Laurel Mallonee LCSW

The mental health system is overwhelming and confusing in a LOT of ways. It can be really hard to understand what kinds of professionals do what, and who you should go to for what kinds of help. Hopefully in this post I can provide a little clarity on this subject.

Without further ado…

Therapy

“Therapist” is an umbrella term for someone who is licensed to do clinical therapy. There are many different kinds of therapists – clinical psychologists, clinical social workers, licensed mental health counselors, marriage and family counselors, and this can also include psychiatrists if they choose to do therapy.

Here are a few credentials that will mean the person can perform therapy. The name of the licenses (letters at the end of the name) will be a little different in every state, but generally having these credentials will be a licensed therapist:

• LCSW/CSW or LMSW (Licensed clinical social worker or Licensed Master Social Worker)

• CMHC or LPC (Licensed clinical mental health counselor or Licensed Professional Counselor)

• Ph.D./Psy.D. (Doctorate of psychology)

• LMFT (Licensed Marriage and Family Therapist, can often also do individual therapy

This is certainly not a comprehensive list. The main difference between types of therapists is the lense through which they were trained to look at human psyche and behavior – social workers tend to put more emphasis on people in their environment and social issues, psychologists learn more about the brain, etc., but all are perfectly qualified to treat a wide range of issues.

Ideally your medication provider and therapist would be talking to each other, but often you will have to be the one to see if they have been communicating.

Medication Management

• Psychiatrist: A medical doctor (MD or DO) with a specialty in psychiatry. Their main job is medication. Sometimes they will do talk therapy, but many of them have moved away from doing therapy.

• Psychiatric/Mental Health Nurse Practitioner: These guys have basically the same capacity as a psychiatrist, but instead of going to medical school they went to nurse practitioner school.

Depending on the issues you’re struggling with, and how severe your symptoms are, these guys will probably want to see you every 3-6 months. There is a major shortage of psychiatrists and psych NPs right now, so in a lot of areas they can be booked out 6 weeks or so! I suggest that if you feel you would like to get on medications, make an appointment now with a psychiatrist/nurse practitioner, then also make an appointment with a primary care or family doctor and see if you can at least get started on something while you’re waiting for your appointment.

Non-clinical support

This includes people such as case managers, crisis or warm lines, peer specialists, support groups, life coaches, online coaching programs, advocates, etc. These people haven’t been trained or licensed to do therapy, but can still be really supportive and helpful and have therapeutic skills. They are often trained in active listening, teaching, validation, skill-building, connecting to resources. This type of support can be a really good supplement to seeing a therapist, and if done right can keep a person very stable.

It’s out of their scope of practice to diagnose. Any time anyone (including a doctor or therapist) gives you a diagnosis I would urge you to do your own research, but if someone who isn’t licensed is telling you that you have a certain diagnosis, I would use caution.

If someone hasn’t had training or supervised practice in therapy, and they are trying to help you in a way that a therapist should be, I believe the likelihood of causing a client more emotional damage goes up. Of course a licensed professional may handle things poorly and cause harm, but in general I would say it is less likely. Licensed therapists are subject to state laws and ethical codes and can be disciplined for malpractice, whereas someone like a life coach isn’t held accountable the same way. Someone with a license has been through several years of supervised practice (or are under current supervision), whereas without a license they are often working unsupervised. Some non-clinical professionals are very knowledgeable and good, so I definitely recommend help on this level if you are interested! Just use discretion in who you choose to talk about your traumas and your really deep, heavy feelings. I don’t want anyone getting re-traumatized or believing bad advice if we can avoid it.

50 Signs of Good Therapy Helpful article that goes over what makes for good treatment. There is also a companion article about warning signs of poor treatment.

If you’re interested in how insurance works with therapy, I have an article written here.