do was virtually freak out to my loved ones and take a shower. Even enjoying Netflix (or anything, really) was a struggle, as I found it hard to concentrate on anything besides my fired up nervous system and overwhelmed brain.

I felt lost and very scared. For the first time in a long time, I didn’t know what to do. I was scared of my body, and afraid for my mind.

What was wrong with me? Where do I go from here? Am I going to get better? All I knew was: this wasn’t normal, this wasn’t me, and this wasn’t something I could just “snap out of.” Because my mental health was already interfering with my daily routine and well-being, I knew that it was time to seek professional help immediately.

Signs, symptoms to watch out for

Experiencing anxiety from time to time is normal, but when an episode suddenly comes without a trigger, recurs too often, and stretches on for too long, that’s when it becomes an issue.

“These anxiety symptoms are common, but if they last for more than two weeks, are getting stronger or more out of control, and are starting to interfere with your daily activities, then it’s time to seek professional help,” Cat Triviño, chief marketing officer of mental health company MindNation, told Rappler.

According to Cat, the following signs are what you should watch out for in your loved ones and in yourself:

  • Significant changes in behavior, such as extreme angry outbursts or bouts of sadness
  • Withdrawal from friends and other normal activities
  • No longer pays attention to grooming and/or personal hygiene
  • Confused thinking, inability to concentrate, lapses at work
  • Significant weight gain or loss, loss of appetite or overeating
  • Talks about doing harm to themselves or to others. Suicidal thinking may be active (i.e. “I want to end my life”) or passive (“I don’t want to wake up tomorrow”).

When getting help, self-awareness is key. According to Cat, it can be harder to recognize the warning signs in yourself, especially if you are the type of person who is frequently perceived by others as “strong,” or if you are the one always providing help to others.

Clinging on to my label as the resident “therapist friend” and “self-help guru” caused a lot of frustration and self-blame at the start. It took a while for self-compassion to help me accept that maybe I just needed to rest. Non-judgmental concern and unconditional support from friends and family also greatly aided me in getting the help I needed.

“Listen to friends and family and keep an open mind if they express concern about the state of your mental health,” Cat said.

The many ‘But’s..’

According to the World Health Organization (WHO), up to 80% of people with mental health issues do not seek treatment. Why is this the case?

Based on a poll conducted on MindNation’s Instagram page last March 2020, Cat listed down the top five reasons why people tend to avoid seeking professional help or therapy.

1. Shame. “I don’t want to be labeled as ill or crazy.” “If people found out I was seeing a therapist, it might impact my career or life goals.”

There is still a deep stigma attached to seeking mental health care in the Philippines. Even just admitting that you need help usually comes with the fear of being judged, belittled, or being labeled as baliw. The right people won’t equate vulnerability with weakness, but when faced with tactless remarks, Cat recommends to just keep calm and carry on.

“When confronted with these negative voices, the best thing to do is to tune them out. If other people harangue you, keep your replies short (“I see,” or “okay”), and resist the urge to expound or explain yourself. Switch the topic if you have to. With nothing to continue on, the naysayer will stop there,” she said. Seeking help is for yourself, and not for anyone else.

2. Practical barriers. “Ang mahal ng therapy. I’d rather talk to my friends; at least that’s free.” “I can’t do tele-consults, my internet connection isn’t stable.”

Therapy and medications can get very expensive, especially if you need both regularly. Cost and accessibility are one of the biggest hindrances to seeking help, but thankfully, many local organizations like MindNation, Ateneo Bulatao Center, MLAC Institute, PsychConsult, Better Steps, and other facilities offer their psychological services and counseling at relatively lower rates. Some even offer introductory sessions, seminars, and assessments for free.

“Reaching out to friends and family is also free and highly recommended when starting your mental health journey,” Cat said. However, even your most compassionate loved ones will also need boundaries when on the receiving end of concerns. Therapists are licensed professionals for a reason, and while your loved ones may have a good listening ear and sound advice, they aren’t trained to process complex emotions in the way psychological counselors can.

“The end goal of therapy is not to have you dependent on it, but to build your resilience so you can approach life and its obstacles as a stronger, better you. Mental health professionals are trained to do just that,” Cat said.

3. Distrust. “I don’t like confiding in a stranger.” “What if he/she judges me?”

“It might sound paradoxical, but the best person to talk about our problems are strangers,” Cat said. Strangers don’t have a preconceived notion of you and your past – all they see and want to treat are the problems you’ve laid out in front of them. Therapists promote an environment of non-judgmental acceptance, in the same way doctors don’t judge patients for getting sick.

“They don’t have the biases that you or your immediate family might have, which can stop them from guiding you or giving you the best advice. Plus, they can offer a fresh perspective on a situation that may have trapped you for a long time,” Cat added.

