Psychologist, psychotherapist or psychiatrist: who to see and when

Many people put off asking for help simply because they do not know whose door to knock on. Psychologist, psychotherapist, psychiatrist: the words sound alike, and it is easy to feel that the wrong choice will cost you time and money. In fact, there is no wrong door. A good specialist will tell you if someone else could help you better. Here is a simple map.

Who does what

• A psychiatrist is a medical doctor who has specialised in mental health. A psychiatrist assesses you, makes a medical diagnosis, can prescribe medication and, when needed, arranges treatment in hospital.
• A psychologist has a degree in psychology, not in medicine. A psychologist is not a doctor and does not prescribe medication. Psychologists help you make sense of emotional difficulties, may use psychological tests, and offer counselling and support.
• A psychotherapist offers talking therapy: regular sessions over weeks or months, working with thoughts, feelings, behaviour, relationships and the body’s reactions. Psychologists, doctors and, in some countries, other professionals can become psychotherapists by training in specific methods, such as cognitive behavioural therapy (CBT) or EMDR.

I am a psychologist and a psychotherapist myself. I do not prescribe medication. When I see that medication could help, I suggest seeing a psychiatrist, and we carry on with therapy alongside.

Who may call themselves a psychologist or a psychotherapist, what training they need and who must be licensed are decided differently in different countries. In some places these titles are protected by law, in others they are not. So do not rely on the title alone. It is perfectly normal to ask a specialist where they trained, which method they use and whether they have supervision. A professional will answer calmly.

Where to start: common situations

• You feel stuck, anxious or overloaded, but you are still coping with daily life. A psychologist or psychotherapist is a good place to start.
• A crisis, a loss, a breakup, a move to another country, conflict in the family. Start with a psychologist.
• Anxiety or panic attacks. Start with a psychologist or psychotherapist: CBT is one of the best studied methods for anxiety. If the attacks come with chest pain or other new physical symptoms, see a doctor first to rule out a physical cause.
• A very heavy low mood: you can barely get out of bed or work, you have almost stopped eating or sleeping. As well as a psychologist, see a psychiatrist or your family doctor.
• You hear or see things that others do not, you have a sudden rush of energy with no need for sleep, or your thoughts become very confused. This needs a psychiatrist.
• Problems with alcohol or other substances. A doctor should be involved here too.
• Thoughts of suicide. Do not stay alone with them: tell someone close and get help the same day.

Depression: which doctor treats it?

This is one of the questions I hear most often. The World Health Organization describes psychological treatments as the first treatments for depression. In moderate and severe depression they can be combined with antidepressants, while in mild depression antidepressants are not needed.

In practice this means:

• With mild depression, you can start with a psychologist or psychotherapist.
• When depression is severe, or therapy alone has not helped for a long time, see a psychiatrist. Medication does not replace therapy, but it can give you enough strength to work in it.
• It is worth seeing your family doctor too. Some physical conditions, such as an underactive thyroid, can cause symptoms that look like depression, and a doctor can check for them with blood tests.

Very often the answer is not “either or” but “both”.

How they work together

Good care is teamwork. The psychiatrist looks after the diagnosis and medication and checks how treatment is going. The psychotherapist meets you regularly and works on what keeps the difficulty going: thoughts, habits, relationships, past experiences. With your consent, specialists can share what matters for your treatment. You always decide what is shared, and with whom.

One more thing. Many people are afraid of the word “psychiatrist”, as if seeing one puts a label on you. It does not. A psychiatrist is a doctor like any other, and getting help in good time often means a shorter, easier path.

How to tell where you are now

If you are not sure how serious things are, you can take the free PHQ-9 (depression) and GAD-7 (anxiety) tests on this site. They take a few minutes. A test is not a diagnosis, but the result helps you decide where to start, and you can show it to a specialist.

If you have thoughts of harming yourself, or feel that life is not worth living, tell someone close, write to me or call 911.

A first step

If you are still not sure whether you need a psychologist or a doctor, book a free 15-minute intro video call with me. We will talk about what is going on, and I will tell you honestly whether I can help or whether it is better to see another specialist first. My sessions are held in Armenian or Russian only, online from any country or in person in Yerevan.