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Tuesday, January 28

How to Pick a Counselor — And Bypass the Bullies and Buffoons

Do I need a psychotherapist, a regular therapist, a psychiatrist, a counselor, a psychologist, a sociologist, a life coach, or arggh!

Who ya gonna call? 

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Say you need a mental-health professional.

Who you gonna call?

Choosing is easier than you might think. Here’s help. 

We start by introducing a few terms you should know before hiring a therapist, then list the five kinds of therapists. Then we help you decide whether the one you’re considering is any good.

(We also describe a few other
kinds of helpers you might consider working with, including those who can prescribe psychiatric drugs.)

Ready? Read on!

Terms you should know

Mental-Health Professional. A mental-health professional is an individual who has earned a license to counsel clients. In the United States, there are just five categories of licensed mental-health professionals (see below), and all five fall under the umbrella term “psychotherapist.” Nobody outside those five categories qualifies as a psychotherapist. All five kinds of psychotherapists are trained and licensed to diagnose and treat mental-health conditions.

Counselor or Therapist? While the words sound quite different, in practice there is no difference between a licensed counselor, a therapist, and a psychotherapist. All are fully qualified mental-health professionals. (While the word “therapist” may be regulated in some states, such as California, the word “counselor” may not be, and so may be utilized by unlicensed and unscrupulous individuals without any particular training or other qualifications.)

License or no license? To become a licensed psychotherapist, individuals must undergo rigorous training, must work under supervision for a number of years, and must pass a national and/or state licensing exam. Additionally, they must undergo continuing education to maintain their licensure, and are overseen by state licensing boards — commonly, the state department of health, which also licenses medical practitioners. A licensed therapist has been vetted by state licensing boards to ensure high ethical standards, genuine academic qualifications, and valid supervision and training. 

Importantly, qualified therapists work from an evidence-based perspective, founding their therapeutic approach on methods that have research-based scientific validity. (We discuss unlicensed “counselors” below.)

The five categories

Here are the five categories of psychotherapists in the United States. Terms may differ slightly, depending on your state:
  • Psychiatrist. A medical doctor who has undergone additional training in psychiatry. This is the only mental-health professional who may prescribe psychotropic drugs, and many psychiatrists are fully booked provided nothing other than medication management. Psychiatrists have the designation MD or DO.
  • Psychologist. A master’s- or, more commonly, a doctoral-level therapist who received training with either a research or a clinical focus. Many psychologists become educators, or work in academic settings. Clinicians often focus on severe forms of mental illness. Psychologists have the academic designations MS, MA, PsyD, EdD, or PhD.
  • Marriage and Family Therapist. A master’s- or doctoral-level therapist who received specialized training in relationship (“systems”) theory. While they work with individuals, as well as with couples and groups, their counseling is informed by the understanding that most mental-health concerns are, at their heart, relationship concerns. They have the designation LMFT.
    (Individuals on provisional status, who are not yet fully licensed in this or the following two categories, may have a designation that includes the letter A for Associate, or P for Provisional.)
  • Mental-Health Counselor/Professional Counselor. A master’s- or doctoral-level therapist trained to work primarily with individuals, though they may sometimes work also with families or couples. Many have specializations such as addiction counseling. They have the designation LMHC, LCPC, or LPC.
  • Social Worker. A master’s- or doctoral-level therapist who is trained to work in collaborative settings, most commonly in government-affiliated or charitable organizations. As with any psychotherapist, social workers may be in private practice, though it is less common for social workers to work alone. They have the designation LCSW, LICSW, LMSW, or LSW.

But are they any good?

The mental-health profession — like any other profession — has talented practitioners who have a deep, profound level of understanding of their field. They are wise, insightful, compassionate, and capable. They have an almost magical ability to help people get back on track and find joy.

But it also has its share of problematic, even destructive, practitioners who may be either too weak, too burnt-out, or too bullying to be effective therapists. Some have been depleted by insurance companies, bad business practices, or difficult cases. Some have personal problems that interfere with their ability to provide effective treatment.

