Should I see a Psychologist or a Psychiatrist?

Credit: CrashCourse

“What’s the difference?”

Psychologists and Psychiatrists share a common goal: helping people feel better. Both disciplines are essential in the research and development of addressing and improving mental and emotional health.

One key difference between the disciplines is that psychiatrists are medical doctors and will generally approach your issues from a pharmacological perspective, while clinical psychologists focus on psychotherapy. Psychotherapy or talk therapy allows a psychologist to work with you in identifying and addressing the underlying causes of your emotional and mental suffering through behavioural and thought modification. Psychologists are also responsible for conducting psychological and psychometric testing, which are critical in assessing a person’s mental state and determining the most effective management plan.

Simply put: psychologists and psychiatrists work as a team to make you feel better.

Because of the division of responsibilities between psychiatrists and psychologists, the frequency of your visits are also different – a follow-up visit to a psychiatrists typically takes place at intervals scheduled around medication while psychotherapy is beneficial only if you participate with regularity i.e. once a week or fortnight.

Fun fact: Psychiatrists are also trained to perform electro-convulsive therapy or ECT.

Emotional Support Animals and Mental Health

Most of us have owned a pet some time throughout our lives. From the beta that we caught at longkang fish farms to a giant golden retriever you recently added to your family, they all bring us the same happiness and joy, or even sadness and anger at times (when they simply refuse to stop barking even at the wee hours of the morning).

Furkids create tails of happiness for pawrents, but can they be used to support us emotionally? The answer is yes! This is where the Emotional Support Animal (ESA) bridges the gap between that of a service animal and a pet.

You may have heard of service or assistance animals, commonly reported on the news or on Stomp. These are animals are trained specifically to assist individuals with physical or psychological disabilities which hinder their ability to carry out activities of daily living. These animals–including guide dogs or signal dogs–help individuals with visual or auditory impairments travel or watch out for danger. In other words, service or assistance animals help their owners to live a more independent life.

While pets can bring us the occasional dose of happiness, an ESA is often employed together with psychotherapy to help alleviate mental health conditions (such as depression or anxiety) and provide a therapeutic benefit. The difference between a service animal and an ESA lies in the training of the animal, as service animals are trained specifically to fill a gap for an individual with a disability. An ESA might not necessarily be trained to do so, but is used to provide emotional support to its owner. 

Benefits of Emotional Support Animals

Apart from being adorable and lovable, ESAs can benefit patients and have been found to alleviate psychological conditions. Evidence suggests that ESA ownership can reduce suicide attempts, hospitalization, anxiety, and medication use. In addition, ESAs can also improve an individual’s functioning, with increased abilities to work and attend school.

It is hypothesized that we typically form an attachment with our pets, and this close attachment can serve as a form of social support for individuals with mental health conditions, reducing social isolation and loneliness. Caring for an animal is also a routine task that we have to engage in daily, which creates stability in life and provides us with some mental space away from negative events. It has been found that in palliative settings and in children with autism, patients experienced elevated moods when animals such as dogs, cats, or rabbits were introduced in the environment.

How Do I Get An Emotional Support Animal?

Getting an ESA is a complicated procedure as the rules and regulations vary throughout the world. Unfortunately, ESAs are not recognized as assistance animals in Singapore, and have to comply with existing import regulations for animals. This means that certain breeds of animals may not be allowed in Singapore, despite a memo from a licensed professional.

In general, an official memo from a psychiatrist or clinical psychologist stating that the ESA will assist an individual’s recovery is required if they are intending to bring the ESA across borders. To obtain the note, the mental health professional will assess and determine if the individual has a mental health diagnosis and if the animal will facilitate recovery.

In addition, you may require import licenses, health certification, import permits, and other documents alongside the memo. You can take a look at the requirements here and here.

Certifying that an ESA is required for recovery can be a tricky issue for both mental health professionals and their patients, due to the differing laws across the world and various ethical concerns. Clinicians may be expected to sign off on their patient’s ESAs, despite no therapeutic benefit being identified. Refusing the request may result in the therapeutic alliance being ruptured. Hence, it is important for patients to understand that while a pet may bring them an abundance of happiness, it may not be required for recovery and thus the clinician may not provide the memo certifying a need.

