Are Counseling and Therapy the Same: A Guide to the Helping Professions
By Aletheia Team | Nov. 20
Mental health professionals refer to themselves in various different ways, and it can be confusing to keep track of who does what. This is complicated by the fact that there are multiple disciplines, licenses, and training that lead to similar or even identical practices. What is the difference between counseling and therapy? Do psychologists and psychiatrists do the same thing? What is a professional counselor? Can a marriage and family therapist treat individuals? It can be helpful to have a guide to navigate the complexities of mental health treatment and the providers’ credentials.
Are Counseling and Therapy the Same Thing?
First, there is not a generally accepted definition of these terms, and they are often used interchangeably. Any definitions provided here should be held with a grain of salt, with the understanding that other professionals may use the terms differently. It may be helpful to discuss how your specific therapist (or counselor) uses or understands these terms.
Counseling, as a discipline, officially began as a part of the guidance movement in the United States in the early 1900s. Frank Parsons, who is considered the father of the guidance movement, developed the first career counseling center in Boston in 1909. The focus of this work was primarily vocational; they sought to help individuals find careers in the midst of social change that impacted employment. These changes included industrialization, urbanization, compulsory education, and early women’s movement.
The counseling field was heavily impacted in the middle of the 20th century by the works of psychologist Carl Rogers. He saw both traditional psychoanalysis and American behaviorism as reductionist and overly pathologizing. He sought to treat the whole human person, emphasizing empathy, congruence, and unconditional positive regard. While he was trained as a psychologist (more on this training below), his theories had a profound impact on the field of counseling.
During the second half of the 20th century, the field of counseling became increasingly professionalized, with licenses, accredited graduate training programs, and professional organizations. The current field of counseling is quite a large umbrella, and includes mental health counseling, rehabilitation counseling, school counseling, and career counseling.
Therapy, or psychotherapy, grew out of the practice of Freudian psychoanalysis. Initially, psychotherapy was the clinical application of the theory of psychoanalysis. As the field grew and evolved, the theories of therapy multiplied. By the end of the 20th century, therapists may practice humanistic, existential, behavioral, cognitive, or transpersonal therapy, as well as psychoanalytic or psychodynamic.
Regardless of the diversity of theories, therapy is generally oriented toward healing, wholeness, and well-being. Various therapies have different theories about how pathology develops, is addressed, and how change takes place, but they generally are all attempting to address some conceptualization of pathology, dysfunction, or struggle.
So, while these are generally used interchangeably, there are subtle differences in the development of each practice. One way we might conceptualize these differences is that counseling is a specific training with a specific history that qualifies individuals to engage in a number of different helping professions - school counseling, guidance counseling, chemical dependency counseling, and career counseling. One of these helping professions is the practice of psychotherapy.
So Who Can Do Therapy?
There are a number of licensure tracts that can qualify a professional to do counseling and therapy. And there are different historical developments, theoretical assumptions, and educational requirements for each.
Masters Level Clinicians
In the state of Texas, there are three professional licenses that are awarded to masters level clinicians to do therapy: Licensed Clinical Social Worker, Licensed Marriage and Family Therapist, and Licensed Professional Counselor.
The Licensed Clinical Social Worker requires a master's degree, as well as 3,000 hours of clinical supervision (prior to completing the supervision hours, the professional is awarded a Licensed Master Social Worker). Social work training focuses on community resourcing and case management, as well as clinical work. Social workers may work in hospitals, prisons, CPS and APS, schools, and other community agencies. The field is a large umbrella, and many social workers do not choose to pursue the clinical licensure to do therapy. Those that do are licensed to do therapy with individuals, couples, families and in groups.
Licensed Marriage and Family Therapists are trained in the treatment of family and relational struggles. The history of marriage and family therapy is rooted in psychologists and psychiatrists who began to conceptualize the struggles of their individual patients as stemming from family dynamics. Rather than attempting to treat their patients intrapsychically (within the patient’s mind), they looked to address the issues interpersonally. Marriage and family therapists are fully trained and equipped to work with individual patients, and may prefer to do so. But their training is in thinking about their patient’s struggles systemically, rather than individually.
Marriage and Family therapists initially receive their LMFT Associate license after completing their graduate work. They are then required to complete 3,000 hours under the supervision of an LMFT Supervisor (1,500 of which must be direct face-to-face hours, 750 of those must be with couples or families).
