Do I Need a Therapist, Psychiatrist, or Psychiatric Nurse Practitioner?
By Anna Blonquist, PMHNP-BC Board-Certified Psychiatric Mental Health Nurse Practitioner and Founder of Yellow Daisy Mental Health
Finding mental health care can be confusing. You may know that something is not right, but still have no idea who you are supposed to call. Do you need a therapist? A psychiatrist? A psychiatric mental health nurse practitioner? What is the difference? And what if you need both therapy and medication? The answer depends on what kind of help you need.
The Quick Answer:
If you mainly want counseling or regular talk therapy, a therapist is often a good place to start. If you want a psychiatric evaluation, have questions about a possible diagnosis, want to discuss medication, or need psychiatric medication management, a psychiatrist or psychiatric mental health nurse practitioner may be a good place to start. Some people benefit from both.
What Does a Therapist Do?
A therapist primarily provides counseling or psychotherapy, often called talk therapy.
Therapy can help you understand your thoughts, emotions, behaviors, relationships, and life experiences. It can also help you learn practical skills for handling difficult situations and managing symptoms.
People may work with a therapist for concerns such as:
Anxiety
Depression
Stress
Grief
Trauma
Relationship problems
Family conflict
Low self-esteem
Life changes
Emotional regulation
Coping skills
Unhelpful thought or behavior patterns
“Therapist” is a broad term. It is not one specific professional license.
A therapist may be a:
Licensed clinical social worker
Licensed professional counselor
Licensed clinical mental health counselor
Marriage and family therapist
Psychologist
Other licensed mental health professional trained in psychotherapy
Therapists generally do not prescribe medication. If what you are looking for is regular counseling, help working through difficult experiences, or support changing thoughts, behaviors, relationships, or coping skills, a therapist may be the right place to begin.
What Does a Psychiatrist Do?
A psychiatrist is a medical doctor, either an MD or DO, who specializes in mental health.
Psychiatrists receive medical training followed by specialized training in psychiatry.
They can:
Evaluate mental health symptoms
Diagnose psychiatric conditions
Develop treatment plans
Prescribe psychiatric medications
Monitor medications and side effects
Consider medical conditions that may contribute to psychiatric symptoms
Provide psychotherapy
In many outpatient practices, psychiatrists focus much of their work on psychiatric evaluation and medication management, although psychiatrists are also trained in psychotherapy.
People may see a psychiatrist for conditions such as depression, anxiety disorders, ADHD, bipolar disorder, obsessive-compulsive disorder, post-traumatic stress disorder, eating disorders, schizophrenia, and many other psychiatric conditions.
A psychiatrist can be an appropriate starting point if you are looking for a psychiatric evaluation or medication treatment.
Psychiatric care from a physician may also be particularly helpful when symptoms, medical conditions, diagnoses, or medication regimens are especially complex.
What Does a Psychiatric Mental Health Nurse Practitioner Do?
A Psychiatric Mental Health Nurse Practitioner, often called a PMHNP, is an advanced practice registered nurse with graduate-level education and specialized training in psychiatric care. PMHNPs are trained to assess, diagnose, and treat psychiatric conditions across the lifespan.
Depending on state law and the individual clinician's scope of practice, a PMHNP may:
Complete psychiatric evaluations
Diagnose psychiatric conditions
Develop treatment plans
Prescribe and manage psychiatric medications
Monitor treatment response and side effects
Order or review appropriate diagnostic information
Provide psychotherapy
Provide education and support
Coordinate care with other healthcare professionals
Psychotherapy is part of PMHNP education and professional training. How much psychotherapy a PMHNP provides in day-to-day practice depends on the provider and the type of practice.
A psychiatric evaluation with a PMHNP may include reviewing:
Current symptoms
Mental health history
Medical history
Current and previous medications
Sleep
Mood
Anxiety
Attention and concentration
Family psychiatric history
Substance use
Safety concerns
School, work, relationships, and daily functioning
The purpose of an evaluation is not simply to decide whether someone “needs medication.” The goal is to understand what may be happening, consider possible diagnoses, discuss treatment options, and develop an individualized plan.
Psychiatrist vs. Psychiatric Nurse Practitioner: What Is the Difference?
Psychiatrists and psychiatric mental health nurse practitioners are different types of healthcare professionals, but their roles can overlap. Both may evaluate psychiatric symptoms, diagnose mental health conditions, develop treatment plans, provide psychiatric treatment, and prescribe medication within their professional and state scope of practice.
