Last week I had a conversation with the parent of a child receiving both therapy and counseling services within the same agency. One of the first questions I was asked was “why is my daughter receiving counseling and therapy, aren’t they the same things?” I began to explain the differences and the purpose for why there is typically a hierarchy of professionals within a mental health agency. Do you find yourself confused by the labels of people within the mental health field? Well, in this article I explain the differences between an unlicensed counselor and a licensed therapist and what to look out for.
Have you ever heard of the National Board for Certified Counselors (NBCC)? This is the most important location for mental health professionals to gain credibility in their field, develop further knowledge beyond graduate school and years of post-college education, and obtain further credentials to highlight achievements, protect the public from misuse of power or exploitation, and develop one’s own private business in psychology. The NBCC provides mental health professionals with the opportunity to remain well-rounded in the field of psychology and to develop skills necessary for providing important services. The NBCC also allows mental health professionals to become licensed (e.g., getting an LPC -Licensed Professional Counselor credential) in multiple states in order to receive insurance reimbursement for sessions.
It’s important to know that the terms “therapist” and “counselor” are often used interchangeably, but are also often used to highlight level of education obtained. For example, a credentialed psychotherapist may be someone who has extensive training, has passed the tests administered by the NBCC, and is able to accept insurance. However, a counselor may be someone who is uncredentialed, has a bachelors degree, and some experience regularly meeting with people such as in pastoral counseling. It’s also important to note that some counselors are trained by their employer. For example, many Red Cross “counselors” are trained in crisis intervention, while many drug and alcohol counselors are certified in addictions.
Psychotherapists, on the other hand, aren’t always licensed or credentialed by a professional organization or Board such as the NBCC. Some psychotherapists are individuals who have gotten their “degree” from the “school of life” or individuals who have backgrounds in physical therapy, meditation, yoga, or life coaching. Licensed Professional Counselors, Mental Health Therapists (typically Masters degree level), Psychiatrists, or Psychologists all typically have advanced degrees, certifications, or a license to provide services.
The best thing to do is ask the counselor or psychotherapist about their level of training and educational experience. This really is the only way you will be able to gauge just how experienced or inexperienced your treatment provider is. The other thing to consider is that certain states, agencies, and regions use different terminology and the terminology may or may not tell you about the level of experience of your healthcare provider.
Despite terminology, it is important to be aware of your healthcare provider’s level of knowledge, education, and experience. There are some cases in which a license, credential, educational experience, or work experience may not produce the competent professional you would think. In cases like this, I encourage you to look at character as your barometer for how likely the individual is to provide you with good services. There are a few things to look out for such as:
- Compassion: Just because a person is licensed, certified, or has extensive education does not mean that they will provide you with the best care. Some individuals have knowledge from sitting in classrooms all their life, but truly lack the etiquette, concern, and bedside manner that truly makes a healthcare provider special.
- Knowledge beyond the books: Many of my colleagues have extensive book knowledge and have been in school for years. Some are even attending seminars, workshops, and trainings all over the world. While this is a wonderful endeavor to pursue as a mental health professional who must stay informed about mental health, it doesn’t assure me that you have any more knowledge than the next person has. Of course, the person may be well informed about almost anything you discuss, but does this truly imply that a healthcare provider will provide the best care for you? No! It’s wonderful when you have a very informed professional working with you, but be sure they can truly help you with what they know!
- Moral values: It’s really saddening to think that a well-educated person would violate any of another person’s values, but it does happen. Just because a so-called professional has a degree, certification, or license does not mean that this person will uphold what is right. Be sure you understand the person’s value system.
- Competence or skill: Again, competence/skill are things that just don’t come from books alone. Life experience, a heart for others, compassion, intuition, and education all come together to create a wonderful whole. Don’t get sucked into a lie just because your provider is educated.
- Intuition: No matter how important the world believes science is or can be, intuition is always just as if not more important. A professional who looks only for facts or only for concrete proof, is overlooking important pieces of the puzzle. Sometimes we simply, in the human experience, must use our intuition to guide us. You want someone like this working with you.
There are simply too many issues that an inexperienced counselor or therapist cannot adequately provider care for, no matter how nice they may be. There are 5 important things I believe a license, certification, or advance degree can offer you that a non-licensed, certified, or experienced individual cannot give:
- The right to sue or file a grievance: A grievance is documentation that something wrong has happened in your treatment. It is a document that is filed against an agency or individual provider who you believe has treated you wrongly. For example, if you feel you have been sexually assaulted, racially profiled against, or treated completely unfairly, you would file a grievance that must be reviewed by that agency. The grievance gets sent up a chain of “important” people until something is done to rectify the situation. This is highly unlikely if you pursue services with a counselor or life coach or someone who doesn’t hold certification, licensure, or an advanced degree.
- The right to confidentiality: Confidentiality is your legal and moral right to privacy. Anything you say to a healthcare provider will be protected unless you report that you want to take your life, someone else’s life, or are being abused in some way. There are other exceptions as well. But for the most part, everything remains private. A counselor or someone who has not been trained extensively or licensed and credentialed may not have to abide by any rules to protect your private information (credit card numbers, banking information, checks, mental health information, information shared during conversations, etc).
- HIPAA protection: HIPAA – Health Insurance Portability and Accountability Act of 1996 in the US was designed to protect all types of information from individuals seeking healthcare services. Your faxed or emailed documents are to be protected as well as what you verbally tell a healthcare provider. But someone who is not licensed or certified or does not work for an agency that is, does not have to keep anything private!
- “Privilege” : A lot of clients have what is called “privileged communication” when they seek help from a therapist. This means that you, as a client, have a right to keep certain information protected from being seen in court if your therapist would ever be subpoenaed. Privileged information could be your journal writing, pictures, or drawings. With someone who isn’t monitored by an agency like the NBCC, you may not have this privilege.
- Ethics Code adherence: Again, all mental health professionals practicing therapy with an advanced degree within an agency, a certification, or license must abide by ethics codes put into place by a Board of psychology such as the NBCC or American Psychological Association or American Counseling Association. Someone who does not have to be apart of these agencies does not have to abide by any ethics codes. Ethics codes ensure that professionals protect privacy, does not sexually or emotionally exploit clients, and other important things.
As you can see, it can be very difficult to identify who you are receiving care from. Certain settings are more likely to have counselors or life coaches as opposed to therapists. For example, community mental health centers typically employ individuals as counselors who have only 4yrs of college experience. Psychiatric hospitals, research universities, school-based mental health programs, or partial hospital programs (where individuals spend part of their day in therapy and the other part of their day at home) are more likely to hire and employ individuals with education beyond 4yrs of college. The best way to ensure that you are receiving the best care is to ask questions about education and experience and consider what you ultimately want from your healthcare provider. Do you want confidentiality, do you want privacy, do you want the right to sue if something goes wrong? Or are you looking for someone very relaxed who can give you life perspective without the stress of paperwork, HIPPA protections, confidentiality protections, and other similar rights?
Consider carefully what you are looking for, research the individual you are scheduling to see, and ask around about the person who is willing to give you counseling or therapy.
I wish you well