Counselor vs. Therapist vs. Psychologist
March 3, 2021 | By
Therapists, counselors and psychologists all deal with issues of mental health and often use similar methods but specialize in treating issues with different levels of severity. Clinical psychologists hold doctorates (PhD or PsyD) and are in a position to deal with psychoses and other severe mental illnesses, that in the worst cases require hospitalization. Counselors and therapists typically hold master’s degrees and are licensed in various specialties, working with individuals and groups in talk-therapy sessions to deal with everything from marital conflict to behavioral addictions.
You know you’re the kind of person who wants to help people with their problems. You’re naturally empathetic, and you have the ability to sit down and talk with people and quickly earn their trust. Maybe you have the calm centeredness it takes to offer clear advice and options to someone who is struggling with the stresses of life. Or maybe you have a gift for helping friends resolve interpersonal dramas, stepping in when they’re at each other’s throats to help them understand one another’s perspective.
You know there’s a place for you in the world where you can dedicate yourself to solving those kinds of problems. You’ve seen those professionals at work. Maybe you have been on the receiving end of some help yourself.
You know you’re cut out to be a counselor, a therapist or a psychologist.
The next step is to simply figure out which one. What do they do? What is the difference? How do they fit into the bigger picture of the mental health and human services field? And how do you fit into those roles… which role is the best fit for your unique interests, talents and goals?
That’s what we’re here to help you figure out.
The Value of Interdisciplinary Training in Counseling, Therapy and Psychology
When new professions emerge in the same treatment areas, there is always some friction at first. Both counseling and therapy associations had to push hard for recognition and professional respect as they emerged on the scene with psychology already dominating mental health work. But just as inevitably, roles that handle similar kinds of issues seem to always come back together again.
That’s been the case with these three professions as the importance of multidisciplinary care and cross-training has shown its value in both complex and routine cases. Multidisciplinary supervision during internships has been the most recent demonstration of this kind of cross-training.
Going back years, studies published by the American Counseling Association have revealed that clinicians working in mental health and addiction clinics developed new clinical expertise and found new opportunities to expand their skills when learning from supervisors outside their own profession.
Counseling vs Therapy vs Psychology: The Way Most People Use These Terms Generally Aligns with Core Definitions
The definitions can seem a little muddled since the terms get used interchangeably in a lot of cases. But the fact is, people generally aren’t that far off. Some confusion comes from the simple fact that these terms describe specific techniques used in different roles. Psychologists, for example, regularly deliver psychotherapy as part of clinical psych services.
You’ll also find professionals offering services under professional titles that don’t exactly line up with what’s printed on their licenses. There are cognitive behavior therapists who are licensed clinical psychologists; there are also cognitive behavior therapists who are actually professional counselors.
It’s no wonder the whole thing is confusing. But what this ultimately says is that the differences are pretty subtle and the similarities run pretty deep.
In the most basic sense, psychology can be thought of an overarching domain that includes therapists and counselors. In fact, psychology is generally thought of as having two main branches – clinical psychology and counseling psychology – though there isn’t a clean demarcation between them either. Not only is there a lot of overlap between clinical and counseling psychologists when it comes to what they do in professional practice, psychology doctorate programs with either term in the title have more in common than not.
Still, looking at clinical and counseling psychology as separate branches within the field provides a simplified understanding of how you can look at psychologists as distinct from roles that involve purely talk therapy and counseling:
Clinical psychology deals with diagnosing and treating all types of mental illness, including everything from the common depressive, bipolar and personality disorders that so many struggle with, all the way up to schizophrenia, clinical depression and other forms of severe and debilitating mental illness.
Although in-patient clinical settings like psychiatric hospitals are definitely where you find clinical psychologists working with patients on the severe end of the spectrum, it isn’t their exclusive domain. Just as often, they work with patients in private practice, using classic talk therapy and other psychotherapeutic techniques.
With psychopharmacological training, some states even allow psychologists to prescribe psychiatric medicine, though prescriptive authority is generally reserved for psychiatrists and medical doctors.
Working with patients across the spectrum of mental health disorders, the ultimate goal of clinical psychology is to help people heal from mental and emotional distress.
Counseling psychology is the umbrella domain that the work of counselors and therapists falls under. This can include the practice of professionals like Licensed Mental Health Counselors (LMHC) and Marriage and Family Therapists (MFT).
It’s important to note, though, that only doctorate-prepared state licensed psychologists can actually refer to themselves as psychologists or psychological therapists.
In this case, counseling psychology refers only to the general branch of psychology that counselors and therapists draw from, not the professionals themselves. It’s a tricky distinction to make, but an important one. By training and under licensing definitions, counselors and therapists do not have the same level of authority to diagnose and prescribe treatment plans as psychologists do.
Counseling and therapy are used to address a broad range of emotional problems, behavioral issues, addictions, substance abuse problems, relationship challenges and even some forms of mild anxiety and depression. The focus of their work is on finding actionable solutions to very specific and relatively manageable issues.
Although counseling can be used to treat mental illnesses, including the most pervasive ones like mild cases of anxiety and depression, licensed counselors or therapists wouldn’t typically diagnose or handle the most severe cases themselves. Instead, if they suspect a client is suffering from something like clinical depression, they would refer the patient to a clinical psychologist.
