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Be An Informed Consumer of Therapeutic Services: Know What Those Titles Mean

—Julie Ambrose, CSW

As a consumer of mental health services you should be well informed about the qualifications and specialty of a "therapist" prior to entering into an agreement for care. The purpose of this article is to help clarify the different therapeutic professions and clarify professional credentials. Due to the variety of degree programs and professions, this is not necessarily a comprehensive list. However it is intended to provide the reader with an overall understanding of education and training.

In the broadest definition therapists or counselors provide direct care to their clients. These are the people who talk to about your "problems". Anyone can "hang out a shingle" and identify himself or herself as a therapist. People providing counseling services should have degrees in social work, counseling and education, family and marriage, or be licensed psychologists. It is important to know what training and education the person and the initials most easily identify this after the name.

Clinical Social Workers: To receive a Masters of Social Work (MSW) a person must complete a graduate program in Social Work. If the social worker has graduated from an accredited social work program then she/he can apply for state licensing. Obtaining a license involves completing a standardized test and then applying to the state. As part of this process, the state completes a background investigation to determine if there have been any complaints or actions taken against the social worker for malpractice. You will know that a social worker is certified by the state by the initials CSW or CSW-R (Certified Social Worker). A social worker can apply to the state for an "R number" after six years of clinical supervision. The R indicates that the social worker is eligible for insurance reimbursements.

Additional credentials can be obtained based on years of clinical practice and additional testing. An ACSW indicates a social worker that is an active member of the National Association of Social Work (NASW), has had two years of postgraduate clinical experience and supervision, and has passed the state test. There are additional certifications that social workers can apply for based on years of experience. For more information of social work practice, code of ethics and licensing go to the NASW site at www.naswdc.org

Master's in Counseling: There are a variety of programs that offer a Masters in Counseling. The credentials MS.Ed or MA indicate that the professional has completed a master's program, usually with a specialty in school counseling, marriage and family or mental health. An extensive internship, supervised by a qualified professional is an integral part of this degree program. Professionals holding this degree work in community mental health centers, schools, and private practice. New York State does not yet license this degree but there is pending legislation that would provide for state licensing. Additional information can be obtained at www.counseling.org.

Art Therapist: An art therapist can also hold a counseling degree in addition to their art therapy degree. The American Art Therapy Association (AATA) provides the credentials ATR-Art Therapist, Registered for art therapist who have successfully obtained a masters degree in Art Therapy and have completed a supervised internship. Many therapists use art therapy techniques within their therapeutic practices. The use of drawing and painting does not mean that a therapist is a qualified art therapist. If you are seeking a qualified, trained art therapist ask about credentialing and training before entering into a agreement for services. For additional information on art therapy contact the Art Therapy Association at www.arttherapy.org

Psychologist: Clinical psychologists hold a doctoral degree (PhD) or (PsyD) in psychology and are trained to administer and interpret psychological testing. Psychologists are licensed in the state for which they practice. A clinical psychologist can also provide individual and family therapy. Despite the use of the title "doctor", a psychologist cannot prescribe medications.

School psychologists hold a masters degree in school psychology and are trained to administer and interpret education testing. Despite the title "psychologist" they do not necessarily have a doctoral degree. Additionally, they can assist with curriculum design and teacher training. School districts are mandated to provide educational testing for any student in their district. As a consumer, you should not be paying for outside educational testing unless your district has completed testing and either they, or your mental health professional are recommending additional testing. Testing helps to identify academic strengths and weakness and provides recommendations for teachers, support personnel and other professionals working with the student.

A summary of the various types of psychologists can be found at academic.smcvt.edu/psy.

Psychiatrist: A psychiatrist is a licensed medical doctor with specialized training in psychology. This is the person you would see for diagnostic clarification and medications. Most psychiatrists do not provide individual therapy themselves. They strongly suggest or mandate that "talk therapy" with a qualified therapist be part of the treatment plan. A child psychiatrist has additional training child development and family dynamics.

Why Do I Need To Know All This?

Licensing: If a therapist holds a license in the state they are practicing then they have accountability to you and to the state. This means that you, as the consumer, have an avenue of recourse. A license can be suspended or revoked if a valid case of malpractice can be proved. Additionally, you can check to see if a therapist or psychologist has ever been charged with malpractice or unethical practice. One avenue for investigation is op.nysed.

Proper Care: Malpractice is a serous accusation made against a professional and could result in suspension of licensing and/or revoking of licensing. Therefore, as word of caution, when you enter into a therapeutic agreement you must take responsibility for your progress. A therapist is expected to provide ethical and culturally sensitive care. If the recommendations made by the therapist are sound and reasonable and you do not accept or follow through on these recommendations then the therapist cannot be held accountable for a lack of progress. If you disagree with the method, approach, and recommendations or simply have a personality conflict with the therapist your best course of action is to find a new therapist. You should discuss these concerns with the therapist prior to making the decision to change therapists. However, if you think the care you are receiving or have received is unethical or immoral then you are obligated to follow through with reporting this individual.

As with any service you receive you want to make sure that you are getting what you are paying for. If you want individual talk therapy then you want to make an appointment with a therapist or clinical psychologist. If you want to be evaluated for medications to manage symptoms you will want to make sure that you are meeting with a medical psychiatrist. People frequently refer to counselors or therapists as "doctors". This is misleading and it is important that the professional with whom you are working with is clear on what their qualifications are. As a consumer, you should feel free to ask questions about their education and training, experience and credentials. If a therapist is uncomfortable or questions why you are asking these questions you may want to ask yourself "why?">

In Conclusion

There are many types of professionals and nonprofessionals you are practicing mental health therapy. This list is by no means inclusive of all degrees and all professions. For example, chemical dependency treatment has its own set of credentials and qualifications separate from the mental health field. Because the term "therapist" or "counselor" has become a genetic word for a person providing "talk therapy" it is important for you, the consumer, to be educated about who's who in this field. The old proverb about an ounce of prevention is true in this field as well. Do not wait until you have begun to establish a relationship before you discover out that the person you have hired cannot provide the services you need.