Psychiatrist vs. Psychologist: Who Does What, and Who to See First

What is the difference between a psychiatrist and a psychologist?

A psychiatrist is a physician who can prescribe medication; a psychologist, in most states trained to the doctoral level, focuses on therapy and testing. That one sentence settles most of the confusion, and the rest of this article fills in what each does day to day, where psychiatric nurse practitioners and physician assistants fit, what "therapist" means, and how to decide who to see first when you are not sure what you need. Both professions treat the same conditions, and many people see both at once, so the choice is less about which is better and more about which kind of help you are looking for right now.

What does a psychiatrist do?

A psychiatrist is a medical doctor. The path is medical school, then a residency in psychiatry, then a state medical license, and often board certification. Because of that medical training, a psychiatrist can do things that, in most states, a psychologist does not: prescribe medication, order and interpret blood work and other medical tests, consider physical illnesses that can look like psychiatric ones, and manage the interaction between a psychiatric medicine and the other medicines a person takes.

In practice, most psychiatric visits are built around evaluation and medication management. The first visit is a structured history: what brought you in, how long it has been going on, what has been tried, your medical history, and your family history. Follow-up visits track whether a medicine is working and what side effects it is causing. Some psychiatrists also provide psychotherapy, and some focus almost entirely on medication while a therapist handles the talking. Our article on what to expect at a first psychiatry appointment walks through that first visit in detail.

What does a psychologist do?

In most states a psychologist holds a doctoral degree in psychology, usually a PhD or a PsyD, followed by a supervised internship and a state psychology license; a few states also license psychologists at the master's level for defined roles. The training is in how people think, feel, and behave, in the research behind treatments, and in psychotherapy. Psychologists are also the profession trained in formal psychological testing: structured assessments of attention, memory, learning, personality, and mood that can clarify a diagnosis when the picture is unclear.

Most psychologists do not prescribe medication. A small number of states allow psychologists with additional training and a separate license to prescribe certain medications, but in most of the country, prescribing belongs to physicians and, within state rules, to psychiatric nurse practitioners and physician assistants. If a psychologist believes medication would help, the usual step is a referral to a prescriber, and the two can then work together.

Where do psychiatric nurse practitioners and physician assistants fit?

They are prescribers, and much outpatient psychiatric care in the United States is delivered by them. A psychiatric nurse practitioner is a registered nurse with graduate training in psychiatric and mental health care. A physician assistant has graduate medical training and practices in psychiatry under state rules on physician collaboration. Both can evaluate, diagnose, prescribe, and manage medication within their state's scope of practice, and a visit with one looks much like a visit with a psychiatrist. Our article on how a psychiatrist and a psychiatric nurse practitioner differ covers that comparison on its own.

The practical point is that "psychiatric provider" is the honest umbrella term. When this site describes our care, that is the term it uses, because it covers the prescribing clinicians a patient may see without promising a specific title.

Is a therapist the same as a psychologist?

Not necessarily. "Therapist" describes what someone does, not a specific degree. Licensed professional counselors, clinical social workers, marriage and family therapists, and psychologists all provide psychotherapy under different licenses and training paths. A psychologist is one kind of therapist, distinguished by graduate training in psychology, usually doctoral, and the ability to do psychological testing. If someone says "my therapist," they could mean any of those professions. If you are choosing a therapist, the questions that matter are the license, the training in the approach you want, and experience with your particular problem.

Who should you see first?

Start with what you want to happen. If you suspect you need medication, if you want a medical evaluation of what is going on, if you are already taking a psychiatric medicine that needs adjusting, or if there is a chance a physical problem is involved, a prescriber is the practical first stop. If you want to change patterns of thinking and behavior through talk therapy, if you want to understand yourself better over time, or if you need formal testing for something like attention or learning problems, a psychologist is.

Many people end up with both, and that is not a failure of the first choice. The National Institute of Mental Health's overview of depression describes treatment as medication, psychotherapy, or a combination, which is the shape of care for many other conditions too. A prescriber can refer you to a psychologist, and a psychologist can refer you to a prescriber; our article on why many patients do therapy and medication together explains how the two fit. If you truly cannot tell which door to knock on, knock on either; a good clinician will tell you plainly if the other one is where you need to be.

What does this look like at MindVibe?

MindVibe provides psychiatric care: evaluation and medication management with therapy included in the visit with your psychiatric provider, for patients aged 13 and up, in person at offices in Texas and California and by telehealth. Should formal psychological testing, or a separate course of therapy with a psychologist, turn out to be what you need, your psychiatric provider will tell you that plainly and help you find it. You can read about what a psychiatric evaluation involves, or book a visit with a psychiatric provider and bring the question with you.

If you or someone you know is thinking about suicide or is in crisis, call or text 988 to reach the 988 Suicide & Crisis Lifeline. It is free, confidential, and available around the clock. If someone is in immediate danger, call 911.

This article is for educational purposes only and is not medical advice, a diagnosis, or a substitute for care from a licensed clinician. In a crisis, or if you are having thoughts of suicide, call or text 988 to reach the 988 Suicide & Crisis Lifeline, or go to the nearest emergency room.

Frequently asked questions

What is the main difference between a psychiatrist and a psychologist?

Training and scope. A psychiatrist is a physician, a medical doctor who completed medical school and a residency in psychiatry, and who can diagnose, prescribe medication, and order and interpret medical tests. A psychologist, usually with a doctorate in psychology, is trained in psychotherapy and psychological testing, and in most states does not prescribe.

Can a psychologist prescribe medication?

In most states, the answer is no. A small number of states allow psychologists with additional training and a separate license to prescribe certain medications. In the rest of the country, physicians handle prescribing, along with psychiatric nurse practitioners and physician assistants where state rules permit. If medication is part of the question, you will be working with one of those prescribers.

Should I see a psychiatrist or a psychologist first?

There is no single right answer. If you suspect you need medication, or want a medical evaluation of what is going on, a prescriber is the practical first stop. If you want to work on patterns of thinking and behavior in talk therapy, or need formal testing, a psychologist is. Many people end up seeing both, and either one can refer you to the other.

Is a therapist the same as a psychologist?

No — not necessarily. "Therapist" describes what someone does rather than a specific degree. Psychologists, licensed counselors, clinical social workers, and marriage and family therapists all provide therapy under different licenses and training paths. A psychologist is one kind of therapist, with graduate training in psychology, usually doctoral, and the ability to do psychological testing.

Where do psychiatric nurse practitioners and physician assistants fit?

Both prescribe. A psychiatric nurse practitioner is a registered nurse who went on to graduate training in psychiatric care, while a physician assistant has graduate medical training and practices in psychiatry under state rules governing physician collaboration. Within their state's scope of practice, both can evaluate, diagnose, and prescribe — and in fact they deliver much of the outpatient psychiatric care in the United States.

Does MindVibe have psychologists on staff?

MindVibe's focus is psychiatric care — evaluation and medication management, with therapy built into the visit with your psychiatric provider. If formal psychological testing or a separate course of therapy with a psychologist is what you need, your psychiatric provider can say so and point you toward it.