If you've ever wondered whether you need a therapist, a prescriber, or both, you're in good company. More people are reaching out for mental health care than ever before. Gen Z and millennial adults averaged more than four mental health visits a year in 2025, more than twice the rate of baby boomers and the silent generation. Eight percent of all adults saw a mental health provider more than ten times last year, double the number reported in 2004.
For more on this data, check out Global Mental Health is Worsening from the American Psychological Association (2026).
That's encouraging. But taking the first step often brings a lot of questions. What's the difference between a counselor and a psychiatric nurse practitioner? Will medication change who I am? Is therapy just talking? Do I have to pick one?
At KDH Counseling, our therapists and prescribers work under the same roof, and we coordinate care every day. So we asked the team to answer the questions we hear most often, in their own words. Check out the conversation that happened below.
"Medication helps to change the physiology of the brain through different neurotransmitter involvement, which is responsible for symptom presentation. Some medications help to improve symptoms quickly and, in some cases, drastically. Medications focus more on your chemical make-up, where therapy may focus more on the physical and behavioral aspect of mental health."
"Medications may reduce symptoms and/ or alter brain processes that make engaging in therapy and learning new patterns more possible. "
"To me, therapy is where the work of 'getting better' or 'being better' comes into play. Medication can be like a step-stool that gets us closer to where we are reaching, but there’s still reaching that has to happen."
"Therapy addresses 'the mind.' The brain is a physical structure that works like any other organic organ, i.e. heart, lungs, kidneys. It uses chemical and electrical signals that influence thoughts and feelings. However, the mind is a construct that must be treated more abstractly. If the brain and meds can influence thought processes and feelings, then the mind can also influence thoughts and feelings. The character Don in Kinky Boots (a Broadway musical) says, 'You change the world when you change your mind.'"
"Medication is generally a last resort when working with children. Sometimes the brain needs medication to calm the nervous system, but therapy is where the child client learns skills for behavior management, impulse control, and mood stabilization."
"Medication can calm the waves; therapy teaches you to ride them. Mental health starts with biology, is shaped by how we were raised, and plays out in how we cope. Medication often eases symptoms faster, but therapy works on the parts you can change: old patterns and how you cope. The best outcomes come from both."
"This comes from years of experience working in acute care. As clients participate in session, their outward presentation or the things that they share in session clue me in to symptoms that may be successfully addressed with medications. When this happens, I start with their thoughts and feelings about taking medications and then suggest that it may be worthwhile for them to explore the possibility of medication management with one of our (very competent and very compassionate) prescribers."
"Medication might be considered if symptoms are severe or progress in therapy is moving too slowly. Since I work with children, I make sure to explain to parents first the potential benefits of meeting with a medication prescriber, and then the potential benefits of the medications themselves."
"There isn’t a real checklist or anything that I use…which makes me wonder if maybe something like that exists elsewhere… But basically, if someone describes working really hard while managing their anxiety/depression/obsessions and compulsions and feeling like very little progress is being made (or maybe progress has been slow), that’s when I bring it up. I do find that most of my clients are fellow anxious people, so medication comes up pretty naturally."
"If I think it, I say it! I suggest a medication evaluation when symptoms are severe, when someone has been struggling for a long time, or when I believe medication would make a real difference. Then I refer in-house to our psychiatric nurse practitioners so therapy and medication work together."
"When I see a client struggling - especially with depression or anxiety, I like to refer them to our psych NP’s. I always explore with them the pros and cons of taking meds and try and help them see the value of taking them."
"At the first med appointment, the therapeutic relationship is started. What this looks like is speaking with your provider about what prompted you to reach out and make an appointment in the first place. I will address each symptom, asking you about them in detail. You will be asked a series of questions regarding your history, including how life was growing up, education, your previous experience with mental health providers (if any), who you can identify as your support system. You may be asked about your daily living and different habits you may have, including sleeping and eating. Your hobbies, interests, and goals may be relevant to the conversation. All of these things help your provider to have a better grasp of who you are as a human being, rather than what symptoms you are experiencing or what diagnosis you may have. Once your history is obtained, you can expect your provider to give you some treatment options. Prescriptions are not told to you - they are offered to you as options that you can then choose from. It's not quite like a menu at a restaurant, but more like you and I are working together to figure out which treatment makes the most sense for the life you are living now and also the life you would like to be living. We do this because you are not alone on your journey to better mental health; we are here to help guide you and provide you with the best treatment options for you."
"I love when this happens. There are times when I am deeply invested in my clients and can feel their struggles…it’s such a relief to know that I’m not the only clinician in their life who is invested in finding relief. I also learn so much from prescribers about medications, since this is definitely out of my scope!"
"This is where the magic happens! I come from a place where the more people supporting someone, the better! It’s more of a holistic experience where a team gets to problem-solve rather than just one person. The combination of medical and clinical is better than just clinical in my opinion."
