Actualizado: 28 de jul de 2020
The first time I set out to find a therapist, I was completely overwhelmed when my search on Psychology Today revealed a long list of names, titles, and degrees. My experience as a recently graduated psychologist left me familiar with the various acronyms, but I had no idea what they meant when it came to choosing someone to help me fix my life. What’s the difference between, say, a Ph.D. and an L.C.S.W. in a therapy setting? Are therapy and counseling the same thing? How do you pick? Does it matter?
For a lot of people, certain degrees aren’t crucial enough to make or break the decision when picking a personal therapist (or counselor—we’ll get there, I promise). In general, many mental health professionals are trained to do a lot of the same stuff, including diagnosing and treating mental disorders and helping you work out all of your shit. But, depending on their degree, some of these professionals have received more years of training, specialize in certain areas, or center their practices around different therapeutic approaches.
With that in mind, let’s get started. Buckle up.
First, you can categorize mental health professionals by their level and type of degree.
To keep you from thoroughly flipping out when it comes time to dive into the specifics of each type of clinician, licensed clinical psychologist Ryan Howes, Ph.D., highly suggests visualizing two overarching distinctions: level of degree (master’s vs. doctorate) and type of degree (counselor vs. therapist). Got that? OK, now think of those distinctions as overlapping into four quadrants.
“A mental health professional will be somewhere in one of those four quadrants,” Howes tells SELF. That could mean someone with a Ph.D. works as a counselor, for instance, while someone with a master’s might practice as a therapist. It could also mean the reverse. It depends on the level and type of degree someone gets.
Here’s how that breaks down.
Level of degree
According to the American Psychological Association (APA), a mental health practitioner will have either a master's degree or a doctorate degree, or some combination of both. In order to practice (meaning, have direct client contact), clinicians also need to become licensed through their state's licensing board. Some states have different requirements, but they all involve the completion of a degree, a certain amount of internship and/or post-degree supervised clinical experience, and passage of a state-recognized exam. The most common mental health licensing exams are administered by the National Board for Certified Counselors (NBCC), the Association of Social Work Boards, Association of Marital and Family Therapy Regulatory Boards, and the Association of State and Provincial Psychology Boards.
Most master’s degrees in the mental health field take two to three years to complete, combining learning and hands-on experience. On average, those licensed at the master’s level have about 2,000-4,000 hours (or 2-3 years—they’re about equivalent) of supervised clinical experience under their belts, according to data from the American Counseling Association, American Association for Marriage and Family Therapy, and Association of Social Work Boards.
On the other hand, most doctorate degrees in the mental health field take five to seven years to complete, according to the APA. These programs focus on advanced coursework while participating in clinical practicums (supervised practical study such as shadowing licensed professionals), internships or residencies (which are a little more hands-on), plus a comprehensive exam completion of a thesis, dissertation, research project, or specialty paper, depending on the program.
So, program length is one clear difference between a master’s and a doctorate. In turn, program length can influence the depth and scope of a clinician’s specialty. Someone with a doctorate simply has more time to learn about various treatment modalities or dive deep into the ones they’d most like to practice.
On the other hand, master’s-level clinicians are often a lot more accessible. There are some parts of the country such as rural areas where there’s a dearth of clinicians with Ph.D.s and Psy.D.s, and just in general, there are a lot more master’s degrees out there, says Howes. “Doctorate-level folks are going to cost a lot more usually and sometimes have less availability,” he adds.
All of that said, here’s a common misconception that Eric Beeson, Ph.D., L.P.C. (licensed professional counselor) and president-elect of the American Mental Health Counselors Association, wants to clear up: Master’s-level mental health professionals are not “therapy lite.” The work of master’s- and doctorate-level professionals can overlap in a lot of ways, but it can also be very different depending on the actual clinician, their approach, their specialty, and their specific degree. To say that one is just a lesser version than the other isn't accurate.
Type of degree
At either level of schooling, there are different programs that concentrate on certain specialities—psychology, counseling, social work, addiction and substance abuse, and marriage and family therapy to name a few—but they are all technically built on a foundation of either therapy or counseling.
