Psychotherapist, psychologist, psychiatrist: who does what and where to go

“I’d like to see a psychologist … or a psychiatrist? Or a therapist? Which of them can actually help me?” If you’ve ever asked yourself this, you’re not alone. Three professions with very similar names, three different professions — and at the very moment when a person most needs clarity, they find themselves in a maze of job titles. Many people put off that first step for exactly this reason: not because they don’t want help, but because they don’t know which door to knock on.

In this piece I untangle who is who: what a psychiatrist is, what a psychologist is, what a psychotherapist is, who can prescribe medication, when a combination makes sense and where to turn first. No jargon, with an honest note about where Slovenian regulation is still unfinished — and what you can check for yourself before entrusting anyone with your story.

Let me say straight away where I’m writing from: I am a therapist in training in marriage and family therapy, working under regular supervision — and that is precisely why it matters to me that the differences between these professions are clear rather than blurred. Trust begins with honest information.

Psychiatrist: a doctor who specialised in mental health

The psychiatrist is the only one of the three who is a medical doctor by training. They completed a degree in medicine and then several further years of specialist training in psychiatry. They understand mental distress through its physical, biological side as well: what is happening with neurotransmitters, how mood is affected by thyroid disease, vitamin deficiencies, neurological conditions, medication a person is already taking.

From this follow their two key powers, which the other two professions do not have: they make medical diagnoses and prescribe medication. Antidepressants, anxiolytics, mood stabilisers, antipsychotics, sleeping tablets — all of this is the domain of a doctor, which means a psychiatrist (some of these medicines are also prescribed by GPs, often after consulting a psychiatrist).

When is a psychiatrist the right choice? Above all when the distress is so deep that it threatens basic functioning: severe depression in which a person can’t get out of bed, suicidal thoughts, psychotic experiences (voices, persecutory thoughts), bipolar disorder, severe forms of anxiety that don’t ease. And when there is a suspicion that a physical cause lies behind the mental distress. Important: seeing a psychiatrist isn’t an admission of defeat and doesn’t mean you’re “mad”. It means your condition also needs a medical perspective — just as a broken leg or pneumonia does.

Appointments with a psychiatrist are as a rule shorter and less frequent than psychotherapy sessions: they focus on assessing your state, monitoring the effect of medication and adjusting doses. Some psychiatrists also have psychotherapy training and offer both, but that is an addition, not a given.

Psychologist: an expert in human experience and behaviour

A psychologist has completed a university degree in psychology — the science of experience, behaviour, emotion, thinking and interpersonal relationships. But note: psychology is a broad profession. Psychologists work in schools and nurseries, in HR departments, in sport, in research, in marketing. The title “psychologist” doesn’t in itself mean that someone works with people in mental distress.

For the healthcare context the key figure is the clinical psychologist: a psychologist who, after their degree, completed several further years of specialist training in clinical psychology within the health service. A clinical psychologist is a specialist in psychological assessment — using clinical interviews, standardised tests and questionnaires to establish what is happening with someone’s mental health: whether this is depression or exhaustion, an attention disorder or anxiety, what the cognitive abilities, personality structure and risks are. Such an in-depth assessment is often an invaluable basis for deciding what kind of help makes sense.

What can a psychologist not do? They don’t prescribe medication — they aren’t doctors. And an important subtlety: a degree in psychology alone doesn’t qualify anyone to conduct psychotherapy. Psychology gives you an excellent understanding of how people work; it doesn’t yet teach you to lead a therapeutic process — just as studying anatomy doesn’t yet make you a surgeon. A psychologist who wants to work psychotherapeutically generally goes through the same multi-year psychotherapy training as everyone else — which brings us to the third title.

Psychotherapist: a specialist in the process of change through relationship

A psychotherapist is someone who has completed specific, multi-year training in one of the psychotherapeutic modalities — as a rule after a completed university degree. Psychotherapy training typically comprises several years of theory and practice, personal therapy (a therapist must first go through the process themselves that they will later lead for others), work with clients under supervision, and the study of one of the established modalities: cognitive-behavioural, psychoanalytic or psychodynamic, systemic or marriage and family therapy, gestalt, transactional analysis and others.

What’s distinctive about this profession is that several routes lead into it: psychotherapists come from psychology, medicine, social work, education, theology and other professions that work with people. The common denominator isn’t the first degree but the psychotherapy training that follows it. This is why someone can be a psychologist and a psychotherapist, a psychiatrist and a psychotherapist — or a psychotherapist who by first training is neither.

What does a psychotherapist do? They lead the psychotherapeutic process: regular, structured sessions in which, through conversation and relationship, the two of you explore the patterns, emotions, relationships and history that sustain the distress — and build change. Decades of research consistently show that one of the strongest predictors of a good outcome is precisely the quality of the therapeutic relationship; I’ve written about this in more detail in my piece on why the therapeutic relationship heals. A psychotherapist doesn’t prescribe medication and doesn’t make medical diagnoses.

Here I must be honest about the Slovenian context: the regulation of the psychotherapy profession in Slovenia is still taking shape. In practice this means the title itself isn’t uniformly protected and that the quality of training varies between practitioners. So a simple rule applies: before you entrust yourself to anyone, check their training. A serious therapist states clearly on their website which modality they studied, where, for how many years, whether they work under supervision and which professional associations they belong to — and answers questions about it without evasion. If that information is missing or vague, that in itself is important information. I’ve gathered more on how to choose in my piece on choosing a therapist.

