Psychiatrist vs Therapist: Who Should You See First?

A psychiatrist is a medical doctor who specializes in mental health and can prescribe medication. A therapist is a licensed counselor, social worker or psychologist who provides talk therapy, and in most states cannot prescribe. When you weigh a psychiatrist vs therapist, the first question is simple: do you want talk therapy, a medication evaluation, or both?

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What is the difference between a psychiatrist and a therapist?

Psychiatrists hold an MD or DO. They finished medical school and then a residency in psychiatry. They diagnose mental health conditions and manage medication. In most outpatient offices, a psychiatrist spends most visits on medication, and fewer offer weekly talk therapy.

Therapists include licensed clinical social workers (LCSWs), licensed professional counselors (LPCs), licensed marriage and family therapists (LMFTs), and psychologists (PhD or PsyD). They help you work through thoughts, feelings and habits through structured conversation. They do not write prescriptions.

Can a therapist prescribe medication?

Almost never. Counselors, social workers and marriage and family therapists cannot prescribe in any state. A handful of states let psychologists with extra training prescribe, and those psychologists are rare.

If you think you might need medication, you need a psychiatrist or a psychiatric nurse practitioner. A therapist can still be a big part of your care. They just can't fill that role.

Who should I see first for anxiety or depression?

For most first-timers, a therapist is a good place to start. Talk therapy helps many people with anxiety or depression. A good therapist will also tell you if a medication evaluation is worth a look.

Some people do better starting with a prescriber. If your symptoms are hurting your sleep, your work or your ability to get through the day, ask for a medication evaluation sooner. If you can't tell which applies to you, say so when you call. The office can help you pick a starting point.

You usually don't need a referral to see a therapist or a psychiatrist. Some insurance plans do require one, so check your plan before you book.

What is a psychiatric nurse practitioner, and can they prescribe?

A psychiatric nurse practitioner, often called a PMHNP (psychiatric mental health nurse practitioner), is an advanced practice nurse trained in mental health. PMHNPs can evaluate you and prescribe psychiatric medication. In some states they work on their own, and in others they work with a supervising doctor.

For an outpatient medication evaluation, a PMHNP can do much of what a psychiatrist does. They often have shorter waits and more open appointments. If the wait for a psychiatrist is long, ask about a nurse practitioner. Our guide on how to find a psychiatrist walks through that search step by step.

Do I need both a psychiatrist and a therapist?

Some people do, and it is common. Many people with depression or anxiety see a therapist for talk therapy and a prescriber for medication. Ask your provider what they suggest for you.

A typical setup looks like this. You see a therapist every week or two. You see a psychiatrist or PMHNP once a month or less to check how a medication is working. The two don't need to share an office, though it helps when they talk to each other.

You don't have to set up both at once. Start with one, get a clearer picture of what you need, and add the other later if it makes sense.

How much does each one cost, with and without insurance?

Without insurance, a therapy session often costs $100 to $200. Prices move with your city and the provider's training. A first psychiatry evaluation usually costs more than a therapy session, because it is longer. Follow-up medication visits are shorter and usually cost less.

With insurance, you usually pay a copay or a share of the bill. All Marketplace plans must cover mental health care, including therapy and counseling, as an essential health benefit, according to HealthCare.gov. Federal parity rules also mean most plans can't make mental health care harder to use than comparable medical care.

Not every provider takes every plan. Before you book, call the number on the back of your insurance card and ask:

• Is this provider in-network?
• What is my copay or coinsurance for outpatient mental health visits?
• Do I have a deductible to meet first?

Those three answers tell you what you will actually pay. For the full breakdown, see how much does therapy cost.

How do I know which provider is right for me?

Most of the psychiatrist vs therapist decision comes down to what you want out of care. Here is a simple way to sort it.

Start with a therapist if you want to talk through what you are feeling. This also fits if you are unsure about medication, or your symptoms are manageable but wearing you down.

Start with a psychiatrist or PMHNP if you already want a medication evaluation. The same goes if daily life has become hard to manage, or a doctor has told you to see a prescriber.

See both if you want therapy and medication, or your therapist suggests adding a prescriber.

The psychiatrist vs therapist choice is not permanent. You can start with one and add the other later. If you are still unsure, describe what you are going through and ask the provider directly: do you think I need therapy, medication, or both? A good provider will give you a straight answer.

Common questions

Can a psychiatrist do talk therapy?

Some do. In most outpatient settings today, psychiatrists focus on medication evaluation and follow-up. If you want regular talk therapy, a therapist is usually the better fit. It is still worth asking when you call.

How long does it take to get an appointment?

Wait times vary a lot by area and provider type. Therapists are usually easier to see quickly. Psychiatrists often have longer waits, sometimes several weeks. Ask the scheduler for the earliest slot and whether they keep a cancellation list.

Does insurance cover psychiatrists and therapists the same way?

Most plans cover both as outpatient mental health visits. Your copay can differ by visit type, and a first psychiatry evaluation may be billed differently from a therapy session. Call your insurer and ask about both before your first appointment.

Do I need a referral to see a psychiatrist or therapist?

Usually not. HMO plans often require a referral from your primary care doctor, and PPO plans usually don't. Check your plan documents or call your insurer to be sure.

What if I start with one and realize I need the other?

That happens often. A therapist can refer you to a prescriber, and a psychiatrist can refer you to a therapist. You don't have to get it right on the first call.

Not sure whether you need a therapist, a psychiatrist, or both? Tell saycalm what's going on, for you or someone you love, and we'll explain your options and help you find a provider who fits. Start a conversation