And let’s be clear – we’re talking about practitioners that follow the rules by operating within the strict definitions of state licensing laws. There are thousands of cases of fraud and misrepresentation that licensing boards across the country deal with every year, dropping sanctions on people who call themselves counselors and therapists but don’t carry the qualifications. They claim to practice every kind of treatment you can imagine under all kinds of different banners. But no matter what they call it, without the right training and licensure, it’s ethically out-of-bounds and a violation of state law.
When It Comes to the Difference Between a Psychologist, Counselor and Therapist, Licensing Authorities Have the Final Say
Who decides what makes a counselor, a therapist or a psychologist? In practical terms, it comes down to state boards of licensing, which set rules for the scope of each license, what kind of work it qualifies the holder to do, as well as who gets to call themselves what.
While there are plenty of common philosophical, theoretical and methodological threads that run through the three categories, one of the clearest distinctions, and the one that’s easiest to grasp, comes down to state licensing:
- Licensed Counselors – Licensed Mental Health Counselors (LMHC), Licensed Clinical Social Workers (LCSW), and Licensed Professional Counselors (LPC)
- Licensed Therapists – Licensed Marriage and Family Therapists (LMFT)
- Licensed Psychologists – Licensed Clinical Psychologists, Licensed School Psychologists (There are also professionals who practice applied psychology outside these roles… it’s important work, but outside the scope of human services.)
Each one of these professional roles is clearly defined. Practitioners have different educational requirements, job duties and licensing obligations to follow. That means that you’ll be picking your path even before you decide what kind of undergrad degree you’re going to earn.
But it’s not crazy to think you’ll cross over, either, moving from one role and eventually on to another. Even with the retraining required, even with the relicensing involved… some people just have a hunger for picking up the skills to help patients from every angle.
One thing you’ll learn fast is that clients don’t care about the difference between a psychologist, counselor and therapist, and care even less about the licenses they hold. In the context of human services especially, they only care that someone is reaching out to help them.
What’s in a Name? Legal Obligations, That’s What
So what if someone wants to call themselves a counselor? Well, it depends on the state. In some states, the law protects the title. Practitioners can do whatever they want, but they can’t call themselves a “licensed” practitioner without meeting all the formal requirements. These are Title Act states. In other states, the law prevents practitioners from engaging in the actual practices of counseling, therapy or psychology without a license, no matter what they call themselves. These are Practice Act states.
Oregon is an example of a practice act state, and has explicit language describing the requirements for licensure, and the restrictions for anybody who is unlicensed:
675.825 Prohibited practices; exceptions; civil penalty. (1) A person may not:
(a) Attempt to obtain or obtain a license or license renewal by bribery or fraudulent representation.
(b) Engage in or purport to the public to be engaged in the practice of
professional counseling under the title “licensed professional counselor” unless the person is a licensee.
(c) Engage in or purport to the public to be engaged in the practice of
marriage and family therapy under the title of “licensed marriage and family therapist” unless the person is a licensee.
(d) Engage in the practice of professional counseling or marriage and family therapy unless:
(A) The person is a licensee, registered intern or graduate student pursuing a graduate degree in counseling or marriage and family therapy; or
(B) The person is exempted from the licensing requirements of ORS 675.715 to 675.835 by subsection (3) of this section.
Chapter 675 of the Oregon Revised Statutes of 2019 governing the titles and practices restricted to licensees in counseling or marriage and family therapy.
A practice act is more aggressive in protecting the public, focused on reducing mistreatment and malpractice rather than strictly trying to stop misrepresentation and the misuse of professional titles.
Where Therapy, Counseling and Psychology Overlap and Complement One Another
Let’s start with what all these roles have in common.
Therapists, counselors and psychologists all deal with issues of mental health and wellness, specializing in different types of treatment techniques and often enough, entirely different kinds of issues.
Each of them requires the same core values and skills, though:
- Empathy and compassion
- Active listening
- Flexible approaches to treatment
- Scientific and experimental expertise
Why do you need scientific and experimental expertise as someone who provides mental health treatment? Because mental health is always a moving target. Each patient is unique. Your ability to shift your approach and use the scientific method to nail down what works is crucial in all these professions.
There’s a kind of similarity to all these jobs that comes out of those core values, and the fact that they treat many of the same conditions. It turns out that what works to help people, works, no matter what you call the person doing the job. A wrench turns the same way for a guy working on a classic GTO as it does for an aerospace technician working on a jet engine.
If you are looking for a father figure that unites the history of all three of these professions, you go back to Wilhelm Wundt. Wundt brought the science of psychology out of the realm of philosophy. His work is the basis for the evidence-driven, experimental approach that therapy, counseling and psychology all rely on today.
Wundt taught in Leipzig, which had been a kind of hotbed for theories of thought and cognition going all the way back to Gottfried Leibniz (in his spare time, when he wasn’t busy inventing calculus). So Wundt wasn’t starting from scratch. Mentors like Ernst Weber and Gustav Fechner set him to work on some of the initial experimentation in sensory perception and measurement that got him interested in psychological sciences.
In 1879, Wundt opened a lab at the University devoted to psychological studies. He attracted students from all over the world, which is part of why his influence is so great in the field today. The psychology family tree in almost every country reaches back directly to his lab.
Though Wundt didn’t develop any great theories or make any astounding breakthroughs in mental health, he broke the ground that made it possible for the likes of Freud and others to develop the practices that are key to psychology, therapy and counseling even today.
All Three Roles Share Many of the Same Treatment Modalities and Therapy Techniques
That means you find practitioners in every role relying on the same kind of treatment techniques.
