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What are the various types of mental health professionals?
One sort of therapist is the Licensed Professional Counselor (LPC) who has at least a master's degree, which may be called an M.Ed., M.S., M.A. or M.A.R.E. and perhaps other things. The subject matter of their degree may be in psychology, behavioral science, counseling, or various other areas, though the particular courses taken are nearly the same.
There is a license in Oklahoma called Licensed Behavioral Practitioner (LBP) for people whose courses had the word "psychology" in their titles, or whose teaching department was called "psychology." Another license is the Licensed Alcohol and Drug Counselor (LADC) sometimes, but not always, possessing a master's degree.
Another practitioner is called a Licensed Marriage and Family Therapist (LMFT) for those whose training included a series of courses relating to family therapy. I have this license, and also the LPC. A family therapist may deal with a mental health problem, or s/he may deal with "problems of living," depending on the case.
There are also social workers, who are called Licensed Clinical Social Workers (LCSW) and by other titles. An MSW (master of social work) may or may not be trained in techniques of therapy.
Psychiatrists are medical doctors. They work mostly using medications. They are authorized to write prescriptions (which other therapists are not) and often have greater knowledge of their specialty than a general practitioner MD would have.
However, in some states, including Oklahoma and Texas, any M.D. who wants to be a psychiatrist can just say so, and he is one. It is desirable to get a "board certified" psychiatrist, who has demonstrated that he has the required knowledge. A "board qualified" or "board eligible" psychiatrist is one who has taken the specialized coursework, has passed the written tests, but has not sat before or been certified by the board.
For certification, the person must sit before a board and answer their questions, to demonstrate that he has the required knowledge. If he is not board certified, he may not have been out of school for very long, or he may not have decided to sit before the board, or he may have failed his boards in the past. He may also be an M.D. without psychiatric training, who isn't qualified to sit before the board. It is a good idea to look at the psychiatrist's diploma and license on the wall, and look for the words, "board certified."
A Psychologist usually has a Ph.D. (doctorate in psychology.) Sometimes that is just a job title, permitted by the state. For example, a school psychologist usually has a master's degree, and is not trained as a therapist. In Texas, a state employee with a master's degree might be called a psychologist, while the same sort of employee in Oklahoma might be called a psychological associate.
A licensed psychologist (clinical psychologist) is a Ph.D. who is trained in therapy, and also has special training in testing. Much of his training at the doctoral level is in research methods, and has little to do with treatment. Depending on the state one is in, other people may be called psychologists, whose whole training is in research. In other states they may have to call themselves psychological researchers.
To obtain his/her license, after acquiring the PhD the candidate must work for a year under supervision, then take a written test. Upon passing the written test, the candidate then sits before a board and orally answers questions. Upon passing his board examination, he is awarded his license.
Some psychologists specialize in sports psychology, industrial psychology or experimental psychology. Persons in those categories often do not have much or any training in therapy for mental health. The industrial psychologist may evaluate applicants for employment or determine what personality types are best suited for what sorts of jobs. The sports psychologist may give advice to athletes on how to maximize their performance.
A person with a Psy.D. has a doctorate in psychology. However, they have different training than a Ph.D. They don't learn as much about testing or research methods, don't write a dissertation, and don't have to learn a foreign language. They have more training in therapy than the Ph.D.
They do not have a psychologist's license, and do not call themselves psychologists. They are often licensed as an LPC or LBP, and sometimes call themselves a psychological practitioner.
Counseling Centers: Trainees, Registered Interns, and Licensed Practitioners
If you are seeking a low-cost, face-to-face option for counseling, one option is with community counseling agencies. Here, we’ll be focusing on the types of counselors and the level of training they’ve received prior to working with you. Note that every state operates a bit differently, so some terms may change based on where you live.
Counselor trainees (also referred to as students) are typically Master’s- or Bachelor’s-level counseling students who are completing an internship with the counseling agency, as part of their education. In general, bachelor-level and pre-graduation counselor trainees have the least direct practice experience; however, this is supplemented by a very high level of supervision and their current enrollment in a counseling education program.
Because trainees are not allowed to provide independent services, you may be formally assigned to the trainee’s supervisor and provided a mix of care from both counselors. While it is essential that trainees are provided the opportunity to receive practice experience, be mindful of the limited work a trainee has completed. Also, trainees are usually assigned to agencies for a short period of time (4 – 8 months); if you are seeking a longer-term relationship, a counselor trainee will likely not be able to provide this.
