What’s the difference between therapy and psychiatry?

Caring for your mental health can be confusing. You’re trying to make sense of yourself while trying to make sense of what you can do about your health. Should you go to a therapist or a psychiatrist? Both? Does your therapist need to be a psychologist? Are psychologists and psychiatrists different? They sound almost the same.

We’ll break down the differences and how they overlap so you know what to expect from your behavioral health care.

Are psychologists and psychiatrists the same thing?

Short answer: No, and not all therapists are psychologists. (We’ll come back to that.)

Yes, psychologists and psychiatrists both treat mental health, as do therapists. They are all trained to assess and diagnose clients. All can also provide psychotherapy, which you may often see shortened to just therapy or counseling. 

The biggest difference is that psychiatrists can use therapy and prescribe medication to treat mental health. Most psychologists can’t usually prescribe medication. Therapists who aren’t psychologists or psychiatrists can’t prescribe medication at all. 

Psychiatrist education and training

Psychiatrists are medical doctors, which means they go to medical school. Psychiatrists will have either a doctor of medicine degree (MD) or doctor of osteopathic medicine (DO). As part of their training, they’ll do a year-long internship and 3 years of residency, during which they learn to diagnose and treat clients. To get their license to practice, psychiatrists take an exam that they must retake every 10 years. 

Psychiatric nurse practitioner education and training

Psychiatric nurse practitioners—also known as psychiatric mental health nurse practitioners—also study and train to provide high quality care. Sometimes you’ll see their titles abbreviated to PNP or PMHNP. Their education and training makes them just as qualified to treat, diagnose mental health, and prescribe medication. 

PNPs start with a nursing degree and are registered nurses (RN). They continue to pursue an advanced degree, either a master’s in nursing or a PhD in psychiatric mental health care. Their PMHNP certification requires an exam—that must be retaken every 5 years—and 2,000 hours of continuing education. 

Psychologist education and training

Psychologists almost always have a doctoral degree but they aren’t medical doctors. After getting their graduate or doctoral degrees, they do another 2 to 3 years of training. Then, they must take a certification exam to be able to do therapy.

Only a few states have psychologists who prescribe medicine: They must complete more hours, train in clinical psychopharmacology, and then take an exam for another certification. Even then, this is rare.

Not all psychologists do therapy. Some have other callings as researchers, teachers, or something else. 

Therapist education and training

As we said earlier, not all therapists are psychologists. Therapists—and counselors—come from a variety of backgrounds and can have different licenses that may come with special areas of expertise. 

For example, a therapist who becomes a Licensed Substance Abuse Treatment Professional (LSATP, CSAC) would excel at guiding someone going through addiction or a Licensed Marriage and Family Therapist (LMFT) would be trained in couples counseling. All of them learn to use therapy to help clients reach their goals. 

Most of these licenses require therapists to earn a master’s degree to practice therapy, complete hours of continuing education, and pass a clinical certification exam.

How can a psychiatrist help me? 

Some people will benefit from psychiatry—but not everyone. Each person’s mental health is different. Talking with your therapist and psychiatrist can help you learn if psychiatry is right for you. 

Psychiatrists (and psychiatric nurse practitioners) go through medical training to understand the relationship between our brains, our body, and the external factors that affect us. They study sciences such as biology, neurology, pharmacology, genetics, biochemistry, disease, and others. 

Along with asking you about your mental health, a psychiatric provider can also conduct physical exams. They look at your medical history and if you’re taking any medications to get a full picture of your condition. A psychiatric provider will evaluate your symptoms and may diagnose you. 

If you receive a diagnosis, your psychiatric provider may prescribe you medication. They may also provide “medication management” on an ongoing basis to track your progress and monitor the medications they prescribed. 

You’ll regularly meet with your psychiatric provider to discuss your health, to check that treatment is going well and adjust your care if it’s not. 

Should you talk to your therapist about psychiatry? Take this assessment.

How can a psychologist or therapist help me? 

Therapy creates a path for change, internally and externally. It provides a space for people to work through their mental health safely and with direction.

Like psychiatrists, a therapist can also evaluate what you’re going through and can provide a diagnosis if it’s appropriate. Your therapist develops a treatment plan to help you reach your mental health goals. They may adapt the plan with your progress. 

There are 5 big buckets of psychotherapy: psychoanalysis and psychodynamic therapies, behavioral therapy, cognitive therapy, humanistic therapy, and integrative and holistic therapy. Within these categories are specific approaches or modalities that therapists use.

Which provider should I see: a psychiatrist or a therapist?

We usually recommend that people start with a therapist. Not every mental health concern can be fixed through medication. For example, grief naturally happens because loss is a normal part of life. Processing grief takes time and emotional support, and therapy can help people navigate more complex parts of it without medication. Or if you want to deal with a conflict within a family or a couple, a therapist can hold space for dialogue and to work through issues. 

If you’re already taking medications for your mental health, you should consult a psychiatrist. If you’re not or have never been prescribed medication for your mental health, your therapist can diagnose your condition and may recommend consulting with a psychiatric provider.  

There are some conditions, such as bipolar disorder or schizophrenia, that tend to benefit from medication. Then you have conditions such as depression and anxiety, which can range from being mild to severe. People can sometimes manage symptoms from mild or even moderate depression and anxiety through therapy. 

Severe depression and severe anxiety, though, are considered more complex conditions. If you have a complex condition, you may find medication to be an effective treatment. Your therapist can then refer you to a psychiatric provider.

Whether you’re seeing a psychiatric provider, a therapist, or both—research shows psychiatry works best combined with therapy—be open and honest with them about your development. It may turn out that you need a different medication or no medication or different kind of therapy. You should also share any medications you’re taking with your primary care doctor. Your mental health affects your physical health, and medications are no exception.