"And how's your job going? You're a psych...iatrist, right? Or psychologist? What is it? What's the difference?"
I pulled the phone away from my ear, pushed my glasses up onto my head, and squeezed the bridge of my nose. It wasn't my sister's fault, and I wasn't upset with her--the question was genuine and valid. The damn mental health fields and their alphabet soup strike again!
My sister's recent version of the question is really only one out of hundreds of iterations I've heard since my mental health training began. I honestly don't blame the people who scratch their heads quizzically--the fields really are confusing! Not only do some of the professional names of the fields beg confusion (there's professional counseling...but social workers provide counseling?), but the sheer quantity of degree and licensure types are mind-numbing. It's confusing for everyone involved: family, friends, clients, and, hell, even the professionals themselves.
The idea for this post came from a course I taught a few years ago, Introduction to Counseling and Related Professions. Students in the course would regularly approach me with confusion about the purpose of so many mental health fields, so I whipped up the really rough guide to the right to discuss major professions. I guess we could call that rough guide "version 1.0."
My intent for version 2.0 of the guide, which I'm calling Mental Health Alphabet Soup, is even more pragmatic than version 1.0. The world of mental health care has not become less confusing in recent years, especially with the rise of "mental health creators" on the internet, who sometimes operate more as cults of personality than effective mental health advice channels. In this modern age of internet grifting, we have to be critical consumers of healthcare information, including mental health care! This guide will present readers (you!) with the information you need to make a (more) informed decision about your mental health care provider.
Mental Health Alphabet Soup isn't close to the first attempt to handle this obfuscation issue. However, many of the existing guides fall short in some ways. Some make confusing false claims, like "there are five mental health fields"--hint, there are more. Some leave out entire fields, like addiction counseling and marriage and family therapy. Others, while decent, are region-specific and might not translate across countries. This guide contributes to the existing demystification work by including as many mental health professions as my tea-addled brain could think of. While I don't intend this to be a perfect guide, I hope it is comprehensive enough to assist those in the target audience: people in the U.S. scratching their heads about all the different degrees, certifications, and scopes of practice in different mental health fields.
With those preambles out of the way, let's dig into this soup!
Descriptions of mental health professions are broken into the following categories: the degree required, the certification/license, estimated years of education, the scope of practice, and in which healthcare facilities you might find the professionals.
Psychiatry
The degree: M.D. (Doctor of Medicine) or D.O. (Doctor of Osteopathic Medicine)
The certification: board-certified by the American Board of Psychiatry and Neurology
Years of education: 4 (undergraduate) + 3 (medical school) + 4 (psychiatric residence) = 11 total years.
The scope of practice: Psychiatrists are physicians, which means they largely deal with understanding and treating the course of disease. As a subfield of medicine, some psychiatrists operate from a medical model of mental health, which assumes that mental health conditions have a physiological or biological basis. Conversely, some psychiatrists operate from a biopsychosocial model of mental health, which assumes that mental health conditions have biological, psychological, and social bases. The similarity between both models is the biological components of mental health, which psychiatrists will often treat through the use of medical psychopharmacology or, more simply, mental health medications. Anti-anxiety, anti-depressive, and stimulant medications all fall under the umbrella of mental health medications, and chances are you know someone who takes them! Psychiatrists can be an important component to a mental health treatment team, especially for clients who could benefit from mental health medications.
Where you might find them: Psychiatrists, like many physicians, can be found in group practices, private practices, hospitals (including VA hospitals), outpatient and inpatient clinics, prisons and correctional facilities, and colleges and universities. Some psychiatrists also work, not as physicians, but as educators in medical schools to help train the next generation of psychiatrists!
Psychiatric Mental Health Nurse Practitioners
The degree: MSN (Master's of Science in Nursing) or DNP (Doctor of Nursing Practice)
The certification: Board certification by the American Nurses Credentialing Center
Years of education: 4 (undergraduate) + [2 (MSN)] or [3-4 (DNP)] = 6 to 8 total years
The scope of practice: Psychiatric Mental Health Nurse Practitioners (PMHNP) are advanced practice nurses with a specialization in the diagnosis and treatment of psychiatric problems. What distinguishes a nurse practitioner from a PMHNP is the additional education and certification in medical psychopharmacology, psychotherapy, understanding of psychiatric conditions, and training in mental health screening. Like psychiatrists, PMHNPs prescribe medication for the treatment of mental health issues. However, PMHNPs should not be seen as "mini-psychiatrists," as advanced practice nursing and medicine are different, although symbiotic, fields with different philosophies.
