Last reviewed July 7, 2026
What Is the Difference Between Therapy and Psychiatry?
Therapy uses structured conversation to address thoughts, feelings, and behaviors, while psychiatry diagnoses mental health conditions and prescribes medication when appropriate. Therapists do not prescribe in most states. Psychiatrists rarely conduct weekly talk therapy.
Therapy treats how you think and behave. Psychiatry treats the brain chemistry underneath.
What Does a Therapist Do?
A therapist conducts weekly 45 to 60 minute sessions focused on a patient’s history, patterns, and goals. Sessions use evidence-based approaches like:
- Cognitive Behavioral Therapy for anxiety, depression, and insomnia
- Dialectical Behavior Therapy for emotional dysregulation
- Psychodynamic therapy for relationship and identity patterns
- Trauma-focused therapy for PTSD and adverse childhood experiences
Common credentials include LCSW, LPC, LMFT, and PsyD or PhD psychologists. Our individual therapy team offers CBT, DBT, and psychodynamic approaches for adults.
What Does a Psychiatrist Do?
A psychiatrist is a medical doctor (MD or DO) who diagnoses mental health conditions and manages medication. Initial visits last 60 to 90 minutes and follow-up appointments run 15 to 30 minutes, focused on symptom tracking and medication adjustments.
Psychiatric care typically includes:
- Diagnostic evaluation for depression, anxiety, bipolar, ADHD, and PTSD
- Medication selection and dose management
- Lab monitoring for certain medications
- Coordination with primary care and therapists
Our outpatient psychiatry team handles diagnosis, prescribing, and ongoing management.
Do I Need Therapy, Psychiatry, or Both?
Most adults with moderate mental health symptoms benefit from both. Therapy builds skills and addresses root patterns. Medication treats the biological component when symptoms interfere with daily function.
You may need therapy alone if you have:
- Relationship, grief, or life transition challenges
- Mild to moderate situational anxiety
- Career or identity questions
- A preference to try non-medication approaches first
You may need psychiatry alone if you have:
- A previously diagnosed condition needing medication management only
- ADHD requiring stimulant or non-stimulant medication
- A stable mood disorder with no current life stressors
- Brief medication review before primary care takeover
You likely need both for:
- Major depressive disorder
- Generalized anxiety disorder with daily impairment
- Bipolar disorder
- PTSD with severe symptoms
- Obsessive compulsive disorder
Can Therapists Prescribe Medication?
No, in most states therapists cannot prescribe medication. Only psychiatrists, psychiatric mental health nurse practitioners (PMHNP), and primary care physicians prescribe psychotropic medications such as antidepressants, mood stabilizers, and ADHD medications.
A therapist who suspects a medication need will refer to a psychiatrist or PMHNP for evaluation. Our team includes both therapists and a psychiatric mental health nurse practitioner to coordinate care under one roof.
What If Medication Has Not Worked?
For depression that has not responded to 2 or more antidepressants, interventional treatments become an option. Our TMS vs antidepressants breakdown compares the two approaches.
TMS therapy is FDA-approved for treatment-resistant depression, OCD, and several other conditions. TMS uses magnetic pulses to stimulate brain regions linked to mood, without the systemic side effects of medication.
How Are Therapy and Psychiatry Coordinated?
When a patient sees both a therapist and a psychiatrist, the two providers typically communicate through shared records, signed releases, or direct conversation. Coordinated care produces better outcomes than fragmented care across unrelated practices, where one provider may not know what the other prescribed or processed in session.
Patients in our virtual IOP receive group therapy, individual sessions, and psychiatric medication management as one integrated program rather than three separate appointments scattered across different offices.
What About Co-Occurring Substance Use?
When mental health and substance use occur together, both need treatment at the same time. Our dual diagnosis program integrates therapy, psychiatry, and recovery support so neither condition undermines the other.
How Do I Choose Where to Start?
Start with whichever provider is easier to access. A therapist can refer for psychiatric evaluation. A psychiatrist can refer for therapy.
For working professionals whose symptoms are affecting job performance, our stress leave team handles short-term disability paperwork alongside the treatment plan.
Contact Lakeside Behavioral Health to schedule an intake.
Take the Next Step
Reach out and our team will walk you through evaluation, scheduling, and insurance verification. In-person care is available in St. Louis and O'Fallon. Virtual therapy and IOP extend throughout Missouri and Illinois.
- CARF Accredited
- Most major insurance accepted
- In-person and virtual appointments
- Adult psychiatry, therapy, IOP, and TMS