Psychiatrist vs Psychologist vs Psychotherapist: differences, paths, roles in Italy

Very often, there is confusion about what they do, how they are formed, and what role the psychiatrist, psychologist, and psychotherapist have. It is important to know these things to choose well, avoid risks with “pseudo-professionals”, and understand your rights. Here is an understandable but precise overview.

Fundamental Definitions

Role	Who he is /what training he has	What it can do /what functions it performs
Psychiatrist	He is a doctor with: degree in Medicine and Surgery + qualification, + specialization in Psychiatry.	Diagnosis of mental disorders, prescription of drugs, medical evaluation, coordination of health treatment; can practice psychological therapy if he has specific training, but is not automatically trained; works in hospitals, healthcare facilities, or as a freelancer.
Psychologist	Degree in Psychology (3 years + 2 master's years — path “3+2” in the Italian university system), passing the State Exam, registration in the professional register of psychologists.	Use of psychological tools: tests, interviews, psychological evaluations; prevention, support, habilitation-rehabilitation interventions; work in public and private services; consultancy, research, teaching. He cannot prescribe drugs, nor make medical diagnoses in the strict sense.
Psychotherapist	It can be a psychologist or a doctor. After obtaining a degree in Psychology or Medicine + registration in the Register, specific post-university training in psychotherapy (four-year specialization at recognized schools) is required.	Psychotherapeutic activity: treatment through integrated psychological models, aimed at mental disorders or psychological disorders, more in-depth clinical interventions; generally focused on the psychological aspect rather than the pharmacological one. He can work in private, health facilities, public services, etc.

Italian legislation: what the law says

Here I list the main laws and regulations that regulate these professions in Italy, with the main elements.

1. Law No. 56 of 18 February 1989 – Ordering the profession of psychologist

   1. Defines the profession of psychologist: “cognitive-intervention tools for prevention, diagnosis, qualification-rehabilitation and support activities in the psychological field aimed at the person, the group, social organisms and communities”.

   2. Requirements to be a psychologist: a degree in Psychology, an internship, a state exam, and registration in the Register.

2. Law 163/2021 & Interministerial Decree 654/2022 (most recent)

   1. They have modified the training/qualification path of the psychologist: for example, the qualifying master's degree, simplification of access to the profession, internship integrated into studies; the final exam of the master's degree can serve as an evaluation test.

3. Decree of the President of the Republic (Presidential Decree) 10 March 1982, n. 162 – reorganization of specialization schools, including qualifying courses for psychotherapy.

4. Ministerial Decree 11 December 1998, n. 509 – Regulation for the recognition of institutions authorized to activate specialization courses in psychotherapy.

5. Regulations for doctors – specialization in Psychiatry

   1. Medical training is regulated through health area specialization schools. To become a psychiatrist, you need Medicine + School of Specialization in Psychiatry. These are also recognized in the university/health system. (Five-year training for medical specialists in general; for psychiatry, usually 4‐5 years)

6. Law 4/2013 on unregulated professions – useful for understanding that counselors, coaches, etc. they are not regulated professionals such as psychologists, psychiatrists, psychotherapists.

   1. Their status is different, they do not enjoy the same protections, they are not registered in the Registers, and they are not legally authorized to carry out diagnoses or prescriptions, unless they have recognized qualifications.

      
      

What is required to form each figure (pathways)

Here are the typical steps for each figure, with some possible variation:

Role	Main training steps
Psychologist	1) Bachelor's degree in Psychology (3 years) + 2 years of master's degree (LM-51) or equivalent. 2) During the master's degree, or immediately afterwards, carry out the compulsory professional internship (defined in the qualifying course). 3) Pass the State Examination for professional qualification in section A of the Register. 4) Enroll in the Register of Psychologists of your region or province. 5) Continue training (ECM, updates) depending on the areas of activity.
Psychotherapist	After already being a psychologist or doctor: (1) enter a school of specialization in psychotherapy (public university or institute recognized pursuant to Presidential Decree 162/1982). 2) The course lasts at least 4 years, with theoretical and practical training, clinical internship. 3) At the end, you obtain a specialization diploma in psychotherapy, which is legally recognized; with this title, you can practice as a psychotherapist. 4) Registration in the Professional Register (of the psychologist or doctor) in the psychotherapy part, if necessary.
Psychiatrist	1) Bachelor of Medicine and Surgery (6 years). 2) Qualification to practise medicine (State examination for doctors). 3) Choice of specialization in Psychiatry through competition at the Specialization Schools in the health area (generally 4-5 years). 4) During specialization: clinical training, internship, hospital rotations, psychiatric internship, possibly also with experience in psychotherapy if planned or chosen. 5) Once specialized, one can practice as a psychiatrist (public or private), prescribe medication, follow clinical cases, etc.