The biggest difference is their educational path.
A psychiatrist completes medical school followed by residency training in psychiatry. A PMHNP begins with nursing education and then completes graduate-level advanced practice education and specialized psychiatric training.
For many people receiving outpatient mental health care, either a psychiatrist or PMHNP may be an appropriate provider. The right fit depends on your individual needs, the provider's experience, the complexity of your situation, and the services available in your area.
Do I Need Therapy or Medication?
Sometimes therapy is the best treatment.
Sometimes medication may be helpful.
Sometimes treatment includes both.
For example, someone with anxiety may benefit from therapy that teaches coping skills and helps change patterns that make anxiety worse. If the anxiety continues to interfere with work, school, sleep, relationships, or everyday life, a psychiatric evaluation may also be helpful.
A person with ADHD may receive psychiatric treatment while also working with a therapist on organization, routines, emotional regulation, relationships, or habits. Someone experiencing depression may benefit from psychotherapy, medication, lifestyle changes, or a combination of treatments. The best treatment depends on the individual person, diagnosis, symptoms, history, preferences, risks, and needs.
Mental health treatment should not be one-size-fits-all.
When Should I Start With a Therapist?
Consider starting with a therapist when your main goal is counseling.
That may include help with:
Stress
Relationships
Grief
Trauma
Coping skills
Emotional regulation
Changing thoughts or behaviors
Working through difficult life experiences
You do not need to wait until your symptoms become severe before starting therapy.
Therapy can also continue while you receive psychiatric care from another provider.
When Should I Consider a Psychiatric Evaluation?
Consider a psychiatric evaluation when you want help understanding your symptoms, have questions about a possible psychiatric diagnosis, or want to discuss whether medication could be appropriate.
An evaluation may also be helpful if:
Mental health symptoms are interfering with everyday life.
Symptoms continue despite therapy or other changes.
You are struggling with mood, anxiety, sleep, attention, or concentration.
You wonder whether you may have ADHD or another psychiatric condition.
Your current medication is no longer working as well as it once did.
You are having medication side effects.
Previous medications have not worked.
Your symptoms are becoming more difficult to manage.
Your therapist or primary care provider recommends psychiatric evaluation.
You do not need to know your diagnosis before making an appointment.
Determining what may be contributing to your symptoms is part of a psychiatric evaluation.
Can I See a Therapist and a Psychiatric Provider at the Same Time?
Yes, this is very common. When appropriate and with your permission, communication between healthcare professionals can also help coordinate your treatment.
A therapist and psychiatric provider often serve different but complementary roles.
Your therapist may work with you regularly on thoughts, emotions, behaviors, relationships, trauma, coping skills, and other concerns.
Your psychiatric provider may evaluate psychiatric symptoms, discuss diagnoses, manage medication when appropriate, monitor treatment response, and make treatment changes.
What If I Still Don't Know Who I Need?
You do not have to diagnose yourself before asking for help.
A simple way to start is: If you mainly want counseling, consider a therapist. If you want a psychiatric evaluation or want to discuss medication, consider a psychiatrist or psychiatric mental health nurse practitioner. If you need both, you can work with both.
The goal is not to find the “best” type of mental health professional. The goal is to find the right type of care for what you need.
Psychiatric Care at Yellow Daisy Mental Health
At Yellow Daisy Mental Health, Anna Blonquist, PMHNP-BC, provides psychiatric evaluation and medication management for appropriate mental health conditions. Treatment begins with understanding the person, not simply choosing a medication.
A psychiatric evaluation may include reviewing symptoms, medical and psychiatric history, previous treatment, medications, functioning, and other factors that could be contributing to what you are experiencing.
Treatment options are then discussed so you can understand the reasoning behind the plan and participate in decisions about your care. If you already work with a therapist, psychiatric treatment can also be provided alongside your ongoing therapy when appropriate.
If you are unsure whether psychiatric care is the right next step, you can contact Yellow Daisy Mental Health for information about scheduling an evaluation.
Sources and Further Reading:
This article is for general educational purposes only. It is not a substitute for an individualized medical or mental
health evaluation. Treatment recommendations vary based on each person's symptoms, history, medical conditions, medications, and other individual factors.
If you or someone you know is experiencing a mental health crisis, call or text 988 to reach the 988 Suicide & Crisis Lifeline. If there is an immediate life-threatening emergency, call 911.
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