Therapist vs. psychiatrist: Understanding the difference

What Is a Psychiatrist?

A psychiatrist is a medical doctor specializing in the diagnosis and treatment of mental illness. 

Becoming a licensed psychiatrist requires four years of medical school and usually four years of residency, which is specialized training in psychiatry. They must earn a degree as an MD (Doctor of Medicine) or a DO (Doctor of Osteopathic Medicine), and select a specialty area to get a licensure in, though they aren’t limited to this path once they’re ready to begin their career. 

There are also psychiatric mental health nurse practitioners (PMHNPs), who have specialized training in psychiatry and medical nursing. Becoming a PMHNP requires a four-year bachelor’s degree in nursing, board-certification and licensure as a nurse, nursing experience, and a master’s degree in nursing with a specialty in psychiatry, as well as  board-certification and licensure as a psychiatric nurse practitioner. In some states, PMHNPs work in collaboration with psychiatrists for some or all of their career, while in other states PMHNPs have full-practice authority.

In recent years, psychiatrists in many communities have become less available, with months-long wait times. Because of this, Thriveworks specifically looks to employ psychiatric nurse practitioners so that we can more immediately serve the demands of the growing mental health crisis.

The extensive education and specialized training received by both psychiatrists and psychiatric mental health NPs gives psychiatric experts the deep knowledge and expertise to be able to diagnose and treat a variety of mental health disorders ranging from acute to severe. They understand the complex relationship between mental health and medical diagnoses, as well as how genetics and family history play into their clients’ well-being. 

Psychiatric providers typically provide shorter appointments with more focus on medication management than therapeutic work. Their services can be more costly than therapists’ given their specialization as prescribers.

What Is a Therapist?

A therapist, specifically known as a psychotherapist in the field of mental health, is a person who treats mental conditions through verbal communication and interaction. There are several types of therapists you could see, and their credentials vary depending on their specialty areas. Here are a few you could choose from:

• Psychologists: Psychologists must attend a doctorate program to learn how to treat various types of mental illness. They also complete a two- to three-year internship where they receive hands-on training in behavioral therapy, psychological theory, and treatment methods. They are taught to understand how the mind corresponds to behavior. They focus on day-to-day problems and may help clients with a range of mental disorders, from mild to severe. 
• Licensed professional counselor (LPC) or licensed mental health counselor (LMHC): Licensed mental health counselors have master’s degrees in psychology or a counselor-related field. They must complete two years of training to get their license and are trained to help people develop better ways to cope with their emotions.
• Licensed clinical social worker (LCSW): Social workers have master’s degrees in social work and must also go through thousands of supervised hours before being able to receive their license. They usually work in community-related fields, but some have private practices. 
• Marriage counselors and family therapists (MFTs): MFTs are mental health professionals trained in psychotherapy (talk therapy) and family systems. They have the ability to diagnose and treat mental disorders that may be the underlying cause of relationship problems. They must have a master’s or doctorate degree in marriage and family therapy, and at least two years of hands-on experience in the field. 
• Pre-licensed therapists: Pre-licensed therapists — such as residents in counseling, supervisees, and mental health interns — make up another group of therapists. These professionals have completed their master’s in social work, therapy, or a related field; however, they’re still acquiring hours to obtain their clinical license. Often, it’s cheaper to work with a pre-licensed therapist. In addition, there are other benefits: For example, pre-licensed therapists often bring a fresh outlook to sessions and are incredibly motivated at this stage in their careers.

That isn’t an exhaustive list, but it is a good representation of the types of licensed counselors you could end up seeing. Therapists use different types of therapy to help treat their clients, including: 

• Cognitive behavioral therapy (CBT): This is a short-term therapy that focuses on changing thought patterns and behaviors. It is recommended for those dealing with anxiety, bipolar disorder, depression, addiction, phobia, and OCD. 
• Dialectical behavior therapy (DBT): DBT is often integrated alongside CBT. It is based on distress tolerance and using problem-solving to overcome mental issues. It is used to treat self-harm, eating disorders, borderline personality disorder, destructive thought patterns, and more. 
• Psychodynamic therapy: Psychodynamic therapy can be described as a simplified form of psychoanalysis. It involves the client becoming familiar with their feelings, thoughts, and behaviors so they can become familiar with the unconscious processes that happen in their mind and the effects those processes have on their actions. It is effective for those dealing with issues in the past that are negatively affecting their mental state. 

