Too many options. Which type of therapist is best? » myShrink

Too many options. Which type of therapist is best?

AUTHOR:

There's no guarantee that a certain type of therapist is any better than another (ie. clinical counselor vs psychiatrist vs psychologist). Rather I'd look at their professional development - after their formal training is completed.

Why the type of profession is no guarantee on the quality of the work

Determining the type of therapist that you want to see requires a bit of sleuthing. Personally, I don't recommend that approach if you're looking to start therapy (see below for my approach to finding a good therapist).

That said, there are a few "trends" that are generally recognized in therapeutic fields and it's useful if you know these starting out.

First off, just know that the higher the academic qualifications, the more likely the practitioner will choose* a "regulated" profession. (eg. I belong to a College of Psychologists; MD's generally have their College of Physicians and Surgeons)

* Having a doctorate doesn't necessarily mean you'll choose to be in a "regulated" profession. You could have a doctorate of psychology and choose to be unlicensed as a practitioner. In this case, you would likely refer to yourself as a "counselor" or "psychotherapist" (and save yourself the headache of pages of regulations and high licensing fees 🙂

The benefit to you as a therapy client is that the more "regulated" a profession is, the more recourses you have if something was to go wrong. You can complain for instance to a College Board.

That doesn't cost you anything - except the heartache that any process like that entails.

However, as much as I'd like to say - being a psychologist and all - that given I have more academic training, you'll have a better chance with me . . . 

. . . it's simply not true. ​

Therapist, psychotherapist, counselor -
what's the difference?

Highly-trained psychotherapists are more likely to work with populations who are suffering from severe problems, particularly if medications are involved in the treatment.

So for example a psychiatrist is more likely to work with someone who is suffering from psychosis than a Master's level counselor. However, there are no hard and fast rules on the matter.

Generally speaking you are more likely to see a psychiatrist if you are receiving medication. But in recent years in a few selected states, psychologists have been allowed by law to prescribe medication to their clients.

The term therapist, psychotherapist or counselor may refer to any of the professions listed below. However some professionals choose their professional or educational title, or designation, when they refer to themselves. The latter are usually from those professions that are regulated by law.

For example, as a psychologist, I have refered to myself as a psychotherapist only occasionally. I usually refer to myself as a psychologist. Similarly, a psychiatrist probably uses the term psychiatrist over the term psychotherapist.

Yup, they all call themselves psychotherapists
  • Clinical social worker
  • Associate clinical social worker
  • Pastoral Counselor
  • Marriage and family therapist
  • Marriage and family therapist registered intern or trainee
  • Physician specializing in the practice of psychiatry or practicing psychotherapy
  • Psychologist
  • Psychological assistant
  • Psychiatric Nurse
  • Psychiatrist

Each profession has a distinct emphasis and scope of practice - according to their professional standards

However, once a graduate completes their education how they choose to​ apply their skills can vary dramatically. In my view, most academic trainings offer just the basics.

Personally, I place more value on the professional certifications for specific treatment models (eg. AEDP, EMDR, SE, SRT etc.) over most academic qualifications. These are usually obtained after a therapist graduates.

These types of professional trainings are usually more rigorous (than most continuing education opportunities) and require workshops where you actually have to do something other than passively listening to a lecture (eg. role playing).

What's the difference between a counselor and a psychotherapist?

This is a question for which there is no clearly defined answer. So I'll tell you what I believe is the traditional viewpoint.

The differences are reflected in the range of problems that are treated.

Counseling* is considered to be of a short term duration and more proactive in dealing with the effects of a problem.

*Actually, in the southern hemisphere, the word 'counselling' is used in place of therapy.

Let's say you're in an abusive relationship. A counselor might help you extricate yourself from the relationship and help you get set up in a better living situation. She might offer suggestions for support groups, or recommend agencies who deal with special housing needs or alternative funding sources for education.

A counselor also makes very specific recommendations based on the problem you are addressing. So a career couselor might recommend doing some information interviews. or an addictions counselor might help you identify specific tasks associated with a 12 step program.

Psychotherapy might also include the above elements but the pace of the therapeutic process is usually thought to be slower.

In the example above, a therapist would help you to identify the pattern in your relationships and promote changes within you so you are at less risk for finding yourself in the same situation in the future. The root of the problem might stem from a poor sense of self worth but the effect of the problem is a bad relationship.

There is considerable overlap between the two professions. Some counselors do deep therapeutic work, and quite a few psychotherapists do short term work.

Neither profession requires a specific level of education. You as the consumer can determine this by looking at the practitioner's credentials.

editor's note

You'll notice on this site that I use the word counseling where the more common terminology might be psychotherapy. I have chosen to do so very specifically.

It's my impression that the term counseling is less stigmatizing. I believe the use of the term counseling makes it easier for those unfamiliar with therapy to accept it as a legitimate and effective option.

