So many types of mental health practitioners… What’s the difference?
As professional counselors, we often encounter misconceptions about what we do. It's no wonder, since there are many types of "therapists" out there. I will try to explain the differences. My explanations will be from my point of view and will be very "Oregon-centric" since that's the state I practice in. Feel free to comment with questions specific to your state, and I'm happy to look up the answers!
Counselors (the licensed kind)
Counselors include Licensed Professional Counselors (and Interns), Licensed Marriage and Family Therapists (and Interns), Licensed Clinical Social Workers, and Psychological Associates. There are three different state boards that govern these counselors, in Oregon. In general, these professionals have master's degrees in counseling, social work, or psychology, and are licensed and monitored by their state board. They can see clients in private practice, with or without a supervisor, depending on the restrictions on their license. All LICENSED counselors are professionally trained to help individuals or families with mental health problems and also help people with normal life stresses too.
Psychologists
Psychologists have doctoral degrees in various types of psychology. Licensed clinical psychologists have five or more years of training in mental health and are licensed by the Board of Psychologist Examiners (the same board that licenses Psychological Associates). Psychologists have longer formal training than most counselors do and can therefore do more comprehensive and formal evaluation and testing of clients. They may also do counseling work, teach in university programs, and are more likely to conduct research than master's level counselors are. In my opinion (OPINION ALERT), since psychologists spend more time in school, they can often treat a wider variety of mental health issues whereas counselors seem to specialize more in particular topics.
Psychiatrists and Psychiatric Mental Health Nurse Practitioners
Psychiatrists graduated from medical school, completed a residency in psychiatry (usually three or more years) and are licensed by the state medical board. Psychiatric Mental Health Nurse Practitioners (PMHNPs) attended nurses training and received advanced practice training in mental health prescribing. Based on what I have heard from my many friends and colleagues who are psychiatrists and PMHNPs, the amount of psychotherapy training they receive varies from program to program. So what you can be pretty sure of in seeking care from a psychiatrist or PMHNP is that they know more than the other professionals above, about prescribing appropriate medications for mental health issues. If psychotherapy is the only thing you are looking for, you might talk with them about their training, experiences, and interest in psychotherapy as it may or may not be their primary approach to treating psychological discomfort.
Other Counselors and Coaches (unlicensed)
There are other types of professionals out there who appear to provide counseling, life coaching, and psychological services who are not licensed through the state to provide these services. Some exceptions do exist under Oregon law, for certified alcohol and drug counselors (CADCs), supervised bachelor's level counselors, and pastors to provide some counseling services under VERY limited scope and usually under the supervision of an agency who is otherwise licensed to provide services.
Nonetheless, there are tons of people in "private practice" who are providing mental health therapy illegally. I'll review a few types and my concerns about them.
Pastors
Pastors and clergy are very important members of our society with specific skill sets from their pastoral training. That said, pastoral training alone is not sufficient to train clergy members to provide mental health treatment. I happen to have interned with a priest who ALSO had his masters degree in counseling and who worked hard to be BOTH a clergy member and a Qualified Mental Health Professional (QMHP). He is an awesome clinician and is providing wonderful counseling on both spiritual and mental health issues. I'm not talking about him... I'm talking about pastors who are not trained in mental health.
Mental health counseling provided by clergy members who are UNTRAINED and UNLICENSED to provide such services is potentially dangerous. Just this week, one of my friends told me about a family member who almost died from a mental illness because their church leaders told the person to pray more about it. Pastoral family and couples counseling can be equally dangerous as it can either mask or encourage the continued suffering of one or both partners from mental illness or domestic abuse. Go to your priest or pastor for support and guidance on spiritual issues but go to a licensed mental health provider for help with psychological issues! We are happy to respect and honor your religious beliefs and traditions AND provide you with quality mental health care
Life Coaches
Let me take a moment to compose myself before I say anything too harsh... (inhale, exhale, inhale, exhale). OK. I have no problem with people who dispence "life-hack" advice on the internet. Look at this awesome photo blog with organizational tips: http://www.lifehack.org/articles/lifestyle/100-life-hacks-that-make-life-easier.html. There are also professional organizers who may be really helpful to people like me who are a little messy but not technically hoarders. This section is NOT about those people.
Take another internet detour and Google "life coach anxiety depression," and you'll find a ton of unlicensed therapists dispensing advice on how to overcome generalized anxiety, social anxiety, sadness, depression, etc. Why should you care, especially if they seem to have good advice?
There are no requirements for life coaches in terms of education, knowledge, or experience. You are essentially relying on their, apparently very special, life experience which they assume to be much better than yours, and therefore worth paying for. How patronizing of YOU, the client! Real counselors never assume their own experiences to be informative of YOUR experience as a client. Instead we refer to our years of training on how the human brain works, and ask you to share your expertise on your own life so we can collaborate on solutions that are supported by evidence. My life experiences and personal perspectives are NEVER EVER superior to those of my clients. It's my professional training and experience that may be helpful.
If something goes wrong, you have no one to tell. During my first visit with clients, I provide them with information on the Oregon Board of Licensed Professional Counselors and Therapists and INVITE them to complain to my board, should they ever be concerned that something I do is unethical or wrong. If I should be found to be in violation of my profession's laws or ethics, they can discipline me up to, and including, stripping me of my license to practice. When a licensed counselor screws up, you have a board to complain to who actually has the power to correct the counselor's behavior and prevent further harm to you and others. If a life coach wrongs you, you have no one to complain to.
What does "unwillingness" or "inability" to get licensed mean to your treatment? It seems safe to assume that a life coach who is providing mental health services is either unwilling or unable to get licensed. Getting licensed means that at minimum, you had to have a bachelors degree, apply to graduate school, complete a graduate degree in mental health, apply to the board, pass a criminal background check, pass a board exam, complete supervised hours of experience, and then maintain your license through continuing education requirements. Which item on that list was the life coach unwilling or unable to do and why? There might be a very good reason as to why that person should not be providing mental health treatment to the public.
So if you are looking for care, consider the type of issue you are facing and whether a counselor (LPC, LCSW, PsychAssoc), a psychologist, or prescribing practitioner would be a good fit. We even work together someimes with each other and with other healthcare professionals! Many of us will even do a phone consultation with you and direct you to our other better-qualified colleagues if we feel that we are not well-qualified to help you with the challenge you are facing. For the love of everything though, PLEASE do not choose an unlicensed practitioner! It actually can be a matter of life or death...