Unfortunately, you can’t tell from an old Psychiatry Today or Health Grades profile which is which. But here are some ways to sift the good from the incompetent:
  • Clean, up-to-date website. If they’re maintaining their website, they’re probably not burnt-out.
  • Online appointment scheduling. If they’re well organized, they’re not likely to sleep through or forget your appointment.
  • Responsiveness. If they don’t answer your texts or emails, they’re probably up to their ears in their own problems.
    (Note, though, that for a variety of reasons, few therapists take incoming phone calls, not even during those rare moments when they’re not in session. A large number of incoming calls come from marketers and robocallers; another percentage come from non-clients wanting to vent about a problem to a listening ear. If you do call your therapist, leave a voice mail, or send a text or an email. You’ll get a fairly quick response from a good therapist.)
  • Warmth, energy, humor, compassion, humility. If any of those elements are missing during your initial appointment, it’s not likely to get better. Arrogant, bossy therapists don’t eventually become compassionate or humble. Weak, helpless therapists don’t suddenly sit up straight and provide useful direction.
  • Compatibility. In our practice, our first session is at a reduced fee. Sometimes, we’re just not a good match for a particular client, and we don’t want people investing good money in a bad match.
    For example, we conduct all therapy sessions via video, text, voice, or email, and we work unusual hours. (I’m located in Europe, and I don’t see clients during the afternoon, west-coast time). So my medium and my counseling hours just don’t work for some clients.
    There are many other ways to be incompatible: Personality, approach, demographics, and life stage are some common ones. Shared values is another. 
  • Expertise. If you have a very specific concern — perhaps you and your spouse are fighting over money, for example — you may want to seek a therapist with training in personal finance. A broke counselor may not be a good match for you. Or you may have a parenting concern. A 23-year-old childless therapist may not have the expertise you need. While all licensed psychotherapists may treat any mental-health concern, their post-graduate training (and life experience) in specialities such as geriatrics, PTSD treatment, grief counseling, or sex therapy may provide them particular insights into your individual concerns.
If your therapist doesn’t make sense for you, is non-responsive, doesn’t share your values, or seems to be talking nonsense, be a smart consumer and find another therapist. Don’t waste a single minute of your short life hoping your therapist will learn to do therapy.

But who can prescribe?

Who may prescribe psychotropic medications? In many cases, psychotherapists and prescribers work in conjunction to diagnose mental-health conditions and prescribe appropriate treatment. Depending on your locale, any or all of the following may have authority to prescribe psychiatric drugs.
  • Psychiatrist (MD, or rarely, DPM)
  • Medical Doctor (MD) and Doctor of Osteopathy (DO)
  • Physician Assistant (PA)
  • Nurse Practitioner (NP, ARNP)

Other kinds of licensure

In many states, there are additional categories of people who can be authorized (or licensed) to provide limited forms of mental-health counseling in very specific fields and usually under close supervision. Only in rare circumstances would they be in private practice. Some of these job titles include:
  • Agency-affiliated counselor
  • Peer counselor (often in addiction-related fields)
  • Certified counselor or advisor
  • Certified alcohol and drug counselor, licensed substance-abuse counselor
  • Designated crisis responder
  • Crisis line volunteers

Who else can counsel people?

Anyone can counsel anyone, so long as they’re not charging money or claiming to have credentials they don’t have. 

Typically, members of clergy provide pastoral counseling to their parishioners at no cost. They work from a spiritual perspective based on principles that align with the doctrinal foundations of their faith — an approach that, in fact, has valid, evidence-based efficacy. Many qualified, licensed therapists also work from a faith-based perspective, informed by treatment approaches that align with their academic training and field experience.

In the US, there is no legal prohibition against providing advice for a fee or a commission, unless the advisor is demonstrably deceitful, or providing advice in a regulated area (such as, law, medicine, or investing). Personal trainers, sports coaches, martial-arts instructors, financial counselors, home inspectors, and business consultants all fall under this heading. Typically, they’ve received an appropriate level of training from an established, legitimate organizational body qualifying them to provide expert advice in their specific and narrow field of study.

Life-coach cat. 
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Life coaching — where unlicensed individuals provide “life” advice for a fee — involves no accreditation, and requires zero academic training, credentialing, or licensure. To provide the veneer of legitimacy, some individuals have set up unregulated organizations purporting to license life coaches, and may even charge exorbitant fees for “training” life coaches. These organizations are not accredited by any recognized accrediting agency. You are free, in fact, to set one up yourself, and to “credential” yourself — or to provide ad-hoc credentials to anyone else. In fact, your cat may become a life coach.

To be clear: Many people will attest to having been helped by a life coach. Some licensed therapists, in fact, also offer life-coaching services. But before hiring a life coach, wise consumers would, of course, inquire about the individual’s philosophical approach, credentials, and experience, and might even ask for verification. And they would be particularly cautious about trusting their mental-health concerns and relationship issues to amateur counselors.

That’s not a therapist!

And just a little side note to this discussion: Amusingly, there have been instances where similar-sounding words have been confused for mental-health professions. Perhaps you’ve known someone who errantly believed one of the following academic subjects had something to do with psychotherapy: sociology, physics, philosophy, social sciences, pathology, linguistics, or thermodynamics. And to clarify, neither is a mentalist, a homeopath, a strategist, a hypnotherapist, or a paranormalist qualified to diagnose or treat mental-health conditions. 

All clear now? If you’re seeking a therapist in your area, drop us a note in the comments section, and we’ll try to point you in the right direction.

LauraMaery Gold, LMFT, lives with her husband in a 400-year-old castle just outside of Paris. She is a licensed marriage and family therapist working with couples and parents. She is also the director of The Relationship Institute and the author of oh-so-very-many books on family concerns.

* Note: All my articles probably contain affiliate links to books or other products I own, use, and love. If I ever earn back what I’ve spent, I’ll very likely buy myself…well, another book that I’ll undoubtedly reference in a future article. This is a very bad way to get rich.