- Psychotherapy – Talk therapy, the traditional sit-on-a-couch-and-emote approach to talking through mental issues.
- Cognitive Behavioral Therapy (CBT) / Dialectical Behavior Therapy (DBT) – Two psychotherapeutic approaches that involve mindfulness and emotional regulation, often used on PTSD and borderline personality disorders (BPD).
- Applied Behavioral Analysis (ABA) – ABA is a behavioral approach to mental health treatment that has branched off into its own licensed and certificated profession (BCBA, Board Certified Behavior Analyst). But ABA is also something MFTs, counselors and psychologists use with positive outcomes on problems ranging from addiction to depression.
- Interpersonal Therapy – A time-limited (12-16 weeks), psychotherapeutic approach offering a unique structure that works well for counselors dealing with specific issues such as grief or disputes. It is also a method that therapists and psychologists use.
- Psychodynamic Therapy – Psychologists often use this form of depth psychology to get to core issues through psychoanalysis, but it is well-aligned with the therapist mindset too since it focuses on systemic and holistic understanding and treatment.
Each profession might gravitate toward one or more of these kinds of therapies, but every role can use them where appropriate.
Most Professionals See Similar Mental Health Issues Walk in The Door
The phone rings at the offices of therapists, counselors and psychologists for the same kinds of mental health problems every day: depression, anxiety, anger management, addiction.
There are some basic tasks, like patient assessment, crisis intervention and other basics that every competent mental health professional can handle.
But when it comes to the types of issues they treat, you start to see more differences between the jobs.
Everyone is familiar with marriage counselors or marriage therapists. And though it may be unusual to see a marriage psychologist, they do exist. But you’ll never find a licensed counselor who treats patients with serious psychotic disorders like schizophrenia.
For some conditions it’s a matter of severity that makes the difference in who is qualified to provide treatment. For the most severe mental health issues, you need to call in the big guns, residency-trained doctorate-prepared psychologists with specialized expertise.
But in other cases, it’s more about custom or practicality. Counselors may end up seeing patients who simply can’t pay the higher rates psychologists command. Family therapists get the bulk of work in couples counseling even if counselors could competently deal with the same issues. And often, that’s for no other reason than because MFT is the more familiar term for most people. Not only does Google auto-fill “therapist” when you type in “marriage and family,” even if you type out marriage and family counseling, you’ll see listings for MFTs come up.
None of these are an all-or-nothing deal, however. It’s actually quite common for all of these roles to overlap and work together on complex cases.
The Core Differences Between Psychologists, Therapists and Counselors
If those are the similarities between these professions, then what are the differences?
There are many, but if you look carefully, you can trace them all back to these core distinctions of philosophy:
- Counseling – Views mental health issues through a practical, individualized perspective, focuses on problem-solving and understanding specific practical details that contribute to problems.
- Therapy – Sees challenges in terms of social and relationship contexts, expanding diagnosis and treatment to the web of interpersonal connections with partners, family and friends that may impact a patient’s mental health status.
- Psychology – Looks to larger theoretical bases of human thought and behavior to trace the root causes of dysfunction, often back to traumas and life events, and then offering treatment on a holistic, individual basis.
Although these different paths have resulted in different professions, they haven’t evolved in a vacuum. Each of them has influenced the others along the way. And just because they approach mental health problems from different perspectives does not necessarily mean they arrive at different conclusions. There is an evolutionary arc toward what works. That can make the day-to-day functions of a typical therapist, counselor or psychologist appear very similar in practice. A screwdriver is still a screwdriver no matter whose hand is turning it.
But the different perspectives from which they approach problems are an important degree of difference. Those different world views start to take root in the paths to education you follow to enter each profession. And as you look at the history of how each of these roles emerged as a distinct profession, you can begin to see how those perspectives came to be part of the package for each one.
Psychology Hasn’t Forgotten its Deep Roots, Even as it Continues to Change and Evolve
Psychology’s history goes back the furthest of any. It also serves as some of the roots for counseling and therapy work, all strung around each other and weaving together at various points in their evolution. Some of the earliest philosophical work from cultures as varied as Greek, Indian, and Chinese, explored the questions of the human mind.
But it wasn’t until German doctor Wilhelm Wundt got interested in the physiology of the brain that psychology really got started on the modern scientific approach its known for now. From Wundt through Freud, William James, John Watson, and then hundreds of other psychologists worldwide, the science evolved quickly and spread widely into every aspect of human behavior and cognition.
The focus of each of them was on science and a scientific understanding of cognitive and behavioral issues. And that’s why psychology emerges as the most deeply engaged of these professions.
The depth and breadth of those roots means that psychology has a tendency to look to theory and data when it comes to assessing mental issues. Psychologists aren’t afraid to take apart the carburetor and get to the heart of mental issues.
Mental Health Counseling Emerged to Help Veterans of War, and Continues to Keep that Promise Today
A mental health counselor, on the other hand, might just have you make subtle adjustments until things start running more smoothly.
The practical, get-it-done perspective of mental health counselors comes from the origins of the profession in vocational and school counseling. Action-oriented, used to viewing individuals based on their own strengths and weaknesses, you can see how counselors naturally became problem-solvers. They started off working with people trying to fit into a changing society by finding them the right roles to fill and eventually applied the same techniques to dealing with more personal, individualized problems.
Right around the same time as thousands of wounded and traumatized soldiers were coming back from the First World War, society came to embrace the idea that individuals with mental health issues could and should be treated and assisted in finding a place in society.
