When you finally decide it is time to get some support, the next question can stall everything: who exactly should you book with? In British Columbia, the titles can be confusing. Counsellor, clinical counsellor, psychologist, psychiatrist, therapist — they sound similar, but they describe different training, different services, and very different costs.
The good news is that you do not need to have this figured out perfectly before reaching out. Most people find that once they understand what each professional actually does, the right starting point becomes much clearer. Here is a plain language guide to how these roles work in BC.
What does a Registered Clinical Counsellor do?
A Registered Clinical Counsellor (RCC) is a counsellor who has completed a master’s degree in counselling psychology or a closely related field and is registered with the BC Association of Clinical Counsellors (BCACC). Registration means they have met education and supervision standards, follow a code of ethics, and are accountable to a professional body.
RCCs provide talk therapy, often called counselling or psychotherapy. In practice, this is the kind of support most people picture when they think about therapy: meeting regularly with someone who can help you work through anxiety, depression, trauma, grief, relationship distress, parenting stress, or life transitions. Many RCCs also have specialized training in approaches like EMDR, Emotionally Focused Therapy, or CBT.
At Sojourn, our clinical team is made up of Registered Clinical Counsellors with a range of specializations, from couples work to trauma therapy to child and youth counselling. If you are curious about the RCC designation itself, we have written more about how it compares to other titles in Is a Clinical Counsellor the Same as a Therapist?
What does a psychologist do, and how are they different?
A registered psychologist in BC is regulated by the College of Psychologists of British Columbia and typically holds a doctoral degree. Psychologists provide therapy too, and many people see one for the same concerns they might bring to a counsellor.
The clearest practical difference is assessment and diagnosis. Psychologists are trained to conduct formal psychological assessments, such as testing for ADHD, learning disabilities, or personality and cognitive functioning, and can provide a diagnosis. If you need documented testing for school accommodations, a disability claim, or a legal matter, a psychologist is usually the right professional.
That added scope comes with a higher fee. Psychologist rates in BC are generally noticeably higher than counselling rates, and formal assessments can run into the thousands of dollars.
What does a psychiatrist do?
A psychiatrist is a medical doctor who has specialized in mental health. Because they are physicians, psychiatrists can diagnose mental health conditions and prescribe medication, and their services are covered by MSP when you are referred by a doctor or nurse practitioner.
Psychiatrists in BC typically focus on assessment, diagnosis, and medication management rather than ongoing weekly talk therapy. Many people see a psychiatrist a few times to clarify a diagnosis or adjust medication, while working with a counsellor for regular therapy alongside that care.
Who can diagnose a mental health condition in BC?
In BC, diagnosis sits with physicians (including psychiatrists), nurse practitioners, and registered psychologists. Counsellors, including RCCs, do not diagnose.
That said, a diagnosis is not a requirement for counselling to help. Counsellors work with the concerns you bring — the anxiety that will not settle, the arguments that keep repeating, the low mood that has crept in — whether or not those experiences have a formal name. Many clients work with a counsellor for months or years without ever needing a diagnosis. Others find it useful to get an assessment from a physician or psychologist while continuing counselling.
Who can prescribe medication?
Only medical professionals can prescribe: your family doctor, a nurse practitioner, or a psychiatrist. Neither counsellors nor psychologists prescribe medication in BC.
If you are wondering whether medication might be part of your care, your family doctor is often the most accessible starting point. Counselling and medication are not either/or. Research generally supports the idea that therapy and medication can work well together, and your counsellor can support you while you explore that question with your physician.
What does each option cost in BC?
Cost is often the deciding factor, so it helps to be realistic about it.
Psychiatrists are covered by MSP with a referral, though wait times can be long. Psychologists and counsellors are private services in BC — MSP does not cover them — but most extended health plans through work include coverage, and plans commonly cover RCCs. It is worth checking whether your plan lists Registered Clinical Counsellors specifically.
Counselling is generally the more affordable private option, and there are ways to reduce the cost further. At Sojourn, our supervised interns offer low cost counselling with a free first session, which many clients use as an accessible way to start. Counselling may also be funded through ICBC after a car accident or through CVAP for victims of crime.
Should you see a counsellor, psychologist, or psychiatrist first?
There is no single right answer, but a few patterns can guide you.
Counselling is usually the right starting point if you want ongoing support to work through anxiety, trauma, relationship difficulties, grief, stress, or a life transition, and you are looking for regular sessions with the same person. A psychologist makes sense when you need formal testing or a documented diagnosis. A psychiatrist, reached through a referral from your doctor, is the path when medication questions or a complex diagnosis are front and centre.
If you are in crisis or worried about your immediate safety, none of these are the first step — please call or text 9-8-8, or go to your nearest emergency department.
For most everyday mental health concerns, starting with a counsellor is both the fastest and the most affordable route, and a good counsellor will tell you if they think an assessment or a medical consult would serve you better.
Can you work with more than one at the same time?
Yes, and it is common. A typical arrangement might look like this: your family doctor or psychiatrist manages medication, while your counsellor provides weekly or biweekly therapy. With your consent, professionals can coordinate so your care stays consistent. Counselling can also be a helpful place to process what a new diagnosis means for you and how you want to move forward with it.
How do you get started with counselling in Surrey?
If counselling sounds like the right fit, the next step is simply finding a person you feel comfortable with. Fit matters more than almost anything else in therapy, so it is worth taking a few minutes to read about the people you might work with.
You can meet our team of counsellors to see each therapist’s background, approach, and availability, then book online through JaneApp at a time that works for you. We serve Surrey, Cloverdale, Langley, and White Rock in person, and clients across BC online. And if you are still unsure who to book with after reading this, contact us — we are happy to help you find a good starting point.
Related reading: Curious about the RCC credential itself? See What Is a Registered Clinical Counsellor? And for how counselling regulation in BC is changing, read Are Counsellors Regulated in BC?
