What is the Difference Between Psychotherapy and Psychiatry?

Psychotherapy and psychiatry sound alike, so it can be confusing to know what the differences are and when to see a psychotherapist versus when to see a psychiatrist.

The Difference Between Psychotherapy and Psychiatry

What is the Difference Between a Psychotherapy and Psychiatry?

While the two terms might sound interchangeable, there are important key differences:

Psychotherapy

Psychotherapists tend to focus on thoughts, including unconscious thoughts, emotions and behavior.

The Difference Between Psychotherapy and Psychiatry

Psychotherapists have at least a two year Masters degree and many of them also have an additional four years postgraduate training from postgraduate institute (like the Institute for Contemporary Psychotherapy, National Institute of Psychotherapies and other institutes).

Aside from traditional talk therapy, psychotherapists who go on for advanced training also provide specialized therapy including (but not limited to):

• Eye Movement Desensitization and Reprocessing (EMDR)

Eye Movement Desensitization and Reprocessing (EMDR)

• Internal Family Systems Parts Work (IFS)

• Accelerated Experiential Dynamic Psychotherapy (AEDP)

• Somatic Experiencing

• Hypnotherapy

• Emotionally Focused Couples Therapy

• Sex Therapy (for individuals and couples)

Depending upon their skills and training, many psychotherapists can help clients to:

• Manage Stress and Anxiety

• Overcome Depression

• Develop Resilience and Better Coping Skills

Couples Therapy

• Improve Relationships

• Process Unresolved Issues, including Unresolved Trauma

• Improve Communication Skills

• Cope with Workplace Issues

• Process Unresolved Grief

• Improve Self Esteem

And many other behavioral and interpersonal issues.

Most psychotherapy sessions occur at least once a week for 45-60 minutes.

Psychiatry

Psychiatry focuses on the medical side of mental health.

Psychiatrists are mental health professions who are medical doctors (MDs or DOs). They provide differential diagnoses, prescribe psychotropic medication such as antidepressants, anti-anxiety medication, antipsychotic medication and other similar medications.

In the past, psychiatrists provided traditional psychotherapy, like Cognitive Behavioral Therapy (CBT), psychoanalysis and psychodynamic psychotherapy. However, these days most psychiatrists provide medication management. 

Some specialized psychiatrists also provide Electroconvulsive therapy (ECT) for severe mental health conditions such as treatment-resistant major depression, ADHD, schizophrenia and  catatonia (a state where someone is awake but unresponsive to other people or the environment).

After the initial evaluation session, psychiatry sessions tend to be shorter in duration (15-20 minutes) to assess how a client is responding to medication management. After a client has been stabilized on medication, sessions might occur every 3-4 months unless the client needs help with medication.

Integrating Psychotherapy and Psychiatry

Clients, who need medication management, benefit from integrating both psychotherapy and psychiatric treatment and many psychotherapists and psychiatrists collaborate to integrate both treatments (see my article: Medication Alone Isn't As Effective As Including Psychotherapy).

For instance, a psychotherapist who is helping a client with anxiety will often be in touch with the client's psychiatrist to provide feedback on what she has observed in therapy sessions and to get information about medications prescribed. This is only done with a written consent from the client.

While some clients choose to only take medication, research has shown that combining psychotherapy and psychiatric treatments is most effective (when psychiatric treatment is needed) rather than just relying on medication because clients learn coping skills and strategies to deal with their mental health issues. 

Psychotherapy can get to the underlying issues that cause the mental health issues and if worked through in therapy, it's possible that medication won't be necessary for certain clients. 

In addition, when clients stop taking medication for certain mental health issues, they often go back to having the same problems they had before they took medication. For instance, if they never learned to manage anxiety symptoms or get to the root cause of their anxiety in therapy, once they stop taking the medication, they are back to where they were before they stopped taking the medication.

At the same time, there are certain mental health conditions that require medication such as schizophrenia, some forms of ADHD or bipolar disorder to mention just a few.

