Who may diagnose, who may prescribe, and who leads the process

The question sounds bureaucratic until you need it. Then it becomes very concrete: who is even allowed to tell me what I have? Who can prescribe me a tablet? And who is the person who will work with me over the next year?

The answers are not obvious, because in Slovenia three professions partly overlap and a fourth was until recently not legally regulated at all. Many people therefore end up with a professional who cannot give them what they came for — and conclude that help does not work.

In this piece I take three remits in turn: diagnosis, medication and process. For each I say who holds it, who does not, and what that means in practice when you are looking for help.

The first remit: diagnosis

A diagnosis of a mental disorder under the International Classification of Diseases can be made by a doctor. In practice this is most often a psychiatrist, but it can also be a GP who recognises a depressive episode and prescribes medication or issues a referral.

A clinical psychologist holds a separate remit: psychological assessment. That means standardised tests measuring cognitive abilities, personality characteristics and the nature of difficulties. Their report is often the basis for a psychiatrist’s decision, but it is not the same as a medical diagnosis.

A psychotherapist does not make diagnoses. This is not modesty but a boundary. A therapist does recognise when something requires medical assessment — and then it is their job to say so and point onwards.

The practical consequence: if you need a document, you will not get it from a therapist. For sick leave, school adjustments, a court, an insurer or an assessment of fitness for work, the address is a doctor or a clinical psychologist.

The second remit: medication

Here the picture is simplest. Medication can be prescribed by a doctor only — a psychiatrist or a GP. Nobody else.

Not a psychologist, not a clinical psychologist, not a psychotherapist. This holds even when a therapist has medical training but is acting in the therapist role at that moment.

What a therapist can and must do: notice when a state is worsening and encourage you to see a doctor. I am often the one who persuades someone to go — not because I know which medication they need, but because I can see the state has moved beyond what conversation alone can carry.

The reverse also holds: if a doctor prescribes medication and says you do not need therapy, it is worth asking again. In moderate and severe depression, combination has the strongest support in research — I have written about this in detail.

The third remit: leading a process

Here there are the fewest sharp lines and the most confusion.

A psychotherapeutic process can be led by anyone with appropriate psychotherapy training — regardless of whether their first profession is psychology, medicine, social work or something else. A psychiatrist with such training leads it exactly as a psychotherapist without medical training does.

Until recently the problem was that nobody checked. The title of psychotherapist was not protected here, so someone with four years of training and supervision could use it exactly as someone with a weekend course.

The new law changes this: it introduces a licence, a register and a chamber with compulsory membership. It begins to apply in April 2027; until then the old situation holds. I have written about the law in detail.

What this means today: checking is still up to you. The question “where did you train and how long did it take” clears up almost everything.

What a counsellor or coach may and may not do

The part people most often overlook.

Alongside the regulated professions there is a wide field of providers offering counselling, coaching, personal growth, energy therapy and similar. This is not problematic in itself — coaching has its place and a good counsellor can be very useful.

It becomes problematic when it is sold as treatment of a mental disorder. Signs worth being cautious about:

• The provider uses terms like depression, trauma or anxiety disorder but does not say where they trained.
• They promise quick results within a set number of sessions.
• They discourage seeing a doctor or suggest stopping medication.
• They never mention supervision.
• They require advance payment for a long package.

The last three are serious. Discouraging medical assessment is the most dangerous sign I know — with conditions that need treatment, lost months can matter a great deal.

How this looks in practice: three routes

So this does not stay at the level of lists, three common situations and who does what in them.

Someone who has not slept for two months and cannot manage work. The first stop is a GP or psychiatrist: assess the state, issue sick leave if needed, prescribe medication if appropriate. Therapy joins once the state has settled enough for work to be possible. The order here is not a matter of taste.

Someone repeating the same pattern in relationships for three years. The first stop is a psychotherapist. A doctor has nothing to offer here, and psychological tests will say nothing the person does not already know.

A child struggling at school and nobody knows why. The first stop is a clinical psychologist or a developmental specialist: an assessment is needed to distinguish a learning difficulty, an attention disorder, anxiety and distress about what is happening at home. Only then is it clear what makes sense.

Common to all three: the route is not the same, and choosing the wrong first stop costs months.

And confidentiality — who tells whom what

A common worry worth clarifying, because it affects what people dare to say.

All the professions listed are bound by professional confidentiality. This means they do not exchange information automatically. A psychiatrist does not receive a therapist’s notes and a therapist does not receive a psychologist’s report unless you expressly permit it.

In coordinated treatment, exchange is useful and is arranged with your written consent — which you can limit (for example to diagnosis and medication only, without the content of sessions) and withdraw at any time.

There are two legal exceptions, applying to everyone: immediate danger to yourself or another, and suspicion that a child is at risk. I have written separately about confidentiality and its limits.

Why the boundaries exist at all

A question many people ask: if a psychotherapist works with people in distress every week, why should they not be allowed to write a diagnosis?

The answer lies in what each remit actually requires.

A diagnosis requires ruling out physical causes. Thyroid problems, anaemia, vitamin B12 deficiency, some medications and the early stages of neurological illness can mimic depression or anxiety closely enough to be mistaken for it. That is medical knowledge, not psychological.

Prescribing requires knowledge of compounds, interactions and contraindications — a field that does not appear in psychotherapy training at all.

Psychological testing requires training in administering and interpreting standardised instruments, which is a specialisation in itself.

The boundaries are therefore not the defence of territory but a reflection of what each profession did and did not study. Set well, they protect people. Set too tightly, they obstruct them — and that is exactly what the debate around the new law was about.

What to ask so you do not go wrong

Three questions few people ask, though they save months.

• “Can you tell me what I have?” If the answer is “that is not my remit, that is for a doctor”, you have received an honest answer.
• “What would you advise if this is not your field?” A serious professional has an answer ready.
• “Does it make sense for me to see someone else as well?” The answer tells you whether this person is thinking about your whole route or only about their own part.

What to remember

A diagnosis is made by a doctor, a psychological assessment by a clinical psychologist, medication is prescribed only by a doctor, and a therapeutic process is led by anyone with appropriate psychotherapy training.

These boundaries are not bureaucracy. They answer the question of who studied what — and the only reason to know them is so that someone in distress does not lose months at the wrong address.