Professional Counselor vs. Psychologist

Professional counselor sounds like a rather amorphous description. It could include counseling psychologists and social workers, but also people with somewhat dubious credentials.

I am not sure why you say you don't need (or want) a Social Worker as a psychotherapist. Some Social Workers do have the clinical training, and a state license, which enables them to be in private practice as psychotherapists. They are not as highly trained as Clinical Psychologists--most licensed Social Workers have completed a two year graduate program and hold an MSW degree, while Clinical Psychologists have generally completed at least four years of graduate study to earn a Ph.D or Psy.D. degree. But many Social Workers are quite good and effective therapists in helping people to deal with particular life difficulties. It is a highly individual matter.

Psychology, as an academic discipline, is a social science which focuses on the understanding of behavior. It is divided into many sub-specialities. Clinical Psychologists, specialize in the treatment and diagnosis of mental disorders, and these are the psychologists most often found in private practice. They utilize various forms of psychotherapy to help individuals gain greater insight and understanding of their behavior, and to help reduce emotional distress, and behavior patterns which interfere with satisfaction in day to day living.

Clinical Psychologists are the most highly trained of all the mental health professionals, and probably the most carefully regulated by a very strong code of ethics and standards. This is to protect the integrity of the profession and to protect the consumer who seeks the services of a Psychologist . A Ph.D. (or a Psy.D) and a state license are the minimum requirements for a Psychologist in private practice, and many Psychologists have additional training beyond their doctoral degree. No one without those qualifications can independently offer their services to the public and call themselves a Psychologist--"Psychologist" is a legally protected term.

So, when you seek the services of a Psychologist in private practice, you know that the individual has completed extensive graduate education and that they have satisfied the stringent Psychology licensing requirements of their state. You know also that they are bound to uphold high ethical and professional standards of conduct in the practice of their profession.

Anyone, including those with no professional qualifications at all, can call themselves a "psychotherapist", or a "counselor" or a "marriage counselor" or a "sex therapist". Any licensed physician can call him or herself a psychiatrist, whether or not they are board certified in psychiatry. When you consult a Psychologist you know they have satisfied certain requirements, as I mentioned above. You can have greater confidence in the professional expertise of the individual, and you will have greater safeguards as a consumer because of the ethical and professional codes of conduct required by both the state and the American Psychological Association.

For all of these reasons, I would certainly urge you to consult a Psychologist. You might also find this information useful.

http://www.apahelpcenter.org/featuredtopics/feature.php?id=62&ch=4

and this

http://www.apahelpcenter.org/featuredtopics/feature.php?id=62&ch=6

And this is a fairly good, broad overview of Clinical Psychology that should answer your questions about what a Psychologist is, how they are trained, what they do, etc.

http://en.wikipedia.org/wiki/Clinical_psychology


You should also think about what you want to gain from your psychotherapy.

Do you want greater insight into your current behavior? Do you want to understand how events from your past are influencing you now? Do you suffer from anxiety you would like to control? Are you feeling depressed or chronically angry? Do you have problems in your relationships? Do you have patterns or behaviors that are destructive--drinking, drug use, compulsive eating, gambling, shopping, etc that you would like to get under control ? Do you just want to manage a currently stressful situation in your life? Are you confused or uncertain about something in your life?

Psychotherapy can address all of those issues--and more. But there are different types of psychotherapy, practiced by different Psychologists. Some types of therapy might be more suited to your needs then other types. Some types of therapy are relatively brief, other types might continue for much longer periods of time. The two main types of psychotherapy tend to be either insight-oriented/psychodynamic approaches or cognitive/behavioral approaches. The insight-oriented approach would be the more traditonal talk therapy, The cognitive/behavioral approach is more specifically directed at symptom removal and at changing patterns of thought and behavior. You might want to do some reading on the internet about these methods to see which might be more appealing to you. You can then seek a Psychologist who practices a particular modality of psychotherapy.

Any Psychologist you consult should be open to discussing the particular types of treatment available and help you to find the one best suited to your needs. It is important that you do find a therapist you feel comfortable with. There is nothing wrong with doing a bit of "therapist shopping" and having initial consultations with more than one Psychologist if you are feeling at all unsure about what to do.

I hope this information is useful to you. If I can answer any further questions for you, I'll be happy to try to do so.

Firefly, Thanks so much for the thorough explanation. I am very grateful.



