To whom to run if it is very bad: psychiatrist, psychotherapist, psychologist

Anastasia Maksimova is a journalist, editor at Cosmopolitan magazine, and writer. In 2017, she was diagnosed with clinical depression. Nastya coped with the disease and wrote a detailed guide to depression to help people in a similar condition.

We publish a chapter from Nastya’s book – about which specialist to contact when you feel bad.

“Contact a specialist”

When from all sides it is advised to “contact a specialist”, you finally decide, because there is no strength to endure. And here several questions arise at once. Firstly, who, in fact, should this specialist be. Secondly, where to find it. Thirdly, how to determine that you are a professional, and not a charlatan. Finding the right specialist is sometimes really difficult. Private psychological practice in our country is not yet licensed. A diploma does not always guarantee that its holder will be able to help. Let’s deal with everything in order.

You have gathered your will into a fist (or reached the handle) and are ready to sign up for … who? Psychologist? Psychiatrist? Psychotherapist? Usually it is between them that people who are in trouble choose.


I decided to start with this specialist, because it is from him that you should look for an ambulance if you suspect depression. If you can only cry and you only have the strength to make one call, let it be a call to a psychiatrist.

The psychiatrist is a doctor, he has a higher medical education. This does not make him conditionally better or worse than a psychotherapist or psychologist – it simply gives him the authority to make a diagnosis. Why do I suggest going to him in the first place?

  • First, a psychiatrist will determine how bad things are and make a diagnosis. Symptoms of various diseases are similar: you may think that you have depression, but in reality it turns out to be an anxiety disorder – and the treatment protocol is different.
  • Secondly, the doctor, if necessary, will prescribe drugs – he has the right to prescribe prescription drugs.
  • Thirdly, this is a graduate, and medical school diplomas are not just handed out.

What is a psychiatric appointment like? For a visit to any other doctor. And don’t let it bother you that the complaints are specific. You complain to a gastroenterologist about stomach pain, and you can calmly tell a psychiatrist about your unwillingness to live, loss of joy and constant tears. The doctor will ask you a lot not only about your mental state, but also about your physical health, past injuries, problems with sleep, food, and much more. Most likely, he will ask you a question about relatives and their diseases.

It is highly likely that a psychiatrist will recommend that you contact a psychotherapist at the same time. By prescribing drugs, the doctor will monitor your condition: how your body responds, how your condition changes, how side effects appear. Be prepared: it is not always possible to find suitable medicines right away. Perhaps the doctor will replace one tablet with another – and this is normal.

You should not think that a psychiatrist is a person who simply prescribes “magic pills”.

In fact, the doctor knows many tricks to correctly diagnose, guide and support the patient.


Formally, in Russia only a psychiatrist can be called a psychotherapist who has completed additional specialization in psychotherapy and has chosen one of the areas: for example, cognitive behavioral therapy, gestalt therapy, and others.

“A psychotherapist in Russia is a psychiatrist who has undergone retraining in psychotherapy. It implies a minimum of 576 hours of lectures and seminars, as a result of which the specialist gains basic knowledge about various psychotherapeutic approaches,” says psychiatrist-psychotherapist Anna Konoreva. – Then he himself receives the knowledge that he needs, having mastered one or another approach: gestalt, psychodrama, cognitive behavioral therapy, psychoanalysis, systemic family therapy, transactional analysis. However, you can get the same knowledge without being a psychotherapist – it is enough to be a psychologist with a higher education. Both the psychologist and the psychotherapist perform the same functions – only a psychotherapist can still prescribe drugs.

The main tool of the psychotherapist is a therapeutic conversation.

It helps a lot if you come not only with your problem, but also with a request: what result do you want to get after treatment. The more specific and precise you are about this goal, the better. So the therapist will quickly understand how to help you.

Requests can be, for example:

I would like to go out again at least once a week.
I want to stop crying every day.
I want to do at least one task at work or at home every day.

As you can see, here we are talking about the “meaning of life” – all the tasks are very simple and specific. Living with depression is very difficult, so don’t over complicate things by asking yourself what you really expect from your meetings with a specialist. Do not think about global tasks, move in small steps. You are not a passive object, but a participant in the healing. And your desire decides a lot.


This specialist works with mentally healthy people who are experiencing difficulties. It does not diagnose or determine if you have depression, bipolar disorder, or schizophrenia. But a psychologist can help develop self-confidence, teach you how to communicate with people, restore peace of mind. This is very helpful, but be careful with yourself. If you suspect that not everything is in order with your psyche, then a psychologist is not the first person to contact.

There is another problem here. In Russia, the activities of psychologists are not subject to mandatory licensing.

This means that almost anyone can become a psychologist if he has a specialized education – higher or postgraduate. Universities usually provide the most basic knowledge, and rarely a psychologist can start private practice immediately after graduation. As a rule, everything depends on further education: then the graduate decides which tasks are more interesting for him, in which direction to work.

Once again, start with a psychiatrist. First, not every psychologist will detect depression. Let me remind you: many psychologists have a humanitarian education, not a medical one. Secondly, in order for him to draw some kind of conclusion, he will have to get together, talk for a long time, and this requires a resource that a depressed person often does not have.

Many psychologists work with depression, and some do it very successfully, but usually in conjunction with medication and psychiatric supervision.

How does a session with a psychologist go? It differs from chatting with a friend over a glass of merlot at least in that the psychologist will not burden you with his problems, but will listen to you and ask leading questions.

In an ideal world, all three professionals – a psychiatrist, a psychotherapist and a psychologist – work together, helping each other and their patients. And most importantly, what professional school they went through and what experience they have.


– If you suspect depression, first find a good psychiatrist – a doctor with a medical degree. Only this specialist can prescribe medications.

– A psychotherapist in Russia formally must have a medical education, but often psychologists who have completed additional specialization in psychotherapy call themselves psychotherapists.

— A psychologist works with mentally healthy people experiencing difficulties in life. It cannot diagnose or determine if you have depression.

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