Licensed Professional Counselors are generalist practitioners. They receive training in diverse theories and practices. While the history of their field is in the guidance movement (as described above), and they are trained in those areas, the focus on the training is largely clinical and therapy oriented. LPCs first receive their LPC Associate license, and are required to obtain 3,000 hours of supervised clinical work (half of which must be direct face-to-face hours), and then receive their LPC license.
All three degrees equip the professional to do individual, marriage, family, and group therapies. While they all come from different traditions, the work that they do can be similar. Many professionals will receive advanced training in a specific type of therapy, population, or diagnosis.
Doctoral Level Clinicians
The two primary doctoral level clinicians are psychologists and psychiatrists.
Psychologists have completed a doctoral degree, as well as extensive supervision. A licensed psychologist has completed either a PhD or a PsyD program. A PhD in psychology includes research as well as clinical work, including a dissertation of original research that contributes to the field. Many academic programs require a PhD to be professor at a university.
A PsyD program is more focused on advanced clinical training, and is less concerned with doing original research or teaching (though they may teach as adjunct faculty). Most programs include multiple practicum experiences (psych hospitals, addiction, private practice, educational), and heavily emphasizes supervision throughout the program.
In addition to psychotherapy and research, psychologists specialize in administering personality tests and psychological assessments, many of which are not available to masters level clinicians.
Psychiatrists are MDs who have graduated from medical school and completed a psychiatric residency. Because of their medical training, psychiatrists are the only mental health professionals who can prescribe medications. Many psychiatrists choose to focus primarily on medication management and will refer out to other mental health professionals for therapy. Others combine therapy with medication management.
Historically, many (if not most) of the theorists who have impacted the field of psychotherapy have been psychiatrists. Until the 1980s, psychiatrists were the only professionals eligible for psychoanalytic training and certification.
Each of the three masters level clinicians listed above may pursue a doctoral degree in their chosen field. Generally, doctoral degrees in social work, marriage and family therapy, or professional counseling serve to allow the clinician to teach in universities as full-time faculty. They may focus on advanced training and research methods. These doctoral degrees do not, however, change the license of the clinician. While they have advanced education and training, they continue to practice therapy with their masters level license.
Other Mental Health Professionals
There are a number of other mental health professionals that are in the field.
Licensed Chemical Dependency Counselors have an undergraduate degree in human behavior and have undergone extensive supervision (4,000 hours) of counseling chemical dependency patients. They often work in residential treatment facilities for addiction, or outpatient addiction treatment centers.
Psychiatric Nurse Practitioners are masters level nurses who work under the supervision of a psychiatrist. Their training is in nursing, with advanced focus in psychiatric care. They are able to prescribe medications under the supervision of an MD.
Licensed Psychology Associates are masters level clinicians who operate under the supervision of a licensed psychologist. This allows them to practice therapy, as well as administer psychological tests and assessments that other masters level clinicians are not qualified for, without having to do doctoral level training.
Psychoanalysts typically hold one of the licenses listed above, and have undergone additional training in psychoanalysis. Their focus is on long-term, depth treatment that traditionally includes multiple sessions a week for several years, though many analysts have become more flexible on their treatment protocols.
Pastoral counselors and biblical counselors are religiously trained professionals that may or may not have a license to practice. Pastoral counselors often operate in churches and other religious organizations. It is important for many people to receive religiously informed care, but it is also important to keep in mind that, if a counselor is not licensed to practice, then they are not accountable to a governing body.
Life coaches occupy a similar space. Life coaches are unlicensed professionals who help to structure the lives of their clients in a more productive, efficient, or meaningful way. They may specialize in particular people groups, or generalize in organization and efficiency. Life coaches can provide helpful services, but are not therapists. Nor are they licensed, and therefore are not accountable to a board of examiners.
What is the Best Professional for Me
It is clear that there are a number of professionals who can provide therapy, so how does one determine which might be the best option?
While training certainly makes a difference, it is only one aspect of the therapist’s work. Experience, post-graduate training, personality, and personal therapeutic style, all play a role in the therapy experience.
It is important that patients feel comfortable and compatible with their therapist. In order to find the right fit, it can be helpful to ask questions, explore options, and “interview” different therapists as you search to find the right one. No therapist is going to be the right fit for everybody, and you have the right to find the right therapist for you.
