Who in the Health Do I Go To For Help?
What different people do in the broader world of mental health.
This article grew out of many conversations I have had while working at an inpatient psychiatric hospital and I figured more people probably had questions about what different professionals do in the mental health field.
Under each heading, I have included a brief summary of services to quickly understand who does what and how they can help. Following this, there is a more detailed outline of some of the differences between each profession. Most of these have to deal with differences in licenses and titles and has little to do with actual function. This is most prevalent in the counselor, therapist, and social worker sections.
Preface
First, I can only speak from my experience and my understanding regarding the state I live in (Louisiana), but I hope these general explanations can be of benefit.
Second, I will try to avoid any biases due to my being in the field. So I will put my cards/license on the table and say that I am currently a provisional licensed professional counselor (PLPC) on my way to being independently licensed in my state — more on what that means below.
Third, the following list is not in any order of importance — each provides vital services to the community based on people’s various needs.
Fourth, there is a lot of overlap between these and if I knew how to make a good Venn Diagram I would.
Counselors and Therapists
When looking at the words counselor and therapist, we need to make a distinction between titles and functions. Functionally, a counselor or therapist is someone who provides therapeutic counseling services for someone in need of mental health treatment.
This is what you think of when you imagine someone sitting in an armchair, wearing a cardigan, and talking to someone on a comfy couch (this is what I do, cardigan, and all because it's drafty in my office). Counseling and therapy, broadly speaking, are what is sometimes called “the talking cure.” Counselors and therapists utilize their respective training to establish and maintain a trusting, healing, and empathetic environment for individuals, families, or groups to heal, grow, or process through a difficult life.
A counselor or therapist is someone who has completed a bachelor's degree (in any subject really) and has gone on to complete a master's degree in a mental health field and has gone even further to pursue a State License in mental health. Their coursework has a large emphasis on family systems theories, group counseling dynamics, human sexuality, theoretical foundations of counseling, and psychopathology — all subjects that help them help you.
The Details (titles)
So is there a difference between a counselor and a therapist? Absolutely and not really.
Short answer: it depends on which licensing board you ask.
Longer answer: the difference between a therapist and a counselor depends on the (1) graduate degree they completed and (2) the license they pursued following that degree. In Louisiana, the two primary licenses at play are licensed professional counselor (LPC) and licensed marriage and family therapist (LMFT).
For both of these licenses, there is the provisional period during which an individual is accruing supervised experience towards becoming independently licensed. I am currently in that liminal stage wherein I am not actually allowed to say that I am a counselor. I must refer to myself as a provisionally licensed counselor. Additionally, I can never refer to myself as a therapist. The workaround for this will be to say that I am a counselor who does therapy and does counseling.
Social Workers
At the hospital, people often come up to me and ask “are you the social worker” to which I often reply “yes, what can I help you with?” In these situations, the person is not actually asking me “what license do you have?” They are really asking me, “are you the person I can sit down and talk with?” or “are you the person doing my case management?” The answer to that question is “yes.”
If I answered the question as asked, I would say no because a social worker is someone who completed a degree in social work and is now licensed under a totally separate entity whereas I am a counselor who completed… You can see where this becomes a longer discussion than it ever needed to be.
A social worker is someone who has completed a master's degree in Social Work and has gone one to pursue a license with their respective board. Generally, someone who is a licensed master social worker (LMSW) is working towards becoming an independent practitioner by becoming a licensed clinical social worker (LCSW).
When it comes to mental health services, social workers (at the LMSW and LCSW levels) can provide the same clinical services as a counselor or therapist. Social workers have a broader range of services in that they have training in advocacy, social welfare, and addressing concrete human needs by connecting people with services in the community. Due to this broader training, they generally have less required coursework in counseling and therapy more specifically.
The Details (degrees)
There are essentially 3 levels of social work that mostly relate to education level: bachelor's level, masters level, and “clinical” level. These are discussed further in the details.
Essentially, an LMSW or LCSW can call themselves a social worker and can provide the same clinical services as a counselor or therapist would. A social worker can, therefore, say that they do therapy and do counseling as a social worker but they cannot refer to themselves as counselors (LPC) or therapists (LMFT).
It is important to note that only LMSW’s (under supervision) and LCSWs can provide clinical/counseling services. Bachelor’s level social workers cannot do so. I have even heard some LMSWs and LCSWs shake their heads at people with bachelor’s degrees in social work calling themselves “social workers.” So take that as you will, I am not here to start any fights.
When it comes to counseling and therapy, social workers are able to provide clinical services in the same way that LPCs and LMFTs are able to. However, because of the broader nature of social work, there is often less training and experience with one-on-one or family counseling. This is not a limitation of the profession. Rather, it allows social workers to be more knowledgeable about broader social services than most LPCs/LMFTs when they complete their degrees.
LPCs and LMFTs are beginning to become more and more involved in the broader world or mental health and social services. This can be seen in the specializations many schools offer at part of their Master's programs. For example, my exact degree name was “Master of Arts in Counseling with a Specialization and Clinical Mental Health Counseling” which included course content involving advocacy, mental health in clinical settings (such as hospitals and the department of child and family services), and social justice issues and their effect on individual mental health.
