DID, PTSD & Dissociation Terms · Therapies & Treatment
Psychiatrists, Therapists and Medications: Who Does What in DID and PTSD Care
In short: Some professionals can diagnose and prescribe medicine. Others can diagnose and give therapy but can’t prescribe. Many people see two: one for therapy and one for medicine.
Who can prescribe medicine
- Psychiatrist. A medical doctor (MD or DO) who has finished extra training in psychiatry. A psychiatrist can diagnose, prescribe and check on medicines, and give therapy. Many psychiatrists today focus mostly on medicine, with shorter visits.
- Psychiatric nurse practitioner. A nurse with an advanced degree and extra training in mental health. You may see the letters PMHNP, APRN, or ARNP (the title used in Washington State). They can diagnose and prescribe in all 50 states. Some states require them to work with a supervising doctor. Not all of them also give therapy, so it’s worth asking.
- Primary care doctor or family nurse practitioner. Your regular doctor can prescribe many mental health medicines too, and may suggest seeing a specialist.
- Physician assistant. In psychiatry, a PA can diagnose and prescribe while working under a psychiatrist’s supervision.
Who gives therapy
- Psychologist. Has a doctoral degree (PhD or PsyD). A psychologist can diagnose, give psychological tests (like the ones on our diagnosis page), and provide therapy. In most states psychologists cannot prescribe. A handful of states let psychologists with extra training prescribe.
- Licensed counselors, clinical social workers, and marriage and family therapists. You may see letters like LMHC, LPC, LICSW, LCSW, or LMFT. They have master’s degrees and years of supervised practice, and are trained to diagnose and provide therapy. They cannot prescribe.
The exact rules are set by each state, so they can be a little different depending on where you live.
Licenses, certificates, and other titles
Only a state can license someone to practice therapy. A license comes from a state board after a graduate degree, supervised practice, and an exam. The board also investigates complaints and can take a license away.
A certificate is not a license. Many professional societies and training groups, including some that focus on trauma and dissociation, offer training certificates. A certificate shows that someone took a course or training. It doesn’t give anyone permission to practice therapy, and no professional society can “license” a therapist.
Some titles aren’t protected. Anyone can call themselves a “life coach.” In some states, even words like “therapist” or “counselor” alone aren’t protected; only full titles like “Licensed Professional Counselor” are. Many people offer help online under titles like these.
People still in training. Clinics, including state and community programs, often have staff who are still working toward a license (sometimes called associates, interns, or residents). They see clients under a licensed supervisor. That’s normal and legal, and you have the right to ask about it. When you’re looking for a therapist, it’s fair to ask about their license, their training in trauma and dissociation, and who supervises them if they’re still in training.
Peer support specialists are different again. They are trained, and often certified by their state, to share their own lived experience of recovery. They don’t diagnose, give therapy, or prescribe. Peer support can be a helpful addition to care, but it isn’t therapy.
How to check: Every state has a licensing board with a free online lookup. You can search a provider’s name to see whether their license is active and whether they’ve ever been disciplined.
Can my therapist diagnose me?
Usually, yes. Licensed psychologists, counselors, and clinical social workers are trained to diagnose mental health conditions, including DID. You don’t need a psychiatrist to get a diagnosis, but you do need a prescriber if you want to try medicine.
Seeing a therapist and a prescriber at the same time
This is very common. It’s sometimes called “split” or “collaborative” treatment. Usually you see the therapist often, for therapy, and the prescriber less often, for shorter visits about medicine.
Your therapist and prescriber don’t automatically talk to each other. To let them share information, you sign a form, often called a “release of information.” Professionals who write about this recommend that the two stay in regular contact, even when things are going well, and that you know which one to call first in a crisis.
Medications and DID
There is no medication that treats DID itself. Medicines are sometimes used for other problems that often come with DID, such as depression, anxiety, PTSD symptoms, or trouble sleeping.
The medical (or biomedical) model looks at mental health through the body and the brain, and medicine is its main tool. With DID, doctors who write about medication describe it as one part of a treatment plan that also includes therapy, not as a treatment by itself.
What medicines are used for
- Depression and anxiety. Antidepressants, such as the groups of medicines called SSRIs and SNRIs, are often used.
- PTSD symptoms. In the United States, only two medicines are approved by the FDA specifically for PTSD: sertraline (Zoloft) and paroxetine (Paxil). Both are SSRIs. Other medicines are sometimes prescribed “off-label,” meaning for a use they weren’t officially approved for.
- Nightmares. A blood pressure medicine called prazosin has often been prescribed for trauma nightmares. Earlier small studies found it helped, but a large 2018 study of 304 veterans found it worked no better than a placebo (sugar pill).
- Dissociation itself. A few medicines have been tried in small studies. A 2023 review found that naltrexone and similar medicines look promising for dissociative symptoms, but said much more research is needed. An earlier 2019 review found the evidence too thin to say any single medicine works.
Before changing any medicine
Never start, stop, or change a medicine without talking to the doctor who prescribes it. Some medicines can cause problems if they’re stopped suddenly.
Related
A note about theories
The therapies and theories about trauma and DID are ideas that researchers are still studying and arguing about. None of them are proven facts. What works for one person may not work for another. Please take the time to read about any therapy yourself, ask questions, and decide what feels right for you.
Sources
National Alliance on Mental Illness (NAMI). “Types of Mental Health Professionals.” nami.org
University of Washington Department of Psychiatry and Behavioral Sciences. “Types of Mental Health Providers.” psychiatry.uw.edu
American Psychiatric Nurses Association. “Frequently Asked Questions.” apna.org
American Psychological Association. “About prescribing psychologists.” apaservices.org
Sentio Counseling Center. “License, Certification, or Registration? What the Words Mean in California Mental Health.” sentio.org
University at Buffalo School of Social Work. “Certificate vs. Certification: What is the difference?” socialwork.buffalo.edu
Texas Health and Human Services. “About Peer Support Services.” hhs.texas.gov
OpenCounseling. “How To Check a Therapist’s License.” opencounseling.com
Mossman, D., & Weston, C. G. (2010). Splitting treatment: How to limit liability risk when you share a patient’s care. Current Psychiatry, 9(3), 43–46.
Khawaja, I. S., & Ebrahim, A. Improving collaborative treatment: 6 simple steps. Current Psychiatry.
Gentile, J. P., Dillon, K. S., & Gillig, P. M. (2013). Psychotherapy and pharmacotherapy for patients with dissociative identity disorder. Innovations in Clinical Neuroscience, 10(2), 22–29.
Şar, V. (2014). The many faces of dissociation: Opportunities for innovative research in psychiatry. Clinical Psychopharmacology and Neuroscience, 12(3), 171–179.
U.S. Food and Drug Administration. Prescribing information for sertraline (Zoloft) and paroxetine (Paxil).
Raskind, M. A., Peskind, E. R., Chow, B., et al. (2018). Trial of prazosin for post-traumatic stress disorder in military veterans. New England Journal of Medicine, 378(6), 507–517.
Sutar, R., & Sahu, S. (2019). Pharmacotherapy for dissociative disorders: A systematic review. Psychiatry Research, 281, 112529.
Escamilla, I., Juan, N., Peñalva, C., et al. (2023). Treatment of dissociative symptoms with opioid antagonists: A systematic review. European Journal of Psychotraumatology, 14(2).
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