How to Choose Between Psychotherapy and Psychiatric Treatment

Making a decision about mental health treatment can be a big step, especially if you are new to it.

Consider what you need:

Are you looking for help with understanding yourself, improving your relationships, dealing with situational anxiety or working on unresolved trauma or are you dealing with more complex long-standing psychiatric problems?

If you are dealing with a mental health issue that requires medication (e.g., ADHD, bipolar disorder), starting with a psychiatrist is a good first step. Then, once you are stabilized on medication, you can see a psychotherapist to help you to make the behavioral changes that medication alone won't do.

How to Discover What is Right For You

It's easy to get confused about the differences between psychotherapy and psychiatry.

The Difference Between Psychotherapy and Psychiatry

You're not a broken machine that needs to be "fixed". You're a human being which means that, like everyone else, you have messy, complicated and wonderful parts of yourself. We all do.

Rather than focusing on being "perfect", the goal is developing a better understanding of yourself, practicing self compassion, finding the right tools and strategies to deal with life's inevitable ups and downs and living a meaningful life.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Parts Work (IFS and Ego States Therapy), Somatic Experiencing and Certified Sex Therapist.

I have helped many individual adults and couples over the years.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Also See My Articles:

Why is Experiential Therapy Better Than Traditional Talk Therapy to Deal With Trauma? 

With Experiential Therapy, There Are No Blank-Slate Therapists 

The Mind-Body Connection: Experiential Therapy Offers a Window Into the Unconscious Mind 

How to Build Your Self Esteem

What is Self Esteem?

Before we discuss how to build your self esteem, let's start by defining self esteem.

Building Your Self Esteem

Self esteem includes 

• A sense of self worth and value

• Self respect

• An overall sense of yourself

What Affects Your Self Esteem?

Your self esteem is shaped by many aspects including

• Early childhood experiences 

• Personal relationships and prior experiences

• Thoughts

• Relationships

• Motivation

• Resilience

• Acceptance of imperfections, mistakes and challenges

What Are the Key Aspects of Self Esteem?

• Self evaluation including your subjective thoughts and beliefs ("I am lovable" or "I am capable") and other feelings about yourself

Building Self Esteem

• A foundation of well-being that supports your mental health and relationships

What is the Difference Between Healthy Self Esteem vs Low Self Esteem?

Healthy Self Esteem: 

• You accept your strengths.

• You recognize areas where you need to improve and accept this with self compassion and without judgment.

• You are resilient to constructive criticism.

Low Self Esteem: 

• You experience self doubt.

• You might have a fear of failure. 

• You might engage in people-pleasing. 

• You might engage in negative self talk. 

• Other possible behavioral dynamics

How is Self Esteem Different From Self Confidence?

Self esteem and confidence are related; however, self esteem is your general sense of self worth and self confidence is usually related to certain skills.

For instance, your overall self esteem might be good, but you might feel less confident in your public speaking ability and more confident in your ability to solve problems.

How to Build Your Self Esteem

Building your self esteem includes:

A Healthy Mindset

• Practicing Self Compassion: Treat yourself with the same compassion and kindness you would treat a loved one. 

Building Self Esteem

• Challenge Negative Self Talk: Become aware of your inner critic and reframe negative thoughts into more realistic positive thoughts.

• Stop Comparing Yourself to Others: Focus on your own journey and progress instead of comparing yourself (see my article: How to Stop Comparing Yourself Unfavorably to Others).

• Identify Your Strengths: Write down your strengths and focus on them.

Actions and Habits

• Set Achievable Goals: Start small and celebrate your victories as you build momentum to bigger goals (see my article: Celebrate Your Success).

• Engage in Enjoyable Activities: Engage in hobbies and activities you enjoy and you're good at.

Building Self Esteem

• Prioritize Self Care: Get enough sleep, eat nutritious meals, exercise at a pace that's right for you (see my article: Taking Time For Self Care).

