What is the difference between a psychologist, psychiatrist and therapist?

The difference between psychiatrists and psychologists can be confusing, particularly with the growing range of mental health professionals available, including counselors, therapists and social workers. With so many options to choose from, it can be challenging to determine which type of professional is best suited to your needs.

Kari Keller Becker, PhD, a licensed psychologist, and Andrew Harper, MD, a board-certified psychiatrist, provide insight for common confusion surrounding the most common mental health professionals.

“In general, with mental health providers, a lot of what they’re trained or competent to do depends on the kind of professional program they were in, the kind of training they received in graduate or medical school and the type of license they received on top of that,” said Becker, who is an assistant director of counseling services for Texas A&M University Health Services.

Psychiatrist

Psychiatrists are trained to look beyond symptoms and understand the broader context of a patient’s life, including their medical history, family dynamics and social environment. Psychiatrists complete medical school, earning either a Doctor of Medicine (MD) or a Doctor of Osteopathic Medicine (DO). After medical school, psychiatrists must pass the United States Medical License Exam (USMLE) before starting residency. Steps one and two of the USMLE are completed prior to graduation, and step three is taken after one year of residency training. To get an unrestricted license to practice medicine, all three steps are needed as well as meeting each state’s individual requirements.

After completing medical school, a four-year psychiatric residency is required for gaining experiences in both inpatient psychiatry (in a hospital setting) and outpatient psychiatry (outside a hospital setting) among different populations, including children, adolescents, adults and seniors. After residency, many psychiatrists pursue board certification by taking a national exam administered by the American Board of Psychiatry and Neurology.

People seek psychiatric help for many reasons. The problems can be sudden, such as hallucinations and harmful thoughts, or they may be more long-term, such as feelings of sadness, hopelessness or anxiousness. Harper, who is a clinical professor at the Texas A&M College of Medicine and a child and adolescent psychiatrist with the Texas A&M Health Psychiatry and Behavioral Health Care clinic, explains his responsibilities as a psychiatrist.

Harper’s role starts by examining a patient’s history and current clinical symptoms. Psychiatrists gather information about the patient’s developmental history, family background, and any traumatic experiences that could influence their mental health. This evaluation often involves ongoing conversations with the patient, as initial diagnoses may evolve over time. Psychiatrists use a variety of different treatments such as talk therapy, medications, psychosocial interventions and other methods, depending on the needs of each patient.

“It may take knowing a patient over time to refine a diagnosis,” Harper said. “For example, a patient with bipolar disorder has two different kinds of mood episodes; they have a significant depression, and then at some point they may have a manic episode or hypomanic episode. If a patient expresses an initial concern experiencing depression, the diagnosis might evolve to bipolar disorder if they have a manic episode down the road.”

Psychiatrists often collaborate with other mental health professionals, including psychologists and licensed counselors, who can’t prescribe medication but provide therapy to treat psychiatric disorders. This ensures comprehensive care for patients, enhancing treatment outcomes and providing patients with access to a range of services.

Psychologist

Psychologists hold a doctoral degree in psychology, and are not only trained to conduct research, but also receive training specialized in conducting therapy and administering psychological tests. They are required to master knowledge in the areas of affective, biological, cognitive, developmental and social aspects of behavior.

The American Psychological Association accredits three types of doctoral degrees that lead to eligibility for licensure in psychology: clinical, counseling, and school psychology. It takes an average of seven years to complete a psychology doctoral program and an additional 1,500-6,000 hours of supervised practice prior to licensure, depending on the state.

In all but five states, psychologists cannot prescribe medications. Instead, they focus on assessing patients’ behavioral and emotional patterns and developing treatment plans that often include therapy sessions aimed at improving coping skills and understanding underlying issues.

Becker trained as a general psychologist, which means she can work with anyone with any kind of mental health concern. She utilizes a variety of different evidence-based practices and approaches that work for different kinds of people. Sometimes patients ask her for medication as a relief for their symptoms, but since psychologists aren’t licensed to prescribe medication in Texas, she refers the patient to a psychiatrist or other health care provider who can fulfill their medical needs.

“I usually encourage patients to start off by thinking, if possible, about what they think they might need. They might not know the answer to this, and that’s okay, but what do they think is going to be helpful,” Becker said.