Many people also wonder how therapists typically serve their clients. Appointments can be conducted in a variety of settings, including in-person or virtually through online therapy. There are also assorted environments like:

• Individual therapy: This is the most common type of therapy. It occurs on a one-on-one basis. 
• Group therapy: Group therapy is performed in a group setting and is usually complementary to individual therapy. Many clients find additional benefit from communicating with others who are also dealing with similar issues. 
• Family therapy: Family therapy is often conducted with multiple family members in the same room. In that way, it’s similar to group therapy but all of the people in the session are typically focused on resolving the same issues and strengthening their relationships with one another.
• Marriage/couples therapy: Marriage counseling or couples therapy is a space for partners to discuss their issues and work toward solutions together with the help of a counselor. Most sessions occur with all three parties present, though each partner can also receive individual therapy in conjunction with couples therapy.

What Is the Difference Between a Therapist and Psychiatrist? Psychiatry vs. Therapy

When it comes to therapists vs. psychiatrists, the main point to understand is that therapists use various types of therapy to provide ongoing emotional and mental support while psychiatrists and psychiatric NPs prescribe medication to help relieve the symptoms of a mental health condition.These medications could include the following: 

• Antidepressants: These balance neurotransmitters in the brain to stabilize emotions and promote a positive mood. 
• Anti-anxiety meds: These medications can help reduce the symptoms of panic disorder, social anxiety disorder, PTSD, and others.
• Mood stabilizers: These are useful for those with bipolar and some other related disorders to stabilize mood and prevent manic, hypomanic, and depressive episodes..

Sessions with a psychiatrist or psychiatric NP are typically shorter than appointments you’ll have with therapists, and their main goal is to analyze how well you’re doing on prescribed medications. Therefore, they will likely refer you to a therapist that you could see on a more routine basis. Many people use a combination of medication and psychotherapy to help treat their conditions, a pairing that often works well together.

That said, it’s important to also know that psychiatrists and psychiatric NPs can leverage the abilities of a medical doctor. They can order and perform medical labs and provide robust assessments to explore any underlying medical issues or comorbid psychiatric issues to help paint a more comprehensive picture of a person’s mental and physical state.

Should I Look for a Therapist or Psychiatrist?

Now that you understand the difference between a therapist and a psychiatrist, you can better understand what option may be better for your needs. 

There really is no black-and-white answer here — it comes down to whether or not you are interested in medication management, therapy, or both. Some mental health issues are best treated with a medication management as well as therapy, including: 

• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Panic disorder
• Severe depression
• Hallucinations
• Bipolar disorder
• Borderline personality disorder

However, some situations can be treated adequately with therapy alone. This may be a better route for conditions like:

• Relationship issues
• Milder anxiety or depression
• Career uncertainty
• Anger or stress
• Negative thinking

In cases like these, you may choose to start out by talking to a therapist. Under their guidance, you can determine whether medication may be necessary or helpful. In any case, it’s recommended to consult with a mental health professional to determine the best course of action. 

When Should You See a Psychiatrist? Why See a Psychiatrist Instead of a Therapist?

As previously stated, you should consider seeing a psychiatrist over a therapist if you feel that you need medical treatment, such as medication or testing for a certain disorder. Psychiatric professionals can prescribe medication to help bring your symptoms down to a manageable level, as well as test you for certain mental disorders in order to make informed decisions about your mental health. They can then refer you to a therapist to help you deal with the emotional ramifications of your symptoms.

Should I See a Therapist or Psychiatrist for Anxiety?

Both therapists and psychiatric experts can help with anxiety and reduce anxiety symptoms. However, if anxiety symptoms are more intense and require medication management, then seeing a psychiatric provider first or in conjunction with a therapist may be most helpful. 

Do Psychiatrists and Therapists Ever Work Together?

It is very common for psychiatrists and therapists to work together. 

In some instances, you may want to see a psychiatrist first. A psychiatric provider can order labs and tests that may help you pinpoint exactly what you’re struggling with and what treatment options would be the best for your unique situation. If necessary, they can prescribe medications alongside treatment that may help you overcome your problems faster than other therapy methods. Then, they will likely refer you to a therapist for more consistent care and treatment. 

If you’d rather not go that route, you could start with seeing a therapist. Depending on how your therapy goes, you and your counselor may decide that medication is necessary. If that occurs, they may refer you to a psychiatric professional to determine what prescriptions you should be taking. 

In short, you don’t have to choose between seeing a psychiatrist or a therapist, and could likely end up seeing both.

Getting the Help You Need

Any mental health condition can get in the way of your ability to live life to the fullest, and putting off treatment could only make these symptoms and side effects worse. Understanding the difference between therapist and psychiatrist can help you take that first step and find the most appropriate form of support.