What they can do, limits, and concrete examples

Here are some typical activities, and also something that is not allowed for each figure.

Activity / Function	Psychologist (not psychotherapist)	Psychotherapist	Psychiatrist
Psychiatric /medical diagnosis	No (cannot diagnose psychiatric illnesses in the medical sense)	Can do in-depth psychological clinical evaluation, psychological diagnosis /psychological disorders, but do not diagnose medical diseases or prescribe medications (unless also a doctor, see later).	Yes, a psychiatric diagnosis can diagnose mental disorders according to medical/psychiatric criteria.
Prescription of medicine	No	No (if not also a doctor; and in any case, you have to be a doctor to prescribe)	Yes, being a specialized doctor, you can prescribe drugs, including regulated psychotropic drugs.
Psychological therapy/psychotherapy	Yes, in many cases: interviews, support interventions, counseling, psychological paths; not all are therapeutic “specialized” paths.	Yes: it is its main function: psychotherapeutic interventions based on theoretical models, clinical approaches, use of psychotherapeutic techniques.	It can offer psychological therapy if it has training (some psychiatrists do), but it is not automatic; the focus can be both biological/pharmacological and psychotherapeutic.
Health interventions /hospital	It can operate in social and health public services (ASL, counseling centers, communities), in mental health services, but without medical functions, under the responsibility of the institution.	Similarly, especially if integrated into the healthcare system, psychotherapists can also work in hospital facilities, mental health centers, and local services, if applicable.	Yes: works in hospitals, psychiatry wards, CSMs (mental health centres), the national health system, etc.
Private Practice	Private practice, counseling, psychological testing, interviews, psychological support, coaching/organizational, if not a hiker in the legal border.	Private practice, psychotherapy, clinical paths with specialist models.	Also in the freelance profession: psychiatric visits, pharmacological follow-ups, and medical/psychiatric consultations.

Some practical examples, cases

• A person who feels severe anxiety or panic attacks can initially contact a psychologist for evaluation, interviews, and psychological interventions. If necessary, a psychiatrist can intervene to evaluate whether drug therapy or integrated psychopharmacological + psychotherapy treatment is necessary.

• A parent who suspects DSA/ADHD in their children: psychologist (developmental age psychologist /neuropsychologist) for cognitive/neuropsychological evaluation. If ADHD is diagnosed, the psychiatrist may prescribe medications; the path is multimodal, often with psychotherapy or psychoeducational interventions.

• A person with resistant depression can be followed by a psychiatrist for pharmacological modulation + psychotherapist for psychological therapy; sometimes the psychiatrist himself has training in psychotherapy.

Common confusion points/risks

• A psychologist offering psychotherapeutic model therapy without having completed graduate school in psychotherapy → not compliant with the law.

• Psychologist prescribing drugs → not legal. Only a doctor can prescribe.

• A psychiatrist who has no psychotherapeutic skills but offers sessions as a psychotherapist without specific training → not legitimate.

• People who declare themselves “psychotherapists” but are neither psychologists nor doctors, or do not have the recognized four-year training → risk for those seeking help.

Synthetic scheme “How to become in Italy”

1. You want to become a psychologist

• Enroll in a university Psychology course (three-year + master's degree LM-51).

• Complete the required professional internship (hours defined).

• Passes the State Examination to get habilitation.

• Enroll in the Register section A of Psychologists.

2. You want to become a psychotherapist

• Become a psychologist (or doctor).

• Enroll in a recognized graduate school of psychotherapy (≥ 4 years).

• Complete theoretical training, clinical practice, and internship.

• Obtaining the recognized specialization diploma in psychotherapy.

3. You want to become a psychiatrist

• Bachelor of Medicine and Surgery.

• Qualification to practise medicine (State examination).

• Having won the competition, attending a School of Specialization in Psychiatry (in the healthcare area) for 4-5 years.

• During specialization, clinical experience, case management, and specific training.

Specific rules on psychotherapy

• Law 56/1989, article 3, establishes that psychotherapeutic activity is subject to specific training (postgraduate in Psychology or Medicine) by means of specialization courses of at least 4 years, at university graduate schools or institutes recognized in accordance with Presidential Decree 162/1982.

• Non-medical psychotherapists cannot carry out interventions that are the exclusive responsibility of the medical profession.

Conclusion / Importance of awareness

• Knowing the difference between these figures is not only “theoretical”: it serves to protect oneself from those who offer services for which he is not qualified.

• It is also used to orient yourself in your studies or treatment path (knowing what you can do as a psychologist or psychotherapist, or which professional to turn to).

• Finally, for legal and professional protection, only those who have the qualifications required by law can use certain qualifications, carry out certain activities, be registered in the professional registers, and be recognized in the NHS or public services.