How to choose a therapist? (Part 2 of 2)

All of the following are types of therapists that can perform psychotherapy (or talk therapy) with clients.  They all perform individual therapy and some do family therapy however they vary in their years of education and specialized skills.  Obviously, I know the most about being a D.O. so that is why the explanation is longer.  However, I tried to be as unbiased as I could be.   I collected the rest from research and clinical experiences. 

Here is a summary: 

PSYCHIATRIST (M.D./D.O.): these are medical doctors that prescribe medications and are trained to work with severe mental illness typically with a strong biological component such as Bipolar disorder or Schizophrenia but include the whole spectrum of illness.  In addition to a four year college, they have 4 years of medical school (comprehensive education in everything ranging from neurology, surgery to medicine), 4 years of psychiatry residency and an optional 1-2 years of specialized fellowship training (forensics, geriatric, child, etc).   Psychiatrists do get training in psychotherapy: 2-4 years of psychotherapy training in residency but this varies in quality depending on the program that we graduate from.  Some psychiatrists elect to get additional training at a psychoanalytic institute.  Some psychiatrists consider themselves to be primarily psychoanalysts and they do "talk therapy" exclusively however, the majority of psychiatrists do medication management because they are the only mental health professional trained to do so. The difference between the M.D. and D.O. is the type of medical school they went to.  D.O.'s graduate from osteopathic school with an additional 200 hours of osteopathic manipulative treatment (Please see What is a D.O.?).  Both passed exams to practice in the state and can prescribe medications.  Education: 8-10 years of training; Requirements for licensure: have to pass 3 medical board exams within 5 years (same requirement for becoming a medical doctor), Supervision: 2 hours of supervision weekly throughout residency training, completing residency

PSYCHOLOGIST (PhD/PsyD): these are doctors that went to a graduate school that focused on clinical psychology which includes the study of mental illness but also how to perform and interpret psychological testing for various disorders.  The distinction between a psychologist and a psychiatrist is a psychologist did not go to medical school and cannot prescribe medications.  On the other hand, a psychiatrist is not trained to perform psychological testing and has variable psychotherapy training.  The distinction between a LCSW and LMFT and a psychologist is the training for a psychologist is longer and tends to be more focused on a client's behavior and thoughts.   The psychologist's educational experience after a 4 year college is 4 years of graduate school and 2 years of an internship with clinical experience.  They are also required to get at least 3000 hours of supervised clinical experience in order to be licensed.  The difference between a PhD and PsyD is the research component. PhD's have to do research and a dissertation whereas PsyD's are more focused on clinical experience. Education: 5-6 years of training; Requirements for licensure: a dissertation, 3000 supervised clinical hours and two exams. 

**psychologists and psychiatrists can be Board certified which means that they took an additional exam by a governing professional board that deemed their knowledge and clinical experience to be at par with the professional group's practices. 

SOCIAL WORKER (LCSW/MSW): these are masters level therapists that do primarily psychotherapy with individuals and families. They make up the largest group of therapists. They end up working in educational systems, health systems, the mental health system etc. and do everything ranging from psychosocial assessments to consultations to case management and advocacy.  They get training in working with multiple systems and are the only therapists that are trained in doing case management.  They tend to work for agencies.   In addition to a four year college degree, they do 2 years of additional training and 3000 clinical hours. Education: 2 years of training, Requirements for licensure: over 3000 supervised clinical hours and an exam 

MARRIAGE AND FAMILY THERAPIST (LMFT/MFT): these are masters level therapists that have an emphasis on the family unit and relationships. They provide individual counseling, couples counseling and family therapy.  In addition to a four year college degree, they do 2 years of additional training and are required to do over 3000 supervised clinical hours.  Education: 2 years of training. Requirements for licensure: over 3000 supervised clinical hours and an exam.

*The "L" in front of the SW or the MFT stands for licensed and means that they completed their licensure.


NOTE: There are others I haven't included such as occupational therapists, music therapists, recreational therapists and art therapists.  All are wonderful providers and offer important services in the mental health field.  I definitely promote their services for my clients however, they are not trained in "talk therapy" and therefore were not included in this article. 

It is my personal opinion that when a client is selecting a therapist, the goodness-of-fit is most important, not the letters behind the name.  However, the letters are important in telling us from what kind of lens will they view the client.  For example, MFTs will look at the client's symptoms from a family systems perspective, psychiatrists have a biopsychosocial lens and a medical background to differentiate between other medical illnesses.  Equally important to ask is what KIND of therapy are they offering the client because certain types of therapy have more evidence for success with a certain diagnosis.  A therapist regardless of what school they graduated from may vary in their knowledge, experience, or talent at doing types of therapies (cognitive behavioral, trauma focused, psychodynamic, working with families, substance abuse counseling etc).  There are many things to consider when choosing a therapist and clients should feel free to interview different therapists to see who would be the best fit for them.