Navigating Therapist Credentials: What to Consider when Choosing a Therapist

At TherapyCloud, we seek to lead the charge in creating a community that allows access to quality and trusted therapists. But, when looking for a therapist, you may be asking “Do I need to see a psychologist?”, “What does a Limited Licensed Marriage and Family Therapist mean?”, or “What’s the difference between ‘LCSW’ and ‘LMSW’?”

The alphabet soup of credentials are confusing and overwhelming to even therapists. What’s more, they are constantly changing and vary not only by state but by region! Because of this, we want to fulfill our mission to educate others in order to create an educated consumer.

It may go without saying. But, all therapists are not the same. Frankly, some of those differences don’t matter. But, some really do. So, we will play our role in educating as many people as possible. To not do so would, we believe, be a disservice to you as the consumer. 

Even the Health Resources and Services Administration describes the lack of uniformity in credentialing vocabulary (e.g. what is in some states called a “Licensed Professional Counselor” is called “Mental Health Counselor” in others), scope of practice, and interstate legislation to be an inherent challenge to the field of behavioral health care. 

If even the federal government can’t keep on top of it, we certainly can’t expect you to! So, here are nine key differences to consider when choosing a therapist that is best for you:

1. Licensure process - Some professional behavioral health providers do not even have a formal license. For example, one can have a certification as an “Addiction counselor,” “ABA Therapist” (”Applied Behavior Analysis is a common form of treatment for those on the Autism Spectrum), or a “school counselor”. This doesn’t necessarily mean those with a certification aren’t just as qualified as someone who has a formal license. They may actually be more qualified given that they have such a speciality, as opposed to a general “Marriage and Family Therapist.” This difference is simply a reflection of how the professional agency (e.g. the American Counseling Association) and the state have decided to offer a credential for a certain type of training (e.g. certification versus a formal license). Think about teachers. There may not be a formal teaching “license” for teaching high school. But, a certification is the standard and is typically required to be employed as a teacher. It is important to still note, though, that licensure does tend to be required for reimbursement for services through insurance or even to be able to legally provide therapy within a certain state. 
2. Educational requirements - Regardless of if it is a certification or license that a therapist has, it is their accrediting body that determines what the basic requirements are to be able to graduate from a program with a set of credentials. Social workers, Marriage and Family Therapists, Psychologists, Mental Health Counselors/Professional Counselors each have a certain number of credits they must complete within their programs. They also have different numbers and lengths of in-the-field experience that are required. Another complication is that such educational requirements may be called different things (e.g. “internship” versus “practicum”) depending on the credential.
3. Specialties within a credential - Certain credentials, like “social worker”, can also mean very different things. There are “macro” social workers, who are focused on public policy and advocacy, and there are “micro” social workers, who provide direct services. There are also medical social workers. Case managers also tend to have a social work degree. So, the general categories of education are only a preliminary consideration.
4. Educational institution influences - Where a therapist received their education is important, too. Some educational institutions tout themselves as focused on diversity. Others focus on research. Others focus on urban communities. Each therapist will be molded in their practice by the philosophy of their certain educational training. 
5. Educational philosophy - While exploring the differences between the various credentials in actual practice is a whole topic in itself (if you missed it, find it here), it is important to note that this is one of the most important things to consider when you are seeking a therapist. Let’s look at some examples.
   
   Because psychologists view symptoms through the medical model of disease, they tend to frequently use formal psychological assessments. School counselors, however, are going to be different in the sense that they focus on practicalities of how to help a student achieve more academic success or stay engaged. And, Marriage and Family Therapists are always going to be looking more at the broader picture of the system, as opposed to the individual. Even if you decide you align most with the approach of American Psychological Association‘s view of symptoms as a sign of chemical dysfunction in the brain, to further complicate things, there are also fully licensed psychologists who could provide therapy but who literally have no training in providing therapy as they are inherently researchers only.