4. Denial. “Why should I go to therapy? There’s nothing wrong with me.” “I’m fine, my problems aren’t that bad, other people have it worse.” “Everyone goes through this; just give me a few days to snap out of this funk I’m in.”

“People usually resort to denial as a way of coping with anything that makes them feel vulnerable or threatens their sense of control,” Cat said. It could also be a defense mechanism against the fear of stigma mentioned. Denying reality not only prolongs your suffering, but it could even aggravate it further. Denial is delaying; sooner or later, your system will call out for help.

“If you have mental health problems, it is best to go to therapy right away to stop it from becoming something more serious. Those few days of ‘trying to snap out of it’ can be addressed in a one-hour session,” Cat said.

5. Other priorities. “I just don’t have the money or the time.” “I’m so busy with more important things.”

Work can wait, but both your physical and mental health can’t. In a pandemic, the saying “health is wealth” has never been more true. What’s the point of rushing a project if the end result is compromised, or if you won’t be around to see it through? We worry that self-care makes us selfish, but it’s actually the opposite – how can we expect to be there for our loved ones if we’re at 0%?

“You need to put your well-being on top of your priority list because everything else revolves around it. If you are mentally unwell, you cannot perform tasks as effectively, affecting your productivity levels,” Cat said. It’s not just work that your mental well-being affects – your self-esteem, relationships, and even physical health are at risk, too. All of the above are very important to me, so to me, investing in my mental health – albeit financially painful – would always be worth it in the long run.

“It’s so important. Seeing a psychologist for mental health issues should be as natural and automatic as seeing a doctor for concerns about our physical health,” Cat said.

“When you feel sick, you can look for remedies online or ask friends for suggestions on what to do, but at the end of the day, nothing beats consulting a trained professional. We should adopt this same mindset when it comes to our mental health.”

Psychologist vs. psychiatrist: Who do I need to see?

Psychologist, psychiatrist, counselor, well-being coach…it’s very easy to get lost amid all the psychological jargon! The simplest way to differentiate a psychologist from a psychiatrist is that the former uses psychotherapy (talk therapy) as a mode of treatment, while the latter is a medical doctor who treats clinical conditions with prescribed medications.

“Psychologists and psychiatrists can work together and usually refer patients to each other depending on the case,” Cat said. Seeking either one shouldn’t be limited to only when you’re already struggling; if you can afford it, it’s also a good way to achieve good well-being by checking in with yourself from time to time.

Psychologists also have clinical training and are either registered professionals with a Doctor of Psychology or PsyD degree. They are heavily focused on psychotherapy, talk therapy, and counseling practice, which is why they are also called “therapists,” because they also create the interventions or treatment plans for their patients. 

“They analyze why certain behavioral patterns occur, and often use the past as a tool for understanding present behavior and coping mechanisms,” Cat said. Clinical psychologists also have special training in diagnosis and treatment of mental illnesses, but cannot prescribe medication.

Psychiatrists, on the other hand, can. They are medically licensed doctors (MD) that are focused on more “severe or complex mental health cases” that usually come with physical symptoms, chemical imbalances, and risky behaviors that may require medication to manage. Their expertise is treating the neurobiological aspect of mental disorders.

Working with a psychologist may take more time, depending on the extent of your issues. They focus on a patient’s socio-cultural factors before diagnosing the illness to try to get to the “root” of any possible trauma.

“Psychologists use evidence-based strategies and interventions to help people overcome challenges and cope with past traumas, present issues, or future concerns. Just like medical doctors, psychologists have different areas of specialization: there are clinical psychologists, educational psychologists, assessment psychologists, industrial psychologists, child psychologists,” Cat said.

While they are all educated in mental health concerns, some are more equipped to deal with certain aspects than others.

“If you need help dealing with day-to-day problems, it is best to see a counseling psychologist. If you are looking for someone who can treat certain disorders, you will need the expertise of a clinical psychologist.” 

For many, treatment is most effective when psychologists and psychiatrists work together. Medications can complement talk therapy, and vice versa.

“If psychologists feel that the physical symptoms of a patient are strong, they may refer the person to a psychiatrist first to lessen the symptoms, then ask him or her to come back to continue with other forms of therapy. For first timers, it is recommended you check in first with a psychologist to assess your therapy needs,” Cat said.

This is what happened to me. I immediately reached out to a psychologist, without considering a psychiatrist, which was my norm. We tried to get to the bottom of my anxiety by unpacking my current and past stressors, but we weren’t making any headway – my lack of sleep, appetite, and other physical symptoms made it hard for me to focus, reflect, and believe I could get better.

