So you’re thinking about getting some counseling, or doing talk therapy, or what some call psychotherapy. In seeking services you will run across an alphabet soup of different letters behind the names of professionals who all perform very similar functions. What is the big difference?

Psychotherapy, or “the talking cure” is historically thought to be the domain of Psychiatrists, who are MD’s or DO’s who have done extensive training and residency in psychiatry. In current practice, most psychiatrists do a lot of prescribing of medication, and spend far less time doing therapy or counseling. They are the only mental health professionals who are authorized to prescribe medication (though physicians and other medical doctors can prescribe psychoactive medication as well). There are some psychiatrists who still do therapy in combination with prescribing medication. This combination approach to coping with mental health issues has been determined (in numerous studies) to be the most effective form of treatment. It is rare and often expensive to get both kinds of treatment from the same person.

For talk therapy, most people find themselves seeking the services of a Licensed Professional Counselor (LPC), a Licensed Master or Clincial Social Worker (LMSW or LCSW), or a Licensed Marriage and Family Therapist (LMFT). These professionals do the same thing but come from slightly different training backgrounds and perspectives. Note the similarity in the legal descriptions of these professions in Texas:

The practice of Professional Counseling includes: the application of mental health, psychotherapeutic, and human development principles to: facilitate human development and adjustment throughout life; prevent, assess, evaluate, and treat mental, emotional, or behavioral disorders and associated distresses that interfere with mental health; conduct assessments and evaluations to establish treatment goals and objectives; and plan, implement, and evaluate treatment plans using counseling treatment interventions that include: counseling; assessment; consulting; and referral.

The practice of Marriage and Family Therapy involves providing therapy services to individuals, families, or couples, alone or in groups by applying family systems theories and techniques. Practitioners evaluate and remediate cognitive, affective, behavioral, or relational dysfunction in the context of marriage or family systems.

The practice of Social Work requires applying social work theory, knowledge, methods, ethics, and the professional use of self to restore or enhance social, psychosocial, or bio-psychosocial functioning of individuals, couples, families, groups, and/or persons who are adversely affected by social or psychosocial stress or health impairment. The practice of Clinical Social Work requires applying specialized clinical knowledge and advanced clinical skills in assessment, diagnosis, and treatment of mental, emotional, and behavioral disorders, conditions and addictions, including severe mental illness and serious emotional disturbances in adults, adolescents, and children. Clinical treatment methods may include but are not limited to providing individual, marital, couple, family, and group therapy, mediation, counseling, supportive counseling, direct practice, and psychotherapy. Clinical social workers are qualified and authorized to use the Diagnostic and Statistical Manual of Mental Disorders (DSM), the International Classification of Diseases (ICD), Current Procedural Terminology (CPT) Codes, and other diagnostic classification systems in assessment, diagnosis, treatment and other practice activities.

BTW, LPC’s are authorized to use the DSM and ICD too, as are Psychologists. Wait, then what else do Psychologists (PhD or PsyD) do? Well, they too do the work of the other counseling professionals, and again come from a slightly different training perspective. In addition to psychotherapy, psychologists do lots of evaluation and administration of tests. They do not prescribe medication.

Ultimately, you probably want to know which is the best? All of them. The best mental health provider for you, when it comes to psychotherapy, is the one with whom you feel most comfortable and confident, despite the letters behind the name. Study after study has demonstrated that the relationship between the client and professional is the strongest predictor of good therapy outcomes.