Registered interns (sometimes referred to as registered clinicians) are the next level up. In Oklahoma they are called "counselors under supervision," and must inform the client of that. These practitioners have completed their counselor program successfully, meaning they have undergone both rigorous educational requirements and many hours of direct practice as a counselor trainee. As a post-graduate, all states require both direct practice work, clinical supervision, and a post-graduate licensing exam prior to a counselor becoming a “licensed practitioner.” This is the transitional period that supervised counselors practice within, and depending on the state, may remain in for several years.
Although these interns require less supervision than counselor trainees, they are required to meet regularly for clinical supervision with an independent practitioner (usually at least one hour per week) in which cases are reviewed and guidance provided. These counselors, while still “getting their feet wet” to an extent, are often extremely dedicated to completing licensure and will provide a level of service similar to a fully licensed professional.
Licensed counselors and practitioners are those professionals who have completed all formal training and educational requirements for their state and license type, and who are now fully licensed to provide clinical counseling services independently in their state of practice. These counselors have the most experience and may also provide clinical supervision to new trainees and interns, depending on how long they have practiced. Typically, this level of counselor is highly experienced, may offer practice and counseling specialties, and is most likely to remain in their practice long-term.
However, with all levels of experience, not every counselor will offer the same insight, personality, or outlook that you might need from counseling. No matter how experienced your assigned counselor is, consider the following as you receive treatment. If the answer to these are no, it may be worth reaching out and requesting a new assigned counselor from your agency:
- Does my counselor seem prepared for my appointments, remembering things we have discussed in the past?
- Does my counselor follow-up with me on assigned “homework” or things I’ve mentioned as important events in my life?
- Does my counselor allow me the space and comfort to share openly about my thoughts and feelings?
- Does my counselor seem equipped to offer me suggestions, readings, or other insight into ways I can improve my mental health or other presenting issue?
- Am I walking away from most sessions feeling more empowered, more confident, or more guided in the next steps I should be taking?
FINDING A THERAPIST
Be careful to protect yourself. Just because someone says they are a therapist does not mean that they have had any training. People can call themselves a therapist (though not legally) a psychotherapist, an analyst, a counselor, a marriage counselor, a hypnotherapist, or a sex therapist and not have had any formal training.
There are people who claim to have a doctoral degree, but do not. Look for a diploma and a license on the wall. There are people with a doctoral degree, but perhaps in city planning, communication, or something else that is irrelevant to doing therapy.
If you have never heard of the university on a diploma, you may want to look it up on the web, and determine if it is accredited. If you still have doubts, you may want to contact the university and ask if that person graduated there. You may want to notice if the diploma looks "official." There is an organization called the Universal Life Church. They will sell a diploma over the internet for $2, giving you a Ph.D. However, their diploma looks sloppy and amateurish, and would put off anybody who has ever seen a "real" diploma.
If you can't see a license, they should be carrying a card-sized license certificate in their purse or wallet and should be willing to show it to you. They are also listed with their state licensing agency, and their name and license can be found on the web. (In Oklahoma, that is the State Board of Behavioral Health. Social Workers are Licensed by the State Board of Licensed Social Workers, and psychologists are licensed by the Oklahoma State Board of Examiners of Psychology.)
So how do you protect yourself ? ...By asking the following questions:
To a Psychiatrist: Have you had residency training in psychiatry and are you Board Certified by the American Board of Psychiatry and Neurology (nearly 2/3 claiming the title psychiatrist are not Board Certified. Sometimes it is because they can not pass their board exams or have not received training beyond the M.D.) If you arrive at their office, look at the certificates on the wall. If there are none, ask why.
To a Psychologist: Are you licensed AS a psychologist? If not, under what license (both title and number) do you practice and what is your training? (In Oklahoma they are licensed by the Oklahoma State Board of Examiners of Psychologists -- OSBEP.)
To any other therapist: What is your license, degree, and training? Generally, a license requires a year and a half or years of supervision after graduation, and a state test, before one obtains the license. Recommendations and a specific list of classes taken are also required. Where is the website of the licensing agency? Does it have all the licensed persons listed there?