It was these early counselors who are credited for discovering that physical disabilities weren’t the only problems that needed to be addressed. But it wasn’t until the 1970s, post-Vietnam era that the profession began doing serious rehabilitation and mental health work with returning veterans using those same perspectives and training.
The American Mental Health Counselor’s Association was created in 1976 when it became clear that this was a whole new ballgame compared to the type of vocational counseling work that was in the wheelhouse of most counselors. But the attitudes that motivated them to help individuals, and to see them as unique and worthy of a place in society, never left.
Marriage and Family Therapy Was Inclusive from the Start, and That’s as True Now as Ever
Marital counseling emerged in the 1930’s in the United States as an outgrowth from the eugenics movement of that era… not a great start.
But in the post-war years and into the 1960s, what came out of the new social upheavals was a renewed interest in marital happiness and family harmony. Drawing on new theories of psychology coming from Bowen and Bateson who believed that treatment of individuals might not be as effective as addressing their entire family group, marriage and family therapy took off in a big way.
Marriage and family therapy came of age as new understandings of multiculturalism, the social contract and gender were evolving. It only makes sense that it embraces mental health and therapy as problems that are best addressed in the context of relationships and social support systems. And it only makes sense that it now seeks to use more inclusive language, these days often being referred to as couple and family therapy.
Degree Paths Into The Mental Health Professions: PhD and PsyD for Psychologists; Master’s for Both Counselors and Therapists
Almost all of the licensed roles for psychologists, counselors and therapists require a master’s degree or higher. Psychologists, other than school psychologists, have to climb all the way to a doctorate.
|Degree Level||PhD / PsyD||Master or higher||Master or higher|
|Typical Cost||$50,000 to over $200,000||$25,000 to over $55,000||$25,000 to over $55,000|
All figures are from the National Center for Education Statistics (NCES) for the 2018-2019 school year.
Those costs don’t include the cost of the undergraduate degree that comes first. NCES pegs a bachelor’s at about $20,000 to $44,000 per year, depending on whether it’s a public or private school and if you are eligible for in-state tuition or not.
One similarity that runs through all of these paths is something that can end up being a big advantage for you. At the undergraduate level, just about any of these majors will work just fine to qualify you to enter any of the others at the master or doctoral level. A BS in Psychology is a really common way to get into master’s programs in counseling or therapy. A BS in Counseling is perfectly acceptable to PsyD doctoral admissions committees.
Specialty Accreditation Standards in Mental Health Keep Each Profession On Track
One thing that makes all these degrees different is that programs should meet the high standards of their respective specialty accreditors. That gives you all the assurances you need about the quality of your instructors and the resources you’ll get at each school, but it also does more than that.
Each specialty accreditor is a standard-bearer for the profession. They keep these programs in their lanes, keeping the culture and philosophy consistent. These accreditors are actually a big part of what establishes the distinctions between all of these roles.
- CACREP – Council for Accreditation of Counseling and Related Educational Programs: CACREP is the youngest agency, established in 1981, but it grew out of the Association for Counselor Education and Supervision that had been putting together standards for counseling education since the 1960s. Unlike the other two accreditors, it is a separate entity from the main professional bodies in counseling.
- COAMFTE – Commission on Accreditation for Marriage and Family Therapy Education: COAMFTE was established in 1974 by the American Association of Marriage and Family Therapy to oversee training programs in the field. They review master’s and doctoral programs and post-graduate degree clinical training programs in marriage and family therapy.
- APA – American Psychological Association: The APA is the oldest group, founded in 1892, and the body’s Commission on Accreditation not only evaluates doctoral programs but also internship and postdoctoral residency programs, controlling the entire scope of clinical psychology training.
Deciphering Differences in Degree Titles
Something you will notice with all of these degree paths is that they lean slightly toward either liberal arts, science or education. And like counseling, therapy and psychology roles, the differences can be subtle, but still worth noting.
- Master of Arts (MA) – For either counseling or therapy, an MA is a traditional humanities degree, with a mixture of interdisciplinary skills drawing from all the different elements of a liberal arts education: philosophy, history, ethics, and so on. You may find less research and experimental coursework and fewer hard science courses in favor of social and cultural studies relevant to counseling and therapy.
- Master of Science (MS) – An MS in Counseling or Therapy, on the other hand, sticks with the sciences. You will have more coursework in hardcore psychological theory and psychometrics. You’ll probably get more research opportunities and learn about methodology and experimental techniques too.
- Master of Education (MEd) – MEd programs in counseling offer specialized training to prepare students for work in educational counseling environments… K-12, colleges, or other institutions like prisons or mental healthcare facilities. They still carry the accreditation for licensure and you will find them with appropriate concentrations in clinical mental health, addiction, and other types of counseling.
- Doctor of Philosophy in Counseling or Therapy (PhD) – The doctoral level of counseling and therapy education is almost entirely designed to prepare graduates for academic and research jobs in the field, rather than practice.
- Doctor of Philosophy in Psychology (PhD) – On the other hand, a PhD in psychology is the traditional degree for all kinds of psychologists, including clinical practitioners. It is focused heavily on research and experimentation, however. For that reason, it’s considered ideal for academic and investigative roles in the field, with a lot of theoretical study of psychological principles.
- Doctor of Psychology (PsyD) – The PsyD is a newer psychology degree, intended specifically to prepare graduates for clinical treatment positions. They focus on the practical applications of psychology in the field, from handling assessments to delivering therapies.