Psychologists focus on treating through various therapeutic approaches, such as cognitive behavioral therapy (CBT). Through this, patients develop coping skills that change their own thinking, emotions and behavior. The primary goal is building an understanding of the problem and developing a treatment strategy for more effective ways of coping with life.

Psychologists may receive training in administering and interpreting psychological assessments. A full assessment provides a clearer understanding of the problem and aids in reaching a diagnosis, much like an X-ray or MRI is used by physicians to clarify and diagnose a problem.

The assessments a psychologist is trained to administer depend on the program they complete. There are a variety of assessments and tests that can assess mood struggles, memory and concentration, eating struggles, personality characteristics and substance use issues. A psychologist’s training in administering and interpreting psychological assessments typically exceeds a master’s-level counselor’s education.

Counselor

A licensed counselor incorporates the application of mental health, psychotherapeutic and human development principles to facilitate adjustment and development throughout a person’s lifetime. They have, at minimum, completed a master’s degree and thousands of supervised clinical hours, and have passed a licensing exam. They’re trained to provide assistance and guidance in resolving personal, social or psychological problems and difficulties.

In Texas, licensed counselors are allowed to diagnose and treat patients but aren’t authorized to prescribe prescriptions. A licensed professional counselor (LPC) or a licensed marriage and family therapist (LMFT) may specialize in working with individuals, families or groups, depending on their training and licensure. A counselor will evaluate and identify a person’s individual needs to determine whether they should be referred to another specialist.

An LMFT’s focus is more on the family unit, looking at the dynamics within the relationship between couples or families. They evaluate behavior that affect the family unit and work on reaching a sustainable solution. LPC’s work with all avenues of clients but tend to focus more on individual mental health struggles or groups with the same “type of issue” by teaching coping skills in order to manage the struggles. Services an LPC or LMFT provides may include individual counseling, group counseling, marriage counseling, family counseling, chemical dependency counseling and rehabilitation counseling.

Social worker

A licensed social worker is a mental health professional who provides services to restore or enhance social, psychosocial or biopsychosocial functioning of individuals, couples, families, groups, organizations or communities. They have earned, at minimum, a master’s degree in social work. A licensed master social worker (LMSW) often takes the master’s exam or the advanced generalist exam, while a licensed clinical social worker (LCSW) takes the clinical exam and has completed thousands of supervised clinical hours.

An LCSW diagnoses and provides counseling for mental health conditions, but an LMSW is not authorized to diagnose conditions or provide counseling without supervision. Both LMSWs and LCSWs are equipped to practice as social work generalists, but LCSWs have more clinical training in mental health and counseling.

An LCSW helps patients address mental health conditions through counseling, while an LMSW helps patients resolve external conditions such as finding stable and supportive housing.

Licensed social workers support clients in identifying and exploring their own options and making informed decisions, provide referrals to resources, and act as case managers. Their role doesn’t include prescribing prescriptions but often involves addressing systemic issues and working with clients to access necessary resources and support.

Clinical social work services include the application of specialized clinical knowledge and advanced clinical skills in the areas of assessment, diagnosis and treatment of mental, emotional and behavioral disorders, conditions and addictions, including severe mental illness in adults and serious emotional disturbances in children.

Connecting with a provider

Selecting the appropriate mental health professional depends on individual needs and the nature of the issue. To find the right mental health specialist, start by consulting with your primary care provider. Talk with them about your mental health concerns, and ask for their guidance on where to go for help. They may be able to address some of your medication needs and can refer you directly to a mental health specialist who can help you explore your concerns and develop a treatment plan to fit your specific needs. Different providers invite a new perspective and different skill sets, allowing you to evaluate different approaches and assistance they might provide.

Students at Texas A&M may access a range of mental health services through University Health Services. Request an appointment through the secure appointment portal or call 979.458.4584 for more information.

For everyone else, Texas A&M Health integrates mental health services with primary care at its Family Care clinics in Bryan-College Station and Navasota. Additionally, the Telebehavioral Care Program provides counseling services through secure video conference technology. Services are available to underserved individuals throughout the Brazos Valley and are often free due to local, state and federal support. Complete the online screening to see if you are eligible to receive free services.