I have a personal bias here - I have family who have the Social Worker credentials you mentioned above and who I would never go to for counseling.



Yes, that is what I will do.




Some of almost all the above except for the drinking/drug use sort of stuff.



I think I will find one Psychologist from my 'in-network' providers and see how that works out. I suppose I should be able to tell after one session how I felt during.

So, if a person is a little screwed up and their world-view is a little skewed - how do you tell if your read of your counselor is accurate? Does that even make sense?

I'm not quite sure I understand exactly what you are asking, but I think you are wondering about how accurately you can size up a therapist. Basically, it's the same way you would size up anyone else.

Do you feel comfortable with the way the person is behaving? Are they professional in their manner? Are they listening attentively and responding in a way which indicates they understand what's bothering you? Are they asking appropriate questions? Are they reassuring in a way which makes you feel confident in your relationship with them? Do you feel you could trust them? Do their comments make you think about why you behave or react in certain ways? Are they willing to answer your questions about the treatment? Do they seem to know what they are doing?

I think you can get some sense of the answers to those questions in just the first few sessions. Sometimes just from the initial session. And I think you can trust your own judgment. You can also tell the therapist what you think and how you feel about what is going between you. That's often a very useful and important part of therapy.

When you call to make the appointment, you can ask the person about their area of specialization and the type of treatment they offer. You can mention why you are seeking therapy and ask if they would be an appropriate person for you to see. You can get some sense of whether you are making the right move just from this phone contact and how they respond to your questions.

It's normal to feel some anxiety about undertaking something like this. Trust your own instincts because they seem to be pretty good. The important thing is that you are taking a step to make your life better. And, hopefully, you will find a therapist who can help you do just that.

I wish you the best of luck, Heatwave. Let me know how this works out.

But a psychologist is not an MD, which every psychiatrist is (they have their PHD). Which means they can prescribe medicine.

Very cool - thanks a bunch, Firefly.

Cjhsa - I did know that about psychiatrists. Thanks.

Actually, the law varies from state to state. In many states, psychologists and psychological counselors are allowed to prescribe. You should check the laws in the state in which you live to determine who is allowed to practice as a psychological counselor, and if you think it will be an issue, who is allowed to prescribe for psychological conditions.

My cousin is a psychologist and she has psychiatrist associates with whom she refers back and forth with thorough evaluations should a med be considered.

My comments in this post, and in my previous posts, are really addressed to someone, like Heatwave, who has decided they would like to consult a psychotherapist. They know that something is bothering them, or interfering with their lives, or their sense of well being or happiness, and they feel that therapy might be helpful to them.
People seeking a therapist have some idea of what therapy is all about, and they are not generally looking for a "quick fix" with a pill, or they might have tried some medication in the past and found it of limited or little value in addressing their problems. They have made a decision to try to address their problems through non-medical means.

But I would like to say some things about psychiatric medications and psychotherapy in general.

When seeking a psychotherapist, ability to prescribe medication is really a non-issue.

I say that for several reasons.

1. Most people seeking psychotherapy really do not need or require medication.

The average person seeking therapy does not suffer from a major psychiatric disorder, such as schizophrenia or bi-polar disorder, which actually requires medication to control symptoms of the illness. Most people seeking therapy have problems which can be addressed by non-medical treatments, such as psychotherapy.

Despite aggressive marketing of drugs, by pharmaceutical manufacturers, and the frequency with which primary care physicians (in particular) write prescriptions for anti-anxiety and anti-depressant medications, there really is no strong data regarding the long term effectiveness of these drugs in terms of alleviating the underlying problem. Despite all the hype, and all the prescriptions being written, these drugs simply just don't seem to work all that well if you look at the research evidence. Because of that fact, and because all medications can have potential side effects, non medical treatments (such as psychotherapy) should probably be considered first by most people.

In the U.S., over recent years, the frequency of prescriptions being written has increased, while referrals for psychotherapy have decreased. Some of this is due to cost-effectiveness on the part of HMO's and managed care companies. It is cheaper to prescibe a pill than to pay for the cost of therapy. It is economically better for physicians to write prescriptions than to refer their patients to therapists--physicians gain financially from this strategy, whether or not it is the best treatment approach. And, not insignificantly, the drug manufacturers handsomely reward physicians, including psychiatrists, for promoting and prescribing their drugs.