And where do coaches, counsellors and mentors fit in?

Since the market offers ever more of them, here is a brief demarcation. Coaching, life counselling and similar practices are not psychotherapy: as a rule they don’t require comparably long training, personal therapy or supervision, and they aren’t intended for working with mental distress. A coach can be useful for clear, future-oriented goals — a career move, organisation, motivation. But when it comes to anxiety, low mood, trauma, grief or repeating patterns in relationships, that belongs in the hands of people trained for it and bound by a code of ethics. The line isn’t always sharp and there are conscientious people among coaches who know how to refer a client on — but conscientiousness isn’t a systemic guarantee. So the same rule applies again: ask about training. What psychotherapy is and isn’t I’ve distinguished in more detail in my piece on what psychotherapy is.

Medication or conversation? Often: both

A question I hear often: “Does medication mean I don’t need therapy — or the other way round?” Research gives a clear answer: these aren’t rivals but tools that work on different levels and often do best together.

Large meta-analyses (among them Cuijpers and colleagues, 2014, 2020) on depression and anxiety disorders show that combining psychotherapy with medication outperforms either on its own, on average — especially in moderate and severe forms. Put simply: medication can lower the water enough for you to be able to swim at all; therapy teaches you to swim. Medication can calm symptoms to the point where a person can think, feel and work on themselves again — while therapy addresses the patterns, relationships and history that helped create the distress, and builds changes that remain even after the medication stops. I’ve written about what research says on the effectiveness of therapy itself in my piece on whether therapy actually works.

In practice this means that psychiatrist and psychotherapist often work together — each from their own end of the same bridge. If you’re taking medication and coming to therapy, it’s useful for both professionals to know about each other. And if your psychotherapist suggests that a psychiatric assessment alongside the process would make sense, that isn’t a sign that you’re “too severe a case” — it’s a sign of responsible practice.

Where to go first: a practical map

Now to the question this piece began with. In Slovenia you broadly have two routes.

Route one: through your GP. Your GP is the entry point into the public health system. You can speak openly with them about your distress (doctors are used to this — mental distress is one of the most common reasons for a visit), and they can refer you to a psychiatrist or a clinical psychologist, prescribe medication if needed and rule out physical causes. The advantage of this route is that it’s covered by insurance; its reality is waiting times that can be long. Many health centres now also have psychologists working within family medicine practices, as well as community mental health centres — ask what exists where you live.

Route two: privately, straight to a psychotherapist. You don’t need a referral to see a private psychotherapist — you call or write and arrange a first session. The advantage is that you can start quickly and choose your therapist yourself; the cost is yours to bear. I’ve described what a first session looks like, with no mysteries, in my piece on the first session with a therapist.

A rough orientation on when to go where:

• Straight to a doctor or psychiatrist: thoughts of suicide or self-harm, being unable to care for yourself, psychotic experiences, severe deterioration. In immediate danger call 112 — I write about the difference between crisis support and therapy in a separate piece.
• To a clinical psychologist (via referral): when you need a diagnostic assessment — “what is actually going on with me?”
• To a psychotherapist: when you’re troubled by repeating patterns, relationships, anxiety, burnout, grief, life transitions — distress you want to understand and change, not merely quieten. I explore when the right time is in my piece on the right time for therapy.

And if you get the first door wrong? No harm done. Each of these professionals is trained to recognise when you belong (also) somewhere else, and to point you onward. I do this regularly myself: when I sense that a medical perspective would make sense alongside our work, I say so and help with the next step. The only genuinely bad choice is putting it off indefinitely — research on help-seeking consistently shows that people wait years on average between their first difficulties and their first professional contact, and every year of waiting tends to entrench the distress rather than ease it.

What to ask before you decide

Because the regulation of psychotherapy here isn’t yet finalised, your best safeguard is being informed. A few questions you may — and would do well to — put to anyone before entrusting them with your inner world:

• What is your training, and which psychotherapy modality did you study? How long did the training last?
• Do you work under supervision? (Supervision — regular professional oversight of a therapist’s work — is a sign of quality, not of weakness; it is compulsory for therapists at the start of their path, and many experienced ones keep it up for life.)
• Are you a member of a professional association and bound by its code of ethics?
• Do you have experience with difficulties like mine?

A therapist who is in the right place will welcome such questions. On my own My Approach page, for example, I state openly that I am a therapist in training in marriage and family therapy under supervision, where I come from and how I work — because you can only trust someone who tells you who they are. You’ll find the forms of work I offer on the services page; and if you’re curious about how the systemic modality actually sees a person, I’ve described its logic in my piece on marriage and family therapy.

Three professions, one team

If one thought stays with you after all this, let it be this one: the psychiatrist, the clinical psychologist and the psychotherapist aren’t three competing answers to the same question, but three links in the same chain. One looks at the body and its chemistry, the second measures and understands, the third walks with you through the process of change. Serious mental distress often needs more than one link — and there is nothing wrong with you if that’s the case.

The confusion around job titles is understandable. But don’t let it be the reason you stay alone. The first step isn’t to choose perfectly: the first step is to knock anywhere — at your GP’s, at a therapist’s, at any of the doors listed here. The doors beyond then open more easily than you think. If you’d like to find out whether the two of us are the right fit, you can write to me via my contact page — and if we aren’t, I’ll tell you honestly and help you look further.