Psychologist, Psychiatrist or Counsellor: What’s the Difference?

The short version is this. Psychiatrists are medical doctors who can prescribe medication. Psychologists have university training in assessment and psychological treatment but don’t prescribe. Counsellor is currently an unregulated title that anyone can legally use in Australia. All three can be useful, and which one fits depends on what you’re dealing with. This article sets out the training, regulation, cost and Medicare position for each, and what usually points toward one rather than another.

Psychologists

Psychologists complete a minimum of six years of university study and supervised practice, and must be registered with the Psychology Board of Australia through AHPRA. Registration is what makes the title legally protected. You can check any psychologist’s registration on the AHPRA public register, which also shows any conditions on their practice.

The work is psychological assessment and treatment. That includes structured therapies like cognitive behavioural therapy, acceptance and commitment therapy and EMDR, along with formal assessment where it’s needed. Psychologists don’t prescribe medication.

Some psychologists hold an area of practice endorsement, such as clinical, counselling, health or forensic psychology. Endorsement reflects additional postgraduate training in that area. A psychologist without endorsement is still fully registered and qualified to practise.

Psychiatrists

Psychiatrists are medical doctors. They complete a medical degree, then further training in psychiatry through the Royal Australian and New Zealand College of Psychiatrists, and are registered with the Medical Board of Australia. Because they’re doctors, they can prescribe and manage medication, order investigations, and admit someone to hospital.

Psychiatry is usually the right starting point where medication is likely to be central, where a diagnosis is complicated or contested, where there’s significant risk, or where someone hasn’t responded to treatment so far. Some psychiatrists also provide therapy, though many focus on diagnosis and medication management and work alongside a psychologist.

You need a GP referral to see a psychiatrist and to claim a Medicare rebate. It is important to be aware that waiting times can be long in many parts of Australia.

Counsellors and psychotherapists

Counsellor and psychotherapist are not protected titles in Australia. There’s no national registration board, which means the training behind the title varies from a full postgraduate qualification to a short course.

Plenty of counsellors are well trained and highly capable. Some hold membership of a professional association such as the Australian Counselling Association or PACFA, which sets its own training and supervision standards. Membership of one of those bodies is the closest equivalent to a registration check.

The practical differences are that counselling sessions generally don’t attract a Medicare rebate, counsellors don’t provide formal psychological assessment, and the standards behind the title aren’t guaranteed by law. If you’re seeing a counsellor, it’s reasonable to ask what their qualification is and which association they belong to.

Social workers and mental health nurses

Two other groups come up often. Accredited mental health social workers are registered through the Australian Association of Social Workers and can provide Medicare-rebated therapy under the same scheme as psychologists. Credentialed mental health nurses work largely in coordinated care, often alongside a GP or psychiatrist.

Both are legitimate options, and in some regions they’re considerably easier to access than a psychologist or psychiatrist.

Cost and Medicare

Psychologists and psychiatrists both attract Medicare rebates, but through different pathways. For a psychologist you need a Mental Health Treatment Plan from your GP, which covers up to 10 individual sessions per calendar year. For a psychiatrist you need a referral, and the rebate structure is different.

Counselling is generally not rebated through Medicare, though some private health funds cover it under extras. There’s more detail in how Medicare covers psychology sessions and claiming psychology on private health insurance.

Fees vary between practitioners in all three groups. What it costs to see a psychologist covers the range and what drives it.

Which one to start with

For most people dealing with anxiety, depression, stress, grief or trauma, a psychologist through a Mental Health Treatment Plan is a reasonable first step. Your GP can refer you and will usually have a sense of who’s available locally.

Psychiatry makes more sense as a starting point where medication is likely to be part of the picture, where previous treatment hasn’t worked, or where the diagnostic question is genuinely unclear.

It’s also common to see more than one. A psychiatrist managing medication and a psychologist providing therapy is a normal arrangement, and the two work better when they’re talking to each other.

If you’re not sure whether therapy is the right move at all, is therapy right for you covers that question separately.

Frequently asked questions

Do I need a referral to see a psychologist?

No. You can see a psychologist without a referral and pay privately. You only need a GP referral and a Mental Health Treatment Plan if you want to claim a Medicare rebate.

Can a psychologist prescribe medication?

No. Psychologists in Australia don’t have prescribing rights. If medication is likely to help, a psychologist will usually suggest you discuss it with your GP or a psychiatrist.

Is a counsellor as qualified as a psychologist?

It varies, because counsellor isn’t a protected title in Australia and there’s no national registration board. Some counsellors hold substantial postgraduate qualifications, others don’t. Psychologist is legally protected and requires AHPRA registration.

Is a clinical psychologist better than a registered psychologist?

They’re different, not ranked. Clinical psychology is one of nine areas of practice endorsement, reflecting additional postgraduate training in that area. A generally registered psychologist is fully qualified to practise, and the Medicare rebate differs between the two.

Which is cheaper, a psychologist or a psychiatrist?

Psychiatrist fees are generally higher, though rebates differ and the comparison depends on the practitioner and the number of sessions. Both attract Medicare rebates where the referral requirements are met.

Working with Veronica

If you’ve worked out that a psychologist is the right fit, you can read about how Veronica works or get in touch. If you’re still deciding, your GP is a good place to start, and they can refer you either way.

About the author

Veronica West is a registered psychologist (BPsychSc(Hons), MPH, MPsych) and Board-approved supervisor based on the Sunshine Coast, Queensland. She works with adults and adolescents across Australia by telehealth and provides clinical supervision to provisional psychologists, registrars and fully registered psychologists. More about Veronica.