First decide if you want a same-sex therapist or one of the opposite sex. If you are apprehensive about therapy then choose the sex of the therapist with whom you feel most comfortable. Consider, is the race or sexual orientation of the therapist important? Does the therapist specialize, for instance, in women's issues, race issues or gay issues? (In Oklahoma there are no official specialties. So a specialty in Oklahoma just means the counselor prefers to concentrate on that area.)
Next find out how much you can afford for therapy. Assuming that therapy is once a week, then figure out how much can you afford to pay for four sessions in a month.
If you have insurance, then contact your carrier and obtain in writing what they cover; i.e. if you have to see a specific therapist on their list, or if you have to see a particular type of therapist. Ask the carrier how much they pay for each office visit, and how many sessions they pay for. Also ask about annual and life time pay out limits. You should be able to find their 800 number on the plastic ID card they give you. Keep in mind that many insurance companies do not pay for a marriage problem, a stop-smoking or weight loss treatment, unless there are other symptoms of a disorder in an individual.
American Counseling Association Code of Ethics:
NBCC Code of Ethics:
AAMFT Code of Ethics:
Now you are ready to contact the therapist.
Ask the potential therapist if he or she has a few minutes to talk to you about therapy.
If he or she is not available at that moment, then ask when you can call at a more convenient time. If you discover that they are too busy for this brief introductory talk, you may want to ask whether they are accepting new clients and when the first available appointment could be made. They may be very busy.
If it is too long until you can get an appointment and you feel the need to be seen immediately, then ask for a referral to another therapist. The average wait is less than a week although rarely, with very busy therapists, it can be up to 6 months; so check with the therapist. Sometimes regulations limit the length of a waiting list, and require the therapist to make a referral, if needed. If you use a directory, perhaps location is important, especially in a big city.
Does the therapist limit his or her practice to a particular type of client?
Does the therapist do family or couples therapy if necessary? What type of therapy does he or she use? What type of experience, training, and license does the therapist have? Will the therapist read your history before you go to your first session? How long are the sessions, and how often does the therapist generally schedule sessions?
And of course, what is the fee and will the therapist accept your insurance and how are
co-payments and deductibles handled? (co-payments and deductibles are the amount that you have to pay beyond the insurance payment.)
Has the therapist ever had a license revoked or suspended; has he ever been disciplined by a state or professional ethics board and would he be willing to discuss it? (You can call the state licensing board or find it on the web, to check out his or her license, credentials, and any ethical violations. In Oklahoma, an LPC or LMFT is licensed by the state Board of Behavioral Health.)
Tell the therapist that you want to talk to a few other potential therapists and you will call back if you decide to make an appointment. Give yourself some time to think over and digest your feelings about the phone conversations. Then choose a therapist and make an appointment for an initial trial session. The first session should be used to help you decide if you WANT to work together.
AFTER YOU HAVE LEFT YOUR FIRST SESSION
Assess carefully your reaction to how it felt. Was the therapist open to the manner in which you presented your history? Did you get a sense that you could be comfortable with this therapist? Did you feel a sense of connection with the therapist?
Remember that each therapist creates a different environment and you have to decide if the atmosphere felt right to you. Do you feel that you will be able to trust this therapist?
Did the therapist push you to reveal things that were uncomfortable too quickly? Were your needs listened to? Did the therapist behave in a professional manner?
Did you feel comfortable about the goals that you two were able to set? Did your therapist tell about how therapy works and were you able to set some goals?
WHAT DOES THE THERAPIST EXPECT OF YOU?
This varies from therapist to therapist, but usually you are expected to:
1.) Show up on time for appointments. Unlike medical doctors that may keep you waiting hours for an appointment or who may accept you even if you show up late, a therapist has a specific hour set aside for you. If you are late, then you are missing out on time that was reserved for you. A busy therapist may have someone coming in right behind you. A not-so-busy therapist had to move things in his personal life aside for you, and went to the office and waited.
2.) Cancel appointments in advance so the therapist can reschedule (usually 24 to 48 hours). Sometimes therapists charge the full fee for missed appointments that are not canceled in advance because you are paying for the therapist's time that was allotted for you. Insurance will not pay for missed appointments. Often all you have to do is call and cancel, and that solves the problem.
3) Share your perceptions and feelings as openly and honestly as you can. This involves taking the risk of sharing your deepest fears and concerns--this will help you to make progress quickly. You should not wait until the end of the session to say what is uppermost on your mind. That makes it difficult to talk much about it.
