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Therapy vs. Psychiatry – The Good Men Project

Do you know the difference between a therapist and a psychiatrist? Many people don’t; they think these terms are interchangeable.

A therapist can be a psychologist (someone with a PhD), a licensed social worker, a licensed marriage and family therapist, or a few others.

(NOTE: Many insurance companies will only pay for therapy from people with certain degrees or licensure and sometimes put a limit on the number of sessions you can attend each year. Make sure to check before you start seeing someone.)

If you suffer from depression, anxiety, or any other mental health condition, having a therapist can really help. Therapy is an invaluable tool in the fight between good and evil that goes on in our heads.

A psychiatrist can also help greatly. But psychiatry comes with its problems, too. One of these is the pervasive idea among practitioners that they only need to see their patients for ten minutes or so every few months (unless you’re in a crisis).

Psychiatrists (aka “shrinks”) are not therapists. They are medical doctors (MDs or DOs, not PhDs) and can, therefore, prescribe meds specifically for mental health. They are generally not there to discuss your childhood trauma or any other secrets you keep. Their job is to find the meds that might help you feel better.


I’ve been in therapy most of my life, starting at age 14. Some of the more common types of therapy are psychotherapy (talk therapy), cognitive behavioral therapy (CBT), and dialectical behavior therapy (DBT).

Talk therapy and DBT have done wonders for me. Sure, I’ve been doing it a long time, and I’ve gone through many therapists over the years. Indeed, by the time I finished grad school, I had stopped counting how many I’d seen.

But it’s taken everything I’ve learned to get to the point I’m at right now – happy, self-sufficient, and looking forward to the future.

Here’s a taste of my therapy history:

  • I had one therapist who barely spoke during our sessions. I don’t know what school of thought that strategy belongs to, but I didn’t like it much. On the other hand, I knew I could say anything and not be judged, so I was able to get a lot of the crap out of my head.
  • They’ve all been females, except my very first one. I only saw him a few times. I’m just not comfortable with male therapists.
  • I’ve made a couple of them cry.
  • Some of my therapists have held social work degrees.
  • Most have had a Ph.D. in psychology.
  • After my first hospitalization for depression at age 19 – I was there for a month – I was referred to therapy with a psychologist who not only specialized in eating disorders, but she insisted that I must have one. Whaaaat??!! Never saw her again! LOL
  • I’ve had a couple of rock-star therapists
  • The longest I’ve seen one therapist is nine years (!)
  • The shortest is one session.
  • They have all been more than competent and offered me help when I needed it. Many have gone above and beyond to help me through crises and keep me safe.

In short, I would be dead without talk therapy.


Most shrinks only have ten or fifteen minutes to see you; there’s not usually enough time for them to dig in and really try to understand where you’re coming from. That is a pitfall and a shame and speaks to the shortage of psychiatrists in the U.S. (How can you help someone if you don’t know how their brain works?)

However, if you get a really good one who has control over his or her own schedule, they can spend more time with you and dive into some of your issues. As far as I’m concerned, that is paramount in them being able to help you.

Even though my depression started at age 14, I didn’t seek psychiatric help until I was 33. What took me so long? I don’t really know. I can tell you that my depression got significantly worse during that time, and by the time I was in my early 30s, I felt like I had no choice.

I was desperate.

I won’t get into my whole story here – I’m saving that for my memoir :). Suffice to say that I’ve had a number of psychiatrists in the last 20 years, and my experience has run the gamut.

Try these on for size:

  • The very first psychiatrist I ever worked with was during my first hospitalization, in 1989. I was 19. I was there for a month. I was severely depressed, actively suicidal, and completely dumbfounded as to what to do. I felt only slightly better upon leaving. But for some reason, the psychiatrist did not put me on any medication – I had to ask for it upon leaving. (I know, right!?)
  • The second shrink I saw, in 2001, is one of only two female shrinks I’ve ever had (and that includes the dozen or so hospital psychiatrists I’ve seen). For reasons no one has ever really been able to defend, she diagnosed me as Bipolar Type II, a misinformed label that stuck with me for 14 very long years. The meds I received during that time were mostly worthless because they treated bipolar disorder, not severe depression. (I’ve mostly gotten over that, but it still chaps my ass. And it reminds me that we each need to advocate for ourselves.)
  • Each of the 15 times I’ve been hospitalized for my depression, I’ve seen the hospital shrink, multiple times. But they are only there to stabilize you. (Yeah, like that’s possible in a few days or a week or a month.) I’ve had decent ones who seem to care, and I’ve had one or two that didn’t really give a shit.
  • One of them, Dr. Whatshisname, had a God complex. And he had it bad! He told me all about himself instead of the other way around, and he said some things to me that damaged my mental health. I saw him once when I got out. He was such an ass that I never went back.
  • I have also had the pleasure of working with one of the best psychiatrists in the Midwest, who I’ve mentioned in previous posts – Dr. Nelson in Minnesota. He treated me like I was his equal. He scheduled me for 30- to 45-minute sessions at least monthly, sometimes once a week.
    Dr. Nelson oversaw my first five rounds of TMS treatments between 2015 and 2019. He’s also the one who did a comprehensive 2-hour evaluation of me and properly diagnosed me with major depressive disorder (which is what I’d been saying the whole time). Because of him, I finally started receiving the proper kinds of treatment. I am forever grateful to him and his wonderful team.
  • The rest of them fall somewhere between fairly competent and good enough.


As you can see, my experience is vast – and these were just the highlights! But both therapy and psychiatric medications are indispensable to my recovery from depression and anxiety – indeed, to my survival.

I highly recommend trying both if you’re suffering. And hey, if the first person doesn’t work out, by all means try someone else. Yes, it’s a big pain in the ass to start treatment over with a new practitioner, but the possibility of feeling better makes it worth it to keep trying, don’t you think?

Keep in mind that my case is somewhat extreme. I’ve had treatment-resistant depression and generalized anxiety disorder for more than 35 years now, and I’ve been in the mental health system since 1984.

Most people do not go through over a dozen psychiatrists and more than a dozen therapists. You probably won’t, either. Just know that no matter what – even when it seems like hope has abandoned you – recovery is possible.

As always, thanks for reading. And let’s Keep it Real out there!


Previously Published on Depression Warrior



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