Therapist, Counselor, Social Worker, Psychiatrist! What’s the Difference??

As a licensed Marriage and Family Therapist I often get asked questions or hear statements like this:

“So I saw a counselor last year, but you call yourself a therapist.  What’s the difference?”  Great question . . .

“Can you prescribe meds to me?” No

“Since you’re a Marriage and Family Therapist, you must not work with individuals.”
I do work with individuals!

“So are you, like, a social worker??” Nope

“Hi, Dr. Gores!” I am definitely not a doctor!

It can be confusing to navigate all the degrees, licenses, and titles that come with seeking therapy.  So today, as simply as possible, I will try to break it down for you.

Lucy-van-pelt-1-

Marriage and Family Therapist – Let’s start with this one, since that’s what I am, so it’s my favorite!  A marriage and family therapist does not just work with couples, and families.  In fact, I would say that a majority of my clients are individuals, and we work on a variety of issues.  The main distinction of a MFT is what I would call a “systems approach.”  Our advanced degree, and training is centered around looking at how the system of that client’s life impacts them, and how they impact it.  The system includes family, friends, work environment, culture, etc.  So if you see a MFT for therapy, they will help you with your issues through a lens of looking at the big picture.  Because MFT’s have been trained with this systems approach, they have a little more ethical latitude of who counts as the client than licensed counselors do.  I have the ability to see an individual, and then switch to couples counseling with that individual if I think that it is ethically appropriate, and the clients give informed consent (meaning that I have explained the risks, benefits, and boundaries around our new therapeutic relationship).  A counselor is more tied to the client they first started with.

Counselor –  A counselor is someone who has a masters degree in counseling, or someone with a master’s in clinical psychology.  A counselor’s training will center more around individual therapy modalities such as psychoanalysis (Freud), Adlerian, Client Centered (Rogers), etc.  Counselors don’t just work with individuals.  They may also work with couples, and families.  So much of what types of clients you end up working with depends on the hands on training and work you do after you complete your degree instead of what degree you graduated with.  Most people who call themselves counselors, have a license with the term “counselor” in the title.

Note: A counselor and a therapist are not that different.  We like to think we’re different, and sadly there can sometimes be an attitude that one is better than the other within the field.  Our training and license process looks a little different, but fundamentally we are both master’s degree level individuals who provide therapy to a wide range of clients.

Social Worker – A social worker is someone who has graduated with a degree in social work, and usually has a master’s degree.  Social workers often work in environments that involve them providing support, and connection to people with resources that they need; be that in a hospital, for the state or county, child protective services, correctional facilities/jobs, and on and on.  Social workers can also see clients for therapy.  Those social workers usually focused on what is called “clinical social work” in their degree or license program.

Psychologist – You cannot call yourself a psychologist unless you have a doctoral degree.  They may have a PhD, or a PsyD.  PhD programs are more centered around research, and PsyD programs are more centered around learning how to do therapy.  Psychologists have additional training that a masters level therapist, counselor, or social worker does not have in testing and assessments.  There are certain assessments that I am ethically allowed to give clients, but most must be administered by a psychologist.  Those include personality testing, IQ testing, and more complicated and thorough assessments than I have available to me.  That is why a therapist, counselor, or social worker you are seeing for therapy may refer to you to psychologist for testing if they think it would be beneficial.

Psychiatrist – A psychiatrist is someone who has a medical degree (and therefore is a doctor) and has specialized in treating psychological disorders with medication.  Despite what Hollywood would have you believe, a vast majority of psychiatrists do not perform therapy.  Someone would need to get additional training above and beyond their medical degree to offer therapy to their patients, and that person would be VERY expensive.  When you visit a psychiatrist you should think of it as any other doctor appointment.  If it is an initial intake, it may be slightly longer, but most med check appointments will be 10-20 minutes long.  I often have clients who are offended that the appointment was so short, but that is always because they misunderstand the role of a psychiatrist in their mental health care.
Note:  Unless you have the simplest form of depression, post partum depression, ADHD, or anxiety, please don’t get your psychological medication from your primary care doctor.  That would be like finding out that you have cancer, and continuing to only see your family doctor.  Your family doctor plays such an important role in initially diagnosing a possible mental illness, but a psychiatrist has specialized in the types of medications used for treating mental health disorders, and it is complicated!!  I heard a speaker at a training few years back say that the goal of any psych medication is HUGE results with little to no side effects.  The number of different types of depression medications, anxiety medications, mood stabalizers, etc. is staggering.  It can take 6-12 months for someone to find the correct medication and the correct dosage of that medication.  For the most part a family doctor does not have the experience to deal with these complicated issues.

So there you have it.  Those are the mental health professionals that I most often hear my clients get confused by when they are trying to figure out who they need to utilize to get the best results in their therapy or mental health treatment.  I didn’t even cover specializations that therapists can have such as play therapists, EMDR therapists, substance abuse counselors (I bet you can guess what that one is all about), etc.  Another post for another day!

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