- Doctor of Education (EdD) – A doctor of education in psychology is another specialized degree that is specifically designed for school psychologists. Although most states only require school psychologists to hold a master’s degree, the additional training offers a greater depth of expertise in the field.
You’ll also see degrees advertised as straight Master of Family Therapy programs. Dig deeper, though, and you’ll see in the college catalog that these are also either MA or MS degrees at heart.
Just as there are nuts and bolts differences in each of these jobs out in the field, though, there are also specific differences in the education and training for each of them.
It Takes a Master’s Degree to Become a Counselor
Mental health counselors must earn master’s degrees in counseling or in closely related areas. States vary on what they will accept, but most will take any master’s program with 60 credits or so of training, with a certain minimum number of credits in specific counseling-related coursework.
That specialized CACREP accreditation means that coursework will include:
- Professional Counseling Orientation and Ethical Practices – You’ll get into the history and philosophy that led to the modern counseling profession and discuss the roles and responsibilities that come with the profession.
- Social and Cultural Diversity – The impact of heritage, attitudes, beliefs and acculturative experience has an enormous effect on mental health and hardship. You’ll understand how to put your brain in the chair across the table and see things from the client’s perspective after this coursework.
- Human Growth and Development – Human beings change as they grow, and the systemic and environmental factors in that process can create abnormalities. You’ll study the theories and etiologies of behaviors at every age.
- Career Development – More than just how to offer job advice, these courses look at the major impact that the work environment can have on individual health and happiness. With one-third of a typical life spent in the workplace, it’s a huge factor in mental well-being.
- Counseling and Helping Relationships – These courses will get into the core of counseling work, developing a rapport with clients and coming up with effective treatment plans. Crisis intervention and trauma-prevention tactics are covered here.
- Group Counseling and Group Work – You’ll get into the theoretical and practical aspects of managing group therapy, learning how to leverage the social spectrum for results in multi-patient settings.
- Assessment and Testing – Standardized tests and various checklists and observational concepts are taught to help you narrow down your diagnoses in various educational, social, and clinical settings.
- Research and Program Evaluation – Finally, although it’s less emphasized in counseling than psychology, you’ll get into the development and uses of evidence-based approaches to program development and evaluations.
CACREP also accredits doctoral degrees in counseling. Those aren’t required for licensure or even for most jobs, but they give you a chance to expand your knowledge and qualifications to the highest level if you choose to do so.
Master’s or Doctoral Level Training to Become a Marriage and Family Therapist
A therapist will go through 45 credit hours or more of graduate-level coursework in addition to at least 500 direct contact hours of fieldwork in multiple internship placements.
COAMFTE’s approach to accreditation ensures that the training all aligns with a relational/systemic philosophy: looking at mental health issues as parts of social or personal interrelationships.
That means a lot of coursework on society and culture. Anti-racism and inclusion are built into therapy master’s programs by design.
Understanding cultural competency is a core requirement. The training is designed to be outcome-based. The Student Learning Outcomes set out by COAMFTE don’t require specific kinds of classes, but allow programs to take different routes to meet these objectives:
Develop competencies in the relational/systemic theories and models of marriage and family therapy, using evidence-based practice and a biopsychosocial perspective.
- Become competent in the clinical treatment of individuals, couples and families from diverse backgrounds and social status, including developing crisis intervention skills.
- Understand and apply knowledge of diversity, power, privilege and oppression in practice with diverse, marginalized or otherwise underserved communities.
- Be able to understand and use research and evaluation methods in support of evidence-based practices, including being an informed consumer of current research in the field.
- Understand the professional identity and legal and ethical responsibilities of marriage and family therapists, centered on the AAMFT Code of Ethics.
- Have a firm understanding of biopsychosocial health and development across the lifespan.
- Develop competencies in system and relational assessment of mental health issues and treatment planning. This includes understanding of the psycho-diagnostic categories including addiction, suicide, trauma, and abuse.
- Familiarity with contemporary issues in marriage and family therapy. The changing nature of social acceptance and custom including effects of immigration, technology, same-sex marriage, violence in schools, and other hot topics should be understood in terms of impacts of therapy practices.
- Graduates will become familiar with community intersections and collaboration with multidisciplinary treatment teams, viewing the therapeutic components of their profession as part of more holistic treatment goals.
As with CACREP, COAMFTE accredits doctoral-level degrees as well. They set out additional and higher standards for those programs, but, as with CACREP, PhDs in MFT are more common for those headed for jobs in the teaching world than for practitioners.
A PsyD or Phd is Required to Become a Licensed Psychologist
Psychologists receive the broadest and deepest education in mental health issues of any of these roles. Up to seven years in a doctoral program gives you a lot of time to hit the books. Psychology doctoral students come away with a core understanding of every element of human cognition and behavior from every angle, from neurology to sociology.
That puts psychologists in a unique place to specialize in any kind of mental healthcare practice. So you will find counseling psychologists and family psychologists in the human services field and beyond, and their practices almost completely overlap with counselors and therapists in this capacity.
Developing that sort of expertise goes beyond just studying. Psychology doctoral programs also involve original research and plenty of hands-on practicum. You can expect clinical field placements throughout a PsyD program, placing you out in the real world to learn as you work under supervision and guidance for between 8 and 20 hours per week depending on your course load. A full clinical internship caps that off with even more on-the-job experience.
PhD programs shift some of this into research hours, but either way, the process is intense.
