The improper use of job titles by mental health professionals confuses and misleads the public. This section is a general guide to understanding who does what in the mental health marketplace. First, it’s very important for the public to understand the the differences between certification and licensure. The safest route to obtaining mental health care is to seek treatment from a professional who is licensed in your state. Licensure means that a profession is regulated by law. Each licensing organization has a process in place to handle complaints from consumers, with the ultimate goal of protecting the public from harm. More information about mental health practitioner licensing in California can be found in the section of this website called Mental Health Licensing in CA. Certification is only a statement or declaration that one has completed a course of study, passed an examination, or otherwise met specified criteria for certification. Certification is a private matter, issued by a private organization. It does not involve the law, and is not a state privilege. Certification gives practitioners a way to increase their competency through a course of study and exams, and to advertise or inform others of their completion of this course of study. This section describes practitioners who are licensed, such as psychologists and psychiatrists, and those who may or may not be certified, like life coaches and healers.
Psychologists are trained to help people cope more effectively with life problems, using therapeutic techniques based on the best available research and their own clinical skills and experience. Psychologists take into account each person’s unique values, goals and circumstances and work collaboratively with the client to identify the goals of treatment and to decide how progress will be defined.a Under CA law, “psychologist” is a protected job title. A person can use this title only if he or she has obtained a doctoral degree in psychology: a PhD, PsyD, or EdD. (The differences between these degrees is explained in the section of this website called Doctoral Degrees for Psychologists). Not all psychologists need to be licensed. Only psychologists who want to independently provide psychotherapy to the public or supervise mental health professional trainees are required to be licensed by the CA Board of Psychology. (To understand more about different the specialties within psychology, see the section of this website called Different Types of Psychologists).
A psychiatrist is a medical doctor who specializes in preventing, diagnosing, and treating mental illness. Psychiatrists cannot legally treat patients independently without having a license from the state’s Medical Board. In CA, psychiatrists are the only mental health professionals who can both provide psychotherapy and prescribe medication. However, they receive limited training in psychotherapy. In fact, the Residency Review Committee (RRC) requires training in only 3 areas: psychodynamic therapy, cognitive behavioral therapy, and supportive therapy.b
The title held by a social worker can vary in different countries and even among states in the US, but two of the most common types are direct-service social workers and licensed clinical social workers (LCSWs). Direct-service social workers help people deal with the challenges in their day-to-day lives. This can involve helping someone deal with a financial crisis, a housing emergency, or an expected medical diagnosis. They often work with people in crisis situations, and then follow up with them to make sure that the situation has improved. LCSWs work with clients to diagnose and treat mental or emotional problems, and often provide one-on-one, family, and group therapy. In CA, you must be licensed to practice psychotherapy independently as a social worker.
Unfortunately, the terms “psychotherapist” and “therapist” are often used interchangeably, adding to public confusion. In CA, in order to use the words “psychotherapy” or “psychotherapist” in an advertisement, “a therapist must spell out the full title of his or her license (i.e. “licensed marriage and family therapist”), and the therapist must be competent by reason of his/her education, training, and/or experience, to perform the professional services advertised or to act in a manner or professional capacity advertised.”c
According to the Merriam-Webster dictionary, a therapist is “a person trained in methods of treating illnesses especially without the use of drugs or surgery.” A therapist is a broader umbrella term for professionals who are trained—and often licensed—to provide a variety of treatments for people. The job title “therapist” is not protected by law, although many professional therapists need to be licensed to practice, such as Marriage and Family Therapists. This title is also not limited to treating mental illness. For example, you can receive services from a physical therapist, massage therapist, art therapist, music therapist, and yoga therapist, among others.
Psychoanalysts are psychotherapists who follow the theoretical orientation of psychoanalysis, originated by Sigmund Freud. In order to be accepted for full psychoanalytic training (called candidacy) at a Psychoanalytic Institute accredited by the American Psychoanalytic Association, a professional first needs a graduate mental health degree and some prior training and experience as a therapist. Historically, professional psychoanalysts had to possess a medical degree in psychiatry, but degrees in psychology or social work have become more common in modern times.d
In the context of mental health, “counseling” is generally used to denote a relatively brief treatment that is focused most upon changing a specific behavior. It often targets a particular symptom or problematic situation and offers suggestions and advice for dealing with it. Many people use the job title of “counselor” to describe the work they do. This job title can include career counselors, spiritual counselors, substance abuse counselors, school counselors, rehabilitation counselors, and grief counselors, among others. The only counselor that is licensed to practice psychotherapy independently in CA is the “Licensed Professional Clinical Counselor” or LPCC. The CA Board of Behavioral Sciences defines “professional clinical counseling” as being focused exclusively on the application of counseling interventions and psychotherapeutic techniques for the purposes of improving mental health and does not include the assessment or treatment of couples or families unless the person has completed specific training and education outlined by law. The LPCC job title also does not include social work services.c
The International Coach Federation (ICF) defines coaching as “partnering with clients in a thought-provoking and creative process that inspires them to maximize their personal and professional potential.”e Coaching is not a regulated profession and the quality of coaches varies considerably. The industry is still not standardized, so not all coaches are required to be certified. That means just about anyone can claim to be a life coach, without any realtraining to back up the claim. For example, some “coaching institutes” offer a credential after reading a book or watching a TV program plus only three additional hours of training. The highest quality coaches attend certification programs approved by the ICF, which sets and monitors standards for professional coaches.
Most healers are not regulated by any government agency due to their integration of healthcare services and religious beliefs and customs. Many cultures utilize healers to help with both mental and physical ailments. For example, curanderos are professional folk healers found in Native American, Mexican and many Latin-American communities who may take the place of a psychiatrist, psychologist, or even general practitioner when ailments of the body and mind are regarded as too sacred for contemporary remedies. Faith healing is prominent in many Christian communities, especially when mental illness is believed to be caused by possession of evil spirits. Christian faith healing is not without controversy. Several states have prosecuted parents for child abuse and felony reckless negligent homicide when they chose to utilize a faith healer and withhold evidence-based medical treatment from their children.f
a Definition provided by the California Psychological Association at cpapsych.org
b For more detailed information on the clinical training of psychiatrists see the Accreditation Council for Graduate Medical Education’s Psychiatry section at acgme.org
c Statutes and Regulations Relating to the Practice of: Professional Clinical Counseling, Marriage and Family Therapy, Educational Psychology, Clinical Social Work. (2014, January). Sacramento, CA: California Board of Behavioral Sciences.
d For more information, see apsa.org
e For more information, see coachfederation.org
fMerrick, Janna C. (2003). “Spiritual healing, sick kids and the law: Inequities in the American healthcare system.” American Journal of Law & Medicine, 29 (2-3): 269–99.