What is the Licensing for a “Therapist,” “Counselor,” etc?

I have found your column informative, although I’ve never considered myself someone who needs mental health assistance. Something has come up, however, and although I would rather not write about it here, I notice that you often recommend seeing a “therapist” or “psychotherapist” or “counselor.” Before I put myself in someone’s hands, what is the training or licensing for these people?

This is a good question, because these terms are actually quite vague. The unfortunate fact is that anyone can hang out a shingle with the title of therapist, psychotherapist, or counselor. (For all intents and purposes, there may be little or no difference among these terms, although some would consider “counseling” to have less clinical and more advice-giving connotations.) When we speak of a therapist in this column, we are referring to someone trained and licensed in any of a variety of specific disciplines.

A clinical social worker (LICSW means licensed to practice independently) has a masters degree in social work, a field with a rich history of addressing social needs and providing assistance by taking into account individual and systems factors. A clinical psychologist has a doctorate (Ph.D., Psy.D., or Ed.D.) including training in psychological theory, clinical techniques, research, and psychological assessment. A psychiatrist is an M.D. who, after medical school, chooses to specialize in mental health treatment in residency, generally gains much hospital experience, and is able to prescribe medications. (In recent years, psychiatry has moved increasingly toward expertise in the biological/medical aspect of mental health treatment, leaving the “talking therapy” to the other disciplines, although there are still many psychiatrists who do both.) A clinical nurse specialist also comes from a medical background, has an RN and a masters degree, and may be able to prescribe medications under the supervision of a psychiatrist. There are a number of other kinds of masters-level therapists, with titles such as “mental health counselor” and “marriage and family therapist.” Some, but not all, are licensed. Finally, there are certified alcohol/drug counselors, who have perhaps a year’s formal training, often augmented by relevant life experience. To complicate matters, many psychologists and social workers also gain certification in alcohol/drug/addiction treatment over and above their other training and licensing.

In many cases, the particular personality, clinical orientation, and experience of the practitioner may be more important than academic/professional discipline. Although a license is no guarantee of quality, we believe it vastly improves the chances of receiving quality care. A major part of our work at LCL is to match people with “therapists,” which is shorthand for any of the kinds of licensed professionals described above.

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