It’s always been confusing to know all the professions that provide counseling and psychotherapy. When I received my Master’s degree at what was then the Alfred Adler Institute in 1986, the only licensed non-medical professions that could provide counseling and psychotherapy in Illinois were social workers (with a master’s degree) and psychologists (who must have a doctoral degree).
Up until the 1980’s or so, there were also many psychiatrists who also provided psychotherapy. The image in the media (from Woody Allen to The Sopranos) was of a psychiatrist listening to patients talk about their problems – often on a couch. Bob Newhart introduced the television image of a psychologist providing psychotherapy.
In the last 25 years or so, most psychiatrists focused primarily on medication management. With their medical degree and (usually) board certification in psychiatry, these doctors have been best equipped to manage the prescription of medications for mental health problems, and to serve as attending physicians when people needed admission to a hospital for psychiatric problems.
In the 1990’s, people (like me) with a degree in counseling psychology began to advocate for the licensing of master’s degree trained professionals. They joined with people trained in counseling programs (often contained in university schools of education) to lobby for counselor licensure in Illinois and other states. These licensing laws were passed in many states starting in the mid-1990’s and continuing to recent years (with California being among the most recent to add counselor licensing).
In Illinois, counselors are licensed as Licensed Professional Counselor (LPC), which means they must work under supervision, or as Licensed Clinical Professional Counselors (LCPC), which means they can practice independently. These licenses are comparable to the social work licenses of LSW and LCSW.
Clinical licensing in Illinois requires the equivalent of two years of supervised practice after earning a Master’s degree. Counselors can be supervised by any licensed mental health professional (LCPC, LCSW, LMFT, or psychologist). Social workers, on the other hand, must be sueprvised by an LCSW in order to sit for the LCSW exam.
As a counselor educator as well as a practicing counselor, I know that it has sometimes been difficult, even for counselors themselves, to have a clear identity that distinguishes them from social workers, marriage and family therapists, and psychologists. Our willingness to be inclusive as we pushed for licensing laws led us to take the attitude that all of us are providing similar services and should be treated equally. Unfortunately, this has made it even more confusing for consumers to know what kind of therapist to choose when seeking counseling services.
So, basically, counselors and social workers both provide counseling and psychotherapy for a wide range of problems. Social workers may also work in agencies that provide casework services and help with referrals and resources for financial and other problems. Marriage and family therapists tend to focus on interpersonal problems and receive training in ways to intervene when family or relationship difficulties are the primary type of problem. However, counselors, social workers, and psychologists also have training in working with these issues, though they are less likely to specialize in family work.
In addition to providing psychotherapy, licensed doctoral-level psychologists are more likely to provide testing and assessment services, and to evaluate people for child custody or other legal purposes. They also tend to be active in research to a greater degree than the other professionals. However, in the current environment, all mental health professionals are more aware of the need to use evidence-based techniques for therapy. Insurance and managed care has also added to this trend. The evidence-based therapy techniques used most often are cognitive-behavioral therapy and interpersonal therapy.
There are other kinds of counselors and therapists that may be certified and/or licensed, as well. These include art therapists, rehabilitation counselors, dance therapists, and music therapists. Many of these therapists work in treatment centers or hospitals, and some may also be licensed (for example as LCPC’s).
In the field of employee assistance, there is also a certification called Certified Employee Assistance Professional (CEAP). This is a person who specializes in workplace issues and often has special training and experience in substance abuse. (I am also a CEAP, as well as a National Certified Counselor). Although CEAPs (like many types of substance abuse counselors) can be certified without having a master’s degree, it is becoming rarer to find one who does not. Certification is different than licensing: Certification attests to expertise and specialty training, while licensing refers to the legal ability to practice within a jurisdiction. Many professionals have both – for example, social workers can be Academy Certified, and psychologists can be certified by the American Board of Professional Psychology.
All of this may only add to the confusion, but consumers can be assured that anyone who is licensed at the independent level of practice should be qualified to provide counseling and psychotherapy. In Illinois, these include LCSW’s, LCPC’s, LMFT’s, and licensed psychologists (Ph.D, Ed.D., or Psy.D.) People with these doctoral degrees may not be licensed as psychologists, and (like me) may be licensed at the master’s level instead.
I hope this has helped you to understand the confusing alphabet soup of credentials for therapists, as well as answering the perennial question, “What’s the difference between a psychiatrist, psychologist, social worker, and counselor?”