Psychologist, Psychiatrist or Therapist: Who Does What in Colorado

In crisis or thinking about suicide? Call or text 988 now (in Colorado it reaches the 988 Colorado Mental Health Line). If you are in immediate danger, call 911.

Why the titles get confusing

People use "therapist," "counselor" and "psychologist" as if they mean the same thing. They do not. Each title points to a different kind of training and a different set of things the person is allowed to do.

SAMHSA, the federal mental health agency, puts it simply: all of these professionals give important care, but some can prescribe medicine and some cannot. It also suggests that your primary care provider can be a good place to start, since they can often help with anxiety or depression.

The quickest way to know what someone can do is to look at their license, not their job title. The license check guide shows how to do that on DORA in a few minutes.

Psychiatrists and psychiatric nurse practitioners

The American Psychiatric Association describes a psychiatrist as a medical doctor (an MD or DO) who specializes in mental health, including substance use disorders. To get there, a person finishes medical school, passes exams for a license to practice medicine, and then completes four years of psychiatry residency.

Because they are physicians, psychiatrists can order lab tests and look at how physical and mental health affect each other. The APA says they use talk therapy, medication and other treatments, depending on the person's needs. Some people see a psychiatrist mainly for evaluation and medication, and see a therapist for weekly sessions.

SAMHSA lists psychiatric or mental health nurse practitioners alongside psychiatrists as professionals who can prescribe for mental health conditions, and notes that the rules depend on the state. Primary care doctors, nurse practitioners and physician assistants can also prescribe for many common conditions, including depression and anxiety. On DORA's lookup, these professionals appear under the Medical or Nursing license types, not the mental health boards.

Licensed psychologists, and the prescribing exception

A Colorado psychologist license requires a doctorate in psychology, at least one year of supervised postdoctoral experience, a written exam and a jurisprudence exam (C.R.S. 12-245-304). Colorado law defines the practice of psychology to include psychological testing, psychotherapy, and the diagnosis and treatment of mental health disorders. That testing can cover areas such as intelligence, personality, cognitive abilities and psychoeducational evaluation (C.R.S. 12-245-303).

Since August 2023, Colorado has allowed a narrow path for psychologists to prescribe. Under C.R.S. 12-245-309, a licensed psychologist may prescribe psychotropic medication only after earning a prescription certificate from the state board, with approval of the Colorado Medical Board. The requirements include a master's degree in clinical psychopharmacology, a national psychopharmacology exam, and a supervised practicum of at least 750 hours with at least 150 clients under prescribing physicians.

Even then, a prescribing psychologist must keep a working relationship with the patient's physician, get the physician's written agreement before prescribing, and tell the patient in writing that they are not a physician. They may not prescribe to anyone under 18 without a parent or guardian's informed consent. A psychologist without that certificate does not prescribe.

You may also meet a postdoctoral fellow or a psychologist candidate. That person has a psychology doctorate and is completing the supervised experience a license requires. Colorado reserves the plain title "psychologist" for licensed psychologists (C.R.S. 12-245-306), though anyone may list a degree they earned, such as a PhD.

Clinical social workers, counselors and marriage and family therapists

Many people who call themselves therapists in Colorado hold one of three licenses: licensed clinical social worker (LCSW), licensed professional counselor (LPC) or licensed marriage and family therapist (LMFT). Each requires a graduate degree, a set number of supervised hours and exams. The table below sums up the training.

Colorado law describes each of these practices as including assessment, diagnosis and psychotherapy. Marriage and family therapy is defined around the way individual problems connect to relationships, and serves individuals, couples and families. Professional counseling covers wellness, personal growth and career development as well as mental health conditions.

None of these licenses allows prescribing. C.R.S. 12-245-210 says nothing in the Mental Health Practice Act lets these professionals prescribe drugs or practice medicine. C.R.S. 12-245-211 adds that they must work with a physician for medical problems and may not diagnose or treat medical problems themselves.

When you might see two of them

It is common to have more than one professional on your side. Here are some combinations people often use:

• A therapist plus a prescriber. Weekly therapy with an LPC, LCSW, LMFT or psychologist, and medication managed by a psychiatrist, nurse practitioner or primary care doctor.
• A therapist plus a psychologist for testing. Ongoing therapy with one clinician, and a one-time psychological evaluation with a psychologist.
• Individual therapy plus a skills group. One-on-one sessions with a therapist, plus a clinician-led group such as a DBT skills group that teaches coping skills step by step.
• A therapist plus your primary care doctor. Therapy for mood or stress, while your doctor checks for physical causes of symptoms like fatigue or poor sleep.

Who to call first, and when this is not the right step

If you mainly want someone to talk with and learn skills from, a licensed therapist or psychologist is a natural first call. If you are wondering about medication, start with your primary care provider or a psychiatrist. If you are not sure, either one can help you sort out the next step. The therapy vs medication guide goes deeper on that choice.

When two professionals share your care, they usually ask for your permission, often in writing, before they talk. Questions about starting, changing or stopping a medication belong with your prescriber.

Mountainside's team page lists each clinician's credentials. The team includes a licensed psychologist, a licensed clinical social worker, licensed professional counselors and a postdoctoral fellow, and the practice's site describes therapy and skills groups; it does not list medication prescribing. For help judging fit, see how to find the right therapist in Denver, or start with a free therapy consultation.

If you are thinking about suicide or feel unsafe, do not wait for an appointment. Call or text 988, or call 911.

Frequently asked questions