Therapist, psychologist, psychiatrist: a 5-minute guide for parents

These three names get mixed up all the time. Here is what each one does. In plain words. Five minutes.

The fast version

• Therapist — Talks with your kid. No medicine.
• Psychologist — Talks with your kid. Or runs a long test. No medicine (in most states).
• Psychiatrist — Sees your kid. Decides about medicine.

That’s it. Now the slightly longer version.

Therapist: the talk doctor

A therapist is the person you usually start with.

They went to school for a master’s degree. They learn how to do talk therapy — guiding your kid through their feelings, teaching them tools for hard moments, and helping the family figure out what is going on.

They cannot give your kid medicine. They are not a doctor in the medicine sense. They do not run long tests.

What they are very good at:

• Helping anxious kids face the things they are scared of
• Helping kids who are sad work on their thinking patterns
• Helping families with conflict
• Teaching kids skills to handle big emotions
• Working with parents on parenting strategies

Most kids who have a mental-health concern start with a therapist.

A therapist usually costs $100 to $200 per session. Many take insurance.

Psychologist: the test doctor (and sometimes talk doctor)

A psychologist went further in school. They have a doctoral degree (which is why they get called Doctor), but they are not a medical doctor.

There are two kinds of psychologists you might run into:

The therapy kind. Does the same kind of talk work a therapist does, but with more training. Often used for harder cases.

The testing kind. Runs a long evaluation — six to twelve hours of tests, spread across a few visits, plus a feedback meeting at the end. This is what people mean when they say psychological testing or neuropsychological testing. The result is a written report that explains what is going on and what to do about it.

Most psychologists in most states cannot prescribe medicine.

You usually see a psychologist:

• When the school asks for a full evaluation
• When you think there could be a learning disability
• When the diagnosis is not clear and you need a deeper look

A therapy session with a psychologist usually costs $200 to $400. A full testing battery usually costs $1,500 to $4,500.

Psychiatrist: the medicine doctor

A psychiatrist is a real medical doctor who specialized in mental health. A child psychiatrist did extra training to work with kids.

They can prescribe medicine.

Most child psychiatrists today do not do weekly talk therapy. They do an evaluation, then they manage medicine if your kid needs any. They work together with a therapist who does the weekly talking work.

You see a child psychiatrist when:

• Medicine is on the table
• The first one or two medicines did not work
• There is more than one thing going on at once
• A safety concern came up
• The pediatrician asks for a second opinion

A first visit usually costs $300 to $600. Follow-up visits are $150 to $300.

Your first call: usually the pediatrician

This is the part most articles skip. Your kid’s regular doctor is the right first call for almost everything.

Pediatricians are trained to spot mental-health concerns. They can do the first round of figuring out what is happening. They can prescribe many of the common medicines themselves. And they can refer you to a specialist when one is needed.

You do not need to start with a psychiatrist. You do not need a referral before calling a therapist. But the pediatrician is the easiest first step, and the one that almost always makes the rest go more smoothly.

The three things you can actually do

Once you have a diagnosis, there are basically three options:

Therapy. Talking work, usually weekly, usually 12 to 16 sessions for a first round. Works for most things kids deal with — anxiety, depression, behavior, family conflict, big life changes.

Medicine. A pill once a day, sometimes twice. The most common ones for kids are stimulants (for ADHD) and SSRIs (for anxiety and depression). Both have decades of safety data.

Testing. A long evaluation that produces a written report. Used when you need to figure out exactly what is going on — especially when learning is involved.

Most kids do one or two of these. A few do all three. None of them is a failure to do any of the others.

A 5-question quiz: who to call

1. Are you not sure what’s going on? → Pediatrician.
2. Pretty sure your kid needs to talk to someone? → Therapist.
3. The school is asking for a full evaluation, or you want to rule in or out a learning issue? → Psychologist.
4. You think medicine should at least be considered? → Pediatrician first. Psychiatrist if it gets more complex than that.
5. Crisis — talking about hurting themselves, refusing food or sleep, sudden severe behavior change? → Pediatrician same day, or 988, or 911.

The short version

Therapist talks. Psychologist talks or tests. Psychiatrist prescribes. Pediatrician is your first call. You usually need one or two of them, not all four. None of this is a failure.