Medicine is practiced by doctors. Law is practiced by lawyers. So who practices therapy? Actually, there are more than a dozen different professions that offer some form of therapy or counseling.

Each group offers something a little different in terms of education, training, and philosophy, but you might be surprised to learn that there’s no evidence that any group is more effective than the others. What it boils down to, then, is personal preference, and that’s a good thing. After all, it’s your therapy.

I’ll tell you a little bit about all of these professions, but first let’s clear up a tricky language question.

What’s the Difference?

While therapists may engage in heated discussions about the difference between therapy and counseling, no one quite agrees on exactly what the differences are. Unless your therapist (or counselor) has a strong opinion on the matter, you can use these terms interchangeably the way I have in this book.

Likewise, most therapists use the term client to refer to the people they help, but psychiatrists and others who work in medical settings prefer patient. Again, it’s more a difference of style than anything else, but if you have a preference, be sure to tell your therapist.

Licensure

Does having a driver’s license mean that someone is a good driver? Of course not, but it does mean that a person has met the minimal qualifications and passed a test. Most importantly, though, since the state issues the license, it can also take it away from a driver who is unsafe or reckless.

Likewise, professional licensure doesn’t guarantee you a good therapist, but it does tell you that they’ve met the minimum qualifications and passed a test. And, just like a driver’s license, it gives the state a way of holding a therapist accountable. Since licensed therapists have more to lose than unlicensed therapists, they have more motivation to act ethically and competently. In almost all cases, only licensed therapists qualify for insurance reimbursement.

Advanced Practice Registered Nurses

Education

Advanced practice registered nurses have a bachelor’s degree in nursing and a master’s degree in an advanced nursing practice field.

Experience

Advanced practice nurses undergo extensive supervised clinical experience as part of their education. In addition, most advanced practice nurses have prior experience in providing individual and group therapy as psychiatric nurses before enrolling in their master’s program.

Licensure

Advanced practice nurses are licensed in most states. In addition to the educational and experiential requirements listed above, most states require certification from a national body for licensure. In addition to practicing therapy independently, advanced practice nurses can prescribe medication.

Typical Settings

• Clinics

• Hospitals
• Private/Group Practices

Typical Initials

Academic: RN, MSN
Credentials: APN, ARNPP, ARPN, MHN

Art Therapists

Education

Art therapists have a master’s degree in art therapy or a closely-related field. Some art therapists choose to pursue doctorate degrees in counseling or psychology, with a specialty in art therapy.

Experience

Art therapists undergo supervised clinical internships and practicums during their education. This is typically followed by two years of supervised clinical experience helping clients through expressive arts.

Licensure

Very few states offer professional licensure specifically for art therapy. Most art therapists seek licensure in another field, such as professional counseling, marriage and family therapy, or clinical social work. Some art therapists pursue board certification from a professional organization.

Typical Settings

• Clinics

• Hospitals
• Non-Profit/Community-Based Organizations
• Private/Group Practices

Typical Initials

Academic: MA, MC, MS, PhD, EdD
Credentials: ATR, ATR-BC, LCPC, LPAT, LPC, LMHC

Clinical Social Workers

Education

At a minimum, a clinical social worker must have a master’s degree focusing on developing practical clinical skills. Some clinical social workers choose to pursue advanced academic study and research by earning a doctorate degree in social work or a counseling-related field.

Experience

Clinical social workers participate in a variety of supervised clinical experiences as part of their education. Those seekinglicensure pursue at least two years of supervised clinicalexperience after graduation.

Licensure

Clinical social workers are licensed in most states. In addition to the educational and experiential requirements listed above, state licensure requires passing a written examination.

Typical Settings

• Clinics

• Community-Based/Non-Profit Organizations
• Government Agencies
• Hospitals
• Private/Group Practices

Typical Initials

Academic: DSW, MSW, PhD
Credentials: ACSW, CSW, LCS, LCSW, LICSW

Drug and Alcohol Counselors

Education

Drug and alcohol counselors may have an associate’s degree, bachelor’s degree, master’s degree, or doctorate degree in a variety of counseling-related fields.

Experience

Requirements vary according to location, licensure type and work setting, but most drug and alcohol counselors undergo supervised clinical experience as part of their education, in addition to supervised on-the-job experience.

Licensure

Licensure and registration laws vary widely from state to state, so you should speak with individual counselors about theircredentials and background. Many drug and alcohol counselors seek board certification from a professional organization.

Typical Settings

• Clinics

• Community-Based/Non-Profit Organizations
• Government Agencies
• Private/Group Practices
• Rehabilitation Clinics and Centers

Typical Initials

Academic: AA, AS, BA, BS, MA, MS, PhD, EdD
Credentials: ADC, CAC, CASAC, CATC

Marriage and Family Therapists

Education

Marriage and family therapists have a master’s degree, which focuses on clinical skills. Some marriage and family therapists pursue a doctorate degree in marriage and family therapy, counseling, or psychology.

Experience

Marriage and family therapists undergo a supervised clinical practicum and internship as part of their education, as well as least two years of supervised clinical work experience after graduation.

Licensure

Marriage and family therapists are licensed in most states. In states that don’t offer this license, marriage and family therapists pursue licensure in a closely-related field such as professional counseling. In addition to the educational and experiential requirements listed above, licensure requires passing a written examination.