Which brings us to the big, complicated question that started all of this: What is the difference between “therapy” and “counseling,” anyway?
The therapists and counselors I talked to struggled to give me a definitive answer, because there really isn’t one. “We all do the same service, we just do it with a different professional perspective and a different philosophical approach,” says Beeson.
In the most rudimentary sense, counseling usually errs on the practical side. Counselors are focused on questions like: How do we fix this? How do we get your needs met? What can you start doing today? Psychotherapy typically focuses on the theoretical side. Why do you feel that way? Where did that come from? What's the origin of this attitude or habit or problem?
“A supervisor once explained it to me this way,” says Howes. “A client in session says, ‘I think there are people outside the door listening to us.’ A psychotherapist asks, ‘Why do you think that? Do you feel this way often?’ A counselor walks over and opens the door. In other words, therapists are more about helping you understand yourself and how you perceive the world, while a counselor finds pragmatic solutions.”
But, because apparently nothing can be simple in this field, Howes and Beeson also emphasize that there is a lot of overlap. You'll undoubtedly run into counselors who ask the feels-y questions about your past and psychotherapists who help you problem-solve your day-to-day issues. For instance, both therapists and counselors can practice cognitive behavioral therapy (CBT), which is a type of therapy that explores your unhealthy thinking and behavior patterns and then gives you the tools to change those thoughts and behaviors. Both theoretical and practical!
In a lot of ways, it’s all semantics. Some people with degrees in counseling call themselves therapists, some use the terms interchangeably, and to complicate things even further, a lot of mental health practitioners have multiple degrees. In fact, the only title that’s regulated—meaning, someone can’t legally use it unless they have the proper education and licensing—is “psychologist”. We’ll get into this in more detail below, but basically, you need a Ph.D. or Psy.D. to call yourself a psychologist. On the other hand, any mental health practitioner can call themselves a therapist, counselor, or clinician.
So basically, you can call it whatever you want, because a lot of mental health professionals sure as hell do.
“Many people feel like saying they ‘went to counseling’ is less stigmatizing than saying they ‘went to therapy’,” says Howes. “I have some clients who prefer to call our work counseling and others say therapy, and I don’t dispute any of them. We’re doing the same work—they’re welcome to call it whatever they want.”
Now that we’ve covered ALL THAT, we’re finally ready to start talking about…
What all those letters after a therapist’s name actually mean
Heads up: The goal here isn’t to tell you, “If you’re dealing with X, you should seek out a therapist with Y degree.” It’s to help you make an informed decision between the many professionals capable of helping you, because there’s a very, very good chance that many of them have the potential to be effective.
“It’s difficult to determine whether one type of mental health professional is better than another based solely on their degree or training,” Teri Brister, Ph.D., L.P.C., director of Information & Support for the National Alliance on Mental Illness (NAMI), tells SELF. “You should look at their interests and specialties to make sure they align with your goals for therapy.”
Here are the most common professionals you’ll probably run into while searching for an individual therapist. Keep in mind that this isn’t an exhaustive list.
Clinical psychologists: Clinical psychologists are mental health professionals with a Ph.D. or Psy.D. in clinical psychology. According to the APA, Ph.D. programs in clinical psychology tend to emphasize theory and research methods for academic and research work more so than Psy.D. programs, which focus more on providing psychological services.
So, when you think back to those four quadrants Howes laid out, clinical psychologists fall in the quadrant of doctorate-level clinicians with therapy degrees (in this case, in clinical psychology). Meaning, they’re bringing a well-rounded set of theoretical tools to the table to help you work out your stuff. If you’re wondering about counseling psychologists (the professionals at the cross section of doctorate-level clinicians and counseling degrees), you’re not likely to run into one when searching for an individual therapist. They tend to wind up working in the realm of school counseling or other community settings, according to Beeson.
