Most undergraduate students in psychology or social work or some other “people-helping” field want to get into the field of mental health, but they don’t know how to go about it. Well, I don’t blame them. To begin with, there are so many different terms that seem to sound like the same thing (for example: psychotherapy, psychology, psychiatry) it can be quite confusing. To add to the confusion, there are different professions that all seem to do the same thing, and different educational pathways towards these professions.
The purpose of this post is to provide an introduction to the different psychotherapy professions and the educational pathways you can consider (and it will be from a biased perspective: my bias!). I will limit my discussion to psychotherapy as it is taught and practiced in North America. First, let us clarify some important terms.
Psychotherapy. Psychotherapy is a broad term that covers therapy that makes use of the psyche (or the mind) for treatment. A psychotherapist uses talk-therapy, cognitive therapy, behavior modification, etc. to treat a person while a medical doctor will tend to resort to pharmacotherapy (or drug therapy) to treat a person. In the USA and Canada, the psychotherapy is NOT a profession, but a description. A more official term to use than Psychotherapist is Mental Health Professional (see wikipedia link).
Profession. A profession is a paid occupation, esp. one that involves prolonged training and a formal qualification (e.g. lawyer, doctor, psychologist). The training tends to last at least 2 years, the formal qualification is often granted by an association after a formal exam, and the individual is licensed by the state and/or country. It is a crime to refer to yourself as a lawyer or a medical doctor, or a psychologist unless you have been trained and qualified as one. These professional titles are legally protected. Types of mental health professions include: Psychiatry (MD), Clinical/Counseling/School Psychology (LP), Marriage and Family Therapy (LMFT), Clinical Social Work (LCSW), Counseling (LPC).
Main Differences Between Mental Health Professions
PSYCHOLOGIST. There are many different kinds of psychologists, and not all are “mental health professionals” in the vein of a psychotherapist. For example, an Industrial/Organizational Psychologist will not see patients with depression. The psychotherapy oriented psychologists include: Clinical psych, School psych, Counseling psych. Nowadays, in order to become a Licensed Psychologist (LP), you need to have a doctorate, either a Ph.D. or a Psy.D.
Clinical psychologists tend to do a lot of mental health assessments from diagnosing depression to figuring out if you have a personality disorder, or even if you have learning disabilities. They can see people of all ages, but usually, will specify if they specialize in seeing children (because special training and skills are required to work with young children).
School psychologists also do a lot of mental health assessments, but they work in the school setting seeing children from K-12. If your child is having problems (learning difficulties or mental health issues), a teacher may likely have them be consulted by a school psychologist.
Counseling psychologists are what you see in movies and TV: the kind that sits on a nice comfy chair opposite their clients, ask questions, nod and look very empathetic. They mostly specialize in adult talk-therapy.
If you are having a simple problem with depression, all the above psychologists should be able to help you.
(See American Psychological Association and Wikipedia entry on Clinical Psychology)
MARRIAGE AND FAMILY THERAPIST. This is my profession, and so I understand this best compared to all the other mental health professions. It is a fairly young profession compared to psychology and social work, but in some states, it is a very strong profession (e.g. California, Minnesota). A marriage and family therapist who is trained through the AAMFT-accredited schools will have training in working with multiple relationships beyond any of the other professions. We are comfortable working with multiple family members at the same time (and I’ll admit that I find it more interesting when there is actual conflict in the room than when everything is going smoothly!)
To become an LMFT, you need to get a two-years masters in an accredited program, then get 1000 hours of face-to-face supervised therapy experience, and then sit for a national exam followed by state oral exam. The key difference between LMFTs and the other professions is that we specialize in working with marriage and family relationship problems.
(See American Association for Marriage and Family Therapy and Wikipedia entry on MFT)
COUNSELOR. The problem with the term counselor is that it is a very generic term, and so people don’t often realize that “going to see a counselor” could mean anything from getting credit counseling from a bank to receiving hypnotherapy at a hospital. And just to make things more complicated, both the American Psychological Association and the American Counseling Association both use the term “counselor” in their professional titles: an LP (licensed psychologist) specializing in counseling psychology or an LPC (licensed professional counselor). In this section, I’m referring to the Licensed Professional Counselor.
An LPC is a masters trained mental health professional that uses a variety of psychotherapy modalities to address people’s mental health concerns. The training received by LPCs is a lot less rigorous than LPs (which require a doctorate) and a little less rigorous than LMFTs (in terms of clinical face-to-face hours).