Typical Settings

• Clinics

• Community-Based/Non-Profit Organizations
• Private/Group Practices

Typical Initials

Academic: EdD, MA, MC, MS, PhD
Credentials: LCPC, LMFT, LPC, LMHC, MFCC

Pastoral Counselors

Education

Educational requirements vary widely depending on religion and denomination. Most pastoral counselors complete relevant coursework in theology, psychology, or counseling.

Experience

Because of the diversity of religious institutions, there are no consistent experiential requirements. Most people who hold themselves out as pastoral counselors have undergone some supervised counseling experience, however.

Licensure
Very few states actually license pastoral counselors. Some pastoral counselors seek licensure in another discipline such as professional counseling or marriage and family therapy, though this is not considered necessary to practice in a religious setting. You should speak with individual counselors about their background and credentials.

Typical Settings

• Churches

• Community-Based/Non-Profit Organizations
• Hospitals

Typical Initials

Academic: DMin, MA, MDiv, MS, PhD
Credentials: CCPT, CpastC

Professional Counselors

Education

At a minimum, professional counselors have a master’s degree focusing on clinical skills. Some counselors pursue a doctoral degree in counseling, counselor education, or psychology.

Experience

Professional counselors undergo supervised clinical experiences as part of their education as well as two years of supervised clinical employment after graduation.

Licensure

Professional counselors are licensed in almost all states. In addition to the educational and experiential requirements listed above, licensure requires passing a written examination.

In a few states, professional counselors are licensed in two tiers: first-level counselors can practice under supervision, while second-level counselors practice independently.

Typical Settings

• Clinics

• Community-Based/Non-Profit Organizations
• Hospitals
• Private/Group Practices

Typical Initials

Academic: MA, MS, MC, PhD, EdD
Credentials: LCPC, LMHC, LPC

Psychiatrists

Education

Psychiatrists attend four years of medical school followed by a year of internship and four years of residency. Some psychiatrists pursue advanced specialty training through a fellowship.

Experience
Psychiatrists undergo extensive supervised clinical experience during the last two years of medical school, internship, residency, and fellowship.

Licensure

All states license medical doctors. In addition to the education and experiential requirements listed above, doctors must pass a medical or osteopathic examination. Most psychiatrists seek board certification through a professional organization.

Psychiatrists are licensed to practice medicine, which may include providing psychotherapy and prescribing medication. Under no circumstances should you accept services from an unlicensed medical doctor.

Typical Settings

• Clinics

• Hospitals
• Private/Group Practices

Typical Initials

Academic: MD, DO

Psychoanalysts

Education

Psychoanalysis is a psychotherapeutic approach, but one can also choose to be licensed as a psychoanalyst in New York State. A licensed psychoanalyst must have at least a master’s degree in a psychology-related discipline, and extensive postgraduate training through an approved psychoanalytical institute.

Experience

Licensed psychoanalysts must undergo an extensive period of supervised post-graduate clinical work. Psychoanalysts also undergo personal psychoanalysis.

Licensure

In addition to the educational and experiential requirements listed above, licensed psychoanalysts must pass a written examination. In most states, psychoanalysis is practiced by other licensed professionals who have undergone training, supervision, and analysis through a psychoanalytic institute.

Typical Settings

• Clinics

• Hospitals
• Private/Group Practices

Typical Initials

Academic: MA, MS, MC, PhD, EdD, MD, DO
Credentials: LP, NCPsyA

Psychologists

Education

Psychologists have a doctorate degree. The PhD emphasizes clinical and research skills; the PsyD program focuses on clinical skills. Some psychologists pursue advanced postdoctoral training.

Experience

Licensed psychologists undergo supervised clinical internships and practicums during their education. Most psychologists undergo at least two years of supervised clinical experience after graduation.

Licensure

In addition to the educational and experiential requirementslisted above, psychologists must pass a written exam. Many psychologists seek board certification through a professional organization.

Typical Settings

• Clinics

• Community-Based/Non-Profit Organizations
• Hospitals
• Private/Group Practices
• School-Based Programs

Typical Initials

Academic: PhD, PsyD
Credentials: LP, LCP

Pre-Licensed Therapists

All licensed professionals undergo a period of supervised clinical experience. During this period, they provide services under the supervision of a licensed professional and are held to the same professional and ethical standards as a licensed professional.

Though pre-licensed clinicians do not qualify for insurance reimbursement, they typically offer services at a discounted rate.

Unlicensed Therapists

Various licensure and registration laws protect certain practices and titles, but in most states no law prevents an unqualified person from simply calling themselves a therapist and seeing clients.

It’s not safe to assume that all unlicensed clinicians are unqualified or incompetent, however. Some therapists work without a license because no license is available for their discipline in the state in which they practice. Other unlicensed therapists are experienced professionals who work in settings in which licensure is not required.

Before considering working with an unlicensed therapist, you should ask questions about the person’s education, experience, and background.

Dissatisfied clients have little legal recourse against an unlicensed therapist if they feel they’ve been injured or defrauded.

Activity 4

At the top of an index card or a small piece of paper, write Professions. Below that, record your top three
choices of profession.

• Advanced Practice Registered Nurse

• Art Therapist
• Clinical Social Worker
• Drug and Alcohol Counselor
• Marriage and Family Therapist
• Pastoral Counselor
• Professional Counselor
• Psychiatrist
• Psychoanalyst
• Psychologist

    Last reviewed: By John M. Grohol, Psy.D. on 7 Jul 2009