• Be Assertive: Recognize the difference between healthy assertiveness and aggression (see my article: What is the Difference Between Assertive and Aggressive Behavior?).

• Learn to set healthy boundaries and ask for what you need without guilt.

• Help Others: Volunteering and engaging in acts of kindness can give you a sense of purpose and meaning.

Relationships

• Choose Supportive People: Choose people who value you and treat you well.

Building Self Esteem

• Limit Negativity: Reduce your exposure to negative influences, including social media.

• Communicate With Trusted Loved Ones: Share your struggles with trusted loved ones to build connection and realize that others often struggle with the same problems.

Deeper Self Esteem

• Clarify Your Values: Understand what values matter to you (e.g., kindness, learning, connection and belonging).

• Take Action: Take steps to build your self esteem rather than waiting for it to happen.

Get Help in Therapy

If you have tried to build your self esteem and you feel stuck, rather than struggling alone, consider working with a licensed mental health professional who has an expertise in helping clients to overcome obstacles that are getting in your way.

Get Help in Therapy

Building your self esteem can help you to live a more fulfilling life.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Parts Work (IFS and Ego States Therapy), Somatic Experiencing and Certified Sex Therapist.

With over 25 years of experience, I have helped many individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

What is the Difference Between Assertive and Aggressive Behavior?

Many people don't understand the difference between being assertive and being aggression, so I think it's worthwhile to define each of these terms and differentiate them from one another.

Assertiveness vs Aggressive Behavior

What is Assertiveness?

Assertiveness is the ability to express your needs, feelings and boundaries with confidence, clarity and respect.  While being assertive, you're not diminishing or violating the rights of others.

What is Aggression?

Aggression attempts to control, manipulate or intimidate others to get your own way. This often violates boundaries and damages relationships.

What is the Difference Between Assertiveness and Aggression?

Based on the descriptions above, the difference between assertiveness and aggression lies in whether you respect yourself and others, which would be assertiveness, or prioritizing yourself at the expense of others, which would be aggressive.

Let's take a closer look at the differences between assertiveness and aggression:

Intent: 

• Assertiveness seeks understanding, resolution and mutual respect. 
• Aggression is often fueled by a desire to control, win or punish.

Respect For Others:

• Assertive behavior seeks to consider the needs of others while expressing your own needs. 
• Aggressive behavior often disregards the needs and feelings of others.

Emotional State:

• Assertiveness is usually calm, rational and firm. 
• Aggression is usually emotionally charged and accompanied by anger or contempt.

Focus:

• Assertiveness focuses on the problem using "I" statements.
• Aggression focuses on attacking and blaming the other person using "you" statements.

Why Is It Important to Know the Difference Between Assertive and Aggressive Behavior?

• Long Term Impact: Assertiveness seeks to build trust, self esteem and healthier, more productive relationships.

• Consequences: Aggression causes resentment, fear and disconnection.

• Cultural Context: Women, people of color and others are often labeled as "aggressive" for behavior that is viewed as "assertive" in others. This makes it important to recognize and challenge these biases.

Examples:

Joe:

After a contentious staff meeting where Joe attempted to intimidate and dominate his colleagues, his director confronted Joe about his aggressive behavior, but Joe told his director that he didn't care if his colleagues didn't like him because the only thing he cared about was "winning" the company prize for highest sales. He told his director he thought his colleagues were "losers" and they should be fired. 

Aggressive Behavior

In response, his director attempted to work with Joe to help him to understand the impact his behavior was having on his work relationships. He explained how Joe could be assertive, rather than aggressive, by speaking in a calm tone and showing his colleagues respect. When Joe's behavior continued to be aggressive, his director terminated him.

Julie:

As the only Black woman on her executive team, Julie talked to the other executives on the team about the negative impact some the company's policies had on women. She could sense their discomfort while she was speaking and she asserted she felt there was a need to address these issues to make certain changes which would benefit employees and the company. 

