What's in a Name?

There are so many different kinds of psychotherapists in the world practicing so many different kinds of psychotherapy. At one point in my post-doctoral fellowship the training director gave us a hand out with a non-exhaustive list of over 300 different kinds of therapy! We spent some time sorting through that list--what had we heard of? What have we tried? What do we think works? What do we think is little more than a modern snake oil?

Different kinds of psychotherapy would be an interesting discussion. I'll save that for a future blog post.

Today I thought it would be helpful to define the alphabet-soup bowl of terms one encounters when looking for a therapist. Ph.D.? MSW? LMHC? Psy.D.? M.D.? What are all these letters and what do they mean to you?

The importance of these letters depends a lot of what kind of question you are asking. If you are looking for someone with a specific kind of training, skill set, or viewpoint, these letters mean something. If you are looking for someone compassionate and can listen, the individual letters mean somewhat less.

Most terms (psychologist, psychiatrist, social worker, counselor) are terms that are set aside by the Commonwealth of Massachusetts to legally define a profession. To call oneself a psychiatrist, for example, one must have a medical degree. Likewise to call oneself a psychologist, one must have a doctoral degree in psychology. The Commonwealth (and every other state) does this to ensure public safety: these professions are regulated by law so that the public can be assured that they are going to a professional with a specific kind of training.

Here is a quick run down of the different kinds of professions that are licensed and regulated by the Commonwealth. Today's blog post is going to be on a basic level: in the coming weeks I'll write more detailed blog entries about the differences between how the different professions view people and their problems.

Psychologist


Psychologists are licensed in Massachusetts by the Board of Registration of Psychologists. According to statue, a psychologist is defined as the following:

Psychologists observe, describe, evaluate, interpret, and modify human behavior by the application of psychological principles, methods and procedures, in order to assess or change symptomatic, maladaptive or undesired behavior. Psychologists' work may focus on issues such as interpersonal relationships, work and life adjustment, personal effectiveness, and mental health. The practice of psychology includes, but is not limited to, psychological testing, assessment and evaluation of intelligence, personality, abilities, attitudes, motivation, interests and aptitudes; counseling, psychotherapy, hypnosis, biofeedback training and behavior therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, and the psychological aspects of physical illness or disability; psychoeducational evaluation, therapy, remediation, consultation, and supervision. Psychological services may be rendered to individuals, families, groups, and the public. Certification as Health Service Provider (HSP) is required in order to independently offer health services to the public or to supervise such services. Psychologists may also teach and do research (license not required), and consult to organizations. The title "psychologist" is protected by law and cannot be used unless the individual is licensed by the Board   

A psychologist must have a doctoral degree (Ph.D., Psy.D., Ed.D.) which normally involves 5 to 7 years of study beyond an undergraduate degree. During school, psychologists-in-training normally complete between 1,500 and 2,000+ clock hours of supervised psychotherapy experience. Prior to graduation psychologists-in-training are required to complete a minimum of a 1 years 2,000 clock hour internship. Prior to licensure, the Commonwealth requires an applicant to receive a passing score on two different examinations and have had a minimum of one full-time year of supervised experience.

Social Work


Social Workers are licensed in Massachusetts by the Board of Registration of Social Workers. According to statue, a social worker is defined as the following:

Social workers provide services to consumers as defined by the statutes and described in the regulations. Generally, social work professionals provide services to individuals, couples, families, groups, and communities directed towards specific goals. They may also assist or refer individuals or groups with difficult day-to-day problems, such as finding employment or locating sources of assistance. Social workers at an advanced level (LCSW, LICSW) may diagnose and treat emotional and mental disorders. Some social workers organize community groups to work on specific problems and help to create social policy and planning.

A social worker must have a masters degree (MSW, MSSA, etc.) which normally involves 18 months to two years of education beyond an undergraduate degree. During the course of training social work programs require a minimum of 900 hours of supervised clinical experience. A social worker may, but is not required, to have a doctoral degree (Ph.D., DSW, etc.). To be an Licensed Independent Clinical Social Worker (LICSW) the commonwealth requires an social-worker-in-training to have at least 3,500 hours of post-masters social work experience under the supervision of a social worker and pass an exam. In order to be a Licensed Clinical Social Worker (LCSW) one is not required to have any documented post-masters experience and pass an exam. 

Licensed Mental Health Counselors (LMHC)


LMHCs are licensed in Massachusetts by the Board of Registration of Allied Mental Health and Human Services Professionals. According to statue, a psychologist is defined as the following:

Mental Health Counselors render professional services to individuals, families or groups. They apply principles, methods and theories of counseling and psychotherapeutic techniques to define goals and develop a treatment plan of action aimed towards the prevention, treatment and resolution of mental and emotional dysfunction and intra or interpersonal disorders.

A LMHC must have a masters degree (MA, MS, etc) which normally involves 2 years of study beyond an undergraduate degree. They can, but are not required, to have a doctoral degree (Ph.D., Ed.D., etc.). During school, LMHCs-in-training normally complete a practicum of 100+ clock hours of supervised psychotherapy experience. Prior to graduation LMHCs-in-training are required to complete a minimum of a 600 clock hour internship. Prior to licensure, the Commonwealth requires an applicant to receive a passing score on an and have had a minimum of two full-time years of supervised experience.

Licensed Marriage and Family Therapists (LMFT)


LMFTs are licensed in Massachusetts by the Board of Registration of Allied Mental Health and Human Services Professionals.  According to statue, a psychologist is defined as the following:

Licensed marriage and family therapists apply principles, methods and therapeutic techniques to individuals, family groups, couples or organizations for the purpose of resolving emotional conflicts, modifying perceptions and behavior, enhancing communication and understanding among all family members and preventing family and individual crises. Individual marriage and family therapists may also engage in psychotherapy of a nonmedical nature with appropriate referrals to psychiatric resources. In addition, professionals engage in research and teaching in the overall field of human development and interpersonal relationships.

A LMFT must have a masters degree (M.A., M.S., etc) which normally involves 2 years of study beyond an undergraduate degree. During school, LMFTs-in-training normally complete 400+ clock hours of supervised psychotherapy experience. Prior to licensure, the Commonwealth requires an applicant to receive a passing score an examination and have had a minimum of two full-time years of supervised experience.

Psychiatrist


Psychiatrists are licensed physicians in Massachusetts by the Board of Registration in Medicine. I was not able to locate a specific legal definition of a psychiatrist from the Commonwealth. According the the American Psychiatric Association:

A psychiatrist is a physician who specializes in the diagnosis, treatment, and prevention of mental illnesses and substance use disorders. It takes many years of education and training to become a psychiatrist: He or she must graduate from college and then medical school, and go on to complete four years of residency training in the field of psychiatry. (Many psychiatrists undergo additional training so that they can further specialize in such areas as child and adolescent psychiatry, geriatric psychiatry, forensic psychiatry, psychopharmacology, and/or psychoanalysis.) 

A psychiatrist must have a medical degree (M.D., D.O.) which normally involves four years of medical school beyond an undergraduate degree. A psychiatrist-in-training then completes a rotating internship (one to four years) divided between a number of different medical settings; a psychiatric residency lasting four to six years; and receive passing scores on several different exams.