What are the differences between Psychiatrists, Psychologists, Psychiatric Nurse Practitioners, and Psychotherapists?


By Raymond Zakhari, NP

Many patients do not exactly know what the difference is between these various mental health care providers and hopefully this article will clarify the difference.  A psychotherapist is a term used to describe any mental health professional regardless of their training level. It refers to the talk therapy that occurs within the session. Simply stated a psychotherapist is anyone who practices psychotherapy.

So what is psychotherapy you may wonder?

Psychotherapy is a structured conversation with the intent of supporting a patient or client in making changes in the way they think or act in order to be congruent with their personal values system. The goal is to restore balance to the environment in which they live. The person who has this conversation with you is a psychotherapist. The title psychotherapist is not protected because it can be used by many different disciplines. So the titles of the disciplines that use the tool of psychotherapy are protected and subject to licensure and state laws.

So who can do psychotherapy?

 Usually people that claim to do psychotherapy are licensed professionals and they can be physicians, nurses, social workers, clergy, psychologists, and mental health counselors.

  • A psychiatrist is a physician either an MD or a DO. They have completed a residency in psychiatry after medical school for at least 3-4 years. They can order and interpret tests, prescribe medications, provide psychotherapy, and order a commitment to an institution.
  • A psychiatric nurse practitioner is a registered nurse who has completed either a masters or doctorate degree with a specialization in psychiatry. A psychiatric nurse practitioner is licensed to order and interpret tests, prescribe medication, and provide psychotherapy.  State laws vary regarding their ability to order a commitment to an institution, and the types of medications that can be prescribed.
  • A psychologist is a doctoral educated person who has either a PhD or a Psy.D. This person is usually an expert in diagnostic testing, in the field of mental health they are primarily the ones that adminsiter Neuro Psychological Tests and interpret them. In some states psychologists can prescribe medication. Most states do not allow psychologists to order physiological tests or imaging studies. Psychologists can provide psychotherapy.
  • Social Workers, Mental Health Counselors, Marriage and Family Therapists, and Clergy: all of these professionals can provide psychotherapy. These mental health professionals cannot order and interpret physiological tests, or prescribe medication. These professionals cannot order a commitment to an institution. These are the most abundant and most common providers of psychotherapy. They are sometimes referred to as simply therapists.

How do I combine both my family practice training and family psychiatry training in a medical house calls practice?

As a nurse practitioner, I am able to diagnose medical illnesses some of which may present as mental health problems.  I pay particular attention to the medical impact of psychological problems and the psychological impact of acute and chronic medical problems. I can also prescribe medications and order and interpret diagnostic tests.

I had a patient with difficulty breathing, who happens to be at home on a CPAP machine, she was frequently getting admitted to the hospital for difficulty breathing. After I evaluated the patient I was able to identify the underlying cause as panic attacks. This same patient subsequently became depressed because of her ailing health, and stopped eating. This led to problems with her blood pressure. Once I was able to diagnose the three problems that were affecting and perpetuating each other I was able to effectively treat the panic attacks, depression, and low blood pressure. This patient whom I had treated complained that these symptoms had progressed over the last 2 years and had not gotten better despite 5 hospitalizations and ICU admissions.  

The patient had been seeing a psychiatrist, pulmonologist, and neurologist. Because I was able to see the patient in her home I was able to physically assess her during the panic attack I was able to distinguish her feeling of respiratory distress from actual respiratory distress.  Also, because of my psychotherapy training I was able to help the family around her cope with the psychological impact of chronic illness, issues of their own mortality, the patients sense of powerlessness, and to explore the likelihood of the patient’s death. I instructed the caregivers and family members how to assess for true respiratory distress, and how to respond to a panic attack. The patient was never readmitted to the hospital again, and eventually died peacefully at home surrounded by family.  Afterwards I was able to provide grief counseling to the family members.

I hope this posting clarifies the differences between all the various mental health professionals that can provide psychotherapy. I also hope it assists you in choosing they type of psychotherapist to best meet your needs.  The most important indicator and predictor of a successful therapeutic outcome is not the type of professional you choose or even they type of talk therapy they provide. It is if you like them and feel they understand you. Mental health professionals call this the therapeutic alliance. More on this later—

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