There are many different specializations and concentrations in psychology. Each of them will have unique coursework that go along with them. But the core program in any psychology PhD or PsyD will cover:
- History and Foundations of Psychology – You start off with the theory going all the way back to the beginnings, and follow the family tree of psychological thought forward through Freud to Peirce to James to Maslow and beyond. The modern schools of psychological thought and interpretation are grown out of this history, setting your foundation firmly in research and experimentation.
- The Bases of Human Behavior – Out of those theories comes understanding. You’ll start down at the neurological level and learn the modern conceptions of the bases of human behavior, from cognitive/affective to social and cultural. It’s a firm picture of what makes people tick.
- Psychopathologies – And after you learn what makes people tick, you’ll study all the different ways they can start missing beats. You’ll dig into the roots of mental issues and learn the categories and effects of abnormal psychology.
- Assessment and Treatment Competencies – This is where the rubber meets the road in psych programs. Learning tests and assessment tools like the Minnesota Multiphasic Personality Inventory (MMPI) and different types of treatments, ranging from cognitive behavior therapy to psychotherapy gives you the toolset that makes psychologists unique.
- Research – Research gets a stronger focus in PhD programs, but it’s a prominent part of all doctoral psychology degrees. Experimental design, ethics statistical and quantitative coursework and best practices all help budding psychologists come to grips with the evidence-driven roots of the profession.
- Ethics and the Law – Like the other mental health treatment roles, ethics are a big part of psychology education. Psychologists are trained not just in the legal and code of conduct standards, but also the philosophy behind ethical behavior and how to reason through difficult situations from those principles.
Not only do they get this intensive education during the program, but they also may spend as many as two years working on a doctoral dissertation in the field. While master’s graduates in therapy and counseling will produce a thesis during their training that fills a similar purpose, a dissertation is expected to be a highly original synthesis of the psychologist’s education and a synthesis of their entire program. It develops a high level of expertise in the subject matter.
How Licensing Works for Counselors, Therapists and Psychologists
All of these roles are licensed at the state level. There is no unified national standard for every profession. So you’ll find some differences not just from job to job, but also from state to state, even where the titles are the same.
But you will also find that all of them jump through a lot of the same hoops to get that little piece of paper at the end. In general, licensure for each of these professions includes checking these boxes:
|Education||Doctorate – 4 to 7 years||Master’s – 2 years||Master’s – 2 years|
|Supervised Experience||1500 – 6000 hours||2000 – 3000 hours||1500 – 3000 hours/2 years|
|License Cost||$500 – $1000||$50 – $400||$130 – $400|
On top of the license cost itself, you’ll also have various testing fees, the costs of getting a criminal background check, and sometimes additional state-mandated classes in domestic violence, HIV-awareness or other subjects.
Every state has a board that is responsible for setting those standards and evaluating qualifications for each license. In many states, like Arkansas and Pennsylvania, you’ll even be dealing with the same licensing boards for therapists and counselors.
But it’s not always so clear. Alaska, for instance, categorizes both Licensed Marriage and Family Therapists and Licensed Marriage and Family Counselors as therapists, even though there is also a Board of Professional Counselors and a separate LPC license.
There is enough common thread running through different types of therapy and counseling that license holders in any of these roles are usually specifically exempted from having to get a license in the other. So you can easily practice across boundaries… to an extent. Local laws will tell you where that line is. And school counselors and psychologists each have a whole separate licensing regime to deal with specific to their jobs.
You can find more details here on how to become a psychologist, as well as therapist and counseling license requirements.
Testing Creates Distinctive Categories For Mental Health Professional Licensing
Testing sets out the boundaries for the role in every state. Tests for each type of license reflect the kind of approach to mental health treatment you got in your degree program. Apart from that, they tend to cover the same kinds of general mental health conditions and clinical skills, just from different angles.
All states rely on one specific test for each of those jobs:
The MFT National Examination, offered by the Association of Marital & Family Regulatory Boards, is the sole exam used to vet couple and family therapist license candidates. It’s an in-person exam taken at Prometric Testing Centers that you will be allowed to schedule after your education and other qualifications have been approved by the state license board.
The test itself covers six domains within marriage and family therapy with a total of 180 questions to be completed in 4 hours.
Psychologists in every state have to face down the intimidating EPPP, or Examination for Professional Practice in Psychology. It’s a two-part exam covering knowledge and skills, with over 200 questions in multiple formats. They go over 14 different domains of psychological information, reflecting the profession’s wide base of expertise.
The exam costs $600 and takes just over four hours to complete. That’s about one minute per question, so there’s no time to contemplate. You need to know the material cold.
Unlike therapists and psychologists, counselors face a lot of different possible exams. That reflects the different practical areas the field covers. The three main exams are:
- NCE – National Counselor Exam from the National Board for Certified Counselors. The most common exam, it has 200 questions on eight content areas specified by CACREP.
- NCMHCE – National Clinical Mental Health Counselor Examination. Also offered by NBCC, this test focuses more specifically on mental health practice. The format consists of 10 simulated clinical mental health cases and covers assessment and clinical problem-solving skills.
- CRCE – Certified Rehabilitation Counselor Examination from the Commission on Rehabilitation Counselor Certification. From the Commission on Rehabilitation, this test covers 12 knowledge domains that are specific to rehabilitation counseling through 175 multiple choice questions.
