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Psychiatrists and marriage and family therapists are both mental health professionals and may work as part of the same team. Diagnosis falls under the scope of practice of each. Typically, though, there is not a lot of overlap in their duties.
Psychiatrists have attended medical school and gone on to complete advanced training in psychiatric medicine. Those employed by large healthcare organizations typically spend their time managing the physical aspects of mental illness. Often this means medication; it can also entail ordering neurological imaging and medical tests. Because they have so many years of education, psychiatrists are also good candidates for mental health research and for some high level directorial positions. Marriage and family therapists have the option of completing a doctoral degree as well.
Marriage and family therapists perform counseling and psychotherapy; their specialty is relational psychotherapy. Psychotherapy is within psychiatrists’ scope of practice, but it does not constitute a big part of their duty in many settings. Managed care programs and medical centers are not willing to pay a psychiatrist salary for services that don't require a psychiatrist's training. Psychiatrists don’t always have a lot of training in relational therapy.
The American Association for Marriage and Family Therapy reports that MFT fees are just 60% those of psychiatrists.
Psychiatrists may earn an undergraduate degree in virtually any field, but are expected to have some science prerequisites. After earning their undergraduate degrees, they do four years of medical school. There is generally more classroom learning in the early part of the program; later work consists primarily of clinical rotations. They will not specialize in psychiatry until later.
Marriage and family therapists also have multiple options at the undergraduate level, though some schools favor candidates with significant coursework in the behavioral sciences. After earning their undergraduate degree, they must do at least two years of master’s level study. As graduates, they take classes in family studies, family therapy models and techniques, and development across the lifespan. They generally take at least one research class and one class in professional ethics.
Both psychiatrists and marriage and family therapists complete a residency, or period of supervised work experience, after completing their degree. During this time, they draw a salary, though it will be lower than what they will ultimately command. In the case of psychiatrists, it is much lower.
A psychiatrist's residency is longer. It may also be more grueling and include longer hours. Though a medical student typically interviews and ranks his choice of residencies, he is not in full control of where he is placed. A marriage and family therapist goes through an interview process much like any other job candidate.
Psychiatrists typically spend four years as residents. The first year of training includes neurological and general medical training. This is followed by three years of psychiatric training. The last year of the residency typically incudes a lot of options, for example, the opportunity to focus on research.
Later the candidate chooses a sub-specialty and does a one-year fellowship. Some sub-specialties require two.
Marriage and family therapists typically spend two years completing their supervised practice, though a few states set the requirement higher or lower. States typically also set a minimum number of hours, but in many cases, it is possible to complete the requirement within two years while working somewhat less than full-time.
Marriage and family therapists are generally required to do half their therapy hours in conjoint therapy: working with more than one person simultaneously. They may be expected to do all their therapy from a systems perspective – that means looking at problems and solutions from the perspective of human relationship.
How much experience a psychiatrist will have doing family therapy or systems work during the residency years is highly variable.
Medical students generally incur significant debt, but they can command high salaries once they’ve earned their credentials. The Bureau of Labor Statistics reports that psychiatrists enjoyed a mean annual salary of $177,520 in 2012.
Marriage and family therapists enjoyed a mean salary of $49,270.
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