What is the difference between a counselor and a therapist?

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    When researching various mental health professions, a common question is: What is the difference between a counselor and a therapist? There can be a great deal of confusion when looking into the various types of mental health professionals whether you are seeking career guidance or help for yourself or a loved one.

    Over recent decades, the mental health field has grown and evolved to meet the increased demands for services. This growth and change has sometimes resulted in misinformation or lingering myths, and this comes from many places. One source that drives change is that mental health treatment is based on science which changes as we learn more information. Insurance providers have also influenced changes to treatment delivery: mental health services available 20 years ago can look very different from how things are practiced today. In addition, stigma around mental health often means that not only are people uncomfortable talking about mental illness, but that professionals working in the sector are less respected than traditional medical doctors. Combining all these factors, it is unsurprising that the world of mental health treatment can be so confusing.

    What exactly is therapy?

    One common and consistent idea is that mental health treatment usually involves therapy.  The term therapist is a general term for any mental health professional that provides talk therapy. This includes psychiatrists, psychiatric nurses, psychologists, licensed clinical social workers and licensed professional counselors.

    One of the most misunderstood is the professional counselor, due to the other meanings counseling is associated with. While counseling is often thought of as advice giving or offering brief supports, professional clinical counseling better aligns with the age-old image of hour-long sessions spent laying on a couch, pouring your heart out while a professional takes notes. Neither generalization quite captures what seeing a professional counselor means.

    What do you mean by counselor?

    Before we examine what a professional counselor is, let’s consider some of the ways the term counselor is used outside of mental health.

    Guidance counselor  

    For many, the word counselor brings up memories of a guidance counselor in school. This role is largely associated with helping students explore college and career options during high school. They may have done a presentation or classroom lesson on bullying or friendships. The term guidance counselor is no longer used and is now called school counselor to better align with the many aspects involved. It is different from a licensed professional counselor who can focus on mental health treatment.

    Pastoral counselor  

    Counseling from a religious leader is not the same as professional counseling. Churches are not subject to the same laws and regulations as professional counselors, including education requirements. Someone providing counseling in this setting may not have advanced education or training. The goal of pastoral counseling may be what is in the best interest of a church and not what is in the best interest of the individual seeking help.

    Adding to the confusion, some professional counselors who have masters level education and related training offer faith-based counseling as part of their practice. This is different from pastoral counseling in that the provider is subject to the same rigorous standards set for professional counseling, but they integrate religious values as a focus of treatment.

    Peer counseling 

    Peer counseling is used in a variety of settings with the goal of receiving support from someone who is going through similar issues as you are, or someone who has recently achieved a goal you also want to achieve. One example is in substance use treatment which incorporates a peer recovery specialist or peer recovery group. This is different from professional counseling services. A peer counselor in this setting usually has at least a year of recovery time and a minimum of a high school diploma. While meeting with someone who has first-hand experience can be helpful, it is not the same as professional evidence-based treatment. A professional counselor does not have to go through the same experiences you have to be helpful. That would be like expecting a doctor to have had the same illness you have had to know how to treat it. Professional counselors are also unlikely to share their own personal experiences with you.

    Legal counsel 

    In a courtroom or other setting handling legal matters, the term counselor refers to a lawyer or attorney providing legal advice or services.

    These terms can lead to confusion when we think of professional counselors as therapists because therapists do not do the things these other counseling positions do. They do not give advice, they do not offer immediate short-term solutions, they do not involve their own personal beliefs into their work and they do not usually go through the same experiences as their clients. This might sound like counseling and therapy are completely different services, but this is inaccurate. This confusion has to do with how mental health treatment options have evolved combined with things like terminology and a general lack of discussion about mental health. Now that we have reviewed some of the ways the word counselor is used outside of mental health, let’s look at what a licensed professional counselor is.

    What is a licensed professional counselor?

    A licensed professional counselor is a mental health professional who provides therapy services. Counseling operates from a wellness model and takes a holistic perspective on the issues a client wants help with. It can be short-term or long-term depending on the needs of the client.

    A licensed professional counselor holds at least a master’s degree in counseling or a closely related field. They are required to complete a supervised clinical internship as part of their graduate school education, followed by 2-3 years of supervised clinical practice after graduation. They also take national and state exams to become licensed in their state and have continuing education requirements.

    Counselors receive advanced education in human development, individual therapy techniques, diagnosis and treatment planning, group counseling, trauma, human sexuality, relationships, and addiction. They are trained in using culturally sensitive techniques and understand that clients are individual and unique. They know how to identify symptoms that indicate mental health disorders, how to diagnose them, and when a referral for medication management or a higher level of care is needed.

    Although treatment goals come from the client, a counselor can help a client identify what those goals might be. A counseling session is very different from talking to a friend or family member. A counselor does not have their own needs to worry about the way you do a loved one, so the therapy session is all about the client. Quite often life stressors or environmental factors are the cause of mental and emotional distress, and a professional counselor can validate these experiences. This can help clients feel less alone or reduce stress, if they feel their problems are their own fault or that something is wrong with them.