"My favorite cases are those in which both the therapist and medication provider work in collaboration. Some issues may be brought to light during a therapy session that was not mentioned in a medication management appointment, and vice versa. The collaboration between a therapist and a nurse practitioner tends to provide the best outcome for patients. Developing a plan together, though our treatment modalities may not be the same, helps to look at more aspects of the patients’ mental health and the overall treatment of the patient. Many times, a client will have more frequent appointments with their therapist than their psych NP. When collaborating with a therapist and psych NP, the issues that may arise between medication management appointments may be brought to light during a therapy session. If a therapist and medication management provider are able to collaborate, these issues can be discussed between the two clinicians and the patient, so that each party involved stay up-to-date on what the client is experiencing."
"Again, working in various inpatient and outpatient psychiatric settings throughout my career, I have done a lot of working with various team members collaborating for the better of clients. Different team members bring different knowledge, understanding and perspectives about client presentations and struggles. Clients sometimes feel more comfortable sharing with one team member over another. Coming together as a team helps us to build a more comprehensive understanding of the client’s experience, creating better outcomes for clients. It is a true gift that we can have that collaboration at KDH Counseling because navigating that team work approach becomes infinitely more difficult when the collaboration has to occur across different settings and agencies."
"It’s such a delight when the therapist and prescriber can collaborate on a client’s care! The client then truly has an interdisciplinary team of professionals working together to make sure symptoms are resolved or managed. It becomes comprehensive quality mental health treatment at that point."
"When a therapist and prescriber collaborate, you have a team! Your prescriber tracks how medication is working, and your therapist tracks your patterns, stress, and coping. With your permission, we share what we notice, so adjustments happen faster and nothing falls through the cracks. Two heads really are better than one. It takes a village:) I love when KDH can be your village."
"That psychiatric medications are addictive. Medications that are taken as prescribed do not lead to addiction or dependence. Many mental health medications do not even have addictive properties! Appropriate prescribing and taking medication as directed help to avoid becoming addicted or physically dependent on the medication. I am trained to prescribe medications appropriately and will help in avoiding addiction and dependence."
"I completely understand the reluctance and resistance that some clients have with either therapy or medication. I believe when the symptoms are bad enough, then the client will eventually come to the conclusion that something has to change. If they are willing to try something new, then therapy, medication, or a combination of the two could be exactly what that client needs. I normalize their fears and explain that we would approach the process with care, caution, and communication."
"New or different things can be scary. The unknown or uncertainty can be difficult to manage or tolerate. However, therapists and prescribers, particularly the ones at KDH Counseling, are well trained, compassionate, and empathic with assisting you to not only manage or tolerate those difficulties but to help you thrive and succeed. Our goal is to help you reach your self-identified goals and then celebrate with you when you get there!"
"In terms of starting therapy - I describe it as similar to dating. You have to find the right fit to build that good therapeutic relationship, and it's totally normal (and good!) to try a few therapists before you land with the one. With medication, I always start with disclosing that I am on medication for my own mental health and, despite the dominance of “scary stories” around medication and side effects, my experience with medication has been overwhelmingly positive. I love my medication! And then I also always mention that medication does not have to be forever - sometimes we do just need that step-stool to help us get where we are reaching with less effort."
"First I share my personal experience of resistance to medications. Then I share about how medications can help them achieve a more homeostatic way of life - which may help them feel more stable and balanced. I also let them know that it may be forever, but just for now medications may be necessary to help them take that first step to feeling better."
"Starting therapy or medication isn't a life sentence. We commit to a real try, usually three to six months, and then reflect together on what's helping and what isn't. You stay in charge the whole time. For more severe struggles, therapy and medication together can give you the support you need. And for many people who've struggled for years, the missing piece was a team. We won't know until we try."
"The fact that you are reaching out and even just considering therapy, medication, or both, does not mean you are weak-it means you are strong. You are strong for caring about yourself enough that you realize help is available. You are strong for realizing that what you have been doing so far is not enough for you. You are strong for being you. Yes, new things are scary sometimes, but you never know the outcome if you never start."
Our clinicians came at these questions from different angles, but they kept arriving at the same place: there is no single right path into care. For some people, therapy alone is exactly what they need. For others, medication makes it possible to get the most out of therapy. Many find that the combination works better than either one alone. The best plan is the one built around you and adjusted as you grow.
You don't have to figure that out on your own before you call. Our team can help you decide where to start, whether that's counseling, a medication evaluation, or a psychological evaluation for ADHD or autism. If you begin with one and later want to add the other, we can coordinate that in-house.
If you're in crisis, you don't have to wait for an appointment. Call or text 988, the Suicide & Crisis Lifeline, any time.
You can also utilize the 988 Crisis Line's chat option at the website.
Whatever brought you here, whether it's a question, a hunch, or a hard season, we're glad you're curious. When you're ready, reach out or visit the contact page to get started.