“Do I need therapy, or do I need medication?” It is one of the most common questions we hear in a first session. The honest answer is that it depends, and for many people it is both. Here is how the different kinds of mental health professionals fit together, and how to tell when it might be time to add a psychiatrist to your care.
Who does what
The titles are confusing, so let us start there.
Who’s who in mental health care
The main roles you are likely to meet in California.
| Professional | Training | Main role | Prescribes? |
|---|---|---|---|
| Psychologist (Psy.D. or Ph.D.) | Doctorate in psychology, supervised clinical hours | Psychotherapy, psychological assessment | No |
| Marriage & Family Therapist (LMFT) | Master’s or doctorate, supervised hours | Therapy for individuals, couples and families | No |
| Psychiatrist (M.D. or D.O.) | Medical school plus psychiatry residency | Diagnosis, medication management, some therapy | Yes |
| Psychiatric nurse practitioner (PMHNP) | Advanced nursing degree in psychiatric care | Evaluation and medication management | Yes |
| Primary care doctor | Medical school plus residency | General health; often starts common medications | Yes |
At our practice, Dr. Laird Bridgman is a licensed psychologist and Dr. Shari Bridgman is a licensed marriage and family therapist. We provide therapy. We do not prescribe medication. When a client may benefit from medication, we help them connect with a prescriber and, with their permission, coordinate care.
What therapy does well
Therapy helps you understand what is happening and change it. For many common problems, including mild to moderate depression, most anxiety disorders, grief, relationship conflict and many habits and compulsions, psychotherapy alone is an effective first treatment. Approaches like cognitive behavioral therapy teach skills that keep working after therapy ends.
What medication does well
Medication can reduce symptoms that are severe enough to get in the way of everything else, including therapy itself. It can be hard to practice a new way of thinking when you have not slept properly in weeks, or when panic attacks are coming daily.
For some conditions, such as bipolar disorder, schizophrenia, severe depression and moderate to severe ADHD, medication is usually a core part of treatment. For many others, research supports combining therapy and medication, which often works better than either alone.
Signs it may be time to see a psychiatrist
- Symptoms are severe, or have not improved after a fair trial of therapy
- Depression includes thoughts of death or suicide (if this is happening now, call or text 988)
- You have periods of unusually high energy, little need for sleep, or racing thoughts
- Anxiety or panic is so frequent that you cannot use the skills you are learning
- Attention and focus problems are affecting work or school
- You are already on medication and it is not working, or the side effects are hard to live with
How psychiatry and therapy work together
Good care is coordinated. With your written permission, your therapist and your prescriber can share what each is seeing, so medication changes and therapy goals support each other. Our patient forms page has release forms for exactly this.
Telepsychiatry has made it much easier to find a psychiatrist, especially if local appointments are booked out for months. Mindful Sewa Psychiatry is one example: it offers private online psychiatry anywhere in California, with psychiatric evaluations, medication management and therapy, in English, Punjabi, Hindi and Spanish. Seeing a psychiatrist from home can make it easier to keep both appointments going.
Questions to ask a prescriber
- What are you treating, and why this medication?
- How long until I should notice a difference?
- What side effects are common, and which ones should I call about?
- How will we know if it is working?
- How and when would we stop it, if we decide to?
Never stop a psychiatric medication suddenly without talking to your prescriber. Some need to be tapered.
Where to start
If you are not sure what you need, start with a conversation. A therapist can help you sort out what is going on and whether a medication evaluation makes sense. Call Dr. Laird Bridgman at (949) 636-2207 or Dr. Shari Bridgman at (949) 581-8334.