Types of Psychotherapist - What are MD, PhD, PsyD, LCSW, LMFT?

Which Therapist For Which Issue?

(scroll down for summary chart)

Professionals who are licensed to practice psychotherapy may have any of these designations after their names. Although they may vary in their approaches to psychotherapy, theoretical orientations, type of clients they are competent to treat, and level of training, all may call themselves 'psychotherapists.' It's important to understand the differences between them in order to help ensure that you choose the professional most appropriate for you.

Each state has its own licensing requirements for psychotherapists, but all people practicing psychotherapy must either be licensed (or registered as interns, in which case they are not yet licensed and have an 'i' after MFT, CSW, or Psy)--see below). Otherwise, just like those who profess to be lawyers or medical doctors without the accompanying education and/or experience, they are breaking the law. You can check the licensure status of any mental health professional by contacting your state's licensing board.

Fees vary across the professions (with more training commanding higher fees) and depend upon location. In some areas, lesser-trained therapists charge the same as higher-trained therapists (see below for comparison chart of training requirements). Many professionals offer sliding scales based on income.

Psychiatrists. Psychiatrists are medical doctors who completed four years of medical school, a one-year internship where they learned psychiatric practice under supervision, and three years of residency training ('on-the-job experience') in psychiatry. Most psychiatrists' training is in mental hospitals or other institutional settings. All are trained in diagnosis and psychopharmacology (prescribing psychotropic medications), but during the past 20 years, relatively few residency programs provide much, if any, experience doing outpatient psychotherapy. Psychiatrists often work with in tandem with psychologists, prescribing medication while the psychologist provides the psychotherapy. Psychiatrists are the only mental health professionals who can prescribe psychotropic medication. Psychiatrists are licensed in all states. In California, they are licensed by the Board of Medical Examiners.

Psychologists. Psychologists are psychotherapists who have earned a bachelor's and doctorate degree in psychology--typically, a Ph.D or Psy.D, although some have an Ed.D. (Doctorate of Education with a counseling emphasis). Doctoral degree programs in clinical psychology (psychotherapy) are extremely competitive, with many more people trying to become psychologists than spaces in programs to train them. Psychologists typically complete a four-year undergraduate degree in psychology, followed by a five-year graduate Ph.D or Psy.D training program at a professional school or university, a one-year supervised internship providing psychotherapy in a mental health facility, and one full-time year of post-doctoral supervision providing psychotherapy in preparation for the state psychologists' licensure examination. Psychologists are trained to diagnose and treat a wide variety of psychological difficulties--from psychosis to post-traumatic stress to depression, anxiety, life transition and relationship problems--in individual adults, couples, families, and children. Psychologists are the only psychotherapists who can perform psychological testing. Psychologists are licensed in all states. In California, they are licensed by the Board of Psychology.

Psychoanalysts. These professionals most commonly have a medical degree in psychiatry, but degrees in psychology or social work are increasingly common. In addition to their degree, they must have at least two years of supervised training at a psychoanalytic institute. Psychoanalysts are primarily trained to work with individuals, couples, and children. They tend to focus on problems such as recurring relationship patterns, depression, anxiety, and somatic (body) symptoms. They are psychotherapists who follow the theoretical orientation of psychoanalysis, originated by Sigmund Freud. They must also be licensed (usually as psychiatrists or psychologists) to practice psychotherapy.

The following (in italics) are definitions from the Business and Professions Code regarding the scope and practice of licensees regulated by the Board of Behavioral Sciences (LMFT, LCSW):

What is an LCSW?

The practice of clinical social work is defined as a service in which a special knowledge of social resources, human capabilities, and the part that unconscious motivation plays in determining behavior, is directed at helping people to achieve more adequate, satisfying, and productive social adjustments. The application of social work principles and methods includes, but is not restricted to, counseling and using applied psychotherapy of a nonmedical nature with individuals, families, or groups; providing information and referral services; providing or arranging for the provision of social services; explaining or interpreting the psychosocial aspects in the situations of individuals, families, or groups; helping communities to organize, to provide, or to improve social or health services; or doing research related to social work.

LCSWs typically obtain a four-year undergraduate degree in a social science and then enroll in a two-year master's degree (M.A.) program in social work or social welfare, as their work focuses on social adjustment. Their training includes fieldwork in diverse human services settings, often community mental health settings. To become licensed usually requires an additional year of post-master's supervised psychotherapy experience in preparation for the LCSW licensure examination. Social workers' training is supportive and community oriented, helping clients to locate and utilize local resources. LCSWs are licensed in nearly all states.

What is an MFT?

Section: 4980.02. PRACTICE OF MARRIAGE, FAMILY, AND CHILD COUNSELING

For the purposes of this chapter, the practice of marriage, family, and child counseling shall mean that service performed with individuals, couples, or groups wherein interpersonal relationships are examined for the purpose of achieving more adequate, satisfying, and productive marriage and family adjustments. This practice includes relationship and premarriage counseling. The applications of marriage, family, and child counseling principles and methods includes, but is not limited to, the use of applied psychotherapeutic techniques, to enable individuals to mature and grow within marriage and the family, and the provision of explanations and interpretations of the psychosexual and psychosocial aspects of relationships.

MFTs have a one- or two-year master's (M.A.) degree in counseling or marital and family therapy from an accredited professional school or college, in which they were trained in couples' therapy and family therapy--general relationship issues. To become licensed requires one or two years of additional post-master's supervised psychotherapy experience in preparation for the LMFT licensure examination. Master's level psychotherapists who are not LCSWs are only licensed to practice in a very few states (including California and Hawaii).

Interns. Interns are people in or just out of a master's or doctoral program who are still earning hours and experience toward their license. They must be supervised by a licensed person with whom they meet, typically, one hour per week. They identify themselves with a lower-case "i."

*** Please be aware that there are a very few unethical professionals who practice outside their level of training and licensure. By far, most professionals are ethical and well-trained. ***

SO WHAT TYPE OF THERAPIST IS BEST FOR ME?

Psychoanalysts and psychologists are trained and licensed to treat any psychological issue, and psychologists are the only professionals who are able to conduct psychological testing. Psychiatrists are the only professionals who can prescribe medication nationwide; some are also trained to do psychotherapy involving any psychological issue. Seeing an LCSW would be an appropriate choice for a relationship issue, or difficulties with social adjustment, including lack of community support. LMFTs are licensed to do couples therapy or family therapy, or to see individuals who are working on a specific family or relationship issue.

 THERAPIST  LENGTH OF TRAINING BEYOND THE B.A. DEGREE  LICENSED TO OFFER  PREVALANCE + average fee per 50-min. session
 Psychiatrist  7 YEARS: 4-yr MD + 1-yr internship + 2-yr residency Psychotropic medication management (some also perform psychotherapy of all issues)  Licensed in all states; average $225
 Psychologist  6-7 YEARS: 4- or 5-yr PhD or PsyD + 2-yr internship Psychotherapy of all issues including serious mental illness (depression, etc.); psychological testing & evaluation  Licensed in nearly all states; average $150
  LCSW  4 YEARS: 2-yr. M.A. + 2 yr internship Psychotherapy focused upon social adjustment or relationship issues Licensed in nearly all states; average $85
 LMFT  3-4 YEARS: 1 or 2-yr. M.A. + 2 yr internship Psychotherapy of couples and families, or of individuals if focused upon relationship issues   Licensed in several states (CA, HI...); average $75


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