Credentials - Types of Psychotherapists

Isn’t it amazing how the same people who know the contents of every last diploma and certificate on their podiatrist’s wall (and I’ve seen offices with 10 such documents) cannot tell you anything about their therapist beyond a name. They know all about the expert who treats their feet, but nothing about the person who deals with their heads and hearts. You ask if this person, in whom they are entrusting their most private thoughts, is a psychiatrist, psychologist, social worker, or what, and they don’t know. You ask if the therapist is licensed, and if so as what; again they don’t know. You ask if the therapist has had special certification or training in particular areas, and they can’t tell you. In fact at this point they probably tell you to lighten up.

Don’t fall into this trap. Be an educated consumer. I know I said in Choosing a Psychotherapist that one should be wary of experts, but some credentials are meaningful.

The term "psychotherapist" is unlicensed; anyone -- and I mean anyone -- can call himself a psychotherapist. The same applies to the term "therapist". "Psychologist", on the other hand, requires some kind of licensure. The practitioner cannot call himself by this title unless he has met certain state and national requirements. These are usually as follows, in descending order of what fees they usually charge.

Psychiatrist: graduation from medical school, and then graduation from a psychiatric residency program. Many psychiatrists are also "board certified", which requires them to take another competency. Bear in mind, here, that unless the residency specifically focuses on psychotherapy, a psychiatrist can conceivably have no training or experience in it! Most who practice psychotherapy, however, do pursue advanced training. The problem with that is that they very likely received such training at a psychoanalytic institute. Such places vary widely in quality, and they can be rather limited in their orientation. Among the practitioners discussed here, at present only psychiatrists can prescribe medication. There are rumblings in the field of certifying psychologists to do so, but don’t hold your breath.

Psychoanalyst: A psychoanalyst must complete training at an analytic institute. Sounds very advanced but there are some cautions. First, there are institutes and there are institutes. Second, some institutes accept candidates who have little or no prior background in the field. A few institutes will not even consider any applicant other than a medical doctor who, as discussed above, may have no background in psychology. Thus, the analyst’s only training may be in the institute’s possibly narrow view of the field.

Psychologist: Ph.D. psychologists have about 5 years of graduate training in psychology and usually an undergraduate psychology degree as well. Psy.D. psychologists have almost as much training but with less emphasis on the scientific aspects of the field. In order to obtain the license as a "psychologist" most states require a further 1 or 2 years of post-graduate supervised experience in the field. A masters level psychologist cannot licensed as a "psychologist", and has only about 2 years of graduate training.

During Ph.D. training, students spend up to half their time in clinical settings -- mental health centers, psychiatric hospitals, schools, clinics -- and receive one-on-one supervision of their work. Bear in mind that a psychologist who studies rats in graduate school and never sees a human patient can sit for the licensing exam, call himself a psychologist, and set up a practice -- although I’ve never heard of one who did. The thing you may want to ask is whether your psychologist is a "clinical psychologist", meaning did he specialize in diagnosis and treatment of humans.

Social Worker: Usually 2 years of graduate training, perhaps an internship, and a year or two of supervised post-graduate work before obtaining the license. The requirements and titles vary by state. Be aware there are licensed and unlicensed social workers. In New York, the two types of clinical social workers are LCSW (Licensed Clinical Social Worker) and LMSW (Licensed Master Social Worker), but only the first is considered a licensed clinical worker. The LMSW thus cannot practice unless under the supervision of a licensed clinical professional - psychologist, social worker, or psychiatrist.

My own bias is strongly supported by psychoanalysts and even the cognitive behavioral literature. All these sources agree that you should start treatment by consulting a well trained, widely experienced therapist. In that consultation, which could last anywhere from one to five sessions, you will determine what kind of approach will work best for you. There are several reasons for such a consultation. First, as already noted, despite what you may believe people donít really know what is wrong with them so they are not in a position to choose their own treatment. Second, among the most common errors made by therapists of limited training and experience is that of overlooking alternatives. You would not want to be seeing a narrowly trained, narrowly focused therapist about depression if in truth you were suffering nutritional deficits, sleep deprivation, even neurologic damage, attention deficit, or Obsessive Compulsive Disorder, all of which can mimic depression. I see this danger most commonly in the case of Attention Deficit Disorder. Very often what looks like this disorder is any number of other conditions, including very straightforward interpersonal conflict among family and teachers. Before rushing to the Ritalin, Adderall, or Cylert (commonly prescribed medications for ADD), the condition should be carefully diagnosed and all alternative possibilities ruled out.

Finding a Psychotherapist