Psychologist, counsellor or psychiatrist: who does what

If you are looking for help with your mental health, the range of job titles can be confusing. Psychologist, psychiatrist, counsellor, therapist and psychotherapist are used in different ways in different countries, and some titles are protected by law while others are not. This post explains the common differences and gives a way to decide where to start.

It does not diagnose anything or tell you what treatment you need. That is for a qualified clinician who has met you.

Why it is worth knowing

The World Health Organization (WHO) reports in its mental disorders fact sheet that in 2023 nearly 1 in 7 people around the world, or 1.2 billion, were living with a mental disorder, with anxiety and depressive disorders the most common. WHO also says effective prevention and treatment options exist, yet most people with mental disorders do not have access to effective care. Knowing who does what helps you ask for the right kind of help, and avoid delays caused by starting in the wrong place.

The main roles

Psychiatrist

The American Psychiatric Association describes a psychiatrist as a medical doctor who specialises in mental health, including substance use disorders, and who is qualified to assess both the mental and physical aspects of psychological problems. It says psychiatrists can order medical tests, use talk therapy and other treatments, and prescribe medication. In many countries the title is protected and a psychiatrist must be on a specialist register.

Psychologist

Psychologists study human behaviour and mental processes and usually have a university degree and further training in psychology. Many psychologists assess thinking, emotions and behaviour, and some provide talking therapies. Clinical psychologists work with mental health conditions, while other branches of psychology work in education, work settings or research. In most countries psychologists do not prescribe medicines, although rules differ in a few places. The title and its requirements vary from country to country, so check how it is regulated where you are.

Counsellor

The NHS describes counselling as a type of talking therapy in which a counsellor listens to you and helps you find your own solutions to problems. It lists uses such as difficult emotions like stress, low mood, worry or anger, life events such as illness or bereavement, and problems in relationships, at school or at work. Counsellors may work in health services, schools, workplaces, charities or private practice.

Therapist or psychotherapist

These are broader terms for professionals who provide talk therapy. The US National Institute of Mental Health (NIMH) describes psychotherapy, also called talk therapy, as a variety of treatments that aim to help a person identify and change troubling emotions, thoughts and behaviours, usually one to one with a licensed mental health professional or in a group. A therapist may be a psychologist, counsellor, social worker, nurse, psychiatrist or another trained professional, depending on the country.

Primary care doctor

NIMH notes that a primary care provider can carry out an initial mental health screening and refer you to a mental health professional such as a social worker, psychologist or psychiatrist. A visit to a general practitioner is a common first step, and it also helps rule out physical causes. NIMH points out that examination by a health care provider can help rule out a physical health issue, because symptoms such as changes in mood or concentration can sometimes come from a medical condition.

Comparing the roles

Treat this table as a guide and not a rule. Training, titles, regulation and scope of practice differ between countries, and professionals often overlap.

How to decide where to start

1. If you are unsure, start with a general doctor. They can listen, check for physical causes and refer you.
2. If you want to talk things through, a counsellor or a psychologist who provides therapy may be a good match. Our first mental health consultation guide describes what a first appointment is like.
3. If a medicine review or a specialist medical assessment is likely to be needed, a psychiatrist is the professional trained for that, and your general doctor can advise on referral.
4. If cost or access is a concern, ask your doctor, employer, school or a charity what is available. The NHS notes that counselling is sometimes available through other NHS services, employers, schools and universities, or charities, and that availability depends on where you live.

Questions to ask any professional

• What is your qualification and what body are you registered with?
• What approach do you use, and how long does a course of sessions usually last?
• What does a session cost, and how are cancellations handled?
• How do you protect my notes and who can see them?
• What do you do if my needs change or if I am in crisis?

Our post on how to verify doctor registration explains how to check a professional on an official register. Remember that not all counsellor or therapist titles are regulated.

If you are in crisis

If you or someone else is in immediate danger or thinking of suicide, contact your local emergency number or a crisis line straight away. Do not wait for an appointment. The NIMH lists crisis resources for the United States, and other countries have their own lines, which a local health service or your doctor can give you.

Finding services on HealthNaro

You can browse the mental health topic, and the specialty pages for clinical psychology, psychiatry and counselling. Profiles show only what HealthNaro has been given and what it has checked. If you want help finding a service, you can send a free, non-medical inquiry and leave out any details about your health.

Frequently asked questions

Can a psychologist diagnose?

In many countries clinical psychologists assess and diagnose within their scope, while in others diagnosis is led by doctors. Ask the professional what they do.

Do I need a referral to see a psychiatrist?

It depends on the country and insurer. Some systems need a referral from a general doctor, others do not.

Can counselling and medicine be used together?

Often yes. NIMH says psychotherapy and medication are the most common forms of mental health treatment, and psychotherapy can be used alone or alongside medication. A clinician can advise what suits you.

Is it normal to try more than one professional?

Yes. A good fit between you and the person helping you matters, and it is acceptable to change if it is not right.

General information only

This article is general information, not medical advice. HealthNaro is a directory and does not provide clinical care.