There is no drug that helps people understand themselves better. There is no drug that helps people learn how to cope with life difficulties more effectively. There is no drug that improves the quality of our interpersonal relationships. There is no drug that helps people make changes to improve the quality of their lives. There is no drug that will actually change an external situation (such as financial difficulties, loss of loved ones, divorce, marital conflicts, employment problems, problems with children, etc.) that cause one extreme stress. There is no drug that can help to make us more successful or more at peace with ourselves or with our lives.

Most of the things that bother people who seek psychotherapy are not due to underlying biological or bio-chemical disorders--things for which medical treatment and intervention would be appropriate. Most people, seeking therapy are dissatisfied with some aspect of the quality of their lives. They worry too much, feel angry or depressed or anxious too often, lack self confidence or have poor self esteem, keep repeating patterns of behavior which are self defeating or self destructive, are bothered by emotions they don't fully understand, find themselves eating or drinking too much or spending too much money impulsively, have problems finding a meaningful relationship, have trouble sleeping or getting things done, they may behave too impulsively at times, feel misunderstood or let down by other people, feel like they can't control their lives, are unsure of what to do about something, and on and on--the entire gamut of things which trouble and bother people by virtue of the fact that we are human, and we suffer from human problems.

There is no drug on earth that will help the average person to really understand themselves better or help them to change themselves, or their lives, in a more positive direction. If there were such a drug, we should all be taking it.

This does not mean that some medications might not be beneficial or helpful as a temporary measure, or for occasional use for symptom reduction, it means they are not generally the main, or even the best, solution for most of the things that bother us in our daily lives, and for which people might seek psychotherapy.

2. Whether or not the psychotherapist can prescribe medication is not really an important consideration when seeking a therapist.

Unfortunately, the people who can prescibe medication, mainly psychiatrists and nurse practioners, are generally the mental health practioners least well trained in doing psychotherapy, and probably the least committed to practicing it. They would be more likely to prescibe medication, whether or not it is really needed, and whether or not the problem can also be addressed by non-medical means.

The main consideration when seeking a psychotherapist should be to find a highly trained, reputable, licensed mental health professional, whose main area of expertise is psychotherapy. Of all of the mental health professionals, it is generally clinical psychologists who have the most training and experience in this area. Only those very few psychiatrists who have actually completed extensive post-doctoral psychoanalytic training would be likely to be well trained and committed to the practice of psychotherapy. Those psychiatrists might also be least likely to use medication in their work.

Psychologists do not prescribe medication. In two states (I think Louisiana and New Mexico) a small number of medical psychologists can prescribe, but that is not generally the norm. Psychologists do recognize when medication might be useful or effective, and they would make an appropriate referral at those times. If one consults a psychologist for psychotherapy, and has questions about their attitudes toward medication, and how referrals might be made, they should raise these issues at the onset of treatment. For people who are already on medication for a psychiatric problem when they consult a psychologist, the psychologist would likely want to confer with the prescribing physician, to ensure a collaborative effort for the benefit of the patient, and the patient should consent to that.

For most people who are thinking about seeing a psychotherapist, it might be better to put thoughts of taking medication on a back burner. First consult the therapist. Get an idea of whether therapy is likely to help with your problem. The purpose of psychotherapy is basically to increase self awareness, and to help put your emotions and your behavior under better conscious control, and help you to make better choices in how you feel and think and act and react. Philosophically, the idea of self control, and self determination, which psychotherapy promotes, is somewhat at odds with the notion of taking pills to alter one's internal states, although both psychotherapy and medication can be useful, and they can be combined. If, at some point in your treatment, you or therapist think that some medication might be useful, discuss it at that time. But don't seek a therapist with medication considerations in mind because there really are more important factors to consider.

Kinda like an Orthopedic surgeon as compared to an Osteopath. MD vs DO.

Not the same.

Those that have spent the time and money getting trained as psychologist or osteopaths (most likely because they couldn't get the higher degree) will argue endlessly about their superiority. It's kinda funny.

cjhsa, an M.D. is not a higher degree than a Ph.D., it is a professional degree, which is simply a different type of degree. The Ph.D. is the highest academic degree a university can award.

I doubt you will find many psychiatrists (if any) who would argue that they were better trained in psychotherapy than clinical psychologists. Psychiatrists actually receive very little training in that area.

