Therapist, Psychiatrist or Online Doctor: Who Should You See?

When you decide to get mental health help, the first question is often “who do I see?” Therapists, psychiatrists, psychiatric nurse practitioners and primary care doctors all play a part, and online services now offer many of them. This guide explains who does what, how to decide, and how services such as PlushCare, Talkiatry and Talkspace fit. It is general information, not a diagnosis or a recommendation about your treatment.

If you are in crisis or worried about your immediate safety, see Get Help Now. In the US you can call or text 988, or call 911 in an emergency.

What does a therapist do?

A therapist, such as a psychologist, licensed counselor, clinical social worker or marriage and family therapist, provides talk therapy. They help you understand patterns, build coping skills and work through difficulties, using approaches such as CBT or DBT. Many therapists can assess and diagnose within their license, depending on the profession and state, but most cannot prescribe medication. Learn more in our overview of psychotherapy and how to find the right therapist.

What does a psychiatrist do?

A psychiatrist is a medical doctor who specializes in mental health. They can diagnose conditions, prescribe and adjust medication, and sometimes provide therapy, though many focus on medication management. Psychiatric nurse practitioners can also diagnose and prescribe in many states. Appointments are often shorter and less frequent than therapy: an initial evaluation, then check-ins every few weeks or months.

What about a primary care or online doctor?

A primary care clinician can assess common concerns such as depression and anxiety, rule out medical causes, prescribe many medications, and refer you on. Online doctor services offer the same kind of care by video. Because they are generalists, they tend to handle mild to moderate, uncomplicated cases, and refer more complex situations to a specialist.

How the services compare

• Talkiatry is a psychiatry practice with psychiatrists and psychiatric nurse practitioners. It says most patients pay around $30 a visit with insurance, treats conditions such as ADHD, anxiety, bipolar disorder, depression, OCD and PTSD, and does not publish self-pay rates. See our Talkiatry review.
• PlushCare offers video therapy for adults at $169 a session, and online doctor visits that can prescribe non-controlled medication, at $129 without insurance plus a membership. Doctors do not prescribe controlled substances. See our PlushCare review.
• Talkspace offers therapy and psychiatry in one account, with an average copay of about $10 for therapy and $15 for psychiatry, and psychiatry that does not prescribe controlled substances. See our Talkspace review.
• Rula offers therapy and psychiatry for ages 13 and up on the same platform, subject to state rules. See our Rula review.

How to decide where to start

Start with a therapist if you want to talk through stress, relationships, grief, life changes or patterns, or you have mild to moderate symptoms and prefer to try therapy first.

Start with a psychiatrist or prescriber if you want a diagnostic evaluation, have symptoms that are severe or getting worse, think medication may help, or have conditions such as bipolar disorder, ADHD or OCD where a specialist assessment matters.

Start with your primary care clinician if you are unsure, want to rule out medical causes such as thyroid problems or sleep disorders, or want a referral covered by insurance.

Consider both if symptoms are moderate to severe. Studies suggest that for many people, combining therapy and medication can be more effective than either alone for moderate to severe depression, and a clinician can advise what fits you.

What about controlled substances?

Many online services do not prescribe controlled substances, such as ADHD stimulants and benzodiazepines, and rules vary by state and clinician. If you need one of these, ask before you book. Read our overviews of antidepressants, anti-anxiety medications and ADHD medications, and never start, stop or change a medication without medical advice.

Questions to ask any provider

• What are your qualifications, and are you licensed in my state?
• Do you diagnose and prescribe, and which medications?
• How long are visits, and how often will I be seen?
• What will I pay with and without insurance?
• What happens if I need a higher level of care?

When to seek in-person or urgent care

Online care may not be appropriate for severe symptoms, psychosis, suspected bipolar mania, or thoughts of harming yourself. Services described here are not crisis services.

Compare your options

See our guides to online psychiatry and online therapy, or the paid comparison pages for the best online psychiatry and best online therapy services. Our PlushCare vs. Talkspace comparison is a useful next step.

The bottom line

Therapists provide talk therapy, psychiatrists and other prescribers manage medication and diagnosis, and online doctors can handle common concerns. Many people use more than one. Start with the professional who matches your main need, and ask for a referral if it isn’t the right fit. Some links on this page are affiliate links and may earn us a commission, which never affects our conclusions. See our affiliate disclosure.