Oct 16, 2026

Therapist vs. Psychologist vs. Psychiatrist: Who Does What

Should you call a therapist, a psychologist or a psychiatrist? It is often the first question an adult asks when a hard season will not lift, or a parent asks when a child or teen is struggling at home or at school, and the titles can make a simple first step feel complicated. The short answer is this: a therapist (a licensed counselor, marriage and family therapist or clinical social worker) provides therapy and, in Virginia, may diagnose and treat mental and emotional disorders; a psychologist holds a doctorate in psychology and provides therapy and formal psychological testing; and a psychiatrist is a medical doctor who can prescribe medication. A psychiatric nurse practitioner, a fourth professional most comparisons leave out, can also evaluate and prescribe. For many people and families, a first appointment with a therapist or with a primary care provider is a reasonable place to begin, and either one can help you decide whether medication belongs in the conversation.

The short version

	Therapist (LPC, LMFT, LCSW)	Psychologist	Psychiatrist	Psychiatric nurse practitioner (PMHNP)
Training	A state license in counseling, marriage and family therapy, or clinical social work	A doctorate in psychology (Ph.D. or Psy.D.), a clinical internship and licensing exams	Medical school (MD or DO) followed by a psychiatry residency	An advanced practice nurse who specializes in mental health care
Diagnoses?	Yes, under Virginia law	Yes	Yes	Yes
Main focus	Ongoing therapy for adults, children, teens and families	Therapy and psychological testing	Medical evaluation and medication	Psychiatric evaluation and medication management
Prescribes?	No	Generally no; some states allow it	Yes	Yes, under Virginia law

The sections below explain each column, with the sources for every line.

What a therapist can do in Virginia

The word "therapist" is not itself a license. It is the everyday name for several licensed professionals, and in Virginia the three you will meet most often are the Licensed Professional Counselor (LPC), the Licensed Marriage and Family Therapist (LMFT) and the Licensed Clinical Social Worker (LCSW).

Many comparison pages leave these clinicians out, which can leave readers with the impression that a diagnosis must come from someone else. Virginia law says otherwise. The Code of Virginia § 54.1-3500 defines counseling as including "conducting assessments and diagnoses for the purpose of establishing treatment goals and objectives," and describes a professional counselor's work as including "remediating mental, emotional, or behavioral disorders and associated distresses that interfere with mental health and development." The same section defines marriage and family therapy as "the appraisal and treatment of cognitive, affective, or behavioral mental and emotional disorders within the context of marriage and family systems." For social work, Code of Virginia § 54.1-3700 defines a clinical social worker as one who is "professionally qualified at the autonomous practice level to provide direct diagnostic, preventive and treatment services."

In plain terms, a licensed therapist in Virginia can assess what is happening, name it, and treat it. What a therapist cannot do is prescribe: Cleveland Clinic notes that licensed social workers and counselors cannot prescribe medication, though they can offer therapy and other mental health support. When medication is worth considering, a therapist works alongside a prescriber rather than in place of one.

What a psychologist does

According to the Bureau of Labor Statistics, clinical and counseling psychologists typically need a Doctor of Philosophy (Ph.D.) in psychology or a Doctor of Psychology (Psy.D.). Cleveland Clinic adds that psychologists complete a one-year clinical internship and pass national and state-specific exams.

In Virginia, clinical psychology is its own license. Code of Virginia § 54.1-3600 defines a clinical psychologist as "an individual licensed to practice clinical psychology," and that practice includes diagnosis and treatment of mental and emotional disorders as well as "testing and measuring," the psychological evaluation of characteristics "such as intelligence, abilities, interests, aptitudes, achievements, motives, personality dynamics." That testing is the work most closely tied to a psychologist. When a school or a pediatrician asks for a formal evaluation of a child's learning or intellectual abilities, the request is usually one for a psychologist.

Psychologists generally do not prescribe. Cleveland Clinic says psychologists "do not prescribe medication or order medical tests," while the Bureau of Labor Statistics notes that "some states permit clinical psychologists to prescribe medication."

What a psychiatrist does

A psychiatrist is a physician. Cleveland Clinic describes the path as four years of medical school, earning either a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree, followed by a four-year psychiatry residency. Because psychiatrists are medical doctors, they can prescribe medication.

The same Cleveland Clinic article notes that psychiatrists often work with other prescribers, such as nurse practitioners and physician assistants, who can evaluate symptoms, diagnose conditions and prescribe medications. That is where the fourth professional comes in.