Where you might find them: PMHNPs can be found in similar healthcare facilities as physicians and other nurses: private practice, group practice, hospitals, community clinics, inpatient and outpatient facilities, and prisons and correctional facilities.
Psychology (Health Service)
The degree(s): PhD or PsyD in counseling psychology, clinical psychology, or school psychology* (or combination)
The certification: Health Service Provider in Psychology (HSPP or HSP, depending on state)
Years of education: 4 (undergraduate) + 6 to 8 (graduate) = 10 to 12 total years
The scope of practice: Health service psychologists (HSPs) are applied psychologists, which means they put the theories and principles of psychological science into application, usually through healthcare service. This designation distinguishes them from experimental psychologists, who might work in research, and who are not involved in patient care. While there is some overlap between the two (many applied psychologists are also researchers), health service psychologists see clients and patients in healthcare settings. HSPs are advanced clinicians with experience in diagnostics, psychological assessment, treatment planning, advocacy, clinical supervision (training), interdisciplinary/interorganizational collaboration, and clinical service provision (individual, group, and family therapy). HSPs are trained as generalists--meaning they are trained to handle a variety of client issues--but they often choose to specialize their practice (i.e., addiction psychology, neuropsychological assessment, consultation/supervision, etc.).
*School psychologists are, in my humble opinion, the most unique of the health service psychology professions. They can also be licensed and credentialed at the masters-level, not as health service psychologists, but as specialists in school psychology using the title "school psychologist." Many health service school psychologists (educated at the doc level) also hold an Education Specialist (Ed.S.) post-master's degree. For master’s school psychologists, a combination of M.Ed. (master’s in education), Ed.S., and NCSP credential will allow for state licensure/credential for independent practice of school psychology.
Where you might find them: You will find health service psychologists in group or individual practices, on multidisciplinary teams in hospitals (including the VA), forensic settings, in college and university counseling centers (especially counseling psychologists), in K-12 schools (especially school psychologists), in community clinics, employee assistance programs, and in prisons and correctional facilities (especially clinical psychologists).
Mental Health Counseling
The degree(s): M.A. or M.S. in clinical mental health counseling
The license: Specific license name depends on state. Common licenses include: Licensed Mental Health Counselor (LMHC), Licensed Professional Counselor (LPC), and Licensed Professional Clinical Counselor (LPCC)
Years of education: 4 (undergraduate) + 2 (graduate) = 6 total years
The scope of practice: Masters counselors are often considered the "frontline workers" of the mental health field. They, along with social workers, comprise a majority of the clinical workforce in the U.S. Mental health counselors receive specific training in screening and assessment, therapy, treatment planning and intervention, advocacy, interdisciplinary collaboration, and individual psychotherapy. Mental health counselors are trained as generalist practitioners, and they often specialize post-graduation (e.g., trauma counseling, art therapy, music therapy, adolescent counseling, play therapy, addictions, etc.).
Where you might find them: You will find mental health counselors in just about every type of mental health facility that might exist: hospitals, inpatient, outpatient, private practice, group practice, community mental health centers, college and university counseling centers, prisons and correctional facilities, and employee assistance programs.
Clinical Social Work
The degree(s): MSW (Master's in Social Work)
The license: Specific license name depends on state. Common licenses include: Licensed Clinical Social Worker (LCSW) and Licensed Independent Clinical Social Worker (LICSW)
Years of education: 4 (undergraduate) + 2 (graduate) = 6 total years
The scope of practice: Alongside professional counselors, clinical social workers make up the bulk of the therapy workforce in the U.S. Social workers receive specific training in treatment planning, clinical intervention, psychotherapy, and diagnostics. While other mental health professions might teach client welfare and advocacy, these are core identities to social work philosophy. This is due, in part, to the history of social work stemming from social change and charity movements that centered issues like poverty and inequality. This philosophy has stayed with social work over time, which makes it the most social-action-oriented mental health profession. Like psychologists and mental health counselors, social workers are trained as generalist practitioners and they often specialize post-graduation (e.g., trauma counseling, adolescent counseling, play therapy, addictions, etc.).
Where you might find them: As arguably the oldest mental health profession, social workers can be found everywhere mental health or social inequality is of concern. This includes standard healthcare facilities (like mentioned in previous sections), private therapy practices, social change organizations--such as Black civil rights or LGBTQ+ rights organizations--and in departments of adult, child, and/or family welfare.