On our second session, I was told by my psychologist to seek a psychiatrist, since my anxiety was already affecting me physiologically. Admittedly, I was hesitant at first – I can’t deny the taboo I had of being medicated for the first time. I’ve seen close family members abuse medications and rely on them heavily, and not get any better. My therapist, aware of this fear of mine, told me: “You are not them. The fact you are here means you are trying to get better.”

“You aren’t here to suffer. The medications, along with therapy, will help you,” was also what I needed to hear from the psychiatrist I reached out to. No different than medicines we take for a cough or the flu, I accepted that we all need help, albeit in ways we never imagined.

I was prescribed Mirtazapine (an antidepressant for sleep and appetite), and in time, I slowly started to regain sleep, my appetite, my strength, and the hope that things would get better. In turn, cognitive-behavioral therapy became more effective, and I also found the will to apply a new self-care routine to further aid my progress.

We treated medication and therapy as training wheels; an empowering way to recalibrate my balance until I was ready to bike on my own again.

First time? What to expect

Therapy and medications are both not a one-size-fits-all approach, or a magic cure that’ll instantly make everything go away. It’s a slow, gradual, and tedious process that will require work from both sides.

“It may take more than one or two tries. The key is not to give up and don’t let it get you down if you haven’t found the right fit,” Cat said, pertaining to finding the right psychologist or psychiatrist for you.

“If for whatever reason you feel that the therapist’s approach is not effective, it’s okay to let them know and try to find someone else. Choosing a therapist is like choosing a partner – it might take you a few tries but if you find one that you click with, it can really bring about something great,” Cat said. Luckily, I was very happy with both my psychologist and psychiatrist – they were understanding, compassionate, non-dismissive, and both aligned in terms of the treatment plan for me.

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Beginner’s guide to seeking therapy: What you should know

Beginner’s guide to seeking therapy: What you should know

Nervous to start your first session? No worries! It’s just like visiting a doctor for a diagnosis. According to Cat, most therapists will start by conducting an assessment.

“Some therapists will ask background questions about your childhood or your family to get to know you better. Others will ask you to share what’s on your mind, what’s bothering you, or your reason for seeing them. You won’t be expected to tell your entire life story. If you booked a session for a specific reason, i.e. work stress, then the conversations will only revolve around that topic,” she said.

Note that you don’t have to answer questions if you are not comfortable or ready. “It is a therapist’s job to ask intrusive questions, but if they are really making you uncomfortable, just say so,” Cat said.

Also, don’t expect all your problems or issues to be solved after just one session. “This is a misconception; talk therapy is not a quick fix,” Cat added.

“We encourage our therapists and clients to foster a connection and have multiple sessions since most of the time, problems are due to bad habits that were formed over the course of our lives and cannot be resolved in just 60 minutes,” she said.

Lastly, expect homework. I was tasked to keep a cognitive-behavioral journal to challenge when anxious thoughts or symptoms arise. I was even asked to write down my life story one time divided into chapters, as well as to list down things I did for myself this week and how each made me feel.

“Most therapists do this to empower clients to tackle the issues they are facing themselves and not be dependent on the psychologist for their mental healing,” Cat said.

The type of homework would depend on your situation and the therapist’s approach, but most use the Cognitive Behavioral Theory approach, which believes that the way individuals negatively perceive a situation is because of their conditioned reaction more than the situation itself. Therapists could also suggest certain grounding, relaxation, or stress management techniques to try out while waiting for your next session.

“Finally, don’t forget to book a follow-up session after two weeks. This will allow the therapist to check on your progress,” Cat said.

MindNation also has Well-Being Coaches on their team, who work one-on-one with individuals who want to know how to build better habits to achieve certain goals. A Well-Being Coach uses concepts from psychology and life coaching to help break down limiting beliefs and prioritize the present and future.

“They can cover a wide range of issues like career advancement, building self-confidence, practicing healthy living, developing accountability and finding purpose,” Cat said. However, they cannot diagnose illnesses or prescribe medication.

Whichever mental health professional you choose to seek first, give yourself a pat on the back – seeking help is the first and most important step to prioritizing your well-being and becoming the best possible version of yourself. Acknowledging that you need help takes strength and courage, so don’t forget to give yourself some love, and remember that help will always be there when you need it. – Rappler.com

You can book a session with MindNation via MindNation’s website, email address (book@mindnation.com), Facebook messenger, or through their Facebook or Instagram pages.

Steph Arnaldo

If she’s not writing about food, she’s probably thinking about it. From advertising copywriter to freelance feature writer, Steph Arnaldo finally turned her part-time passion into a full-time career. She’s written about food, lifestyle, and wellness for Rappler since 2018.