Should you see a psychologist or psychiatrist first?
Seeking help for those who are struggling with their mental health is an important step toward living a full and meaningful life. However, determining which type of practitioner will provide the most effective treatment is not always straightforward.
Experienced mental health professionals have the necessary training and knowledge to assist clients to make an informed decision about the course of their treatment. Patients are frequently referred to psychiatrists and psychologists.
However, in general, here are some things to think about before deciding whether to see a psychologist or psychiatrist first.
- A psychologist may be a good fit if a person wants to spend time talking about and working through an issue in a one-on-one setting.
- If a person wants to pursue psychiatric medication for symptom relief from a mental health disorder, they should first consult with a psychiatrist.
- If the issue a person wants to address is one of the relationships, such as a problem at work or with a family member, a psychologist may be able to help.
- A psychiatrist may be a good place to start if a person is experiencing debilitating mental health symptoms that are interfering with their daily life.
Psychiatrists and psychologists, as previously stated, are both concerned with assisting people to optimize their mental wellness, and both are frequently trained in a variety of treatment modalities.
The best place to begin is with a practitioner with whom a person feels at ease. They will listen to the patient’s purpose, assess their symptoms, consider their medical, psychiatric, and family history, and assist the person to decide the next step.
Also, keep in mind that many people visit more than one mental health practitioner before finding the best fit.
The terms “counselor” and “psychotherapist” are often used interchangeably and have many similarities, but there are some important differences as well. In general, counseling is recommended for specific issues and situations, such as addiction or grief, and takes place over weeks to several months.
Psychotherapy, in contrast, tends to explore past issues that might be contributing to present day problems. It often takes place continually or intermittently over a period of years. In actual practice, however, there is a great deal of overlap between the two types of therapies.
Understanding some more of the differences between counseling and psychotherapy may be helpful in choosing the type of therapy that will be most effective for you as an individual.
Counseling vs. Psychotherapy
While the same therapist may provide both counseling and psychotherapy, psychotherapy generally requires more skill than simple counseling. It is conducted by professionals trained to practice psychotherapy such as a psychiatrist or psychologist, a trained counselor, or a social worker.
While a psychotherapist is qualified to provide counseling, a counselor may or may not possess the necessary training and skills to provide psychotherapy.
That said, a therapist may provide counseling with specific situations and a counselor may function in a psychotherapeutic manner.
Technically speaking, “counselor” means “advisor.” It involves two people working together to solve a problem. It is a term that is used in conjunction with many types of advice giving. For example, financial planning and spiritual guidance are both types of counseling.
Just about anyone may claim to be a counselor if they are in the role of giving advice. The term counseling may also properly be used to refer to what occurs in a relationship with a psychotherapist.
In the context of mental health, “counseling” is generally used to denote a relatively brief treatment that is focused primarily on behavior. It often targets a particular symptom or problematic situation and offers suggestions and advice for dealing with it.
In this setting, the counselor offers guidance and support as the individual figures out ways to better manage life and adjust to change or adversity.
There are many types of counselors, such as marriage and family therapists, grief counselors, addiction and substance abuse counselors, and more.
“Psychotherapy” on the other hand is generally a longer-term treatment that focuses more on gaining insight into chronic physical and emotional problems. Its focus is on the person’s thought processes, and how these may be influenced by past events such that they cause problems in the present.
In other words, psychotherapy addresses the root cause and core issues of current problems so that lasting change and personal growth may occur.
There are several different types of therapy that fall under the general heading of psychotherapy, including approaches such as cognitive behavioral therapy, dialectical behavior therapy, psychoanalytic psychotherapy, and much more.
There are many similarities between counseling and psychotherapy, and even with the distinction, counseling often includes some psychotherapy and psychotherapy often includes some counseling. Similarities include:
- Development of a healing, safe, and therapeutic relationship between a therapist and an individual
- Effectiveness for a wide range of people, both adults and children
- Understanding a person’s feelings and behaviors, and addressing issues with the goal of improving a person’s life
While mental health professionals with more advanced degrees (eg. psychology PhD or PsyD) are more likely to provide psychotherapy, the same provider may do both types of therapy. There are some key differences between the providers, however.