These days very few psychiatrists bother to do psychotherapy at all. They generally only write prescriptions and see the patient only at 1-3 month intervals.

Since this thread is about someone seeking a psychotherapist, it would make little sense for that person to consult a psychiatrist.

And your degree is in????

Geez cj, lighten up. Thought your previous post was excellent, firefly.

These are different approaches, obviously, and chosen for different reasons. My own experience would be with a physical ailment -- frozen shoulder. I could have chosen surgery (performed by a medical doctor and covered in total by my government health insurance) instead I chose physiotherapy which took months and which I paid for myself. A small price to pay IMO for not going under the knife regardless of the surgeon's qualifications.

I guess I should have posted a smiley. :wink:

Never let it be said that I cannot be clueless before my second cup of coffee.

Firefly, that was an excellent post. You're absolutely right - and I would probably laugh and walk out of any doc's office that tried to prescribe a drug for my issues.

As I am trying to gauge how good my counselor(a licensed Psychologist) is, a couple good things he did:

After weeks (months?) of almost a complete communication breakdown, my husband suggested we each draw up a list of things we don't like about each other and then work on them. I asked my counselor what he thought of it. He gave me a sheet that he said he generally gives to couples who come in for couples therapy. He calls it the I-statement list. Basically - a list of things each partner states that he/she is willing to work on in order to improve their marriage. He suggested using that list instead of listing things we don't like about each other - because that is finger-pointing and could (Yes, it would!) lead to more resentment. I REALLY liked the idea. Of course, I haven't brought it up to B (my bitter half), he doesn't think much of counseling & therapists, etc. But I will, when the time seems right.

I mentioned B's thoughts on couselors/therapy to my Counselor - let's say C. Basically, I wanted to tell him that B would probably never agree to couples counseling, and would/could therapy still help me/us with just me in counseling. C said it still would - although having at lease B's perspective would help. He suggested I ask B (when I felt the time was right) if he could perhaps just go in (NOT 'to be shrunk' as B would call it) to just provide his take on things. So that C could help me improve. I said that sounded perfect, specially since B thinks I don't communicate well enough. Not sure why this interaction was reassuring, but it was.

Heatwave, it sounds as though you feel comfortable with your therapist and the way he responds to you and the difficulties you are having.

Therapy certainly can help you, whether or not your husband participates. It may not help your marriage, but it can help you.

If your husband is so negative about therapists/counselors, would much be gained by getting him to come in for a session? Are you hoping that if your husband put his toe into the water that he'd be more likely to wade in--and agree to marital therapy? While anything is possible, that seems like a real longshot, based on what you've said.

We really can't change other people. We can only work on trying to change ourselves, and how we act and react to the other people in our lives. You're obviously trying to do that, but it sounds as if your husband is no where near that point, at least not yet.

In the meantime, why not work on your own I-statement list from the sheet your therapist gave you. It sounds like a great approach. It takes the emphasis off trying to change the other person, and puts the focus back on what you can change--yourself. You can formulate your own list and think about those things you are willing to change, or work on, to improve your marriage. Maybe, after you've done your list, and tried to implement some things, you can then ask your husband if he'd be willing to try doing it too. Then it can become a joint venture. But, even if he doesn't like the idea, you can still do it for yourself, and it might be very instructive for you to do it. It does force you to shift your own perspective.

Your therapist's suggestion about how to get your husband in for a session was also very good. By saying, to your husband, "I need your help to change myself and how I act in our marriage, and, if you come to a session, you will be helping me to do that", you take the focus off trying to change him. You are not saying you want to drag him into a session so the therapist can go to work on him. It helps to make the situation less threatening for your husband, but it also emphasizes that working on your marriage is a collaborative effort. And, ideally, you do want it to be a collaboration. And that's a far cry from your husband's idea of each of you making a list of what you don't like about the other one and then just trading lists.

Grievance lists won't do much, except, as you know, lead to more resentment. If anything, you should both try making lists of what you still do like, and admire, and respect, about the other person. And then read your list to the other person. Particularly when things are bad in a relationship, it helps to remind oneself of what positives there are. It reminds both parties why they want to try to save the relationship. It can help both of you to feel more connected and to bridge some of the gulf that's apparently in your relationship. It can help to thaw some of the ice.

