Hindie M. Klein, PsyD
Beginning psychotherapy can be very liberating. It is often the first step in a therapeutic process that hopefully ends with a decrease in disturbing symptoms, improved relationships and a restored sense of well-being.
Getting to that first step takes strength and courage. It requires recognition that there are vulnerabilities, problems, and challenges. It requires a true desire for change.
A frequent question may arise for many who have chosen to embark on the journey of psychotherapy. “Okay, now what? Whom do I call? What type of therapist is right for me and my situation?”
Psychotherapy is a general term referring to therapeutic interaction or treatment contracted between a trained professional and a patient, family, couple, or group. There are many different types of therapists who can provide many different types of treatment. There are individual therapists, group therapists, child therapists, family and marital therapists, psychoanalysts, sex therapists, art therapists, and music therapists. These modalities are not inclusive of all types of psychotherapeutic treatment, but these are the most well-known and popular. Creative arts therapists and music therapists usually train in specialized programs specifically geared to their specialties, though they may also have initially trained as social workers, psychologists and mental health counselors. In general, most of the therapists listed in the above categories are usually initially trained as social workers, psychologists, and mental health counselors, and then continue on for their specialty training. So for example, a child therapist may receive initial training as a social worker or psychologist, but then continues on to receive specialized training in child treatment under close supervision of a child therapy expert.
In addition, psychotherapists may have different orientations, meaning that in addition to being trained in their specialty they may follow a particular theory or technique. So for example, a child therapist may work within a cognitive-behavioral framework or within a more psychodynamic framework. The different orientations refer to the theory behind and method in which the treatment will be provided.
But no matter what the modality or the orientation, one standard must remain non-negotiable. The therapist must be licensed in their field. This is a must!It is also highly recommended that the therapist receive advanced certification in their specialty, i.e. family and marital therapy. Although this is important, and certainly adds to the expertise of the therapist, it does not take the place of licensure in their particular profession. Licensure signifies that the person has attended a program accredited by the Department of Education, has complied with all requirements, placements, internships, and has passed the licensing exam of that state or any state where the therapist wishes to practice. These days it is fairly easy to check if a person is licensed via each state’s Department of Education and Licensing website. Try googling “Online License verification” while adding the profession and particular state.
Who are the practitioners?
As noted above, although psychotherapeutic treatment is usually sought by specialty, most therapists are usually trained initially in one of three disciplines. Though this is not totally inclusive (i.e. psychiatric nurses, etc.), these disciplines encompass the training of most treating professionals. Here is a brief overview:
Social workers are Master’s level clinicians who have completed a 2-year postgraduate course in Social Work from an accredited university. Social workers should be licensed by the state where they practice. A social worker will often have their name listed, followed by the letters LMSW, which indicates that they have passed their licensing exam, Master’s level. A social worker will become an LCSW after they have completed at least 3,000 hours of supervised experience in diagnosis, psychotherapy and assessment based treatment. This is followed by a second licensing exam. Some social workers continue on for their doctorates, which will be noted by a PhD or DSW following their names. In addition, there is an older designation known as an “R” or “P”, which is no longer offered. However, there are practitioners who have LCSW’s along with an R or P suffix, which is an additional certification that involved submitting clinical case presentations to an examining board.
Psychologists are doctoral level clinicians who have completed 4-5 years of postgraduate training in Psychology from an accredited university. Psychologists will have the letters PhD or PsyD following their names. In addition to coursework, psychologists must complete several pre-doctoral externships and a full year internship. Psychologists are qualified to provide comprehensive psychological evaluations that can include tests of cognitive ability, social/emotional functioning, personality assessment and academic functioning. Psychologists are also trained to provide various forms of psychotherapy. It should be noted that the term “psychologist” is a legal term in the state of New York. This means that in order to be called a psychologist, one has to have completed a doctoral course of study and be licensed by the New York State Department of Education licensing board. Regulations for licensure in other states vary; psychologists need to be licensed in the state where they wish to practice. In order to sit for licensure as a psychologist, psychologists have to complete 1,750 hours of post-doctoral supervised experience.
Mental health counselors are Master’s level clinicians who can provide psychotherapy and counseling. They are also trained in psychological evaluation but to a much more limited degree than psychologists. What distinguishes MHCs from social workers or psychologists is their emphasis on prevention via psycho-education and a holistic approach to treatment. Mental health counselors receive training via a 2-3 year post-graduate program which involves coursework and 600 hours of pre-Master’s supervised experience at various externships. Upon graduation, they are awarded a degree in mental health counseling (MHC). However, they can only sit for licensure after they have completed 3,000 hours of post-Master’s supervised clinical experience.
Licensed Marital and Family Therapist
An LMFT may be trained specifically in this area, without first receiving a pre-specialty degree in social work, psychology, etc. but having completed Master’s level training and a certain number of hours of supervision post Master’s. Their practice is limited to marriage and family.
Psychiatrists
Psychiatrists are medical doctors who have completed 4 years of medical school and a post-medical school residency training program in psychiatry. Psychiatrists need to be licensed in the state in which they practice. Some psychiatrists continue for further training in child psychiatry or geropsychiatry (geriatric treatment). Psychiatrists are qualified to evaluate for medication treatment and can dispense psychiatric medication such as anti-depressants or anti-anxiety agents. If psychiatric medications are necessary in the treatment of any psychiatric disturbance, they should only be dispensed by a qualified and licensed psychiatrist (as opposed to a general medical practitioner or other medical specialty). Although psychiatrists are most often utilized for medication evaluation and treatment, some psychiatrists will engage patients in psychotherapeutic treatment, in addition to dispensing medication. To that end, some psychiatrists receive further clinical training in many of the sub-specialty treatments listed above.
Licensure regulations vary from state to state, so it is important that the therapist be licensed in the state where they are providing treatment.
Coaches and Pastoral Counselors
Coaches and pastoral counselors are an unlicensed and unregulated field. There are various training institutes that offer training and certification in these disciplines. Some are quite professional and thorough, while others may be no more than a diploma mill. Certifications are sort of like semicha – they are not regulated by the state and are only as good as the reputation of the institution that gave it.
In a general sense, some of these practitioners can be helpful, insightful and supportive, while others could be dangerous. There is no way to know. In addition, if the problems being treated are of a serious psychiatric nature, and not merely “life problems,” one should only see a professional who is licensed to provide treatment.
Additional Training
Psychologists, social workers and mental health counselors often receive further training in clinical sub-specialties such as cognitive behavior therapy, hypnosis, Dialectical Behavior Therapy, EMDR (Eye Movement Desensitization and Reprocessing) for trauma, marital therapy, group psychotherapy, psychodynamic psychotherapy and psychoanalysis, or in the treatment of eating disorders or substance abuse disorders, to name a few.
The road to recovery via psychotherapy can be exhilarating, painful, difficult and enlightening. Most often psychotherapy evokes all of those feelings, as well as a myriad of others. What is most important is that the treatment be provided by someone who is well-trained, competent, experienced and licensed in their profession. Although this is not a fool-proof system, it certainly ensures a greater probability that you will be treated with dignity and respect in a highly confidential, emotionally safe environment. In addition, when a person is licensed, they have to agree to a professional code of ethics and can be censured by their licensing board if they stray from their profession’s guidelines.