Therapy or psychiatry: which one do you need?

The short version

A psychiatrist is a medical doctor who has specialised in mental health. They diagnose, consider physical causes, and can prescribe and review medication.

A clinical psychologist or psychotherapist is trained in assessment and structured talking therapies such as cognitive behavioural therapy, and works with patterns of thinking, feeling and behaviour over a course of sessions. They do not prescribe medicine.

What a therapist actually does

Therapy is not advice. A psychologist works with you to map what maintains the difficulty — the loop of thoughts, avoidance, sleep, relationships and habits that keeps it in place — and then works through a structured method to change it.

It is usually the right starting point for stress, relationship and family difficulty, grief, mild to moderate anxiety and low mood, adjustment after a life change, and anyone who would rather begin without medication.

What a psychiatrist actually does

A psychiatrist assesses the whole picture, including physical contributors such as thyroid problems, anaemia, sleep disorders, pain or the effects of alcohol and other substances, and is the person who can start, change or stop medication.

Psychiatric input is usually appropriate where symptoms are severe or persistent, where there are episodes of mania, psychosis or significant self-harm risk, where an ADHD or bipolar assessment is needed, or where therapy alone has not shifted things.

Situations where both are involved

For many people the useful answer is not one or the other. Medication can lower the intensity enough for therapy to be possible; therapy provides the skills that keep the gains after medication is reduced.

• Moderate to severe depression, where medication and therapy are often combined.
• Panic disorder and OCD, where therapy is central and medicine sometimes supports it.
• ADHD, where diagnosis and medication sit with the psychiatrist and coping strategies with the psychologist.
• Bipolar disorder, where psychiatric review is ongoing and therapy supports routine and relapse signs.
• Addiction recovery, where medical management and relapse-prevention work run alongside each other.

How to choose where to start

If you are unsure, start with whichever appointment you can get sooner and say you are unsure. Both professions are trained to recognise when a case belongs with the other and will refer rather than keep working outside their scope.

A reasonable rule of thumb: if the difficulty is mainly about how you are coping, thinking or relating, begin with a psychologist. If it involves severe or unexplained physical symptoms, medication questions, or a diagnosis you want confirmed, begin with a psychiatrist.

Frequently asked questions