Are Therapy and Counseling the Same Thing?

We continue our look at frequent therapy-related questions in this entry.

I touched on this a bit here with the end of the story being “not really.” Let’s take a look at this subject with one of those brushes archaeologists use to uncover artifacts (in fact, that’s a great metaphor for therapy, or how I like to go about providing therapy).

Therapy is a general term. We have lots of kinds of therapies. Physical therapy, massage therapy, speech therapy, occupational therapy, respiratory therapy (I think we all learned about that one in 2020), and psychotherapy (that’s me!). According to my dear friend Google, therapy means 'to treat'—originally, medically. We’ve come to think of psychotherapy as meaning to treat or heal the mind, but as word origins go, it’s really treating or healing the soul/spirit (which is an idea that is even more difficult to grasp than the mind).

Counseling is also a general term. Financial counseling, genetic counseling, career counseling. In New York State, psychotherapeutic counseling is officially recognized as mental health counseling. For me, the word “counseling” evokes some kind of guidance— probably because of those helpers in schools. Counseling, as a profession, started in the realm of school and career-related guidance. Of course, when you’re working consultatively to uncover someone’s wants and needs, more than just school and career-related concerns erupt. One thing leads to another and here we are, as psychotherapists.

When asking the difference between a therapist and a counselor, I think the question may be, what are all of these different types of psychotherapists? Briefly, I’ll go through New York State’s licensed mental health practitioners as well as helpers who are not yet accredited.

  • Psychiatrists are medical doctors. Frasier and Niles Crane (I don’t know if you know about the two decade long psychiatric powerhouse) are both psychiatrists meaning they went to medical school, can prescribe medication, and as we see from their ability to have a therapy practice, also study and practice psychotherapeutic theory. Psychiatrists exist outside of the Cheers/Frasier universe as well. At one time, it seemed like people thought of psychiatrists as the only kind of psychotherapists. Some psychiatrists do act as both, seeing clients/patients for weekly therapy. Others see their patients for monthly medication management and ask them to seek outside consistent therapy. Here’s where all of the other professions come in.

  • Psychologists can either be PhDs or PsyDs. A PhD psychologist does a lot of research in their doctoral program. A PsyD is a doctor of clinical psychology. They spend more time in school doing clinical work (interning as a clinician). When they meet the requirements of the classwork in their school’s doctoral program, they go on to work a number of clock hours under the supervision of a licensed clinician or doctor before they can be licensed themselves. If the special thing that a psychiatrist can do is write prescriptions, a special thing that psychologists do is formal assessments/testing. If your child needs testing completed at school to determine classification, it should be a psychologist administering and scoring those tests. (There are masters level psychologists, but the NYS website notes that clinically practicing psychologists have doctorates).

The following professions can go on to doctoral work in their fields; however, it is not necessary to practice.

  • Social Workers have Master’s degrees from education that includes both internship and classwork. They don’t need a master’s degree to be a social worker. They can have a bachelor’s in social work and become a case manager. They do need a master’s degree to practice psychotherapy. When they graduate with their social work degree, they take a test to become licensed— a Licensed Master Social Worker (LMSW) (this is all New York specific). They then have a license but need to continue to practice under a supervisor for thousands of hours in order to take another test and be able to practice alone. An LCSW (Licensed Clinical Social Worker) can accept insurance, but insurance may not provide reimbursement. However, after thousands more hours of clinical experience, social workers “get their ‘R’” (like a magical appendage that springs forth from their bodies). An LCSW-R has the most clinical experience and according to NYS, insurances have to reimburse for services rendered. Social workers have been around a long time. Their educational background tend to take a systems approach. They can work in schools, hospitals, or for the state, and not necessarily take a clinical role.

  • A Mental Health Counselor (hi!) also has a Master’s degree. There is a certain number of credits of class work about psychology, multiculturalism, assessment, research, etc… as well as clinical experience. Then, mental health counselors work clinically under the supervision of a licensed practitioner for thousands of hours and take a test (sound familiar?). After that, they are able to practice on their own and accept insurance (if insurance accepts them). NYS and the American Counseling Association state that counseling is about working with the client to promote change and “optimal mental health.” To me, this always sounded like there is more of a wellness model than an illness model which was attractive.

If you’re still reading, there are lots more therapeutic professions having to do with mental health!

  • Creative Arts Therapists (LCAT) are trained in psychotherapy as well as the therapeutic use of creative expression (dance/movement, fine art, music, poetry, the performing arts). They take a test and practice thousands of clinical hours under supervision (surprise!). They may accept insurance, but not as often as the aforementioned practitioners.

  • Marriage and Family Therapists (LMFT) study psychotherapy under the lens of family systems. After two years of classwork and clinical internship, they take a test and practice thousands of hours of clinical work under a clinical supervisor. In a more formal way than other mental health practitioners, they are taught to see the client in the context of their relationships. They can also accept insurance following licensure.

  • Psychoanalysts (LP) can have a Master's or Doctorate in various fields, but they then have to complete a program for psychoanalytic study in which they are both in psychoanalysis as clients, practice psychoanalysis as interns, and learn psychoanalytic theory. Following, they— you guessed it— take a test and accrue thousands of supervised clinical hours. Psychoanalysts use deep knowledge of theory and the relationship between the analyst and the client in order to promote client’s growth.

  • There’s also Licensed Behavior Analysts and Certified Behavior Analysts Assistants. We see these professions helping with those who are diagnosed with Autism or Developmental Disabilities. They use Applied Behavioral Analysis to design programs that aid in the well-being of the affected individuals (and those in their environment). Behavior analysts also work under supervision for many hours before they can obtain their licenses. They often work for organizations that serve individuals with disabilities.

So, those are all the mental health or mental health adjacent practitioners that are recognized by the New York State. Their industries are regulated, they have to pass rigorous testing and years of learning. They have to complete continuing education credits so that they are ALWAYS learning. As humans, we’re always evolving and the professions need to be as well.

  • I keep coming across Life Coaching, so I want to make a note about them. There are Certified Life Coaches. It looks like there are a few governing bodies for Life Coaches; some of them international. There are lots of different programs that can provide them certification and many psychotherapists are also coaches. However, they can not accept insurance when doing coaching work. I’m not an expert on this and because Coaching isn’t centralized, it’s hard to put the info together without more knowledge. I just want to say, they exist. Coaching isn’t a “protected term” so anyone can call themselves a coach. “Psychotherapist” isn’t a protected term, which is why most of the above professions can call themselves psychotherapists, however, “psychologist” or “mental health counselor” are protected terms and people can’t call themselves these professions if they aren’t legally recognized as such.

I hope this clarifies the difference between therapy and counseling. It’s an oft searched question which makes me think it’s also a loaded question. Part of it is trying to navigate the alphabet soup of all the different professionals. But I think a big part of it is around the anxiety of asking and getting help. Will it help? Am I going to the “right” person? Can I trust them with my innermost self? It’s scary and the good ones, in all of these professions, will be open to talking about those concerns with you.

All information from NYS Office of Profession.

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