Addictions Counselor
While counselors, therapists, and social workers are able to do addictions counseling, they are not “addictions counselors.” If you have not picked up on the trend yet, mental health practitioners (but more specifically their licensing boards) are very picky about how one refers to themselves (or, rather, how other professionals refer to themselves). No one ever felt betrayed when I answered “yes” to their inquiry about my being the social worker at the hospital only to find out that I was, in fact, a provisionally licensed professional counselor.
An addictions counselor is a specialist in one area of mental health, addictions, and has less formal training and education in broader mental health like the professions listed above. As I mentioned above, this is not a drawback. Addictions counselors being able to specialize and focus on one major area of research, practice, and training allows them the opportunity to really dive deep and help people with very specific needs that come with addiction.
The Details (hours)
Unlike with the previous professions which require a master's degree, there are several levels of addictions counseling that do not. Here is a brief rundown.
Someone can actually enter into this field as early as 16 and become an addiction treatment assistant (ATA) provided they are 16 and have not had a substance use issue in the past 6 months. The next level is to become a counselor-in-training (CIT) if you are 18, have a high school degree, and have completed 180 hours of addictions related education. This is 180 clock hours, not course hours like you see in higher education where one class is 3 hours of credit.
From here, people can move up the ladder in addictions treatment by accruing more hours of education and supervision. The next step would be for someone to become a registered addiction counselor (RAC) which requires a high school diploma and the completion of the required clock hours of education/supervision/testing.
To become a certified addictions counselor (CAC) one needs a bachelor's degree roughly 2 years of full-time practical work and to become a licensed addiction counselor (LAC) one needs more practical hours and a related master’s or doctoral degree.
There are a lot of details that have been left out of here but what is important for the “consumer” to know is that being an addictions counselor can mean a wide range of things so it is beneficial to know what level of training someone has in order for them to meet your needs for counseling.
Doctors, Practitioners, and Psychologists
Let’s start with doctors and let’s do so by discussing doctorates. There are, very broadly speaking, 2 sets of letters that allow someone to call themselves a doctor: M.D. and Ph.D. A Ph.D. is a Doctor of Philosophy and is typically the highest academic level of education someone can achieve in their field of work.
However, a Doctor of Philosophy is not just given to philosophers, it is given in all fields of study from engineering to English Literature. Completing a Ph.D. generally involves the testing of a theory, called a thesis, and the discussion of the results of that tested theory, called a dissertation.
Why is this at all important?
Just because someone introduces themselves as a doctor does not mean that they are a medical doctor. This is not a bad thing, it is just a confusing thing. In terms of mental health, people can complete Ph.D. programs in social work and counselor education and supervision (the one in which I am enrolled) and be called doctor. In this case, they are a mental health professional who has completed a doctorate and is not a medical doctor. Accordingly, they cannot prescribe medications.
Medical Doctor (M.D.)
A medical doctor is someone who has completed medical school (4 years) and a residency in a specific area (generally 4 years) such as podiatry (feet), oncology (cancer), internal medicine, etc. Medical doctors can also, in many cases, prescribe psychotropic drugs (meaning anything that has a primary purpose of treating an imbalance in the brain) to treat depression and anxiety — major components of mental health more broadly. In many cases, a primary care physician (PCP) will address mental health concerns with a patient and could prescribe medication and then refer out for counseling/therapy or refer out to a psychiatrist.
A psychiatrist is someone who completed medical school and then specialized in psychiatry. These are doctors primarily concerned with the human mind and treating the broad range of mental disorders. Psychiatrists can prescribe medication and in some (but increasingly fewer cases) provide talk therapy in service of medication management. More often, however, a psychiatrist will refer out for the counseling/therapy components of treatment.
Psychologist
A psychologist is someone who completed a PsyD, or a Doctor of Psychology. Most PsyD programs are a 5-year program that people enter into after their bachelor's degree and is a combination of Masters and Doctoral work done concurrently. A psychologist differs from a psychiatrist in that they do not prescribe medications and will have more of an emphasis on research, assessment, and psychotherapy.
Generally, people will seek out a psychologist if they are addressing concerns related to organic or genetic components to mental disorders such as autism spectrum disorder. Psychologists are the more classical version of talk therapists and are often more involved in the research and individual assessment realm of mental health than are the other professionals addressed above.
Practitioners
Lastly, there are practitioners. The most common practitioners that I have worked alongside are psychiatric nurse practitioners who have completed higher levels of training than that of registered nurses (RNs) which allows them more privileges and scope of practice in the medical and mental health field (depending on their specialty).
While there are many routes a nurse practitioner can take (Family Practice, Oncology, Pediatrics, and many more), one of primary concern is a psychiatric nurse practitioner. These practitioners are able to prescribe medication, diagnose mental disorders, and several other privileges not afforded to registered nurses. Finally, a nurse practitioner can also complete a Doctorate of Nursing Practice which allows them to be called doctor but it is because they have received a doctorate.
Conclusion
While no list can ever be exhaustive, I hope this can be an introduction to the broader world of mental health and the individuals whose job, and hopefully passion, it is to help others. I have worked alongside each one of these types of professionals and have learned, grown, and been challenged by each of them. It is encouraging to me that different professions have branched off to form different but complementary approaches to addressing the whole person when it comes to mental health.
Lastly, nothing listed above should be taken as medical or mental health advice. These are the opinions of the author mixed with information about degree/license requirements to receive and maintain a certain professional status.
If you are ever in need of help, seek help. There are many professionals within many professions that can be of great service.