Where a psychiatric nurse practitioner fits

A Psychiatric Mental Health Nurse Practitioner (PMHNP) is a nurse practitioner who works in mental health care, and nurse practitioners, as Cleveland Clinic notes, can "evaluate symptoms, diagnose conditions and prescribe medications." In Virginia, Code of Virginia § 54.1-2957.01 gives a licensed advanced practice registered nurse "the authority to prescribe Schedule II through Schedule VI controlled substances and devices." Under Code of Virginia § 54.1-2957, a nurse practitioner practices under a written or electronic practice agreement with at least one patient care team physician until completing the equivalent of at least three years of full-time clinical experience, after which the nurse practitioner may practice without one.

For a family weighing medication, this means a psychiatric evaluation does not have to come from a psychiatrist: a psychiatric nurse practitioner can provide it, and when a nurse practitioner is part of a counseling practice, the evaluation can happen in the same place as therapy. You can read more about what a psychiatric nurse practitioner does on its own page.

"Dr." does not always mean psychologist

A doctorate is a degree; a license is permission to practice. The two are easy to confuse, because a clinician with a Ph.D. or an Ed.D. (Doctor of Education) is properly called "Dr." whatever their license happens to be.

At Life Enrichment Counseling Center, there is no psychologist or psychiatrist on the team at all: our therapy is provided by counselors, marriage and family therapists, social workers and an art therapist, and those among them who hold a Virginia license may diagnose and treat under state law; our medication management is provided by a Psychiatric Mental Health Nurse Practitioner, whom Virginia law allows to prescribe; and four of our clinicians hold a Ph.D. or Ed.D. while being licensed as counselors or social workers, not as psychologists.

The simplest way to read any clinician's name is to separate the two kinds of letters after it. Degree letters (MSW, M.Ed., MA, Ph.D., Ed.D., Psy.D.) describe education. License letters (LPC, LMFT, LCSW, or a license in clinical psychology) describe what the person is licensed to do in that state. If it is not clear from a profile, it is always appropriate to ask a clinician how they are licensed. You can see every clinician's degrees and licenses on our therapist roster.

Choosing a professional for a child or teen

For a parent or guardian, the question is rarely about titles. It is about what you are seeing at home and at school, and who can help you and your family understand it.

When a child or teen is anxious, withdrawn, angry or not themselves, a therapist who works with young people is a natural first step. For younger children, a therapist may use approaches such as play therapy, in which a therapist uses play to help a child express what they cannot yet put into words. You can read more about counseling for children and counseling for adolescents.

When therapy is underway and questions about medication come up, a psychiatrist or psychiatric nurse practitioner is the professional who evaluates whether medication may help. Any decision about starting, changing or stopping a medication belongs with that prescriber, and therapy can continue alongside it.

Throughout, you remain part of your child's care. A good clinician will explain what they are seeing, what they recommend, and why, in words that make sense to you.

Who to call first

The National Institute of Mental Health notes that a primary care provider "can perform an initial mental health screening and refer you to a mental health professional (such as a social worker, psychologist, or psychiatrist)," and that treatment "usually includes therapy (virtual or in person), medication, or a combination of the two." Cleveland Clinic agrees that "the best place to start is often with your primary care provider."

From there, a reasonable way to decide:

You want someone to talk with regularly about what is happening, for yourself, your child or your family: start with a licensed therapist.
You are wondering whether medication could help, or you already take a psychiatric medication and need it managed: see a psychiatrist or a psychiatric nurse practitioner.
Someone has asked for psychological or educational testing: ask for a psychologist.
You are not sure: book a first consultation with a therapist or your primary care provider. Part of that first conversation is working out who else, if anyone, should be involved, and you do not have to sort that out alone.

If it cannot wait

If you or someone in your family is thinking about suicide or is in emotional distress, call or text 988 to reach a counselor at the 988 Suicide & Crisis Lifeline, which is available anytime, day or night. In a life-threatening situation, call 911 or go to the nearest emergency room (NIMH).

Therapy and medication in one place

Regardless of which title brought you here, the goal is the same: the right help, from someone who will walk alongside you, your family and your loved ones as you move toward the other side of a difficult season. At Life Enrichment Counseling Center, therapy and psychiatric evaluation and medication management can be offered within the same practice. We see adults, adolescents, children and families in Gainesville, Alexandria and Haymarket, VA, and Port St. Lucie, FL, as well as through online therapy. If you would like to talk through where to begin, we welcome you to request an appointment.