Focus on present problems and situations
Specific situations or behaviors
Short term therapy (for a period of weeks and up to 6 months)
Action and behavior focused
Guidance, support, and education to help people identify and find their own solutions to current problems
Focus on chronic or recurrent problems
Overall patterns, big picture oriented
Long term therapy, either continuous or intermittent over many years
Feeling and experience focused
May include testing (such as personality, intelligence), talk therapy, other therapies such as cognitive behavioral therapy
In-depth focus on internal thoughts/feelings (core issues) leading to personal growth
How to Choose Between a Counselor and Psychotherapist
When choosing a therapist, it’s helpful to learn about the differences noted above, as well as the background of specific providers and the approaches they use. Sometimes the choice will come down to personal preferences, access, or insurance coverage.
The most important step, however, is to find a therapist you can trust. In fact, the level of trust a person has in their mental health care practitioner plays the greatest role in whether the therapy will be successful or not.
You may actually need to talk with a provider or visit for a few appointments before you know which type of therapy is best for you. For example, with some situations it can be difficult to know if it is a short term, a limited problem you are facing (and thus, may fall under conditions best treated with counseling), or if instead there are events or situations in your past that are leading to the current problem.
When You May Wish to See a Counselor
Counseling may be a better option than psychotherapy if:
- You have specific issues or short term problems you wish to address
- You wish to learn coping skills to help better manage stress and improve relationships
- You are coping with life transitions and adjustments, such as divorce or grief
- You are coping with addiction issues
- You are looking for someone who is essentially a “coach” who can guide and support you as you learn to recognize problems and formulate healthy solutions yourself
When You May Wish to See a Psychotherapist
A psychotherapist may be a better option if:
- You have problems that are significantly impacting your life and relationships
- You are coping with past trauma, or if you believe situations in the past may be playing a role in your current issues
- Your present issues are chronic or recurring concerns
- You have a chronic medical condition (such as autoimmune disease, cancer, etc.) that is affecting your emotional well-being
- You have a diagnosed mental health condition such bipolar disorder or a major anxiety disorder
- You have seen a counselor and your issues aren’t improving even though you’ve been actively working on solutions
Counseling vs. Psychotherapy for Depression
Both counseling and psychotherapy are used in the treatment of depression, and the choice can depend on the severity of the depression, whether it is a new issue for you or rather an ongoing or recurrent problem and more.
As far as the effectiveness of the two approaches, a 2016 study found that counseling was just as effective for the treatment of previously untreated mild to moderate depression diagnosed in primary care.
Another 2016 study, however, found that interpersonal psychotherapy was somewhat more beneficial than counseling in adolescents with depression, with respect to both symptoms, and overall functioning over the short-term. That said, a 2018 study looking at the same group found that long term, the effects of counseling were more beneficial.
People with chronic, severe depression might benefit most from psychotherapy, whereas people with mild to moderate depression may benefit most from developing a good relationship with a therapist based on mutual trust, and then talking with them about which approach would be most helpful.
Preparing for a Visit With Counselor or Psychotherapist
Whether you choose to see a counselor or a psychotherapist, your initial appointment will likely be more rewarding if you do a little homework ahead of time. Doing so will not only help you clarify why you are seeking professional help but will help the provider you see know whether she believes she will be able to help you or not.
Before your appointment, make a list of:
- Any issues, concerns, or symptoms you are coping with, even if they seem to be unrelated or are not the reason why you are seeking therapy
- Key personal information, including any major stresses or recent life changes
- All medications, vitamins or other supplements that you’re taking, including doses
- Questions to ask your healthcare provider
Depression Discussion Guide
Get our printable guide to help you ask the right questions at your next doctor’s appointment.
A Word From Verywell
There are some reasons why you may wish to choose a counselor instead of a psychotherapist, or vice versa, but the most important step is getting started. It can take some time to find a therapist who you fully trust, and you may need to visit a few providers before you find the right fit. Keep in mind that you are the consumer, and it’s OK to shop around. Personalities differ, and the best therapist for someone else may not be the right therapist for you.