It does sound as though you found a fine therapist. He seems to understand your situation, and his suggestions (based on your two examples) are very sensible, and designed to reduce friction between you and your husband. Even if this continues to be just your own individual therapy, rather than marital therapy, I think you will find it helpful. Although, as I said before, it might not help to improve your marriage. But it may well reduce your stress in the marriage by helping you to deal with things differently. And, when one partner starts to change, it does affect the other partner, so you never know what might happen.

Are you happy with your therapist? Are there any things about your therapy that concern you?

I empathize with your confusion, there are so many varying descriptions when it comes to "professional counseling or therapy" or whatever else you call it. Personally, for severe issues of childhood abuse/neglect, I saw as a woman (a nun) who had a masters degree in clinical social work and a doctorate in divinity. Being a"new age nun" she didn't wear the clothing/garb nor was her religion in any way apparent in the framework of her work. She was a wonderful woman because, unlike some of the professionals in ANY field you will encounter out there, this was one person who genuinely CARED about doing her job very well, and about how well she was able to help you learn to help yourself. I saw her each month for many years and the difference in my life has been so very remarkable that if you had known me before I began my "family counseling" and met me afterwards, you would not believe that I was the same person.

Sounds damn fine to me.


As for the "who to choose" thing......there are brilliant therapists who are social workers, psychologists, AND psychiatrists.

And some who haven't done any training at all...they are just like that!


The qualifications are a protection of sorts from random nutters, they mean someone understands (or ought to.....it's no absolute guarantee) professional ethics and boundaries, and will not work beyond their capacities.

In my country (Australia) psychologists tend to be mainly trained in cognitive behaviour therapy, and some will rigidly use this method and this only. It is a well researched methodology, though by no means as well supported as rigid adherents to it claim (people who drop out often do not get included in studies, for example) and is often very helpful.


Any decent therapeutic method has cognitive and behavioural components anyway!!! Hopw do we change? We receive new and meaningful feedback and understanding of our behaviour and way of viewing the world and ourselves.

Where it has often fallen down is in neglect of the crucial relational aspects of therapy (and neurological research is more and more supporting what any good therapist has always known, that change occurs in the context of a strong relationship with a therapist) and in any attention to, and understanding of, the contextual and systemic and social and political aspects of people's situation.

Psychiatrists, if and when they do therapy, will often only know about analytic concepts. Interestingly these, while having long been roundly ridiculed by many psychologists and social workers, are experiencing renewed interest as attachment and trauma research appears to be strongly supporting many of its basic and less out there concepts (many of which are strongly ties to the cultural conditions of its birth).


Social workers tend to be more eclectic, which may mean messy and dumb, but may mean a very comprehensive and well rounded approach.


For myself, if choosing a therapist, I would go on who the person is and their reputation....but I work in the filed and have good access to information...not their particular discipline.


One of the absolute best therapists I know, who is a psychiatrist, sees a social worker as her own therapist, for example!

I would agree with the poster who said that normal psychiatrists are the least likely to be good therapists of the three disciplines, because they are the least likely to have focussed on therapy in any well rounded and intensive way. But...where they have had such a focus, thsay can be great. They often focus on drug treatments...which is damn fine for the seriously mentally ill, and often rely on other disciplines to do the rest of the work.


In my country, I'd be very wary of "professional counsellors". I base this on knowing what their courses teach, and I am very unimpressed.


This may not be true at all where you are, though.


I am similarly unimpressed by what my own discipline's university degres consist of, and I know many psychologists who say the same about theirs.

For myself, my important skills have come from extensive study and experience that I have done since graduating, as I became more and more able to know what I needed and was interested in.


A lot of it has to do with "fit", too.


Some people just work well together.....the same therapist may not be able to work effectively with someone else.

Eg: A friend and ex-colleague of mine, a psychiatrist, went to see a psychologist for a specific phobia...in his case a cancer-phobia.

He was very happy with the person, and achieved a lot.


I decided, therefore, to see the same fella about some simple little anxiety. He was what I rudely call a "pig CBT psychologist"...ie only interested in the straight down the line, CBT-manual way of doing things.

(The manuals now acknowledge the importance of developing a relationship these days....generally...but I digress..)


I wanted to kill him after the first 5 minutes...he was like a robot. I would never have considered going back...but my friend was perfectly happy. This is "fit".


(I add that lots of psychologists are not like this at all...they are great people and great therapists for people who don't like robots!)