    A counselor can help identify patterns of behavior that may be getting in the way of client goals or teach helpful coping skills. If a client is struggling with personal relationships, these can be improved by what a client learns in session. Counselors provide unconditional positive regard and hold space for each client. This means they do not judge or blame clients.

    Licensed professional counselors can diagnose mental health disorders and can bill insurance companies. As of this time, professional counselors cannot directly accept Medicare. Psychiatrists, psychologists, and licensed clinical social workers can. This has more to do with bureaucracy than it does ability, and does not indicate counseling is less than these other professions.

    The establishment of licensure requirements and related legislation for counseling is more recent than for other mental health professions. This is also why a professional counselor in Maryland is a Licensed Clinical Professional Counselor showing the LCPC credential after their name, but just across the state line in Pennsylvania or Virginia it is a Licensed Professional Counselor or LPC. In Florida, Iowa, or Hawaii professional counselors are distinguished by the LMHC credential.

    The credential given to a professional counselor depends on the state they are practicing in and one is not better than the other. Psychiatrists, psychologists, and clinical social workers also need state licensure and exams set by their professions, but their general title remains the same across state lines.

    Should I become a licensed professional counselor?

    If you have thought about providing talk therapy services, a career as a professional counselor might be for you. Graduate school is required, but master’s level counseling programs are more accessible than psychology doctoral programs. They also take less time to complete. To diagnose and treat mental health disorders, a master’s degree in counseling is the minimum level of education required.

    Some programs offer advanced training within their master’s program such as marriage, couples and family therapy, addiction, or clinical mental health. These offerings apply to the operations within the university, and to not restrict you to working within that specialty beyond graduation: it is not the same as having a specialization within the counseling field. After graduation, you can choose to receive additional training to specialize in the treatment of specific issues.

    After getting the needed hours for licensure, you can open your own private practice providing therapy services if desired. Counselors can expect to enjoy a variety of career options once they have earned their license.

    What to consider when deciding on a therapist

    You may think that the more education someone has or the more well-known their job title is the better your treatment will be, but it really depends on what you need and what services are available to you. Depending on the specialists available in your area, your insurance plan, and your treatment goals, you can expect to see a licensed professional counselor, licensed clinical social worker, psychologist, psychiatric nurse practioner, or psychiatrist for mental health therapy services. You may see more than one provider. You might have one person for talk therapy and a different one for medication management. In some areas, there is a shortage of psychiatrists. Sometimes a primary care doctor can manage psychiatric medications, but they might prefer you also see a therapist. Many people become upset when their psychiatry appointment is much shorter than they expected and focused only on how they are feeling regarding medications. In some settings, the psychiatrist and therapist work together as part of a treatment team. This is where insurance plays a huge role. A psychiatrist can see a few patients for medication management appointments within an hour compared to seeing only one person in that same amount of time for a therapy session. It is not that your psychiatrist doesn’t care about the details of your life, but sometimes they are not able to focus on that in the way people expect when they think of therapy.

    A professional counselor is one type of therapist. Just like there is confusion around the term counselor, many people do not think of a psychotherapist when they hear the term social worker. A licensed clinical social worker can diagnose and treat mental health disorders. They have at least a master’s degree and their training involves using a psychoanalytic and systems approach looking at how things like family dynamics and socioeconomic status might affect mental health symptoms. They can practice independently offering therapy services or they may work in an agency setting or as part of a psychiatric treatment team. They can often help clients with getting connected to needed resources as part of their therapeutic treatment plan.

    Psychologists complete a doctoral degree. A doctorate is the minimum level of education for a psychologist and this may be seen in their title as either a Ph.D., Psy.D. or Ed.D. In addition to providing talk therapy, psychologists can do more in depth testing such as personality testing or intelligence testing for schools or legal purposes. In 5 states, psychologists can prescribe certain medications. Some psychologists choose to work as researchers or consultants rather than provide talk therapy. Not all psychologists are therapists.

    Psychiatrists are medical doctors. A psychiatrist completes medical school followed by a residency in psychiatry. They may provide talk therapy depending on the clinical setting. It is common for this job to focus on medication management. Their training involves the biological aspects of mental illness. If they do not provide therapy services directly, they may suggest that you seek talk therapy as part of your treatment.

    What is the best mental health treatment? Medication or talk therapy?

    There is no one size fits all approach to best manage mental health symptoms. Some people need medication across their lifespan, and for others medication management is short term. Sometimes people need therapy and do not benefit from medication at all. Any type of mental health provider can help you to figure out what might be the best course for you because they all have training in assessment and general best practices designed to put the client first. This means a therapist will suggest you seek a psychiatric evaluation if they think medication might help even though medication is not something they can provide directly. Medication alone is generally not effective when the distress is rooted in life stressors, so sometimes a medical provider may suggest therapy as a place to begin.

    Conclusion

    The answer to— what is the difference between a counselor and a therapist?— is that there isn’t one. The most consistent indicator for therapy to be considered successful is the therapeutic relationship. This can come from any mental health professional you feel connected to or that you aspire to become.

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