Anxiety Counseling vs. Therapy vs. Psychiatry: Which Do You Need?

In Colorado, over 650,000 adults seek care for anxiety disorders each year, yet less than 40% receive the treatment they need¹. 

The biggest barrier? Confusion about where to start. 

"Should I see a counselor? Do I need a therapist? What about a psychiatrist?"  

These questions keep people stuck in indecision while their anxiety grows worse.  

At Axis Integrated Mental Health, our experts in Denver, Boulder, and Westminster, hear these questions daily.  

The good news?  

Understanding your options is the first step toward feeling better, and we're here to clear up the confusion once and for all. 

Understanding the Basics: What's the Difference? 

Here's a secret: even mental health professionals sometimes use these terms interchangeably.  

The overlap is real, but the distinctions matter when you're seeking help.  

Think of it like choosing between urgent care, your family doctor, or a specialist.  

Each serves a purpose, and knowing which you need saves time, money, and frustration. 

In Colorado's mental health landscape, these professionals often work together.  

Anxiety Counseling: Your First Line of Support 

Anxiety counseling typically refers to shorter-term, problem-focused support.  

Counselors help you develop coping strategies for specific life stressors causing anxiety (think work stress, relationship issues, or major life transitions). 

Who Provides It: 

• Licensed Professional Counselors (LPC) 
• Licensed Clinical Social Workers (LCSW) 
• Marriage and Family Therapists (LMFT) 
• Some pastoral counselors 

Training in Colorado: 

• Master's degree (2-3 years) 
• 2,000-4,000 hours supervised practice 
• State licensure exam 
• Ongoing education requirements 

Best For: 

• Recent onset anxiety 
• Specific situational stressors 
• Mild to moderate symptoms 
• Need for practical coping skills 
• Short-term support (8-20 sessions) 

Anxiety Therapy: Deeper Healing for Complex Issues 

Therapy (psychotherapy) goes deeper than counseling, exploring how past experiences, thought patterns, and unconscious beliefs fuel your anxiety.  

It's like the difference between treating a cut and addressing why you keep getting injured. 

Who Provides It: 

• Clinical Psychologists (PhD or PsyD) 
• Licensed Clinical Social Workers (advanced training) 
• Licensed Professional Counselors (with therapy specialization) 
• Marriage and Family Therapists 

Advanced Training Includes: 

• Doctoral degree for psychologists (5-7 years) 
• Specialized therapy certifications 
• Extensive supervised clinical hours 
• Research and assessment training 

Best For: 

• Long-standing anxiety patterns 
• Trauma-related anxiety 
• Complex mental health needs 
• Desire for deep personal growth 
• Longer-term work (6 months to years) 

Therapy Approaches for Anxiety: 

• Cognitive Behavioral Therapy (CBT): Learn more about CBT for anxiety in Colorado 
• EMDR: For trauma-linked anxiety 
• Psychodynamic: Exploring unconscious patterns 
• Somatic: Body-based anxiety work 

Psychiatry: The Medical Approach to Anxiety 

Psychiatrists are medical doctors specializing in mental health. Psychiatric Mental Health Nurse Practitioners (PMHNPs) are advanced practice nurses who diagnose mental health conditions, provide therapy, and prescribe medications, including controlled substances. The key difference between psychiatrists and PMHNPs is in training: psychiatrists attend medical school and complete a four-year residency, while PMHNPs earn a master's (2-3 years)or doctorate in nursing (3-4 years) with psychiatric specialization and complete 500–700+ hours of clinical training. In Colorado, PMHNPs can prescribe independently and operate without physician supervision after completing a provisional period, making them essential providers in addressing the state’s psychiatric care shortage.

Both view anxiety through a medical lens, considering brain chemistry, genetics, and physical health factors.  

They're the only mental health professionals who can prescribe medication in Colorado and sign off on paid mental health leave (FAMLI). 

What’s the Difference Between Psychiatrists and PMHNPs?

"Jamie Teunis, DNP, PMHNP at Axis Integrated's Westminster clinic explains: "I can run medical tests to rule out thyroid issues mimicking anxiety, prescribe medications when needed, and coordinate with your other doctors. It's comprehensive medical care for your mental health." 

Colorado's Mental Health Landscape: What You Need to Know 

The Provider Shortage Reality 

Colorado faces a significant mental health provider shortage, particularly in rural areas.  

The Metro Denver area (including Denver, Boulder, and Westminster) has better access but wait times can still stretch 4-6 weeks for new patients.