Supervised Experience Requirements For Counselors, Therapists and Psychologists Have a Lot in Common
Each state also has specific requirements for supervised clinical experience for each kind of practitioner. Although you’ll notice a few differences if you really get down into the weeds, in fact, there are really more practical differences from state to state than there are from profession to profession.
Everywhere you go, you’ll have to spend at least a year and probably closer to two years practicing under the supervision of a qualified practitioner. Some of your college experience will count while some of the hours must be earned after graduation, depending on the state. It can take anywhere from 1,500 to 6,000 total hours, but some states will give you credit for more education versus hours: extra graduate credits can reduce that total count.
In a sign that there is more that unites these jobs than divides them, in many states your supervisor can actually be a licensed professional from one of the other two roles.
In other words, a psychologist can be the supervisor for a counselor, or an LPC for an LMFT.
Psychology students in training, members of the clergy, licensed therapists and psychologists, medical doctors and even attorneys in some cases, can be exempt from licensure laws. And school counselors have their own credential tree to climb, although it often mirrors LPCs.
All the little hoops into professional practice tend to be similar for each role, too. That includes a jurisprudence exam in most states, where you verify how well you understand what you can and cannot do with that license. You’ll also have to pass criminal background checks in most cases, fill out a bunch of forms, and pay the required fees.
And all three professions will require continuing education to keep those licenses current. The hours vary from state to state and job to job. In general, you can expect to have to put in between 10 and 20 hours per year to keep current with the latest developments in your field. In most cases, courses will only be accepted if they are endorsed by the governing national body for the role:
- Psychologists – APA Continuing Education
- Therapists – AAMFT Courses
- Counselors – NBCC Continuing Education
Differences and Similarities Emerge in The Day-to-Day Life of Therapists, Counselors and Psychologists
|Jobs in the U.S.||192,300||319,400+||66,200|
Data for all professions retrieved from the U.S. Bureau of Labor Statistics, published May 2019.
You’ve seen the differences in education and licensing for these jobs. But what makes the actual day-to-day tasks different from one another? How is life different for a counselor who shows up at an addiction treatment center versus a psychologist in private practice seeing clients in a luxury office suite each day?
That’s a fun visual, but it’s actually the wrong question. A day in the life of a psychologist working in addiction treatment will have a lot more similarities to a counselor working in the same role than it will with a fellow psychologist treating wealthy clients in a private office. And an MFT working in the same office park as that psychologist will probably see a lot of the same kinds of patients and engage in the same kinds of assessment and treatment.
In fact, they may even hold the same board certifications. Many specialist mental health treatment boards offer elective professional certification to licensed mental health professionals regardless of their title:
- BCPC – Board Certified Professional Counselor (American Psychotherapy Association)
- CCBT – Certified Cognitive-Behavioral Therapist (National Association of Cognitive-Behavioral Therapists)
- CST – Certified Sex Therapist (American Association of Sexuality Educators, Counselors, and Therapists)
These are generally awarded for master’s and higher degrees in a broad range of areas like psychology, counseling, social work, psychiatry and occupational therapy.
The Unique Skills Required of Counselors in the United States
Professional counselors in the U.S. go by a lot of different titles. The License Requirements for Professional Counselors overview published by the American Counseling Association found the following to be the most common:
- Licensed Professional Counselor
- Mental Health Counselor
- Clinical Professional Counselor
- Licensed Professional Clinical Counselor of Mental Health
- Licensed Clinical Mental Health Counselor
- Licensed Mental Health Practitioner
Counseling looks at today’s problems and figures out what you can do about them today. That’s why you find career and college counseling mixed in with heavy-duty stuff like addiction and mental health… it’s all part of the package. From a therapeutic methodological perspective, there aren’t bright lines between “I’m having a tough time in the classroom” and “My mother just passed away.”
Counselors don’t spend a lot of time digging into your innermost feelings or childhood traumas. They work to get a handle on today’s problems and provide workable, proven solutions.
Due to their practical perspective on mental health problems, counselors end up in a lot of hands-on, functional, specialized roles. In fact, CACREP defines them specifically:
- Clinical Mental Health
- Clinical Rehabilitation
- College Counseling and Student Affairs
- Marriage, Couple, and Family Counseling
- School Counseling
In many cases, those jobs are directly with a non-profit or a government agency. But a surprising number of mental health counselors work independently… 65 percent according to one study.
But counselors working in larger systems tend to apply fixed programs of treatment and are often working with clients who already have a diagnosis or a problem that fits into a clear category. There’s not a lot of room for innovation or creativity.
You can see a lot more detail on all the different types of counseling jobs out there on our overview to becoming a counselor page.
Therapist Jobs Focus on the Family
Therapists might have some of the most consistent job duties out of any of the roles. They are concentrated in individual and family services and other clinical centers, with 52 percent of jobs found in those industries.
Because of their systemic view of mental health issues, therapists are more likely to spend their time conducting group sessions or working with a set of related individuals both one-on-one and together. The nature of the job also puts therapists more consistently into contact with kids, either as patients or as pieces of a larger puzzle when dealing with issues of marital conflict.
Family therapists owe much of their unique approach to therapy to Doctor Murray Bowen. Bowen started off investigating schizophrenia in the 1950s. The major psychological therapeutic approach to the disease at the time was rooted in Freudian thinking.
But Bowen felt that was too narrow. He believed that the basic emotional unit might not be the individual, but the family group. And if that was the case, the only way to treat it was to engage in systems thinking. It was a major shift in mental health treatment, one that marriage and family therapists have made their own. Their first emphasis in diagnosis and treatment is to see the big picture of relationships around the person or people in therapy.
