In short: psychiatrists and psychiatric nurse practitioners can diagnose and prescribe medication. Psychologists diagnose, provide therapy and perform psychological testing. “Therapist” is a broader word for anyone who provides talk therapy, which in New York usually means a licensed clinical social worker, mental health counselor or psychologist.
Part of our guide: Getting Started With Mental Health Care
If you want medication considered, start with a prescriber. If you want talk therapy, start with a therapist. If you are not sure, either one can evaluate you and tell you whether another type of clinician should join your care. If you are in crisis or worried about your safety, call or text 988 (988 Suicide & Crisis Lifeline), call 911 or go to the nearest ER.
The four roles at a glance
| Role | Core training | Talk therapy | Prescribes in New York |
|---|---|---|---|
| Psychiatrist | Medical school, then psychiatry residency | Yes, though practices vary | Yes |
| Psychiatric nurse practitioner | Registered nurse, then nurse practitioner education in psychiatry | Often some counseling | Yes, within the certified specialty |
| Psychologist | Doctorate in psychology and supervised experience | Yes | No |
| Therapist (LCSW, LMHC and others) | Usually a master’s degree and supervised experience | Yes | No |
Psychiatrist: a medical doctor focused on mental health
The American Psychiatric Association describes a psychiatrist as a medical doctor (an M.D. or D.O.) who specializes in mental health, including substance use disorders. Training includes medical school and four years of psychiatry residency. Many go on to take a voluntary board exam.
That medical background is the main difference. Psychiatrists can assess both the mental and physical sides of a problem, order lab work and prescribe medication and other medical treatments. They can also provide psychotherapy, although how much therapy a given psychiatrist offers varies from practice to practice, so it is worth asking.
A psychiatrist is often a good first call when symptoms are severe, when a diagnosis is unclear, when several medications are involved or when a medical condition may be part of the picture. Our article on signs you should see a psychiatrist goes into more detail.
Psychiatric nurse practitioner: diagnosis and prescribing from a nursing background
In New York, a nurse practitioner must be a licensed registered nurse and meet education and experience requirements before being certified, and psychiatry is one of the state’s recognized specialty areas. State law allows nurse practitioners to diagnose illness and issue prescriptions, but only within the specialty in which they are certified.
New York’s rules also address how nurse practitioners work with physicians. A newer nurse practitioner works under a written practice agreement with a collaborating physician until completing 3,600 hours of experience. After that, the state says the nurse practitioner may practice independently.
The APA notes that psychiatric nurse practitioners are trained in the diagnosis and treatment of mental health conditions and provide counseling as well as medication management. The training path is different, so it is reasonable to ask about experience with your specific condition, or about when the clinician would consult a physician colleague.
Psychologist: therapy, testing and diagnosis
A psychologist in New York needs a doctoral degree in psychology, two years of supervised experience and a passing score on a national exam. The state’s definition of the profession includes psychological testing, psychotherapy and the diagnosis and treatment of mental disorders.
Psychologists are often the clinicians people see for formal psychological or neuropsychological testing, along with ongoing therapy. They can be addressed as “Doctor,” which sometimes causes confusion. New York’s law on psychology states that licensees are prohibited from prescribing or administering drugs as a treatment. Some other states, such as Idaho, allow specially trained psychologists to prescribe, so rules you read about elsewhere may not apply here.
“Therapist”: a role more than a license
The word therapist describes what someone does. NIMH points out that many types of professionals offer psychotherapy, including psychiatrists, psychologists, social workers, counselors and psychiatric nurses. So when you see “therapist” on a website, the useful question is which license stands behind it.
In New York you will most often see:
- LCSW (licensed clinical social worker): holds a master’s in social work with at least three years of post-degree supervised experience in diagnosis, psychotherapy and treatment planning.
- LMSW (licensed master social worker): holds a master’s in social work and may provide clinical services only under supervision.
- LMHC (licensed mental health counselor): holds a master’s or doctorate in counseling with at least 3,000 supervised clock hours after the degree. Diagnosing outside an approved supervised setting requires a separate state privilege.
The laws covering social workers and mental health counselors, family therapists, creative arts therapists and psychoanalysts bar these licensees from prescribing or administering drugs. If medication becomes part of the plan, your therapist would work alongside a prescriber. Our guide to what clinician credentials mean explains each set of letters.
Other clinicians you may meet
Psychiatric physician assistants also appear on some teams. The APA says they work with psychiatrists to diagnose and treat mental health disorders, and they can prescribe. In any setting, the role can be narrower than the license: a clinician qualified to prescribe might work purely as a therapist, for example. So it helps to ask what this person does in this practice, in addition to reading the letters after their name.
How to decide who to see first
There is rarely one correct door. These are reasonable starting points, and they are general guidance, not a recommendation for your situation:
- You want to talk through patterns, stress, grief or relationships: a therapist or psychologist.
- You are wondering about medication, or already take it and it is not helping: a psychiatrist or psychiatric nurse practitioner.
- You have severe symptoms, a past hospitalization, or several conditions at once: a psychiatrist is a sensible first step, with a therapist added as needed.
- You or your child needs formal testing: ask a psychologist, or ask any clinician whether testing is the right next step.
- You have no idea where to begin: a primary care clinician can do an initial screening and make a referral, or you can request a psychiatric evaluation. See whether to see your primary care doctor or a psychiatrist first.
Seeing a prescriber does not commit you to medication. An evaluation can end with a recommendation for therapy alone. Likewise, starting with a therapist does not rule out a medication consultation later. Our earlier article on choosing between a therapist and a psychiatrist covers that two-way decision.
When more than one clinician is involved
Many people see both a prescriber and a therapist. The prescriber follows symptoms, side effects and whether the medication is working, while the therapist usually spends more time with you and may notice changes first. That arrangement works best when the two communicate. Federal privacy rules allow clinicians to share information for treatment, though state law or a practice’s policy may call for your written permission, so ask how yours handle it. Here is more on how psychiatrists coordinate care with therapists.
Questions to ask any clinician
- What is your license, and are you currently under supervision?
- Do you prescribe, provide therapy, or both?
- How much experience do you have with this particular concern?
- What happens if a patient needs something you do not provide?
- Do you coordinate with a patient’s other clinicians when given permission?
Finding the right fit here
Mind Body Seven’s team includes psychiatrists, psychiatric nurse practitioners, psychologists and psychotherapists. You can read about each clinician on our team page, or learn how a psychiatric evaluation can help sort out what you need.
FAQs
Can I see a therapist and a psychiatrist at the same time?
Yes, and many people do. One clinician handles medication and the other handles regular therapy. Ask both whether they are willing to share information with your written permission.
Is a psychiatric nurse practitioner a doctor?
A nurse practitioner is an advanced practice nurse and is not a physician. Some nurse practitioners hold a doctoral nursing degree, so asking about a clinician’s specific training is always fair.
Which one should a child see?
Age and symptoms both matter, and a pediatrician is often a helpful first contact. Our article on when a child should see a psychiatrist or therapist walks through that choice.