6. Theoretical frameworks - Aside from what general philosophy of treatment a credential offers and what educational institution a therapist attended, there are dozens of different theories from which therapists can work. A therapist may strictly adhere to only one theory so much so that they reject any other approach to symptoms or improvement. For example, you can see a therapist who is very specifically a “Behaviorist.” This therapist would be directive in session and only look at actions and cause and effect. Emotions may be viewed as irrelevant. Another therapist may use Narrative Theory to help people creatively explore the emotions of their story, coming from the perspective that, as the therapist, they are not the expert and that they do not know any more than the client. A therapist may also be in the middle and use a blend of approaches, like Attachment Theory, Cognitive Behavioral Therapy (CBT), or Feminist Theory.
7. Licensure requirements - Within some states, a psychologist who is only trained to do research (and not therapy) or a social worker who graduated with their “macro” degree (and doesn’t have training to provide any therapy directly to clients) may have the same credentials or license as those who are trained to provide therapy. In addition, while most licensure requirements include passing a formal licensure examination, what licensure examination is available or required can vary even within a certain credential. Some who have completed their master’s degree in a behavioral health field may also not elect to take a licensing exam, which affects their path to licensure. In some cases (e.g. the “Social Work Licensure Modernization Act”), passing a formal licensing exam may no longer be required in order to attempt to meet the exponentially growing need for mental health services, particularly after the COVID-19 pandemic. Additionally, a professional may not even need a formal license to legally provide therapy, as is the case in Virginia, where all you need is a master’s degree in social work. States may even change the names of certain credentials, as is illustrated by the push to change the name of “Marriage and Family Therapist” to something more inclusive that does not include formal legal marriage. Formerly billable credentials (e.g. Bachelor of Social Work) may no longer even be able to be renewed as the license no longer exists within certain states. 
8. Post-degree supervision - Even after a formal educational master’s degree has been completed and licensure (whether limited or full) has been awarded, each credential has their own set of supervision requirements. “Supervision” is earned via thousands of documented hours (with the exact number, again, depending on the credential and accompanying professional organization) in consultation with a fully-licensed provider.
9. Continuing education - Each state board (which is the entity that awards formal licensure) is in charge of requirements for continuing education even after the process of education, supervision, and licensure is completed by a therapist. While it is not uncommon for certain state boards to require basic ethics training every so many years per state legislative requirements, there are some credentials in some states that do not even require any continuing education at all, no matter how many years ago it was that the therapist was first trained! If you are curious about regulations for therapists in your state, here is a helpful resource breaking down the Continuing Education (CEs) or “Continuing Education Units (CEUs) requirements for therapists. Also keep in mind that, while a certification in a certain topic may not be required to earn or maintain licensure, some therapists have additional certifications (e.g. Certified Sex Therapist) they have achieved voluntarily that illustrate their specialties and areas of interest. 

Given all of the above information, you are probably starting to understand just how complicated therapist’s credentials are. This is accurate information as of the date of this post. However, things are constantly changing given legislation, state policies, and the various professional association’s proposals to make their field even better. It is the presence of these variations and nuances that makes it so important for you to do your research when looking for a therapist. 

As you work to navigate therapist’s credentials when you are choosing a therapist, whether using our therapist search feature or another resource, navigating credentials may partially be about busting myths. For example, social workers not only are not just Child Protective Service (CPS) workers or case managers. They make up 70% of the behavioral health workforce nationwide. Marriage and Family Therapists, as another example, may be the majority of those providing therapy in some states whereas, in other states, there may only be a handful of Marriage and Family Therapists licensed in total. And, there are no credentials that are inherently more prestigious than others. Even those who have gone beyond the standard requirement for therapists to have a masters degree and have earned a doctoral degree may have done so related to research and not necessarily in clinical practice.

The reality is that the difference between certain credentials outweigh the commonalities. So, consumers need to do their due diligence and ask questions. Do your own research to feel confident and comfortable in the therapist with whom you are working. If you want to get a better idea of the therapist someone is before officially working with them, you can also visit our Therapy Marketplace to find content they have available before you make any commitment. 

At TherapyCloud, we also believe that therapists should be constantly growing, learning, and getting better, just as is taught to clients in therapy. So, consider what specialties or areas of interest a therapist has or ask about their recent continuing education (which is not required to be publicly posted, as is the case with formal licensure). This is why we offer ratings at TherapyCloud - so you have the ability to view and provide objective feedback about the experienced values of the therapist. 

At the end of the day, however, research shows what matters for the outcome of therapy is NOT the credentials, their level of experience, theoretical framework, or any other factor. It’s the relationship with the therapist with whom you connect that creates change. So, ask questions and do your due diligence. But, find a good fit for you as you are the most important consideration.