Conclusion

Owning a pet can have many benefits to us and our mental health. However, it is important for us to recognize that not every pet can be certified as an ESA, but this may not be necessary unless you are travelling overseas. If you are travelling overseas and require a memo from a psychologist, come talk to us. Our psychologists are able to give you a hand (unfortunately not a paw) with conducting an assessment and subsequently determining if your pet can classify as an ESA.

Consultation Fees - Psychology

Consultation Fees (Clinical or Counselling Psychologist)

Fees for a 60-minute individual consultation with a psychologist range from $218.00 to $359.70 (with GST).

A different fee applies for diagnostics and psychological assessments or tests.

Please read our Terms to understand our fee structure, including our cancellation policy.

Consultation Fees (Others)

Fees for a 60-minute consultation with an Associate Psychologist starts at $141.70 (with GST).

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Why are Psychologists expensive? 

We were asked if therapy was meant to save lives, why is it so expensive? Here’s a full take of that editorial feature!

The most obvious costs are clinic overheads – rent, basic furnishings (hello IKEA, Taobao淘寶 - don’t say bo jio), salaries of support staff, etc.

What is usually less obvious to many is the cost that comes with paying properly educated and qualified Clinical Psychologists. In Singapore, the basic requirement to practise as a Clinical Psychologist is a Master’s Degree. At the minimum, that is a 3-year bachelor’s degree, a 1-year honours degree, and a 2-year master’s degree (3 + 1 + 2 = 6 years).

In jurisdictions where psychology is regulated by national law, a clinical doctorate (a D Psych or post graduate degree) is typically required followed by an approved psychology residency or registrar programme. Depending on the jurisdiction, this adds another 2 to 6 years of graduate study and professional training.

All in, the journey towards becoming a properly trained Clinical Psychologist takes anywhere between 7 and 10 years. But this only places a Clinical Psychologist squarely at the start line, with limited real-world experience. Clinical Psychologists often begin their professional careers working in hospitals or other clinical settings.  

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Placing a Premium on Mental Health?

Most of us accept the costs that come with seeing a General Practitioner, a Medical Specialist, or a Surgeon. We usually have a sense of the ailments and conditions that might affect our physical health. However, many of us might be less attuned to the ailments that afflict our mental health, and consequently, find the cost of therapy expensive especially when compared to the costs of treating physical ailments.

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Consultation fees for psychology depend on the level of training and experience of the psychologist. When one takes into account the time spent on education and in professional training, and factors in the experiences that they have accumulated in various hospital, community, and private settings, the costs of hiring a psychologist increase.

A psychology practice also incurs a range of expenses, including practice insurance, continuing psychological education, registration and professional membership fees. These expenses often run into the thousands each year and are necessary to ensure that a psychologist is able to conduct their practice professionally, ethically, and responsibly.

While a client typically pays only for the duration of a session, those fees must also take into account last minute cancellations and no-shows, and time for out of session work such as keeping contemporaneous notes, liaising with healthcare professionals, and planning and reviewing management plans. Session fees must also cover personal expenses when a psychologist take time off work for study, rest, or other personal reasons.

Neuropsychological, psychometric assessments, and other diagnostic tests are charged differently from consultations. An assessment will typically comprise one or more clinical interviews, administration of an assessment or battery of tests, formulation, a formal written report, and a feedback session. There are costs involved to purchase and administer each assessment or test, and these costs will make up the total fee for an assessment or test. 

How are psychology fees priced?

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Subsidised, Discounted or Reduced fees

In Singapore, private psychotherapy is not covered under MediSave, MediShield, or other healthcare schemes. The government provides a partial subsidy for psychotherapy in most government hospitals and facilities.

In a private setting, your healthcare insurer may reimburse you for psychotherapy if it is covered under your insurance policy. Please enquire with your insurer on your eligibility for cover.

Neuroplasticity and Psychotherapy

No, it is not the latest scientific breakthrough in biodegradable plastics that are actually biodegradable.

Neuroplasticity is the brain’s ability to change its structures and functions by establishing or rearranging its neural connections.

Let us explain.

Our brains are constantly building new cells from the moment we are born. These cells make an incredible number of neural connections as they grow, and these connections underpin our capacity to learn and remember what we need and use, as well as our capacity to forget what we don’t. For example, as a child learns a new skill, cycling for example; new connections are formed in the brain. As a child continues to practice this skill, his or her neural connections will become denser and stronger with each repeated activation.