So, even though this site is mostly about psychotherapy--as described above--I have used the terms interchangeably.

What can a psychologist do that a counselor cannot?

There's no difference in terms of what treatments they can do. It depends on their specific training.

It used to be that there were some specific tests where only psychologists could administer. That's changed today as Master level practitioners have become trained in using all kinds of tests. (The documents might be "signed off" by higher trained practitioners.)

It also used to be the case that Canadian psychologists were the only ones who could provide a formal diagnosis - aside from the medical profession. 

That's been changing over the last few years as more Master level practitioners have taken on this task as well.​ 

When you need a "formal" diagnosis

A formal diagnosis entails using the descriptions of clinical disorders and their appropriate coding from a manual known as the Diagnostic and Statistical Manual IV ("DSM III, IV, V etc").

Often, but not always, a formal diagnosis requires testing. While many tests can be administered by other practitioners, the more complicated ones are only available through psychologists who have taken the training required to interpret the tests appropriately.

Master level practitioners can also administer these tests if they are supervised by a psychologist. However, by and far, most testing is done by qualified health professionals usually with a minimum Master level qualifications.

In Canada a formal diagnosis comes in handy if you need a completed insurance form for extended health or long term disability insurance, or for a government application (e.g. for CPP long term disability). A formal diagnosis is also often necessary for purposes related to litigation.

Nonetheless, several categories of health care professionals in Canada have also been given the power to officially diagnose. This is a contentious issue among psychologists as they question whether these practitioners have sufficient training to make these determinations, particularly decisions involving custody arrangements. (That's often the case when professions are competing for the same territory.)

Keep in mind that most health care professionals make a diagnosis for treatment.

As mentioned above, a few States have allowed psychologists with the appropriate training to prescribe medications.

Are there treatments only psychologists can do?

Nope. All advanced courses for treatment - that I am aware of - are open to practitioners who have a Master's level degree. For example. you need not be a doctoral level psychotherapist if you want specialized training in EMDR, hypnosis, CBT etc.

Indeed, many trainings these days are offered to other non-Master's level practitioners as well.

Well then, how do you choose the best therapist?

The best therapist is one who is "attuned" to your needs. Research identifies - over and over again - that the critical agent for change is the connection between you and your therapist. That result by the way holds no matter what type of therapy.

When you have an attuned connection where you feel safe it's easier to access areas of your memory that affect how you feel about yourself.

That said, what if you want very specific changes - you're not interested in transformation? What options do you have?

Well, there are other therapies out there where the treatment - for some individuals - does not require an attuned connection with a therapist. For example, you can receive neurofeedback therapy and not necessarily have a strong connection with your therapist and yet derive full benefits from that type of therapy.

My conclusion then is that you choose your therapist based on your goals.

Are therapist credentials important?

Good news! Standards are rising. Don't hold your breath though . . . despite more rules and regulations . . . it's a 'buyer-beware' jungle out there. 
Here's why. . .

Anyone can call themselves a therapist

First of all, the terms counselor, therapist and psychotherapist are not regulated by law. This means anyone can put out a shingle and advertise with these terms. As far as I know this is allowed in most provinces and states.

Nonetheless, standards for the provision of health care are rising and counseling is no exception. This is reflected in the growing number of professional titles.

For example, when I was researching this article I came across several organizations in the process of changing their qualifications. This must be terribly confusing for the average consumer--it sure was for me.

It's not all in the name...

I could see a neurofeedback therapist or a behaviour therapist. One could have a B.A. in psychology with a certificate course, and the other a doctorate in psychology registered with a Board of Examiners.

Only the letters after the name define which therapist is more qualified. (Keep in mind that a "qualified" practitioner may have the appropriate credentials but whether or not he or she has the requisite experience or expertise is another manner.)

Most counselors use professional designations conferred by an organization or association of their peers to indicate their level of education, experience and/or specialization.

Some of these organizations have stringent membership requirements while others do not. Typically, the educational designations are listed immediately after the counselor's name, followed by the professional credentials.

e.g. Dr. Susan LaCombe, Ed.D., R. Psych.

I have a doctorate in education (Ed.D.) and I am registered with the College of Psychologists of BC (R.Psych.).

e.g. Steve Milner M.A., L.M.F.T., N.C.C.

Steve has a Master's in Psychology (M.A.), a license in Marriage and Family Therapy (L.M.F.T.) and is a National Certified Counselor (N.C.C.).

e.g. Ms. Mariola Matcher M.S.W., R.S.W.

And, what do you do for a living?

It's been my impression that most doctoral level therapists prefer the term psychotherapist or therapist to the term counselor in reference to their profession. But even here there is no consistency.