This shortage means: 

• Higher demand for all provider types 
• Longer wait times for specialists 
• Increased use of telehealth 
• More integrated care models 

At Axis, appointments can be scheduled same week for telehealth.

Insurance Coverage in Colorado 

Understanding coverage helps you choose the right provider: 

Medicaid (Health First Colorado): 

• Covers counseling, therapy, and psychiatry 
• No referral needed for outpatient care 
• Axis accepts Medicaid for all services 

Private Insurance: 

• Most plans cover all three services 
• Check for in-network providers 
• Understand your deductible and copays 
• Some plans limit annual sessions 

Self-Pay Considerations: 

• Counseling: $80-150/session 
• Therapy: $120-250/session 
• Psychiatry: $200-400/initial, $100-200/follow-up 

Telehealth Revolution in Colorado 

Since 2020, Colorado law ensures telehealth parity, meaning: 

• Virtual visits covered like in-person 

• Providers can see you anywhere in Colorado 

• Perfect for Boulder County's Mountain communities 

• Reduces transportation barriers 

When to Choose Counseling for Your Anxiety 

Signs Counseling Is Your Best First Step 

Counseling works well when anxiety is: 

• Linked to specific life events 

• Relatively new (less than 6 months) 

• Mild to moderate in intensity 

• Not accompanied by severe depression 

• Responsive to lifestyle changes 

What Happens in Anxiety Counseling Sessions 

Week 1-2: Assessment and Goal Setting 

• Identifying specific anxiety triggers 

• Creating measurable goals 

• Beginning relaxation techniques 

Week 3-8: Skill Building 

• Stress management strategies 

• Boundary setting 

• Communication skills 

• Mindfulness practices 

Week 9-12: Integration and Planning 

• Applying skills to real situations 

• Preventing relapse 

• Creating maintenance plan 

When Therapy Is the Better Choice 

Therapy becomes necessary when: 

• Anxiety persists despite counseling 

• Past trauma fuels current anxiety 

• Patterns repeat across relationships 

• You want to understand "why" not just "how" 

• Family history of anxiety disorders 

The Therapy Journey: What to Expect 

Phase 1: Building Safety (Months 1-2) 

• Establishing trust with a therapist 

• Learning emotional regulation 

• Creating stability 

Phase 2: Processing (Months 3-8) 

• Exploring anxiety's roots 

• Challenging core beliefs 

• Healing past wounds 

Phase 3: Integration (Months 9-12+) 

• Applying insights to daily life 

• Building new patterns 

• Strengthening resilience 

Specialized Therapy Approaches in Colorado 

1. EMDR for Anxiety: Particularly effective at Boulder's trauma-specialized clinics  
2. Somatic Therapy: Popular in Denver's holistic health community  
3. DBT Skills: Offered at many Westminster treatment centers  
4. Nature-Based Therapy: Unique to Colorado's outdoor culture 

When Psychiatry Becomes Essential 

Red Flags Requiring Medical Evaluation 

See a psychiatrist when experiencing: 

• Panic attacks with physical symptoms 

• Anxiety preventing basic functioning 

• Suicidal thoughts (call (720) 400-7025)

• Suspected medical causes 

• Failed previous treatments 

Medication Management

Medication management is often combined with therapy and natural alternatives in more severe cases. 

Common Medications Prescribed: 

• SSRIs (Zoloft, Lexapro) 

• SNRIs (Effexor, Cymbalta) 

• Buspirone for general anxiety 

• Short-term benzodiazepines (carefully monitored) 
  

Ready to Start Feeling Better? 

Finding the right mental health provider doesn’t have to be overwhelming. Whether you’re navigating new anxiety symptoms or seeking help for long-standing struggles, understanding the difference between counselors, therapists, psychiatrists, and PMHNPs is a powerful first step. At Axis Integrated Mental Health, we simplify the process by offering all these services under one roof so you get the right care, right away. Don't forget to also read The Ultimate Guide to Anxiety Diagnosis and Treatment in Colorado to learn more.

Ready to get started? Book an appointment at our Denver, Boulder, or Westminster clinic today and let our team help you take the next step toward feeling better.

FAQs

• How do I know if I should start with counseling, therapy, or psychiatry for my anxiety?

• Can I switch providers if my symptoms change or if I need more support later on?

• What’s the difference between seeing a PMHNP and a psychiatrist for medication?

• Does Axis accept my insurance for all these services, including psychiatry and therapy?

• How quickly can I get an appointment with someone who fits my needs?