What Really Happens in Therapy (The Mental Health Kind): Part 2 of 4

In this edition, I’m going to talk about  how therapists get those fancy letters and periods after their names.  It may surprise many people when they learn about the amount  of education and training that is involved.   Also, we’re going to look at what is important when choosing a therapist.

License Types

There are many types of licensed therapists that conduct counseling services.  Each type comes with their own shortened version of licensure  better known as “credentials.”  In the state of Minnesota, those licensure types (credentials in parenthesis) typically include the following:

• Licensed Psychologist (LP)
• Licensed Marriage and Family Therapist (LMFT)
• Licensed Independent Clinical Social Worker (LICSW)
• Licensed Professional Clinical Counselor (LPCC)

These professionals, as a whole, would all be considered therapists, clinical therapists, clinicians, or psychotherapists. There are also people that call themselves therapists (the mental health kind) but are actually unlicensed or working towards their licensure.  Confusing isn’t it!

Education

In general, each licensed therapist has a four-year bachelor’s degree along with a Masters or Doctoral degree.  Just to finish their schooling, it will take them between six to ten years after graduating high school.  In addition to completing classroom work, each program requires a certain period where the “trainee” practices at a facility.  This time period varies, but it can take to a year.

Licensing

After the schooling is completed, and the degrees awarded, each clinician must meet state licensure requirements, which vary based on their particular license (see “License Types” above).  Most licensing boards require up to two years of practice under the supervision of specially trained supervisors before they will even consider  individuals for licensure.   Once this requirement is complete, the clinician must pass a rigorous national written exam; some licensure boards also require an additional oral examination in front of their state board before awarding the license.   Let’s sum this up:  In addition to 6-10 years of school, clinicians practice up to two years unlicensed before being able to take an exam that would lead to a license.   Tired yet? 

So What’s The Difference?

 I contacted some of my colleagues outside of my clinic to get their take on the distinctions between the various fields.  Dr. Jennifer Connor, PhD, LMFT, Associate Professor in the Marriage and Family Therapy program at St. Cloud State describes an LMFT as a person who “provides therapeutic services to individuals, couples, and families.  Typically, this involves resolution of a problem, whether it resides within the individual, couple system, or family system.”

Dr. Jennifer Rocheleau, PsyD, LP at Central Minnesota Mental Health Center in St. Cloud said that “A licensed psychologist is a professional with experience and training in therapy for those with mental health problems (even for those with transient symptoms that are adjustment in nature), psychological assessment and diagnosis/treatment.”

Barb Jochum, MS, LICSW at the Center for Family Counseling in St. Cloud stated that “An LICSW comes from the perspective of person-in-environment, which means, we believe that a person is shaped by their interactions in their environment around them.  We look at the “big picture” of a person and how all systems are intertwined and affect our outlook of the world and how we fit in it.”

When asked about what sets apart their respective specialties, Dr. Connor reports that “An LMFT has significantly more coursework in how to work/intervene with families and couples than other licenses. An LMFT also has coursework on how to conceptualize an individual’s problem by including their family, even if they are not physically present in therapy, during the assessment.”

Ms. Jochum stated that “the advantage of an LICSW is the multi-faceted perspective of a bigger picture of oneself that can lead to a greater understanding of one’s struggles.”

Dr. Rocheleau noted that while psychologists also do standard therapy, “psychological assessment is a skill area distinctive to a licensed psychologist that other Master’s level therapists do not typically perform. “

What Therapist Is Right For You?

With all of the types of therapists and all of the things that make them different and the same, how does an average person who just wants some help choose?  In my experience, most people simply call their insurance company and ask for names.  They then break that down into whether they would rather see a male or female therapist.  Some clients ask about specialties of the clinicians, but most do not. 

I asked my colleagues about this. Ms. Jochum believes “therapy should be based on relationship and specialty versus licensure type.  When someone is seeking therapy they should look for someone knowledgeable in their area of struggles and then see if there is a connection with that person.  A relationship with their therapist is going to be much more significant in the outcome, than the licensure type.” 

Dr. Rocheleau states: “For clients wanting standard individual psychotherapy, I believe goodness-of-fit is most important versus type of licensure.  Many professionals believe and research supports that the therapeutic relationship is most important to therapy outcomes.  If a client has a specific issue they want to work on such as divorce or trauma history, he/she can ask a therapist about his/her specialty or competency areas.”  Dr. Rocheleu adds, “I would recommend to clients to “shop around” if necessary to find a therapist with a personality/style that feels trusting, comfortable and like a good match.”

Dr. Connor relays the following: “Most important is - does the person feel like a good fit to you? If not, you have the right to switch to another provider.  I would also consider the licensure type as it fits to my specific problem.  If I was having marital issues, I would preference a LMFT.  If I needed consultation on a psychotic disorder, I would preference someone with a strong history of abnormal psychology, such as a LP.  However, there are LMFTs who specialize in assisting families where members have a psychotic disorder and psychologists who have a background in family psychology, so I would also want to know more about the therapist’s specialties.” 

It’s Mostly About the “Fit”

I echo the sentiments of my colleagues. While taking your insurance type is usually a must in this economy (check with your insurance to make sure they reimburse for the particular license type of the therapist you would like to see), gender should not always be a primary concern (except in cases of abuse).  Additionally, while it’s important to find someone that is experienced with your particular set of concerns, the consensus is that the relationship and personality “fit” are the most important factor in having a successful therapeutic outcome – not usually licensure.  Without that “fit,” when you are looking for “standard therapy,” it doesn’t matter what amazing arsenal of specialties and education a clinician brings, because you probably won’t come back.

In Part 3, I will talk about typical reasons people come into therapy.  I think those reasons are not what many readers will expect. Until then, I’m happy to answer questions in the comments section.

Craig Rens is the Clinical Director of Solutions Counseling located in downtown St. Michael, MN.  He is a Licensed Marriage and Family Therapist who provides therapy to individuals, couples, and families of all ages and ethnicities.  Learn more about Solutions Counseling at www.HelpWithSolutions.com. Or call 763-515-4563.