Counsellor, psychologist or psychiatrist: who to see

The three titles get used as though they mean the same thing, and in everyday conversation people swap between them without thinking about it. When you are trying to decide who to actually contact, that vagueness stops being harmless.

Here is the difference in plain terms, and an honest note about which situations each one suits.

The three roles, in plain terms

A counsellor works with you through conversation. The focus is on what you are living with now: the situation, the feelings around it, and what you want to do next. It suits difficulty rather than illness.

A Psychologist has studied psychology to postgraduate level and is trained to assess mental health conditions and treat them with talking therapies. In India, the ones qualified to do that assessment work are usually registered with the Rehabilitation Council of India, often described as a Clinical Psychologist.

A psychiatrist is a medical doctor who specialised in mental health. They can diagnose conditions and they are the only one of the three who can prescribe medication.

What I am, and what I am not

I should be straightforward about where I sit in that list, because it is the part people are often too polite to ask. I am a Counsellor. I hold a Diploma in Counselling Psychology. I am not a psychologist and I am not a psychiatrist, so I do not assess, diagnose or prescribe.

What I do is the conversation. I work with people through stress, anxious patterns, relationships, feeling stuck and feeling alone, in individual counselling sessions online. If what you describe needs assessment or medication, I will tell you that rather than keep you in sessions that cannot give you what you need.

How to work out which one you need

Rather than starting from the titles, start from what is actually happening.

• Something specific is weighing on you: a relationship, a decision, a loss, pressure at work. A counsellor is a sensible first step
• You feel low or anxious more days than not, and it has lasted weeks rather than days. A counsellor can help, and may suggest an assessment alongside
• You want to understand whether what you are experiencing has a name, or you have been asked for a formal assessment or report. That is psychologist territory
• Daily functioning has become difficult, or someone has raised medication with you. See a psychiatrist
• You are having thoughts of harming yourself, or you feel unsafe. That is urgent and is covered further down this page

These are not walls. Plenty of people see a psychiatrist for medication and a counsellor for the conversation, and the two sit alongside each other perfectly well.

Why the titles get blurred in India

Two reasons, and neither is your fault for finding it confusing.

The word counsellor is not protected in the way some professional titles are, so the amount of training behind it varies. And the word therapist is used loosely by nearly everybody, including me in ordinary conversation, without pointing to any particular qualification.

So the useful question is not which word someone uses about themselves. It is what their actual qualification is, and whether they will tell you plainly when you ask. Anyone who will not is telling you something.

What to ask whoever you contact

Whichever of the three you approach, a short exchange of messages before you book will tell you most of what you need to know. Useful things to ask:

• What is your qualification, in full
• What sort of difficulties do you usually work with
• How long is a session and what does it cost
• Do you work with this kind of situation, and if not, who does
• What happens if you think I need something other than what you offer

That last question is the most revealing one. Someone comfortable saying where their work stops is usually someone who is good inside it.

They are not alternatives to each other

It is worth breaking the assumption that you have to choose one and stick with it.

People often see a psychiatrist for medication and a counsellor for the conversation at the same time, and the two support each other rather than compete. Medication can make daily life manageable enough that talking becomes possible. Talking can help you notice what is actually changing.

Equally, someone might have an assessment once, understand what they are dealing with, and then do the ongoing work with a counsellor. Getting assessed is not a permanent arrangement.

You do not have to get this right first time

People delay for months trying to work out the correct door. In practice the first conversation usually sorts it out faster than the research does, because the person you speak to can hear what you are describing and say where it belongs.

If you start with me and it turns out you need something else, I will say so. That is a normal outcome, not a wasted session. Nobody loses anything by starting one step to the side of where they eventually end up.

When it needs more than counselling

If you are having thoughts of harming yourself, or you feel unsafe where you are, please treat that as urgent. Counselling is not emergency care. Contact local emergency services on 112, or the government Tele MANAS helpline on 14416, which runs at any hour, and tell one person near you.

If you want to talk it through

If you are still not sure which of the three you need, that is a fine reason to send a message rather than a reason to wait. A line saying what is going on is enough, and if online counselling is not the right fit I will point you somewhere it is. It may also help to read what a session is actually like and how privacy works in practice.