4) Actively work on your issues with your therapist.
Some people come into therapy with the attitude, "I'm here, now fix me," when in actuality the process has to be one of both of you working together. If you won't do anything about your situation, it won't solve itself automatically.
5) Complete any "homework" which was assigned. (Homework is designed to help the benefits of therapy to extend beyond the therapy hour)
6) Think about and reflect on your therapy between sessions. Be ready to discuss thoughts that you have about the previous sessions or any insights that have come to you since your last session with the therapist. You may even want to start keeping a journal of your experiences. If you have tried but can't come up with any thoughts about the therapy then that is understandable.
7) Discuss with the therapist when you feel that you are finished with therapy BEFORE actually stopping. If you do not plan to come back, the therapist will not be mad at you if you do not continue. S/he will be a little perturbed if s/he waits an hour for a client who does not show up.
If you follow these guidelines, you are not only living up to the expectations of therapy, you are also putting yourself in the best position to get the most out of the experience.
WHAT NOT TO EXPECT
Don't expect a miracle cure from your therapist. Your problems have been with you for a long time and long-established patterns can take a while to change. Ann Landers and Dear Abby could solve a problem in a day, but no therapist is that good.
Do not expect your therapist to be your friend outside of the therapy session. This can lead to complications with your therapy and should be avoided. It is called a dual relationship, and is unethical. Doing business with the therapist (other than therapy) is generally discouraged. If there is any sort of business between you, you should be the one who clearly gets the "good deal."
Also don't expect your therapist to attend parties or other functions. Some therapists will come to significant life milestones such as a graduation or marriage, but other therapists feel that it is not appropriate. None should attend fun gatherings just to have a party. Talk to your therapist about your feelings in regard to these matters.
WHAT TO WATCH OUT FOR
If you feel that the therapist is setting goals for you which are based on what the therapist considers is important for you to change, and these goals are not your own, then discuss this with the therapist. At times some therapists may unwittingly introduce their own unresolved issues which influence their treatment decisions.
For instance, if you mention that you are in an unhappy marriage and yet you are going to therapy to get over stage fright, and the therapist says you have to work on your marriage first, then he may be a therapist to avoid. That therapist may be dealing with unresolved personal relationship issues which are influencing his or her judgement in regard to your treatment. This is rare, but it is something to be aware of.
If, for example, you have a symptom, such as chronic anger, and it is apparent that there is a continued stressor, such as your marriage, it might be reasonable that you should work on the stressor first, if the symptom is to be resolved. If you have had a traumatic childhood, that may be as important to deal with as annoyances that provoke your anger.
Never let the therapist perform any action or ask you to do anything that is against your morals and values. If a therapist ever asks you to do something unacceptable and does not respect your wishes then leave immediately. Of course, this is assuming you have told him of that.
Therapists at times are in a position of power and at times try and wield that power by saying "I know what is best for you." As with any profession, there is a small percentage of bad therapists who will abuse this power.
Remember, never do anything that is against your values. If necessary, discuss this with the therapist. On the other hand, don't use values as an excuse to avoid therapy. If you say your religion forbids this or that when it doesn't, or falsely state that you are not especially devout anyway, the only one you are hurting is yourself.
A therapist should never touch you without your permission. Some therapists will put their hand on your shoulder once they know you to offer support, but if such a gesture makes you uncomfortable then tell the therapist. If he or she does not respect your wishes then leave immediately.
If you ever have a particular problem or disagreement with your therapist, it is vital to bring this out in the open.
Disagreements will inevitably arise; and this is part of the therapy process. You should watch out for therapists who don't listen to your concerns or apologize for mistakes.
Therapists are expected to uphold the moral and legal standards of the community.
Clients should be treated with dignity, respect, and fairness. Therapists are also bound by professional codes of ethics, connected with their licenses or professional associations.
The following are behaviors that are not ethical for a therapist:
Any sexual approach is unprofessional and unethical for a therapist. Asking you to remove any of your clothes, or touching you in any way without your permission is unethical. Having romantic encounters or even asking to see you outside of therapy is also unethical. Doing commercial business with you is generally unethical, unless the "good deal" is for you, rather than the other way around.