Assertive Behavior

After the meeting, she overheard one of the male executives remark quietly to another male executive, "I can't stand aggressive women." She reflected on her behavior in the meeting and she concluded that she was assertive and not aggressive. Soon after that, she consulted with the human resource director who agreed that the policies should be reviewed and changed. She also told Julie she would do a company-wide training to educate employees about the difference between assertiveness and aggressiveness especially as it applied to women and people of color.

Mark:

When his friends confronted Mark about his aggressive behavior with women at a club they often attended, Mark shrugged it off by saying, "Women want men to dominate them. No matter what they say in public, privately they want a strong man." In response, his best friend, John, pointed out that women usually rebuffed Mark at the club because they were put off by his controlling behavior. 

Aggressive vs Assertive Behavior

He also explained that some of the women in their friend group also complained that they sometimes felt bullied by Mark and that he usually focused on what he wanted even if the rest of the group wanted something else. Mark respected John so he thought about the negative consequences his aggressive behavior had in his personal relationships and he decided to try to change. John suggested that Mark get help in therapy to understand what caused him to try to control and manipulate others. Over time, he realized that his father, who was aggressive within the family, only expressed praise for him when Mark was also aggressive in his relationships. At that point, Mark realized he had a lot of work to do in therapy and he felt it was worth it.

Conclusion

Although many people confuse assertive and aggressive behavior, there are important differences.

Understanding the differences can help you to have a healthier relationship with yourself and others.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Parts Work, Somatic Experiencing and Certified Sex Therapist.

I have over 25 years experience working with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me,

Also See My Article:

Assertiveness: Learning to Say No

Relationships: Jealousy Isn't Love

Jealousy is a common emotion experienced in varying degrees in most romantic relationships (see my article: Overcoming Jealousy That's Ruining Your Relationship).

What is Jealousy?

Feeling jealous is often a signal of perceived danger to the relationship. 

Jealousy usually involves a fear of losing a partner to a rival. 

Jealousy Isn't Love

A little bit of jealousy can be a signal that you and your partner need to talk about insecurity and unmet needs. 

Communication between you and your partner about what makes each of you jealous or uncomfortable can help you to make positive changes in your relationship.

Why Do People Confuse Jealousy and Love?

People confuse jealousy and love because jealousy tends to: 

• Signal a deep emotional investment
• A fear of losing someone who is important 
• A perceived threat to a valued bond

Jealousy is often romanticized as proof of devotion, but this is incorrect because jealousy isn't love.

What Can Trigger a Jealous Reaction?

Almost anything can trigger a jealous reaction. It depends on the person.

Examples might include:

• Spending time with friends
• Talking to an attractive person at a party
• Going to lunch with a coworker
• Talking about a former romantic partner which is called retroactive jealousy

How is Jealousy Different From Envy?

People often confuse jealousy and envy.

Whereas jealousy is losing someone or something to a third party, envy is wanting something that someone else has.

When Does Jealousy Become Unhealthy?

A fleeting pang of jealousy which leads to you and your partner talking about the relationship in a calm and thoughtful way can be a good thing and can bring you closer.  

This is different from excessive jealousy.

Jealousy Isn't Love

Excessive jealousy can lead to:

• Obsessive thoughts and an inability to let go of fears, which leads to constant worry

• Controlling behavior like dictating who a partner can see or where a partner can go, dictating what a partner can wear, forbidding certain activities and so on

• Constant unwarranted suspicion with unfounded accusations and excessive questioning

• Possessive or accusatory reactions

• Invading privacy such as checking a partner's phone and demanding constant updates, which can erode a relationship

• Psychological manipulation using guilt or self pity

• Isolation such as trying to isolate a partner from friends and family

Overcoming Excessive Jealousy

• Self Reflection: If you're the partner who is excessively jealous, reflect on your behavior and identify your insecurities. Recognize that you have a problem and work on building your self esteem and confidence.               

