Counselor, therapist, psychologist or psychiatric nurse practitioner: how they differ
Counselors and clinical social workers hold master's degrees and provide talk therapy. Psychologists hold a doctoral degree and provide therapy and assessment. Psychiatrists are medical doctors, and psychiatric nurse practitioners are nurse practitioners with graduate training in mental health. Those two can prescribe medication. Therapist is a general word people use for anyone who provides therapy.
Key points
Counselors, clinical social workers and psychologists provide therapy and generally do not prescribe.
Psychiatrists and psychiatric nurse practitioners can prescribe medication.
Therapist describes the work someone does. The license tells you their training.
Some people see a therapist for talk therapy and a prescriber for medication.
What is the difference between a therapist and a counselor?
In everyday speech the two words overlap. People say therapist for almost anyone who provides psychotherapy, which is also called talk therapy. The National Institute of Mental Health lists psychiatrists, psychologists, social workers, counselors and psychiatric nurses among the professionals who offer it.
Counselor is narrower. The American Counseling Association describes professional counselors as people with a master's degree or higher from a counseling program who are licensed to practice in their state. They help people with life changes, relationship and work concerns, difficult events and mental health goals.
So a counselor is one kind of therapist. A clinical social worker or a psychologist who provides talk therapy is a therapist too. When you want to know someone's training, look past the job title to the license.
What does each type of mental health professional do?
The summary below follows Mental Health America's descriptions of each role. Exact titles and rules are set by each state.
Professional counselor: a master's degree in counseling, psychology or a related field. Trained to diagnose and to provide individual and group counseling.
Clinical social worker: a master's degree in social work from an accredited graduate program. Trained to diagnose, provide individual and group counseling, and offer case management and advocacy.
Marriage and family therapist: a master's degree with special education and training in marital and family therapy.
Clinical psychologist: a doctoral degree in psychology. Trained to diagnose and to provide individual and group therapy.
Psychiatrist: a medical doctor with special training in diagnosing and treating mental and emotional illnesses. Can prescribe medication, and often does not provide counseling.
Psychiatric or mental health nurse practitioner: a registered nurse practitioner with a graduate degree and specialized training in diagnosing and treating mental and emotional illness. Can prescribe medication.
Who can prescribe medication for mental health?
This is the clearest dividing line. Psychiatrists and psychiatric nurse practitioners can prescribe. Mental Health America groups them as professionals who can prescribe medication but who may not provide therapy.
Counselors, clinical social workers and marriage and family therapists do not prescribe. Psychologists generally cannot either, although Mental Health America notes that some states allow it. A primary care doctor, physician assistant or nurse practitioner is often able to prescribe as well, depending on the state.
Decisions about whether to use medication, which one, and at what dose belong to you and your prescriber. A therapist can describe what they observe and help you prepare questions, but they do not make those decisions. Our article on therapy and medication together covers how the two kinds of care fit.
How do these roles work in Maryland?
Maryland licenses each profession through its own board, and the letters after a clinician's name come from that license. For social workers, state regulations spell out what each level may do.
A licensed certified social worker-clinical, written LCSW-C, may evaluate, diagnose and treat mental and emotional conditions, provide psychotherapy, and practice independently. A licensed master social worker, or LMSW, may provide psychotherapy only under the supervision of an LCSW-C.
Counselors have a similar ladder with different letters. Our guide to Maryland credentials explains LCSW-C, LMSW, LCPC and LGPC one by one, and how to look up a license.
Which mental health professional should you see first?
It depends on what you are looking for. These steps can help you sort it out.
Start with what you want help with. If you want to talk things through, learn skills, or work on a relationship, a counselor or clinical social worker is a reasonable place to start.
Ask yourself whether medication is a question. If you already take a psychiatric medication, or want to find out whether one is appropriate, you will need a prescriber. That can be in addition to a therapist.
Consider testing. Psychologists are trained in psychological assessment. If a school or doctor has asked for formal testing, ask any practice you call whether they offer it.
Talk to your primary care provider if you are unsure. A primary care provider can do an initial mental health screening and refer you to a mental health professional.
Check comfort and specialty. Whatever the title, ask about experience with your concern. Feeling comfortable with the professional you choose is important to how treatment goes.
In a crisis, the title does not matter
If you or someone you love is in crisis, call or text 988 or call 911. Our office does not provide emergency services.
How Balanced Life can help
Our team in Salisbury and Bethesda includes licensed clinical social workers, a licensed clinical professional counselor, licensed master social workers, a licensed graduate professional counselor, and a board-certified psychiatric mental health nurse practitioner. That means individual counseling and psychiatric medication management are available in one practice.
You can read about each clinician's license and training on our team page. If you are not sure who to start with, contact us and tell us what you are looking for.
Frequently asked questions
Is a psychologist the same as a psychiatrist?
No. A psychologist holds a doctoral degree in psychology and provides therapy and assessment. A psychiatrist is a medical doctor who specializes in diagnosing and treating mental and emotional illnesses and can prescribe medication. Psychologists generally cannot prescribe, although some states allow it. People sometimes see one of each.
Can a psychiatric nurse practitioner provide therapy?
It depends on the provider and the practice. Psychiatric nurse practitioners are trained to diagnose and treat mental and emotional illness and can prescribe medication. Mental Health America notes that prescribers may not provide therapy. Some people see a nurse practitioner for medication visits and a counselor or social worker for talk therapy.
Is a clinical social worker a real therapist?
Yes. Clinical social workers hold a master's degree in social work and are trained to diagnose and provide counseling. In Maryland, a licensed certified social worker-clinical may diagnose and treat mental and emotional conditions and provide psychotherapy independently. Social workers also bring training in case management and advocacy.
Do I need to see a psychiatrist before starting therapy?
No. You can begin with a counselor or clinical social worker without seeing a prescriber first. Treatment for mental health conditions usually includes therapy, medication, or both. If questions about medication come up during therapy, your therapist can talk with you about seeing a prescriber, who makes those decisions with you.
Sources
If you are in crisis or thinking about suicide, call or text 988 (Suicide and Crisis Lifeline). In an emergency, call 911.