Counselor vs. Psychologist vs. Psychiatrist
understand the Differences Between These Mental Health Providers—So You Can Make the Best Choice
Reframing the Path, by licensed therapist Melissa Rolfes, is your guide to making the most of your therapeutic journey—helping you feel more confident and effective every step of the way. The information provided here is for educational purposes only, and is not a substitute for professional mental health or medical care, nor does it establish a therapist-client relationship. If you're experiencing distress and feel unable to keep yourself safe, please call 911 or go to your nearest emergency room immediately.
What’s Up With All These Titles?
I once worked with a psychiatrist at a community clinic, who had a new patient show up, kick off his shoes, and sit back like he was waiting for a foot exam. Turns out, he thought he was seeing a podiatrist—not a psychiatrist. Easy mix-up, right?
Okay, maybe not that easy. But when it comes to mental health care, the titles can feel just as confusing: counselor, psychologist, psychiatrist… who does what? Who prescribes medication? Who’s licensed to diagnose? Who’s actually going to sit and talk with you?
As a licensed professional counselor in Virginia, I want to break down the key differences—especially what these titles mean here in our state. Because knowing who you’re talking to (and what they’re trained to help you with) is pretty important…
COUNSELOR
Master’s degree · State license · Provides therapy
Counselors are trained mental health professionals who help people navigate emotional challenges, patterns, and life stressors through talk therapy. In Virginia, the two most common types are:
LPC – Licensed Professional Counselor
LCSW – Licensed Clinical Social Worker
Both require a master’s degree, thousands of supervised clinical hours, and passing a state licensure exam. They’re qualified to diagnose mental health conditions, provide therapy, and support clients through things like anxiety, trauma, grief, or relationship struggles.
Counselors do not prescribe medication, but should be able to collaborate with medical professionals when medication might be part of someone’s care plan.
You’ll find counselors in private practice, but also in community clinics, hospitals, schools, employee assistance programs (EAPs), and nonprofit settings.
Want to learn more about counseling?
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PSYCHOLOGIST
Doctoral degree · State license · Provides therapy and psychological testing
Psychologists are licensed mental health professionals who hold a doctoral degree—either a PhD (Doctor of Philosophy) or a PsyD (Doctor of Psychology). They’re trained in both psychotherapy and psychological testing, and often specialize in assessment, research, or complex clinical work.
In Virginia, psychologists can diagnose mental health conditions, provide therapy, and conduct specialized testing.
What’s “psychological testing”?
What really sets psychologists apart from counselors, aside from a higher graduate degree, is that they have specialized training to conduct formal assessments, which are a structured way to gain a better understanding of how your brain works. Psychological testing can confirm conditions like ADHD and other forms of neurodivergence, mood disorders, personality pathology, and learning differences.Assessments are different from screenings, which are brief questionnaires or checklists often used in primary care or therapy settings. Screenings don’t confirm a diagnosis—they simply show whether a formal assessment by a psychologist may be warranted.
Depending on what’s being assessed, testing may involve answering written questions, completing visual or logic-based tasks, or doing memory and attention exercises. It’s not about passing or failing—it’s about getting a clearer picture of your cognitive and emotional functioning, so mental health care can be better tailored to you.
Psychologists do not prescribe medication, but should be able to collaborate with medical professionals when medication might be part of someone’s care plan.
In addition to private practice, psychologists often work in hospitals, academic or research institutions, VA centers, or specialty clinics where psychological testing is needed.
PSYCHIATRIST
Medical degree · state license · Prescribes psychiatric medication
Psychiatrists are medical providers who specialize in assessing and treating mental health symptoms. They hold an MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine), and are licensed to diagnose mental health conditions and prescribe psychiatric medication. In some cases, psychiatric nurse practitioners (PMHNPs) provide similar care and can prescribe medications, particularly in areas with fewer psychiatrists available.
Psychiatrists are trained to look at mental health through a medical lens—considering things like brain chemistry, physical health, and how symptoms respond to medication. While some offer brief talk therapy, most focus on diagnosing conditions and managing psychiatric medications.
Depending on the complexity and severity of your symptoms, your primary care provider may also be able to prescribe mental health medication—especially for more common concerns like anxiety, depression, or sleep issues. But for more specialized or complex needs, a psychiatrist is often the next step. Like a cardiologist is a medical specialist for your heart, think of a psychiatrist as a medical specialist for your mental health.
Psychiatrists may work in private practice, but are also commonly found in hospitals, inpatient psychiatric units, community mental health centers, and integrated care teams within primary care clinics.
Making the Best Choice for Your Mental Health
If you’ve ever stared at a list of provider names and acronyms and had no idea what any of it meant, you’re not alone. The mental health system isn’t always user-friendly, and all the titles can make it even harder to figure out who does what.
But understanding the differences between counselors, psychologists, and psychiatrists can help you make a choice that actually fits your needs—and saves you time and stress along the way.
Here’s a general guide:
If you’re feeling overwhelmed, stuck, anxious, or just need someone to talk to—a counselor is often the best place to start. They’re trained to help you understand your emotions, build coping strategies, and work through life’s challenges in a supportive, therapeutic setting.
If you’re looking for formal testing—for ADHD, learning differences, or deeper diagnostic clarity—a psychologist can provide assessments and help interpret results, along with offering therapy if needed.
If you’re thinking about medication—either for anxiety, depression, mood swings, or more complex symptoms—talk to your primary care provider first, or connect with a psychiatrist. They’re trained to diagnose and manage mental health concerns from a medical perspective.
You don’t have to figure it all out alone. The mental health system can be confusing—and access isn’t always easy. But knowing the roles of different providers can help you ask better questions, advocate for your care, and move forward with more clarity. Wherever you decide to start, know that a good provider will help guide you to the next step if your needs change or aren’t within their scope.
Looking for a counselor in Virginia?
I offer virtual therapy for adults across the state—focused on practical tools, real conversations, and science-backed support. If you're curious about working together, click here to learn more about my services or reach out with any questions.