Jealousy Isn't Love

• Personal Safety: If you're the partner who is experiencing excessive jealousy from your partner, consider your personal safety first. If your partner is threatening you, you need to confide in at least one trusted loved one and remove yourself from harm.

• Communication: Assuming you can both remain calm, speak openly with your partner about your feelings without blame.

Get Help in Therapy

• Seek Help: Seek help in individual therapy or couples therapy to work out issues around jealousy.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Parts Work (IFS and Ego States Therapy), Somatic Experiencing and Certified Sex Therapist.

I have worked with individual adults and couples for over 25 years.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Also See My Articles:

Recognizing When You Feel Safe or Unsafe in Your Relationships

Irrational Jealousy and Mate Guarding in Relationships

How Do You Know If You're in an Unhealthy Relationship?

Obsessive Jealousy

Overcoming Jealousy

The Traumatic Impact of Verbal Abuse on Self Esteem

In a prior article I began a discussion about verbal abuse (see my article: The Connection Between "Tough Love" and Verbal Abuse).

The Traumatic Impact of Verbal Abuse on Self Esteem 

In the current article I'm focusing on how verbal abuse can affect self esteem.

How Does Verbal Abuse Affect Self Esteem?

When children experience verbal abuse, the abuse can have long lasting effects on their self esteem.

Clinical Vignettes

The following vignettes, which are composites of many cases, illustrates how verbal abuse can have long lasting effects and how trauma therapy can help:

John

As the youngest child, John grew up in a household where his father yelled and criticized him while his mother, who was intimidated by the father, stood by passively and did nothing. His older siblings would also join in the criticism by bullying John. He grew up feeling that he couldn't do anything right. His self esteem was so low that, even though he was intelligent, he was fearful of raising his hand in class to answer the teachers' questions. He only had one friend who also came from a household where he was verbally abused. 

The Traumatic Impact of Verbal Abuse on Self Esteem

By the time John got to college, he spent most of his time alone until he met Peggy in English class. She was friendly and outgoing and she asked John out on a date. They dated throughout college and both of them planned to move to New York City when they graduated. By then, John's confidence was so low that he was afraid to apply for jobs, so Peggy encouraged him to get help in therapy. 

After he began seeing a trauma therapist, John learned how his father's verbal abuse affected how he felt about himself. His therapist helped John by using EMDR Therapy (Eye Movement Desensitization and Reprocessing) to help him to overcome the traumatic effects of the childhood verbal abuse.

Nina

Nina was an only child with a single alcoholic mother. She learned to take care of herself at an unusually young age because she couldn't rely on her mother, who was often drunk and passed out. When her mother woke up with a hangover, she would be angry and hostile towards Nina. She would call her names and tell her she wished Nina had never been born. 

The Traumatic Impact of Verbal Abuse on Self Esteem

After one of her teachers suspected that Nina was being abused, she called the Administration For Children's Services Child Protective Services and Nina was eventually placed in kinship foster care with a maternal aunt who lived nearby. 

Although her aunt was much more nurturing, the impact of the mother's verbal abuse had already had a devastating effect on Nina. Even though she was no longer around her mother, Nina had internalized her mother's verbal abuse to such an extent that she was now criticizing herself silently by repeating in her mind, "I'm so stupid" or "I'm no good." 

By the time she was 18, her self esteem was so slow that she told aunt she didn't want to go to college. So, her aunt found Nina a trauma therapist who did AEDP (Accelerated Experiential Dynamic Psychotherapy) to help Nina overcome the impact of her mother's neglect and verbal abuse. After working in trauma therapy, Nina felt more confident and she applied to several colleges. 

Tom

By the time Tom was 35 years old, he had been living an lonely and isolated life for all his life. Growing up as the youngest child, he watched his parents argue constantly and his father frequently left the household for extended periods of time without saying when he would come back. Tom and his older brothers spent most of their time isolated in their own rooms. 