Because they are more likely to be seeing kids, it also puts them on the front lines of an epidemic among American youth: autism treatment. CDC estimates put the prevalence of Autism Spectrum Disorder as affecting roughly one in every sixty-eight kids in the country as of 2017. Marriage and family therapists may work directly with kids on the spectrum, or they may concentrate on helping the families of those kids while coordinating with more specialized types of therapists, namely like applied behavior analysts.
The training for therapists revolves around communication and helping others see different points of view. So discussions and training with clients around issues of self-awareness and communication techniques make up a large part of the day for therapists.
Psychologists Have Unlimited Specialty Roles Available
The APA estimated there were only around 106,000 licensed psychologists in the United States as of 2019. It’s the most exclusive of these jobs, which also makes it the highest paying of the three. It’s also the role that can take on the most varied types of specialties.
A psychology doctorate unlocks the option of engaging in just about any sort of mental health treatment.
Addiction counseling? It’s on the table. Family therapy? Any time you like. Or you can head over into research and academic functions, maybe even teaching in MFT or clinical counseling degree programs.
But most clinical psychologists handle patient treatment from the solid theoretical grounding they receive in school. They can use any sort of therapeutic approach in treatment, but it will always be fixed on determining a root cause and addressing the source of the disfunction. Psychologists are more likely to see patients for longer periods of their lives. That gives them a chance to build a rapport that therapists and counselors can rarely achieve.
As some of the most highly trained mental health professionals, you’ll find psychologists have a lot more room to set their own agenda from day-to-day. They have wide latitude in diagnosing clients, deciding on treatment plans and delivering direct treatment.
Salary Differences Between Therapists, Counselors and Psychologists
Because of the way that the Bureau of Labor Statistics tracks data, these numbers won’t be on the nose—they don’t include many types of counseling roles, which are split off into other categories, but they do lump in many non-licensed, non-clinical psychologists. Still, you get an idea of how things break out for each kind of job.
Where you will notice the biggest differences will be in the specializations available to the different roles, and the paycheck they cash at the end of the month.
What can you make in those roles? According to the Bureau of Labor Statistics, entry-level roles for licensed professional counselors run between $35,000 and $54,000 per year. But specialties and industries matter, too:
- Rehabilitation Counselors – $35,950
- State government – $51,260
- Individual and family services – $33,590
- Community and vocational rehab centers – $32,310
- Nursing and residential care – $31,070
- School and Career Counselors – $57,040
- Elementary – $64,060
- State, local, and private educational services – $51,880
- Colleges – $51,120
- Healthcare and social assistance – $40,620
- Substance Abuse, Behavioral Disorder, and Mental Health Counselors – $46,240
- Government – $52,720
- Hospitals – $49,100
- Individual and family services – $46,090
- Outpatient mental health and treatment centers – $44,750
- Residential mental health and treatment centers – $36,690
The top ten percent of counselors can earn more than $76,080 per year. It’s the lowest high of all three professions, but with the right job, you can reach more people and make more of a difference in the world than in any other role.
Marriage and Family Therapist Salaries
The $49,610 median salary for marriage and family therapists is generally higher than the average for counselors. But it can also approach the rates for psychologists in some cases. The top ten percent of therapists earn more than $87,700.
The pay can vary by industry, however. Surprisingly, some of the best salaries come with government jobs:
- State government – $72,230
- Outpatient care centers – $52,140
- Individual and family services – $45,660
- Other healthcare offices – $45,150
Psychologists have the greatest earning potential out of any of these positions. That’s what you would expect considering they are sitting around in classrooms and racking up practicum for almost five years longer than their therapist and counselor counterparts.
If Freud were alive today, he might not say that the best way to surpass your father is to pull down big paychecks as a clinical psychologist… but that doesn’t mean he wouldn’t be thinking it.
The huge range of job opportunities open to psychologists also means that they have a broad set of possible salaries to look at. BLS shows that the average psychologist made $80,370 in 2019, but the clinical psychology role had a median of $101,790 that year. And like counseling and therapy jobs, where you work matters. These are some of the salaries by setting for psychologists in clinical practice:
- Physician’s offices – $89,060
- Hospitals – $92,560
- Government – $94,670
- Other healthcare offices – $133,710
The APA has also done a lot of number-crunching for different specializations in psychology. From a survey published in 2017, they found that the average salaries varied widely from specialty to specialty:
- General psychology – $73,606
- Clinical psychology – $107,183
- Counseling psychology – $89,108
- Educational psychology – $87,257
- Experimental psychology – $113,747
- Industrial/organizational psychology – $149,912
- Social psychology – $85,860
They also took the time to calculate regional differences in salaries. Regional differences hold true for all three roles, but psychology happens to be where we have the most concrete data as reported in the APA survey:
- Pacific – $93,322
- Mountain – $73,645
- West South Central – $97,195
- East South Central – $69,782
- South Atlantic – $82,631
- West North Central – $103,652
- East North Central – $77,288
- Middle Atlantic – $144,970
- New England – $98,011
Working in major urban centers or near the coasts tends to pay better. Since those are also higher cost-of-living areas, of course, that only makes sense.
With all these professions, though, your real compensation comes in terms of lives changed.
With all the options for practice you can find between the three, there’s no question you can get into the kind of job you find most challenging and rewarding for your life’s work.