Choosing a therapist: What do the letters mean?
It’s so difficult to find a good therapist! A friend of mine recently contacted me, asking “what are all these letters?! What do they mean? Is one better than the other? Is one more right for me?” The different tiers and disciplines of therapy can be hard for even some therapists to understand and explain, so it makes sense that you might be confused. Before you read this, here’s a spoiler alert: it doesn’t matter what letters the person has after their name, what matters is that they are a good fit for you. If you still want to nerd out on some therapist nitty-gritties, read on…
Here’s how I look at it: You have three tiers of providers when it comes to your mental health:
Psychiatrists: These are the people who prescribe medication.You will see the letters M.D. after their name. They are the highest tier, which means they are the most expensive. You’re not very often going to see a psychiatrist doing therapy, because their sessions are often about 15 minutes long (after the initial assessment). It’s someone you check in with maybe once a month to once every few months, depending on what medication you’re taking.
Psychologists: These are people with a doctoral level degree and license. You might see a PhD. or a Psy.D. after their name. A Ph.D. is someone who went the traditional route to get thier doctorate, and focused on research. Many people get this degree and become practitioners, so you will definitely see these letters when you’re looking for a therapist. A PsyD. is a doctor of psychology, and this is someone who went to the doctoral level in order to become a practitioner. They focused less on research and more on the practice of therapy during their schooling than a Ph.D.
Master’s Level therapists: This is where it gets really confusing. At this level of education, the licenses are split into three disciplines. None is better or worse than the other, and to be honest, the person you pick is more important than which of the three disciplines they are licensed in. Each discipline gets some training in the areas of focus of the other disciplines, but the education and testing is more focused on their area of expertise. The three disciplines are:
Licensed Professional Clinical Counselors, LPCC (that’s me!). Also called Licensed Mental Health Counselors (LMHCs) in other states, the training for LPCCs is generally focused on individual mental health or illness. They are the experts in diagnosing/assessing and treating things like depression, anxiety, schizophrenia, bipolar disorder, etc. In California, unlike other states, this license is exempted from providing couples therapy or family therapy. These therapists can get an extra level of certification called a Confirmation of Qualification from the Board of Behavioral Sciences (BBS). This involves doing 500 hours of supervised therapy and taking extra graduate level classes (I have this!).
Licensed Marriage and Family Therapists, LMFT. These therapists are the specialized in how a system (such as the family or romantic partner(s)) impacts an individual. They often want to have contact with as many people in the system as possible, to fully understand the problem. MFTs often prefer not to diagnose, because they see mental health as a function of the complex interplay of the relationships in the individual’s life.
Licensed Clinical Social Workers, LCSW: This individuals training will have been focused on communities, groups, and organizations. They are zoomed out to look at the whole society and how it is functioning. Although this license can be used to provide therapy, the training can also be for folks who want to create change on a macro level, for example by affecting policy.
Now that you know all of that, I’ll say that none of it matters unless someone is a fit for you. I would actually say that, looking at those descriptions, and being many years removed from my grad school days, ideologically I fit more in with the MFTs, although I am an LPCC. I don’t love the idea of diagnosing (although I do respect that it can be helpful for many people), and I think it’s very important to take into account the systems in someone’s family or society that may be affecting them such as discrimination, stigma, and patriarchy.