You’ve decided to get help, which is the hard part. Then you hit a smaller but very real question: do you book a psychiatrist or a therapist? The two jobs overlap less than most people think, and picking the right one first can save you weeks of waiting in the wrong line.
The Difference Between a Psychiatrist and a Therapist
A psychiatrist is a medical doctor, with an MD or DO, who specializes in mental health. Psychiatrists diagnose conditions, rule out physical causes, and prescribe and adjust medication. A psychiatric mental health nurse practitioner (PMHNP) is a nurse with advanced training in mental health who can also diagnose and prescribe. At BNBA, prescribing is done by psychiatrists, psychiatric nurse practitioners, and physician assistants, all listed on our prescribers page.
A therapist works with you through talk therapy. That might be a licensed clinical social worker (LICSW or LCSW), a licensed mental health counselor (LMHC), a licensed professional counselor (LPC) or a psychologist (PsyD). Sessions are usually regular and focus on what’s going on in your life, how you think and react, and what you can change. Therapists don’t prescribe medication in most states.
So the simplest way to put it: a psychiatrist works mainly on the medical side of a mental health condition, and a therapist works on the day-to-day side. Some people need one. Many need both.
Can a Therapist Prescribe Medication?
Usually not. In most states, prescribing is left to psychiatrists and other medical providers, so counselors, social workers, and most psychologists focus on therapy instead.
There is one exception worth knowing. A small number of states let psychologists with extra training in psychopharmacology prescribe certain medications. As of July 2026, Becker’s Behavioral Health reported that this includes Colorado, Idaho, Illinois, Iowa, Louisiana, New Mexico, and Utah, with Vermont and Hawaii adding their own programs. It’s still uncommon, even in those states.
At BNBA, medication is handled through medication management with our psychiatrists and psychiatric nurse practitioners, while our counselors and psychologists focus on therapy.
When a Psychiatrist Is the Better First Step
Start with a psychiatrist when mental health symptoms are severe, persistent, or require medical or pharmaceutical intervention.
It also makes sense when symptoms are making your daily life harder. If you can’t sleep, can’t eat properly, can’t get through a workday, or feel a little worse each week, a psychiatrist can help you understand what could be causing these symptoms and what treatment may help. The same goes for mood swings that include stretches of very high energy and little need for sleep, since bipolar disorder is often mistaken for depression at first (our post on how bipolar disorder can be missed for years explains why). Hearing or seeing things other people don’t understand is another reason to visit a psychiatrist.
And if you’ve been in therapy for a while and things aren’t progressing, a psychiatric evaluation can reveal whether something else is going on.
If you’re having thoughts of suicide, don’t wait for an appointment. Call or text 988 to reach the Suicide and Crisis Lifeline, or call 911 in an emergency.
When a Therapist Is the Better First Step
Therapy is often the right place to start when life feels heavy but you’re still getting through the day. Stress at work, grief, a breakup, a big move, conflict at home, or low mood and anxiety that come and go all fit here. So does wanting to understand why you keep ending up repeating the same patterns.
It’s also a good fit if you’d rather not start with medication. A therapist won’t push you toward a prescription, but if they think you’d benefit from one, they can suggest a psychiatric evaluation. Regular sessions also mean someone is watching how you’re doing over time, which makes it easier to spot when things are improving or slipping. You can read more about how individual therapy works at BNBA.
When Seeing Both Makes the Most Sense
For a lot of conditions, especially moderate to severe depression and anxiety, the two work best together. Medication can take the edge off symptoms enough that therapy actually sticks, and therapy gives you tools that medication alone doesn’t. Our post on therapy vs medication vs both for depression goes into this in more detail.
What matters is that your psychiatrist and therapist aren’t working in separate bubbles. BNBA’s medication management page describes combining medication with therapy and lifestyle support when that’s the right fit, so both sides of your care can be planned together.
What to Expect at Your First Appointment
A first psychiatric evaluation at BNBA typically takes 60 to 90 minutes. You’ll talk through your symptoms, full medical history, any medications you take now, what you want to get out of treatment, and how life is going outside of all that. It’s worth bringing a list of your current medications and doses, so that nothing gets missed.
A first therapy appointment is shorter, usually 45 to 60 minutes. Expect it to feel more like a conversation: what brought you in, what’s been happening, and what you’d like to be different. Neither appointment commits you to a particular treatment.
Seeing a Psychiatrist or Therapist at BNBA
BNBA has providers in Massachusetts, Rhode Island, New Jersey, Maryland, Illinois, New York, and Florida, with both in-person and telehealth appointments. Intake is usually scheduled within a week. Age ranges depend on the state and the service. For psychiatry, BNBA sees clients from ages 5+ in Massachusetts and Florida, and from 18+ in Rhode Island and New York.
BNBA is in-network with Medicare, Medicaid, and major commercial plans – including Aetna, Blue Cross Blue Shield, Cigna, and UnitedHealthcare. You can browse our therapists and counselors or our prescribers by location.
Not sure which to book? Say so when you call (508) 979-5557, or request an appointment online.
Frequently Asked Questions
Is a Psychologist the Same as a Psychiatrist?
They’re different jobs. A psychiatrist is a medical doctor who can prescribe medication, while a psychologist has a doctoral degree in psychology and mainly provides therapy and psychological testing. In most states psychologists can’t prescribe.
Can a Therapist Prescribe Medication?
Not in most states. Counselors and social workers can’t prescribe anywhere, and psychologists can only do so in a handful of states, including Illinois, and only with extra training.
Can You See a Psychiatrist and a Therapist at the Same Time?
Yes, and for many conditions that’s the most effective setup. The psychiatrist manages medication while the therapist works with you in regular sessions, and at BNBA both can be part of the same treatment plan.
Should I See a Psychiatrist or a Therapist for Depression or Anxiety?
It depends on how much the symptoms are getting in your way. If you’re still managing your day-to-day life, therapy is a reasonable place to start. If you’re struggling to function, already on medication that isn’t helping, or having thoughts of suicide, it might be best to see a psychiatrist first.