Psychologist, Psychiatrist, Therapist: What’s the Difference?
Highlights:
Mental health providers often use different labels interchangeably
Psychiatrists and other mid-level providers can prescribe psychiatric medication; psychologists and therapists do not
There are key differences in the scope of practice between licensed clinical psychologists and school psychologists; school psychologists can practice independently in Florida but few other states
Different providers often use the terms ‘therapist’ and ‘counselor’ regardless of degree earned or training background
The mental health field is confusing. Terms describing different providers are convoluted and often overlapping (e.g., so a clinical psychologist can be referred to as a ‘therapist,’ but a therapist isn’t always a ‘clinical psychologist?’). Other labels are using interchangeably. To add more confusion, certain states, including Florida, permit specific providers (i.e., school psychologists) to practice privately, whereas most other states do not.
A few common questions:
Who can prescribe and manage my medications?
Who can provide therapy?
Who performs psychological testing, and how is that different from psychoeducational testing completed by a school psychologist?
What’s the difference between a clinical psychologist and a school psychologist?
Psychiatrists and Related Mid-Level Providers. Psychiatrists (M.D., D.O.) have historically served as the primary prescriber of psychiatric medications. A psychiatrist is a physician who specializes in mental health, and who treats psychological challenges through a combination of medication, psychotherapy, and other related interventions. Psychiatrists complete an undergraduate degree (B.A., B.S.), medical degree (M.D., D.O.), and a four-year psychiatric residency program after medical school with additional options for further specialized training. They practice without restrictions following licensure.
Importantly, recent studies reveal most psychiatrists no longer provide psychotherapy as a component of their treatment and instead focus largely on medication management.
Other mid-level providers, including advanced practice registered nurses (APRN) and physician assistants (PA), can also prescribe psychiatric medications when under certain levels of supervision and with specific restrictions, including the age of the patient and the type of medication. PAs and APRNs require a combination of education at the undergraduate and graduate level, as well as prior healthcare experience and passing of standardized exams.
Pediatricians (M.D., D.O.) also occasionally prescribe psychiatric medication, especially when specific issues arise in early childhood and in the primary care context, and prior to when younger patients have been referred to psychiatric-specific providers. Pediatricians routinely ‘refer out’ to psychiatric providers when mental health issues become complex or when use of multiple psychiatric medications may be indicated.
Other physicians (M.D., D.O.) across specialties (e.g., neurology, sleep medicine, adolescent medicine, endocrinology, developmental pediatrics, etc.) also often prescribe psychiatric medication for a variety of issues.
In certain states, including Idaho, Illinois, Iowa, Louisiana, and New Mexico, licensed psychologists may also prescribe psychiatric medications following completion of specialized training. Psychologists cannot prescribe medication in Florida.
Licensed Psychologists. Psychologists treat individuals with mental health challenges using a combination of psychotherapy and psychological testing. Psychologists complete extensive educational requirements to support their clients/patients, including an undergraduate degree (B.A., B.S.), a four- to six-year doctoral degree (Ph.D., Psy.D., Ed.D.), and one or more years of post-doctoral supervised experience (in Florida, this includes two years or 4000 hours of supervised experience in the field). To obtain licensure and practice independently as a clinical psychologist (and thus use the designation of “licensed psychologist”), one must pass the Examination for Professional Practice in Psychology (EPPP), the national test administered by The Association of State and Provincial Psychology Boards (ASPPB), as well as state-specific tests pertaining to law and regulations. Psychologists practice without restrictions following licensure.
Licensed psychologists often use other terms interchangeably to describe themselves based on their specialty area, including clinical psychologist, child psychologist, developmental psychologist, or pediatric psychologist. Licensed psychologists who work primarily in schools also use the term ‘school psychologist” to describe their role, though importantly, not all school psychologists are licensed clinical psychologists (see below).
Licensed psychologists function as integral members of treatment teams and are often tasked with assessing for, diagnosing, and treating a wide variety of psychological disorders. Given their training and education, licensed psychologists are also often the professional most qualified to complete psychological testing, including academic/psychoeducational testing, to help inform educational decision-making, guide treatment, and accurately diagnose mental health and/or developmental conditions (e.g., ADHD, depression/anxiety, mood, personality issues, developmental disabilities, etc.).