For instance, the term counselor is most often used by Master's level practitioners. But in any listing of therapists you could find a doctorate level counselor, or a Master's level psychologist. It's enough to make your head spin!1

Several titles in the USA are regulated by law. For example the Marriage and Family Therapist, several social worker licenses and licensed psychologist are all designations processed under legal statute.

The term psychologist is a designation regulated by law in both the USA and Canada; it's use depends on the specific laws of the province, state or country you reside in. In the USA psychologists who obtain and meet the criteria for licensure are referred to as Licensed Psychologists. In Canada, they're referred to as Registered Psychologists.

As I understand it, in some U.S.states (e.g. Virginia, Pennsylvania) practitioners who have a doctoral degree in psychology (or counseling or a related field) can use the term Psychologist to refer to their profession. However in other states, only psychologists who obtain licensure can refer to themselves as Psychologists (e.g. California).

Pretty much everywhere in Canada (as far as I know) has similar legislation as California. That is, doctoral level individuals with a degree in psychology can refer to themselves as a psychologist only when they are registered (i.e. licensed) with a regulatory body.

It will vary from state to state or province to province...you can call yourself a School Psychologist if you possess a Master's in School Psychology.

In Canada, there's an interesting anomaly. If you teach at a school of higher education can you can call yourself a psychologist even if you're not registered. You just can't say you're a registered psychologist.

Other professions that are regulated by law in Canada are psychiatric nurses and social workers. And in some states along with these two professions, mental health workers, certified counselors are also governed by statute.

What EDUCATION really means

Many full-time psychotherapists have not formally studied beyond the Master's level (i.e. went on to obtain credentials from a school of higher education.) Those who obtain a Doctorate degree often do so in order to have the option of supplementing their practice with research, teaching, writing or administrative work.

The exception is the Psy.D. (Doctor of Psychology), a degree that focuses heavily on clinical practice. Most people who obtain a Psy.D. intend to do psychotherapy full-time.

Most practitioners first get a Master's degree which requires at least two years after the Bachelor's. Most Doctorate degrees then require at least four years after the Master's, and at least a one year internship or residency.

The following are the most common educational degrees held by psychotherapists:

M.D. - Doctor of Medicine This is the degree most common for psychiatrists (some have a Doctor of Osteopath or D.O.'s). However in some states and provinces M.D.'s are doing long-term counseling without obtaining a specialty in psychiatry.

Ph.D - Doctor of Philosophy This is the most common degree among psychologists. A Ph.D. can be in many areas but for those working as psychotherapists they usually specialize in Clinical Psychology.

Psy.D. - Doctor of Psychology This degree emphasizes clinical practice rather than research and operates under a "practitioner-scholar" rather than a "scientist-practitioner" model. Like other doctoral degrees, it requires completion of an original piece of research.

Ed.D. – Doctor of Education Schools of Eduation offer this degree. Counseling, School Psychology and Rehabilitation Counseling are the most common types.

D.Th. - Doctor of Theology (pastoral counseling)

D.Min. - Doctor of Ministry (pastoral counseling)

D.Div. - Doctor of Divinity (pastoral counseling)

D.S.W. - Doctor of Social Work

M.S.W. - Master of Social Work

D.Sc. - Doctor of Science

D.S.W. - Doctor of Social Work

Interesting facts about designations for psychologists

Only the Psy.D. designation refers specifically to psychology, but a Ph.D. or an Ed.D. can be acquired in several different fields e.g an Ed.D. in Administrative Studies.

One can get a Ph.D. in Physiology (something very far removed from psychology) yet still promote oneself as an "expert" in behaviour and relationships. Dr. Laura is probably perceived as a "real doctor" for example, yet she only has a Ph.D in physiology!

One can get a doctorate from an obscure school that has minimal standards. However, if a school is “Accredited” this means they have passed government standards. (It also means one can generally deduct the tuition.)

A Doctor of Education does not necessarily mean the holder knows about learning disabilities. I personally have an Ed.D. but I didn't take specialized courses so I know little about learning problems.

As mentioned above, Psychologist is a legal designation and is regulated by the College of Psychologists in each province in Canada and in each State in the USA.

A counselor does not need credentials to have a listing in the Yellow Pages. Anyone can list their name under ‘Counselors’, ‘Marriage Counselors,’ and ‘Psychologists’ even if they lack appropriate training.

Super Pages (at least in Canada) won’t object if someone lists without actually being a registered psychologist. However the College of Psychologists will, and they will certainly send the legal beagles out if someone does!

Notes

1 As I understand it, all USA states require a minimum of a doctorate in order to become a licensed psychologist. However there are few Canadian provinces that still allow a Master's level candidate to apply for registration enabling them to use the term psychologist.

There are literally hundreds in both countries who have been grandfathered in i.e. they were licensed or registered when the requirements were lower. These practitioners offer years of experience to their clients.

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