Therapists may mention personal anecdotes to assist with your therapy, but the focus should not change to dealing with the therapist's problems.
The therapist may give you a reduced fee to help to accommodate your financial situation. When your situation improves it is customary to re-evaluate the circumstances and possibly pay the therapist's regular fee.
However, the therapist cannot increase his standard fees, just because he feels you can afford more. Though these situations are rare, if you believe that your therapist behaved in an un-professional manner then discuss this behavior with the professional ethics committee of your state's licensing board. Also, see the professional codes of ethics near the top of the page.
- Counselor does not have sufficient and specific training to address your issues and/or attempts to treat problems outside the scope of the practice.
- Therapist is not interested in the changes you want to make and your goals for therapy.
- Counselor cannot or does not clearly define how they can help you to solve whatever issue or concern has brought you to therapy.
- Therapist provides no explanation of how you will know when your therapy is complete.
- Counselor does not seek consultation with other therapists.
- Therapist makes guarantees and/or promises.
- Therapist has unresolved complaints filed with a licensing board.
- Therapist does not provide you with information about your rights as a client, confidentiality, office policies, and fees so you can fairly consent to your treatment. Note: The requirement for information provided to new clients by therapists differs by state and licensure requirements.
- Counselor is judgmental or critical of your behavior, lifestyle, or problems.
- Therapist “looks down” at you or treats you as inferior in subtle or not so subtle ways.
- Counselor blames your family, friends, or partner.
- Counselor encourages you to blame your family, friends, or partner.
- Therapist knowingly or unknowingly gets personal psychological needs met at the expense of focusing on you and your therapy.
- Counselor tries to be your friend.
- Therapist initiates touch (i.e., hugs) without consent.
- Counselor attempts to have a sexual or romantic relationship with you.
- Therapist talks excessively about personal issues and/or self-discloses often without any therapeutic purpose.
- Counselor tries to enlist your help with something not related to your therapy.
- Therapist discloses your identifying information without authorization or court mandate.
- Counselor tells you the identities of other clients.
- Therapist discloses they have never done personal therapy work.
- Counselor cannot accept feedback or admit mistakes.
- Therapist focuses extensively on diagnosing without also helping you to change.
- Counselor talks too much.
- Therapist does not talk at all.
- Counselor often speaks in complex “psychobabble” that leaves you confused.
- Therapist focuses on thoughts and cognition at the exclusion of feelings and somatic experience.
- Counselor focuses on feelings and somatic experience at the exclusion of thoughts, insight, and cognitive processing.
- Therapist acts as if they have the answers or solutions to everything and spends much time telling you how to best fix or change all things.
- Counselor tells you what to do, makes decisions for you, or gives frequent unsolicited advice.
- Therapist encourages your dependency by allowing you to get your emotional needs met from the therapist. Therapist “feeds you fish, rather than helping you to fish for yourself.”
- Counselor tries to keep you in therapy against your will.
- Therapist believes that only the therapist’s counseling approach works and ridicules other approaches to therapy.
- Therapist is contentious with you or frequently confrontational.
- Counselor doesn’t remember your name and/or doesn’t remember your interactions from one session to the next.
- Therapist does not pay attention or appear to be listening and understanding you.
- Counselor answers the phone during your session.
- Therapist is not sensitive to your culture or religion.
- Counselor denies or ignores the importance of your spirituality.
- Therapist tries to push spirituality or religion on to you.
- Counselor does not empathize. (Try to see things from your point of view. Not the same thing as "sympathize," which involves agreeing with your point of view, or taking your side.)
- Therapist empathizes too much.
- Counselor seems overwhelmed with your problems.
- Therapist seems overly emotional, affected, or triggered by your feelings or issues.
- Counselor pushes you into highly vulnerable feelings or memories against your wishes.
- Therapist avoids exploring any of your emotional or vulnerable feelings.
- Counselor does not ask your permission to use various psychotherapeutic techniques.
- Therapist tries to get you to exert overt control over your impulses, compulsions or addictions without helping you to appreciate and resolve the underlying causes, or provide you with coping skills.
- Counselor prematurely and/or exclusively focuses on helping you to appreciate and resolve the underlying causes of an issue or compulsion when you would instead benefit more from learning coping skills to manage your impulses.
- Your counselor habitually misses, cancels, or shows up late to appointments.
If you have questions, please go to the Contact page and ask.