Psychologist, psychotherapist, psychiatrist: who is who

A psychiatrist is a medical doctor who specialised in mental illness and can prescribe medication. A psychologist has a degree in psychology, which is a science degree rather than a medical one. A psychotherapist is someone trained and licensed to deliver psychotherapy — a description of what they do, not of what they studied. The three are not ranks of the same profession.

• Psychiatrist means physician everywhere: a medical degree first, then specialist training in psychiatry.
• Psychologist means a psychology degree. In the UK it is not a protected title on its own; in the US it is licensed in every jurisdiction; in Germany it is protected only indirectly.
• Psychotherapist describes a licensed activity. In Germany it is protected by criminal law. In the UK it is not protected at all.
• Prescribing is medical almost everywhere. Nine US jurisdictions are the exception, and specially trained psychologists there can prescribe.
• The safest question to ask is not which title someone holds but which register or licence they are on, and who maintains it.

The one-line answer for each

Two of these words describe a training, and one describes a job. That is the source of nearly all the confusion, because it means one person can honestly hold two of the titles at once.

Psychiatrist

A psychiatrist is a doctor. They completed a medical degree, then postgraduate specialist training in psychiatry, and they work with the full medical toolkit — physical examination, investigations, diagnosis and medication. Many are also trained in psychotherapy, which is where the overlap starts.

Psychologist

A psychologist studied psychology: an empirical science covering perception, memory, development, personality and method, most of which is not clinical at all. A psychology degree on its own is not a licence to treat anybody. Clinical, counselling, forensic, educational and occupational psychologists then specialise, and only some of those routes lead to therapeutic work.

Psychotherapist

A psychotherapist delivers psychotherapy. The word says nothing about the first degree, which is the point: depending on the country, the person may have arrived from psychology, from medicine, or from a route with no university degree behind it at all. What matters is the licence or register, not the noun.

What each title covers, side by side

Diagnosis follows the same pattern. Psychiatrists diagnose as doctors; licensed clinical psychologists and psychotherapists diagnose mental disorders within their scope of practice; someone holding only a psychology degree, with no clinical licence, does not.

Why “psychologist” is not a protected title everywhere

This is the single most useful thing to know before you contact anyone, and the answer genuinely differs by country.

United Kingdom

The Health and Care Professions Council protects nine psychology titles, including “practitioner psychologist”, “clinical psychologist”, “counselling psychologist”, “forensic psychologist”, “educational psychologist”, “health psychologist”, “occupational psychologist” and “sport and exercise psychologist”. Using one without being registered is a criminal offence. But the HCPC states plainly that the job title “psychologist” is not, by itself, protected by law.

“Psychotherapist”, “counsellor” and “therapist” are not protected in the UK either. Psychotherapy is covered by voluntary registers accredited by the Professional Standards Authority — the UKCP, BACP, NCPS and ACP among them. Accreditation is real oversight, but it is opt-in, so the check is whether a given person is on such a register rather than what they call themselves.

United States

“Psychologist” is a licensed title in every US jurisdiction, administered state by state. The Association of State and Provincial Psychology Boards reports that all 66 of its member jurisdictions require the Examination for Professional Practice in Psychology, and that most require a doctorate — though about half also allow master’s-level practice under the supervision of a doctoral-level licensed psychologist.

Germany

Germany protects “Psychotherapeut” and not “Psychologe”. Section 132a of the German criminal code makes it an offence, punishable by up to a year’s imprisonment, to use the titles “Psychologischer Psychotherapeut”, “Kinder- und Jugendlichenpsychotherapeut” or “Psychotherapeut” without entitlement. “Psychologe” is not on that list, and there is no professional act for psychologists at all.

It is not unprotected either, just protected indirectly. The German professional association of psychologists explains that the protection comes from competition law — you may not mislead people about your qualifications — and from the same criminal provision’s separate protection of academic degrees, which covers the psychology degree itself rather than the occupational label.

Can a psychologist prescribe medication?

Almost never, and the exceptions are geographic rather than professional. Prescribing is a medical act in most countries, so a psychologist or psychotherapist who wants a patient medicated works alongside a doctor.

The United States is the exception. Specially trained psychologists — a master’s in clinical psychopharmacology, an examination, and supervised clinical experience — can prescribe in nine jurisdictions: New Mexico (2002), Louisiana (2004), Illinois (2014), Iowa (2016), Idaho (2017), Colorado (2023), Utah (2024), and Vermont and Hawaii, both in 2026. Guam has had a limited form since 1999, and psychologists in the Department of Defense, the Public Health Service and the Indian Health Service prescribe under federal rather than state authority. ASPPB maintains the current list.

Hawaii belongs on that list with a caveat, because it is not the same kind of law as the others. It is a three-year pilot limited to two counties and to federally qualified health centres, restricted to adult patients and conducted under active physician supervision. Counting it as a straightforward tenth or ninth state overstates what passed.

How it works in Germany: Approbation and the 2020 reform

The German word that carries the meaning is Approbation — the state licence to practise. Without it, a psychology graduate in Germany may carry out psychological assessment and research but may not treat patients, and may not call themselves a Psychotherapeut.

How you get one changed completely on 1 September 2020, when a new Psychotherapeutengesetz came into force. Before that date, the route was a psychology degree followed by a separate postgraduate training of three years full-time or five part-time, ending in the title Psychologischer Psychotherapeut. Since that date, there is a direct route: a five-year university programme in psychotherapy, a bachelor’s plus a master’s, leading straight to Approbation as Psychotherapeutin or Psychotherapeut.

The old route has not vanished. People already in it can complete it until 1 September 2032, with hardship provision to 2035, so for the next several years both kinds of title will be in circulation and both are valid. Anyone already holding the older titles keeps them.

German statutory health insurance also reimburses a defined set of methods rather than any therapy at all, which has no equivalent elsewhere. The Federal Joint Committee’s Psychotherapy Directive covers behavioural therapy, the two psychoanalytically grounded methods — tiefenpsychologisch fundierte and analytische Psychotherapie — and, since a decision of 22 November 2019 that took effect in January 2020, systemic therapy for adults. Systemic therapy was extended to children and adolescents in 2024.

German psychiatrists are doctors, as everywhere. The specialist title is Facharzt or Fachärztin für Psychiatrie und Psychotherapie, and the Bundesärztekammer’s model regulations set a minimum of sixty months of specialist training after the medical degree, including six months of neurology.

The titles nobody regulates

Alongside the regulated titles sit words that anyone may use. “Coach”, “life coach”, “counsellor”, “therapist”, “mental health practitioner” and “psychological consultant” are, in most countries, unrestricted. Some of the people using them are highly trained. The word itself tells you nothing either way.

Germany has a specific case worth knowing about: the Heilpraktiker beschränkt auf das Gebiet der Psychotherapie, usually shortened to “Heilpraktiker für Psychotherapie”. It rests on a 1939 law on practising healing arts without a medical licence, and the requirement is passing a knowledge check at the local public health office rather than completing any prescribed training. There is no regulated curriculum behind it.

Two consequences follow. Such a person may treat, but may not call themselves a Psychotherapeut. And statutory health insurance does not pay: the German social code lists who may deliver reimbursable psychotherapeutic treatment, and this route is not on the list. Private insurers sometimes do.

This is a terminology article rather than advice about whom to see, and that is a boundary this publisher takes seriously — who we are and what we are not is stated plainly. Two related pieces: what the word burnout does and does not classify, and why these professional titles resist translation between English and German — three job titles is exactly the kind of near-synonym set that has to be learned as a group. What any of them actually practises is a third glossary again, of therapy names and what each one works on.