Marriage and Family Therapy
The degree(s): M.A. or M.S. in marriage in family therapy
The license: Most commonly, Licensed Marriage and Family Therapist (LMFT)
Years of education: 4 (undergraduate) + 2 (graduate) = 6 total years
The scope of practice: Marriage and Family Therapy--also called Couples and Family Therapy--is a field of counseling that theoretically draws from a systemic/relational philosophy. That is, MFTs are ultimately concerned with understanding the individual as a component of a system and/or in relation to other people--not in isolation. While some individual clinicians in other fields (counseling, social work, psychology) might do this in practice, MFT is the only field that explicitly operates from this lens as a training goal. Because of the core nature of MFT as a relational profession, MFT students are often required to engage in a certain amount of relationship and/or family counseling during their training. To contrast, most other clinical programs don't require any relationship or family counseling experiences.
Where you might find them: You may be most likely to find LMFTs in private practice, either individual or group, and community or private mental health facilities.
Addiction Counseling
The degree(s): Bachelor's or master's degree, depending on state
The license: License name varies heavily by state: Licensed Addiction Counselor (LAC), Licensed Clinical Addiction Counselor (LCAC), Licensed Drug and Alcohol Counselor (LDAC)
Years of education: Depends on level of licensure. Most often: 4 (undergraduate) + 2 (graduate) = 6 total years
The scope of practice: Addiction counseling is one of the newest and least standardized professional clinical paths. Some U.S. states do not have addiction counseling licenses, while other states treat addiction licensure as an "add-on" specialty credential, targeted towards other professional clinicians (LMHCs, LCSW, HSPs, etc.). As one of the less standardized licenses, there is no national credentialing organization to define the addiction counselor scope of practice. However, from my experience, many states require clinicians to have advanced knowledge of psychopharmacology, group counseling, and systemic issues related to addictive behaviors. Uniquely, and unlike most other mental health licenses, some states allow for restricted licensing at the bachelor's level in addiction counseling. These restricted licenses often allow the practitioners to engage in some clinical services, like group counseling and short assessment, but not others, like individual counseling and diagnosing. In most states, a master's-level addiction counselor is likely to have a degree (and license) in a different mental health field, as well.
Where you might find them: Like LMFTs, you are most likely to find addiction counselors at locations which cater to the populations they serve: inpatient and outpatient addictions facilities, hospitals (especially psychiatric addiction facilities), and community mental health centers.
I've written about these professions as distinct entities here, but it's important to note that many of of them work together on collaborative teams to provide you with the best care! Perhaps you see your professional counselor every other week for therapy, your psychologist for ADHD assessment, and your psychiatrist for medication management: each of these professionals are serving an important role in your mental wellness journey!
Now THAT was some good soup. But before we put our bowls away, I want to make a brief mention of two other mental-health adjacent fields: spiritual counseling and mental health coaching. While very different in their in scope of practice, these two fields are quite similar in their lack of standardization. Spiritual counseling and mental health coaching are almost completely unregulated practices. That means they don't have specific educational requirements, licensure requirements, supervision requirements, grievance processes, etc. The lack of standardization could be important for client welfare.
Spiritual counseling
Spiritual counseling (often called pastoral counseling in the U.S.) has been around as long as humans have. Priests, imams, rabbis, indigenous healers, shaman, and witch doctors are sacrosanct professions and callings for those of the respective belief systems. To dismiss them because of their lack of Western standardization (i.e., judicial laws) would be short-sighted. For many, spiritual healers, guides, confidantes, etc. are as critical to their holistic wellness as any of the aforementioned clinicians.
It is helpful to note that, because of the lack of standardization, abuses in some of these systems--here, I'm specifically centering Western Christian Counseling--can be hard to track, end, and remedy. With no organizational grievance boards to report to, no license to suspend, and restricted ability to impede further practice, little can be done to prevent specific harm in these communities--like conversion therapy and clergy spiritual abuse.
Mental health coaching
Mental health coaching, also called "life coaching" is a field that has exploded in popularity in recent years, although it has been around for quite some time. Remember when we discussed bachelor's licensure in addiction counseling? Well, some of that standardization in credentialing actually morphed out of the coaching movement. For addiction counseling, in particular, we often see "peer support specialists" who are integral contributors to the treatment team of the person in recovery. Mental health coaching can be a valuable component of a holistic treatment team.
However, there are some real issues with mental health coaching that impact the lives of people who participate in the services. These include: a) practice creep (coaches acting like licensed professionals without the training), b) lack of ethical guidelines, c) confidentiality issues, and d) liability issues. A helpful overview of life coaching issues can be read here.
The mental health fields can be so confusing--especially in the U.S. with our 50 different ways of standardizing clinical practice. I hope that in reading through this blog, the alphabet soup of the mental health professions is a little less murky than before. Maybe we've gone from a beef broth base to a chicken broth base or, *gasp*, maybe even a clear soup!
Happy snacking!