Like other providers, licensed psychologists typically practice within a specialty area with regards to both presenting issues (i.e., treatment of emotional or mood issues, trauma, etc.) and type of service (i.e., individual or group therapy, family therapy, psychological testing/assessment). Other psychologists are generalists and diagnose and treat a wide array of mental health issues via both psychotherapy and testing. When working with a licensed psychologist, ask them directly if you have questions about their background, training, or whether they are the right fit for you or your child’s pattern of challenges.
School Psychologists. School psychologists are primarily concerned with the assessment of academic or developmental challenges that impact students’ educational performance. They perform psychoeducational assessments, engage in short-term and solution-oriented interactions to support educational performance, and consult with other professionals to develop and evaluate the effectiveness and appropriateness learning programs. School psychologists can, but are not required to, hold a doctoral degree (Ph.D., Psy.D., Ed.D.), and can otherwise practice in some capacity with a one- or two-year specialist or master’s degree (Ed.S., M.A., M.S.) after completion of an undergraduate degree. School psychologists must also have a minimum of three years of school-based experience, two of which must be supervised by a licensed school psychologist or related provider (i.e., licensed clinical psychologist), and pass a departmental exam.
School psychologists employed directly by school districts are often not permitted to diagnose mental health conditions. Instead, they classify students into 13 different categories based on the nature of their disability and the need for school-based accommodations (i.e., 504-disablity plan) or alterations to the general curriculum (i.e., Individualized Education Program [IEP]).
Florida is unique in that school psychologists can practice privately without supervision. This is not permitted in most other states. Their scope of practice is limited to academic-focused services inclusive of psychoeducational evaluation, counseling, consultation with other professionals regarding students’ academic performance, and program development.
When working with a school psychologist either inside the school or in private work in Florida, ask questions about their background and training, the scope of their practice (including what mental health or psychological issues they may not ethically be able to address), and whether their work can fulfill you or your child’s specific needs. For example, organizations like the College Board (SAT, AP exams) and other higher-stakes exams (GRE, MCAT, LSAT) often require a comprehensive psychological evaluation conducted by a licensed clinical psychologist, and inclusive of psychoeducational testing and provision of formal diagnoses, to determining eligibility for testing accommodations.
Psychotherapists and Counselors. The term “therapist” is often used by a wide variety of mental health clinicians, including licensed clinical psychologists who primarily provide psychotherapy. Other professionals who utilize the term therapist include licensed professional counselors (LPC), licensed clinical social workers (LCSW), licensed mental health counselors (LMHC), and licensed marriage and family therapists (LMFT), among others.
The educational and training requirements differ among licensed therapists. However, each requires, at minimum, an undergraduate and one- to two-year (or more) master’s degree, pre-licensure supervised experience, and successful passing of a standardized licensure exam.
It is not uncommon for therapists or counselors to focus on a specific type of issue (e.g., a LMFT may focus exclusively on treating relationship infidelity for couples). In general, ‘counseling’ refers to more targeted, short-term treatment, while ‘therapy’ typically aims to treat a broader range of challenges and may be longer in duration. This is not always the case, however, and this variability underscores the importance of asking prospective counselors and therapists about their approach to treatment, their specialty area, and what knowledge and experience they have in treating your specific subset of issues.
In general, a large body of research supports the finding that the most important thing to consider when selecting a therapist or counselor is the therapeutic relationship you maintain with that individual. Asking clarifying questions to determine your ‘goodness of fit’ with a treating professional is welcomed, encouraged, and appreciated by clinicians.
For psychological and psychoeducational testing, it is important to ask questions about certain clinicians’ scope of practice. Inquiring about their background and training, licensure status, and limits (if any) of how their written findings can be used across clinical, school, and other settings, can help ensure your time and money spent devoted toward services is the most appropriate form of support for you or your child.
We are happy to answer any additional questions about differentiating the role of licensed clinical psychologists from other treating professionals, or if/how comprehensive psychological testing by a licensed psychologist can benefit you or your child.
Have questions or interested in scheduling an appointment? Contact us here to schedule a free 15-minute consultation call.