Therapist, Psychologist, Psychiatrist or PMHNP: Who Does What?

What does each kind of mental health professional generally do?

The clearest dividing line is prescribing. Therapists, counselors, clinical social workers and psychologists generally treat with talk therapy and do not prescribe. Psychiatrists and psychiatric nurse practitioners can prescribe, and they are also trained in therapy, although how much therapy each one offers varies from practice to practice.

Job titles and licenses vary by state, so treat the table below as an overview and not a rule. A person's actual credentials, which you can ask about, tell you more than a title on a website.

How is a psychiatrist different from a psychiatric nurse practitioner?

The main difference is the training route. A psychiatrist is a physician who went through medical school and then a psychiatry residency. A PMHNP comes through nursing: a registered nurse license, then graduate education in psychiatric-mental health care, usually followed by national board certification.

In an outpatient clinic, the day to day work can look similar: a detailed conversation, a diagnosis, a treatment plan, and follow-up. A psychiatrist's medical training can matter more when mental health symptoms are tangled up with serious medical illness. Our page on the PMHNP and psychiatrist roles goes through this in more detail, including when a physician may be the better fit.

Where should I start for my situation?

No one has to get this exactly right on the first try. Good providers of any kind refer people on when another kind of help would serve them better. These are common starting points, not rules:

• You want to talk through stress, grief, a relationship problem or a pattern you keep repeating, and medication is not on your mind: a therapist, counselor, clinical social worker or psychologist.
• You think medication might help, or you already take a psychiatric medication and need someone to follow it: a psychiatrist or PMHNP. A primary care provider may also be able to help.
• You do not know what is wrong, or symptoms such as low energy, poor sleep or trouble concentrating came on without clear reason: a primary care visit is a sensible first step, because some of these symptoms can have a medical cause.
• A school, employer or clinician has asked for formal psychological testing: a psychologist, since testing is part of their specific training.
• Your diagnosis has never been clear, or several treatments have not helped enough: a psychiatric evaluation with a psychiatrist or PMHNP.
• You have a serious medical illness and also have mental health symptoms: consider a psychiatrist, and ask how they would work with your medical team.

Can I see a therapist and a psychiatric provider at the same time?

Yes, and many people do. According to the National Institute of Mental Health, treatment for mental illness usually includes therapy, medication or both, and therapy can help with specific issues even when medication relieves symptoms. Those issues might include self-defeating ways of thinking or difficulty coping at home, school or work.

One common arrangement is regular sessions with a therapist plus separate visits with a prescriber. If you would like the two to talk to each other, you can give your permission for that. Our guide on medication, therapy or both covers how people weigh that choice.

At our clinic, medication decisions are made after an evaluation. Not every medication can be prescribed at every kind of visit, some may require an in-person visit, and we explain what applies to you on our medication management page and at your visit. Please talk with your prescriber before starting, stopping or changing any medication.

What should I ask before choosing one?

A short conversation before you commit can tell you a lot. Whichever kind of provider you are considering, the National Institute of Mental Health suggests questions along these lines:

• What are your credentials, and do you have a specialty?
• What experience do you have with someone in my situation, and at my child's age if this is for a child?
• What approach do you use, and why?
• How will we know whether this is working, and what happens if it is not?
• Is medication an option, and are you able to prescribe it?
• Are our conversations confidential, and what are the limits of that?
• Do you accept my insurance, and what will treatment cost?

What kind of provider will I see at DanShalom Behavioral Clinic?

Our provider is a nurse practitioner, and we want that to be plain before you book. Victor Onodjacha, MSN, PMHNP-BC, is a board-certified psychiatric-mental health nurse practitioner. He is not a physician and not a psychiatrist. You see the same provider at every visit, either at our Sugar Land office or by secure video if you are physically in Texas, Idaho, Arizona or Maryland at the time of the visit.

The clinic's services are psychiatric evaluation and diagnosis, medication management, brief psychotherapy and mindfulness-based cognitive therapy, for patients ages 5 to 65. Brief psychotherapy is short-term and focused. People who need longer-term or specialized therapy may be referred to a dedicated therapist, and with your permission we can coordinate with a therapist you already see. Ask us which therapy options would fit what you are looking for.

To begin, send a short appointment request or call. We check your coverage before the first visit, and plan and self-pay details are on our insurance page. DanShalom Behavioral Clinic is not an emergency service: if you are in crisis, call or text 988, or call 911 if there is immediate danger.