Eventually his older brothers moved out without a word, so Tom was left alone with his combative parents. He tried to stay out of their way, but they would often turn their anger on him by yelling at him and criticizing almost everything he did. As a result, Tom grew up with a lot of shame and low self esteem.  

The Traumatic Impact of Verbal Abuse on Self Esteem

In his mid-30s, he knew he needed to get help in therapy because he was suffering with anxiety and depression, and his self esteem was so low that he lacked the confidence to meet women. So, he sought help from a trauma therapist who did Parts Work Therapy and he began to recover from the impact of his childhood trauma.

Conclusion

The negative impact of verbal abuse experienced in childhood often endures throughout adulthood.

Even though verbal aggression tends to be minimized in our culture, verbal abuse can be just as traumatic as physical or sexual abuse.

The vignettes presented above are just some of the possible ways verbal abuse can be traumatizing. 

Often, adults don't connect their low self esteem, depression or anxiety to their childhood history.  Instead, they might blame themselves or believe they are "not good enough" or they are "unlovable" without ever making the connection to their history or realizing they can get help in trauma therapy.

Getting Help in Trauma Therapy

If you have been struggling with low self esteem as a result of unresolved trauma, you can get help in trauma therapy.

Getting Help in Trauma Therapy

A skilled trauma therapist can help you to overcome harmful effects of unresolved trauma so you can lead a more fulfilling life.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Somatic Experiencing and Certified Sex Therapist.

I have over 20 years of experiencing helping individual adults and couples (see my article: What is a Trauma Therapist?).

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Why Are Close Friendships Important?

According to a 2021 American Perspectives Survey, Americans tend to have fewer close friends in recent years than they did in years past (see my article: Overcoming Loneliness and Social Isolation).

The survey also found that Americans talk to friends less often and rely on friends less for emotional support than they did in the past (see my article: Emotional Support From Your Family of Choice).

Close Friends Are Important For Your Overall Well-Being

According to the survey, there are reasons for this, including:

• Americans are more mobile than they were before so this makes it difficult to maintain friendships with the consistency that these relationships need.

• Americans are working and traveling more for work which doesn't leave time to develop and foster friendships.

• American parents are spending more time with their children than previous generations so this doesn't allow much time for friendships.

Why Are Close Friendships Important to Your Mental Health?

Close friendships can improve mental health because friendships:

• Reduce Loneliness and Social Isolation: Spending time with friends can help prevent loneliness and social isolation which can have mental health benefits.

• Provide Emotional Support: Friends can help with getting through difficult times and to cope with anxiety, depression, stress and major changes.

Close Friends Are Important For Your Overall Well-Being

• Improve Self Esteem: Positive interactions with friends can improve self esteem.

• Foster a Sense of Belonging: Close friends can increase feelings of belonging and community which can help with feeling connected and supported (see my article: The Need For Emotional Connection and a Sense of Belonging).

• Increase Happiness and Satisfaction with Life: Close friends can contribute to overall happiness and satisfaction with life.

• Help With Personal Growth: Friendships can challenge you to learn, grow and become a better version of yourself.

• Provide a Sense of Purpose: Close friendship can contribute to a sense of meaning and purpose in life (see my articles: A Search For a Meaningful Life and Living a Meaningful Life).

Why Are Close Friendship Important for Your Physical Health?

Close friendships can improve your physical health benefits because friendships can:

• Improve Cardiovascular Health: Having supportive friends can contribute to having healthier blood pressure and reduce the risk of cardiovascular problems.

Close Friendships Are Important to Your Overall Well-Being

• Enhance Immune Functions: Social support from friends can potentially enhance immune functions which reduce the risk of illness.

• Help Increase Life Expectancy: Studies have indicated that people with strong social connections tend to live longer.

Future Articles:

I'll continue to explore the importance of friendships in future articles.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Somatic Experiencing and Sex Therapist.

I have over 20 years of experience helping individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.