Licensed Mental Health Counselors (L.M.H.C.) and Licensed Professional Counselors (L.P.C.): These are master’s-level clinicians with counseling degrees. Another quadrant! According to Beeson, L.M.H.C.s and L.P.C.s are nearly identical in training. They mainly differ by license title state by state, so I’m lumping them together. L.M.H.C.s and L.P.C.s bring a solid set of practical tools to their practice, usually from one or two modalities, like CBT or dialectical behavioral therapy (DBT), two types of therapy that are aimed at changing unhelpful thought patterns and improving emotional regulation.
The scope of an L.M.H.C. or L.P.C.’s practice is probably a lot like what you imagine when you think of therapy: They work with individuals, families, and groups to treat mental, behavioral, and emotional problems and disorders and equip them with the tools (such as CBT exercises) to combat challenges. According to the American Counseling Association, they also make up a large percentage of the workforce employed in community mental health centers, agencies, and organizations.
Licensed Clinical Social Workers (L.C.S.W.): These are counselors with master’s degrees in social work. More so than other degrees in the mental health field, their training involves working in bureaucratic systems like a state’s Division of Child Care Services or Department of Mental Health, says Howes. Because of this, they sometimes provide case management services, meaning that they help evaluate, coordinate, and advocate for a client’s mental health service needs, according to the National Association of Social Workers. Case management is a wide umbrella, but as an example, this might look like supporting a patient and their family in a hospital or helping a survivor of domestic violence find temporary or permanent housing.
In one-on-one therapy, Howes says L.C.S.W.s typically fall more on the “counseling” side of the spectrum since they are especially focused on problem-solving. “Because of their bureaucratic experience, social workers are rockstars when it comes to resources,” he says. For example, if you go to therapy because you’re burnt out on taking care of an aging parent, an L.C.S.W. can help you navigate available adult services, or if you’re dealing with a financial crisis, they can help you enroll in a food stamp program. For the same reason, they can be especially adept at exploring the societal and environmental factors that can impact your well-being, such as systems of oppression, like racism, classism, and sexism.
Licensed Marriage and Family Therapists (L.M.F.T.): And lastly, we have the master’s-level/therapy quadrant. These are mental health professionals trained and licensed in therapy and family systems. Similar to how L.C.S.W.s take into account how various social and societal systems might affect you, L.M.F.T.s can work with you on figuring out how the interpersonal relationships in your life and history could be causing distress, says Beeson.
L.M.F.T.s often specialize in a few things that might appeal to you: couples issues such as conflict, infertility, divorce, and adoption; sex therapy; childhood and adolescent therapy; family issues like caregiving, financial distress, grieving, anger issues, and anything else that might be informed by your home life and relationships. Contrary to the name, L.M.F.T.s offer individual therapy, too.
And if you’re wondering, “Why are they called marriage and family therapists when I hear it referred to as marriage counseling all the time?”...well, once again, my friends, this is a phenomenal example of how NOTHING MAKES SENSE AND WORDS DON’T MATTER.
It’s really about finding the right person, not finding the right degree.
The difference between the right and wrong therapist or counselor for you is not going to come down to the letters after their name. It’s about whether you feel comfortable with them and vibe with their personality and therapy style. That might take some trial and error, since finding the best therapist for you is kind of like dating: You might have to sit through a few bad sessions before meeting a match. Beeson and Howes both suggest checking out a therapist or counselor’s website when possible; many practitioners go out of their way to make their personality shine through.
“The question when I'm looking for a provider is, What provider is going to help me develop a strong therapeutic relationship that will get me where I want to be?” says Beeson. “It’s, Who's going to be able to connect with me in a unique way that's actually going to help me?”
The search could involve narrowing down possible therapists and counselors by their degree, but it also might not. “While it is important for therapists to be educated, trained, and up-to-date on current practices, there is so much more to a good therapist than just their background and education,” says Brister. It's not unlikely that you'll find someone who looks perfect on paper (and, in fact, has written several papers on the exact issue you're struggling with) but when you sit down in their office, the chemistry just isn't there. Knowing all these different levels and types of mental health degrees can make your search less overwhelming, but when it comes down to it, finding the right fit for you personally is the crucial part.