For the last few weeks I’ve been working with a large online provider of counseling to comb through informative and self-help articles for accuracy. Its been a fun project to check through writing, edit, and make sure things are accurate and helpful for those who enter the great unknown of the internet with questions about mental health.
This project has shed some light on things that it would seem (judging off the articles I’m going through) are confusing for people. It adds an additional layer of stress to the hunt for information when every article you click on has contradictory information, uses different words to describe the same things, or has flat out false information.
Here you are, cruising the ‘net, and looking for information or help – and people are slinging useless advice pellets filled with confusing junk at you while you’re doing it. That isn’t helpful at all.
My professional organizations, the American Counseling Association (ACA) and the National Board for Certified Counselors (NBCC), both work diligently to a few ends that are applicable to these issues. The ACA urges counselors to use the word “counselor” to describe their work. The thinking is that all the professionals in a field using the same word will help prevent confusion. Sadly, our claim on that word goes into a long list of people who also use the word – and without the education or licensure to do so: camp counselors, financial counselors, legal counselors (lawyers), peer counselors, faith counselors – and on, and on. The ACA has also advocated for its profession and members by working with state legislatures to protect the word “counselor” from misuse and misrepresentation. This hasn’t worked either.
My home state’s answer to this was to grant us and only us the access to use the term “licensed professional counselor”. That is both a mouthful and not much of a move to explain to the public who or what we are. Add to this that in other states “professional counselors” are called something different, like “licensed mental health counselor” (LMHC), and there are hundreds of other license names for the exact same profession across state lines. The ACA and the NBCC are both working hard to create continuity for our profession and a clear sense of who and what we are for consumers, and state boards and lawmakers simply aren’t as cooperative as they could be.
Even right here in Texas there are multiple licensed professionals that use the word counselor.
So today I am writing to demystify and decode some mental health community conundrums.
My hope, is that in the vast vacuum of the interwebs, if you are searching for mental health or emotional health help that this article finds you and helps you, even just a tiny bit.
Psychologist, psychiatrist, therapist, counselor.
Can a psychologist see patients? Is a therapist a psychologist? Can a psychiatrist provide therapy? Can a counselor diagnose? All good questions. Some definitions and clarity for you:
Psychologist – a psychologist who uses the title ‘psychologist’ typically has a minimum of a doctoral degree in psychology. Doctorates in psychology vary. Emphasis can be on research (why we do what we do), teaching (a psych professor), or clinical applications (like in therapy). Psychologists who are licensed as practicing or clinical psychologists can provide testing to determine what the problem is when there is one, diagnosis of issues, and treatment. Psychologists don’t prescribe medication. Bottom line: can see clients if licensed, can test and diagnose if licensed, usually has a doctoral degree, works in private practice, clinics, and hospitals.
Psychiatrists (M.D.)– a psychiatrist is a medical doctor who went to medical school and chose to focus on the medical and biological side of mental health. Psychiatrists should have the abbreviation, M.D. behind their names (medical doctor) in most states and will be licensed in their respective states as psychiatrists. They may work in hospitals, clinics, or private practice. Their specialty is in the medical side of mental and emotional health concerns. They prescribe medications to treat mental health conditions, perform diagnosis and testing, and usually don’t provide therapy. They may work with your therapist or your family doctor while they address your mental health concerns. Bottom line: can see clients to diagnose, test, and treat (usually with medication), has a medical degree.
Therapists – this word isn’t “protected”. There are all sorts of therapists out there. Occupational, physical, respiratory…so take this word with a grain of salt and pay attention to the license, education, and eye chart behind this person’s name. This person could and should have any number of licenses: licensed as a psychologist, a professional counselor, a marriage and family therapist, an social worker. Therapists typically don’t prescribe medication (unless your psychiatrist calls himself or herself a therapist). Bottom line: if its a mental health “therapist” they may be a counselor, marriage and family therapist, or social worker using this title. If licensed each has a minimum of a master’s degree and can use talk therapy, treat, diagnose, and assess (depending on state regulations).
Counselor (LPC/LMHC) – this word isn’t as “protected” as it should be. A professional counselor has a minimum of a master’s degree in counseling, counseling psychology, or clinical mental health counseling. They should also be licensed by their state (reflected in the name eye chart) to practice. This may be LPC, LMHC, LMC, and many others. Counselors work with individuals and groups using any number of “talk therapy” methods from cognitive behavior therapy (CBT) to family systems theory. I’ll come back to theories in a later post. Counselors can also diagnose (in Texas, anyway – be sure to check in your state by contacting your state’s board of counseling), provide testing, assessments, and evaluations of many kinds. Counselors don’t prescribe medication, but they will work with you and your doctor should you be on or desire medication to help you with your diagnosis or issues. Counselors work in clinics, hospitals, community mental health centers, and in their own private practices. Bottom line: can see clients for talk therapy treatment, assess, evaluate, diagnose (in most states), and has a minimum of a master’s degree and 3,000 hours of supervised practice before licensure (in most states).
Social Worker (LMSW/LCSW) – Social workers don’t all work for ‘social services’. Many of them work as counselors in multiple settings. A social worker functioning as a therapist or counselor should have a master’s degree in social work at a minimum. “Social worker” isn’t a protected term in the way it should be. Just meeting someone who uses that title doesn’t indicate education or license. Someone calling themselves a social worker may have a bachelor’s or master’s degree. If they are practicing therapy, they should have a master’s degree and a license issued by their state. Bottom line: social workers working as therapists should be licensed by their state and have a master’s degree. Individual states will have regulations about diagnosis. Social workers are typically trained to deal with more basic needs (safety, etc.) while other types of therapists are trained to deal with higher order needs. See Maslow’s Hierarchy of needs for a picture of this. Counselors and marriage and family therapists focus on the top half of that triangle, social workers on the bottom half in most of their educational programs.
A special note on “coaching”. Life coaching and other popular forms of “coaching” aren’t, at the time of this writing, regulated by any state licensing board. A coach may have any education from high school equivalency to a master’s degree, from a certificate in coaching to none at all. The coaching profession has several organizations and people who issue trainings and certifications in it, and anyone can get one and open up a practice as a life coach. If you want to work with a coach, try finding a counselor or social worker that offers coaching services. At the very least, ask questions and do research before you sign up with a coach.
If you want or need medication-based intervention for mental health struggles your first stop should be either your family doctor or a psychiatrist. They are typically the only two professions that can prescribe medication. While its ideal that a psychiatrist oversees your medication treatment for mental health matters, it may not always be possible. There is a shortage of psychiatrists in my home state (Texas) and few of them here accept insurance. This means that many times going to your regular family doctor is the best option.
A Final Thought
Any professional you go to for help with your mental health concerns should be willing to answer questions from you about their education and qualifications. If you go to work with any sort of ‘therapist’ – counselor, social worker, or psychologist, ask what theory or method they use when working with clients. If the person you contact doesn’t want to answer questions, keep looking.
If you’ve got questions relating to the counseling profession or mental health professions in general, I’d love to hear them in the comments.