It is similar to wading through a thick wheatfield for the very first time. Sickle in hand, one has to bash through the thick vegetation and forge a new path in order to get across. Eventually, you would have created a pathway from your starting point to your destination. This process is analogous to neuroplasticity, where the new pathway represents a neural connection that you have formed in your brain through the repeated activation of the same set of neurons. The pathway becomes easier and more pleasant to traverse the more it is used.

Neuroplasticity and Psychotherapy

However, while neuroplastic changes are often thought of in a positive light, such as learning a new skill or knowledge, the same process applies to unhealthy and unhelpful thoughts and behaviours.

Maladaptive thoughts, distressing emotions and unhelpful behaviours that underlie many mental disorders are formed in the same way. For example, the negative thoughts and feelings characteristic of clinical depression may become entrenched and reflexive as a result of maladaptive plasticity, which is why it is becomes incredibly hard for sufferers to break out of this vicious cycle. In fact, many mental disorders are a direct result of the formation of such undesirable neural connections.

Through a good understanding of our brains and neuroplasticity, clinical psychologists employ various psychotherapies to reduce the strength of these undesirable neural connections while promoting the use of the desirable ones. Your psychologist will work with you to disrupt negative pathways and decrease neural activity in particular areas of the brain. As new (and healtier) pathway are forged, the old ones eventually fall into disuse. Much like Chernobyl.

Tip: While neuroplasticity has been observed to a lesser extent in adults than in children, adults are just as capable of effecting adaptive neuroplastic changes and neurological growth through consistent effort and by maintaining a healthy lifestyle.

When should I see a psychologist?

Talk to a psychologist if you feel that your problems have reduced your quality of life, your mental well-being has a disruptive impact on your daily routine (e.g. work, social life), your relationships and mood has been affected, or generally if you feel you are not living a meaningful life or not according to your values.

It is a commonly held misconception that one must wait until a problem becomes a diagnosable disorder or a serious mental health concern.

When should I seek psychological intervention?

Seeking psychological intervention*

(*basically, seeking professional help)

Credit: American Psychological Association

Visit http://www.apa.org/helpcenter to explore this and other helpful videos in this series

“What good does talking do?”

“That’s what friends are for?”

“What can a psychologist do? Isn’t psychotherapy just ‘talking’? I talk to my family about my problems”

These are familiar refrains among those with anti-therapy attitudes.

But don’t get us wrong.

Support from family and friends you trust is often your first line of defence. However, the “talking” therapy that you will have with your psychologist involves so much more. Clinical psychologists undergo many years of education, supervised training and workplace experiences. This allows them to diagnose and address psychological, intellectual, emotional, and behavioural maladjustment issues ranging from daily stressors to severe clinical psychopathology.

What is Psychotherapy

Credit: The School of Life

Repairs & Tune-ups for your mind

Think of your body, your bones and your flesh as your hardware. Important physiological tools for your survival.

Your thoughts, emotions, and feelings: this is your software. Your software controls your hardware, dictates your mood, and is responsible for your well-being. It’s important stuff. But your software may not always work as well as you’d like it to. Software issues cannot be resolved by telling the problem to go away, the way you would give your old television an occasional knock (and thereby revealing this author’s age…). Life happens, and you may not always have the necessary tools to rough it out. Or you may simply need the occasional tune up. This is psychotherapy.

Psychotherapy is understanding and dealing with your inner thoughts and emotions productively

with your psychologist, in a completely honest environment. Effective psychotherapy requires deep engagement and constant two-way feedback. And research shows that psychotherapy is most effective and helpful when an honest dialogue takes place between you and your psychologist.

The techniques a Clinical Psychologist employs during psychotherapy are developed over decades of research and involve more than unstructured conversing and listening. Clinical Psychologists assess, diagnose and provide therapy for individuals suffering from psychological distress and mental illness. They also perform psychometric testing such as IQ assessments for adults or kids.

How Psychologists Address Mental Disorders

Clinical Psychologists recognise behaviour or thought patterns objectively, more so than those closest to you, who may have stopped noticing, or perhaps not all. Your psychologist will be able to identify the next steps that you may face in your challenge, and offer coping strategies. Their observations may sound similar to what your family or friends may say, but an experienced psychologist using their clinical skills framing these conversation in a therapeutic setting will make a significant difference.

If your difficulties have been ongoing for some time, or would like preventive therapy before your difficulty becomes insurmountable, now is the time to seek help from a trained psychologist.