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Psychiatric versus psychological evaluation: What is the difference?

“I think I need a psychiatric evaluation? Can you test me?” 

This is one of the questions we get from time to time that reveal ongoing confusion about testing, assessment, evaluations, the world of psychiatry, psychology, and neurology. Let me try to differentiate a bit here for those who have interest or need to find a good evaluation option.

What is a psychiatric evaluation? 

It is usually done by a psychiatrist who is a physician with special psychiatric training (courses and residencies). This evaluation is comprehensive but medical in nature. Expect the person to ask for your physical, behavioral, and cognitive histories, order blood tests or other medical exams, evaluate (by observation and interview) your mood, your reality testing, and mental status etc. Ultimately, after an extensive interview, the doctor will arrive at a psychiatric diagnosis (if appropriate) and may also recommend medicines to help with the problem–which they can prescribe. A few also provide ongoing talk therapy but most do not. Rather, they recommend you find a therapist for that part. They will follow up with med checks as needed to titrate or refine your medicines. When a person has a very difficult, complex, or lengthy history of mental health problems, or, when the person is needing a diagnosis for legal reasons, a psychiatrist is a good choice. They are usually gifted at extracting subtle physical and behavioral matters that may help correctly pinpoint the problem. While a person might well get anti-depressants from their internist or family doctor, a good psychiatrist is better able to deal with complex matters and follow you more closely to get the right compound and dosage.

Neurological Evaluation. 

Stating the obvious, a physician with neurological specialties and qualifications does a neurological evaluation. Neurologists specialize in the nervous system (brain, spinal cord, and 12 cranial nerves). A neurological evaluation includes many of the things evaluated by psychiatrists but with special attention to your motor and sensory systems, your reflexes, and similar kinds of things. You might more likely see a neurologist when you obviously have a neurological issue. Neurologists are more likely to specialize in ADHD, brain injuries, and psychiatric problems that result from dementias or other known physical problems. They are often better able to give and interpret MRIs and other imaging that might be appropriate. They will also prescribe and follow medications.

Psychological Evaluation (also known informally as testing or psych assessment). 

These are offered, mostly, by doctoral level psychologists. These evaluations will cover much of the same history, mental status, and provide diagnoses when appropriate. Interviews, just like the previous two options, are essential. However, what sets psychological evaluation apart is its use of standardized tests. These may be paper and pencil or electronic. They may be filled out by the client or by family members. The results provide a snapshot of behavior, cognitive functioning, or mood by contrasting the individual results with a peer group. For example, a child may complete a computerized test to assess attention span. The results are compared to thousands of children taking this test who either are “non ADHD” and or known to have ADHD. A good psychologist collects data from multiple data points (test data, interviews by client and maybe family, observations, etc.) and uses that data to make interpretations and recommendations for ongoing care. Usually, the best psychological evaluations begin with a very objective, specific question. Just throwing a bunch of tests at a person to “see what comes up” isn’t all that helpful. Just because something pops up doesn’t mean it is meaningful.

Assessments may also be completed by masters level therapists (licensed or not). But some assessment tools can be only given and interpreted by either doctoral level clinicians or those with specialized training. 

There are other types of evaluations. Neuropsychologists are doctoral psychologists with specialized training and help pinpoint brain injury, unravel more complex learning disabilities, etc. Neuropsychiatric evaluations are done by another similar but slightly different professional.

So, how do you choose what is best for you? Answer a few questions.

1. What do I really want to know when it is all said and done? What might help me decide how to proceed? (The more specific you are, the more likely you can get the answer you want.)

2. Do I think I need to focus more on physical options or behavioral options?

3. Do I think I’m likely to need medications? Then physician types are better. Psychologists usually cannot prescribe meds.

4. If I am given a diagnosis, what do I need it for? Both doctoral level psychologists and psychiatrists are capable of giving you diagnoses. However, some people or systems value one opinion over another. Figure out if it matters for your purposes.

5. Am I looking for specific behavioral/relational suggestions? Then psychological evaluations are more appropriate.

6. Am I looking to form an ongoing therapeutic talk based relationship? See the psychologist or psychotherapist.

“Work in the trenches; serve the afflicted and needy; do the little by little redemptive work. But also lift up your hearts and see the world. And as you look, you who understand the soul damage of trauma and abuse – speak to the church and call her to loving action around this globe. ”

Diane Langberg, Ph.D.

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