It is interesting to me that if you go to the CACREP website, you will find programs in career counseling, college counseling, community counseling, gerontological counseling, marital couple and family counseling, mental health counseling, etc.
In general, of the LP, LMFT, LCSW, and LPC licenses, the LPC license is considered the less well regarded (at least in California and Minnesota). But I have met a couple of LPCs whose work I respect very much.
(See American Counseling Association and Wikipedia entry on Licensed Professional Counselor)
CLINICAL SOCIAL WORKER. The main difference between social workers and other psychotherapists is that their field advocates going out into the field where the people are. If psychology is about seeing people in private offices, then social work is about going to the people where they are. Some social workers train to become clinicians, in that they are licensed to do psychotherapy. These are often referred to as Licensed Clinical Social Workers (LCSW, or LiCSW).
To become a LCSW, you go through a Masters Degree in Social Work, and do a few more psychotherapy-related coursework. Of all the psychotherapy training mentioned here, social workers are least trained to be “clinicians” (compared to psychology, counseling, or MFT). This does not mean that a LCSW is a bad psychotherapist—they may have obtained further training on their own to build up their competence as a clinician. I personally know some LiCSWs who are excellent clinicians.
(See National Association of Social Workers and Wikipedia entry on Social Work)
PSYCHIATRY. A psychiatrist is a medical doctor. Psychiatry is a specialty of medicine, and you need to have a medical degree in order to become a psychiatrist. It is the highest salaried of all the mental health professions. Psychiatrists often see patients to diagnose mental health disorders and to prescribe medication. At the same time, psychiatrists tend not to be very well trained in talk-therapy. They tend to see mental health problems as pathologies using the language of the DSM (Diagnostic and Statistical Manual of Mental Disorders), for example, Bipolar Disorder, Schizophrenia, Borderline Personality Disorder, etc.
Usually, a patient will go and see a psychiatrist through the referral of a counselor (LPC) or a clinical psychologist (LP). And usually, patients are referred to a psychiatrist for specific diagnosis of mental health disorders and to receive medication.
(See American Psychiatric Association or Wikipedia link on Psychiatry)
Sometimes, too much information can be more confusing than helpful. The reason why people give a lot of information is so that they can be accurate as to their representation. I’m sure many psychologists, social workers, and counselors will read my entry and offer corrections (you are welcome to do so, please leave me a comment). But for the student who wants a “big picture,” let me offer very some grossly exaggerated caricatures of what each of these professions do or are regarded (from my lens as an MFT). Here we go.
• The psychiatrist is a medical doctor. He (usually a man) is more interested in giving out drugs than in talking to patients. We psychotherapy types don’t usually consider him as one of us, unless we need his help for assessment and to have our clients get medicine when talk therapy is not working.
• The psychologist is the “ooh—aah” of the psychotherapy professions. We masters-level trained types think that they think too highly of themselves. But we secretly wish we were LPs too because they earn a lot more than we do (average $70k compared to our measly average of $40k). When we masters-trained types feel stuck with our clients or need specialized assessments, e.g. for learning disability, we will consult them.
• The marriage and family therapist is a snob. (Yes, we are!). We think that ours is the best field of all because we are systemically oriented—all “problems” stem from relationships. We are so snobbish that some of us will even refuse to use mental health disorder categories (like borderline personality disorder) because we think they come from an individually oriented medical model, and is not a helpful way to think of problems, for example, a woman who is depressed is not depressed by herself, but rather her depression is strongly associated with her poor marriage or family of origin problems, etc. We marriage and family therapists are a small profession, and unless we are loud and aggressive about our work, we may likely get squeezed out by psychology or social work in the future.
• Social workers are not really clinicians. They are more advocates than anything else. And their training in psychotherapy is very poor. The only reason why they are well accepted as a license is because social work as a profession overall is very old (as old as psychology) and they are very loud and aggressive.
• Licensed professional counselors are master’s level psychologist-wannabe’s. Comparatively speaking, it’s one of the easier of the mental health professions in which to get licensed
• Ph.D. = the ticket! You can increase your salary to be at the same level as a psychologist if you obtained a Ph.D. in MFT, or Social Work, or Counseling. Not only will you be better reimbursed, you will also get the same level of respect that a psychologist gets. In fact, even a psychiatrist will respect you when you say that you are Dr. So-And-So with a Ph.D. in MFT or Social Work, etc. BUT, you pay for it through about 4-6 more years of schooling post Masters.
[This post was written for Avis and other people in her situation.]
9 months ago