Help! Do I need a therapist or a counselor? What is the difference between mental healthcare roles?

That moment when you've worked up the courage to get some help from a counselor or therapist... only to realize, you don't know what you are looking for!

Today's blog is for anyone who has thought "Psychologists? Counselors? Therapists? Social Workers? Psychiatrists? What makes them different? What makes them the same? What do they do?" We will answer these questions and then spend some time on how to know whether your counselor/therapist is a good fit for you.

The main thing to remember is that although each of these was trained to view mental health or life issues from a unique perspective, in practice, there is a LOT of crossover in mental healthcare roles.

What are the roles of mental healthcare professionals?

Psychotherapists, Therapists, and Counselors

These terms are used interchangeably to describe licensed professionals who talk with an individual to help them solve issues and work on goals in their life. Those who provide psychotherapy are trained extensively to help clients examine their lives holistically (their relationships, their concept of self, their emotional and thinking patterns, their past, etc.). They are also qualified to work with trauma and mental illness and can accept insurance or Medicare if they choose to. The terms terms therapist and counselor are usually used interchangeably outside universities and licensing boards, and they refer to someone who has at least a master's degree and a license in counseling, social work, marriage and family therapy, psychology, or psychiatry.

There is a large assortment of psychotherapy models. Some that you may have heard of include psychoanalysis, CBT, or EMDR. The model that an individual practitioner uses depends on their training, the model's effectiveness for a client's issue, and the practitioner's personal preference.

Case Management

This term refers to coordination of care. For example, a case manager may help individuals or families to access resources for counseling, healthcare, and other community resources in order to help them through a crisis or difficult circumstances. Although any of these professions can take on the role of case manager, social workers are specially trained to provide case management services.

Psychopharmacological Medication prescription

This term describes medications that are used to balance brain chemistry. They are used for conditions such as depression, anxiety, bipolar disorder, and several other diagnoses. You may have heard of psychopharmacological medications such as Prozac, Zoloft, or Paxil. Psychopharmacological medications must be prescribed by a psychiatrist (a medical doctor who has special training in these types of medications) or another type of medical doctor.

Psychological Assessment and Diagnosis

Psychological assessments can be administered by any of these licensed professionals to determine whether a mental health diagnosis is needed. The results are often used for treatment planning, billing insurance, or for doctors and psychiatrists to prescribe psychological medication.

Family therapy

Family therapy is a type of psychotherapy where the client is two or more related individuals who are working on their relationship. The therapist is trained to remain impartial and help the family address their relational processes and patterns. Although any licensed counselor/therapist can do therapy with a family group, marriage and family therapists are specially trained to understand family (or individual) issues through a relational lens.

Marriage or Couple Counseling

This term refers to counseling or therapy for a couple where both members of the couple are committed to stay in and work on their relationship. Like family therapists, the therapist is trained to remain impartial and help the couple address their relational processes and patterns. Here again, any therapist can provide couples counseling, but a marriage and family therapist has been relationally trained for working with couples.

Sex Therapy

This type of therapy is for helping couples or individuals address issues with sex such as sex drive differences, pain during intercourse, or inability to reach orgasm. This is done through discussions about sexual health, education, background, emotional responses, and beliefs. Any counselor/therapist can and does work with their client on sexual issues. There are also counselors who have been specifically certified as sex therapists.

Discernment Couple Counseling

This is therapy for a couple where at least one member of the couple is unsure about whether they can continue in the relationship. In discernment counseling, the impartial therapist works with the couple as they decide whether their relationship has a future. If at some point during discernment counseling, the couple decides to commit to working on the relationship, the next sessions will become couple counseling sessions. If through discernment counseling, they decide that there is no future for their relationship, they have the option of pursuing individual counseling to help them work through their divorce.

Play Therapy, Art Therapy, and Music Therapy

Although any licensed mental healthcare professional may incorporate music, art and play into their therapy, the terms 'music therapy,' 'play therapy,' and 'art therapy' are used for distinct types of therapy that require specific training and certification. Play therapy sessions are conducted in a playroom that is intentionally organized for the therapist to observe and participate with a child in a way that addresses their emotional or behavioral issues. Art therapy is a therapeutic process where art making gives an outlet for expression, communication, exploration, and resolution of issues. Similarly, music therapy utilizes the power of music to process and resolve client issues.

Life Coaching

Although this post is about licensed mental healthcare professionals who have at least a master's degree in their field, I will briefly mention life coaching here. Life coaches work with their clients on specific goals giving them direction, feedback, and accountability. There are no educational requirements to become a life coach, but there are courses that life coaches may choose to take to improve their effectiveness.

Mental healthcare roles summary

finding a counselor or therapist that fits for you

Even though there is some trial and error required to find a therapist that is a great fit, there are some things you can do to improve your chances.

For one thing, you can ask friends and family members if they know of a good therapist. It can take some courage to admit to them that we need help, but therapy is more common than you might think. These days, people understand that everyone needs help, and those who go to therapy are the ones who have enough courage to work on themselves. Chances are that when people we respect and trust say that they like a therapist, then we will like that therapist as well. It may not make sense to go to the same therapist as a friend or family member, but their therapist can be a good referral source for other good therapists. Most therapists have a network of colleagues to whom they can refer someone who doesn't fit with them. There are also therapist databases where you can look up profiles of therapists to see whether their specialties and vibe fit for you. One of the most popular is Psychology Today, but there are others as well.

Once you have started therapy and are deciding whether your therapist is a good fit, here are some questions you can ask yourself.

Does this counselor get me?

Do they accept me non-judgmentally?

Do they understand my goals?

Do I agree with their plan for working on my goals?

Do they move at a pace that fits mine?

Am I seeing any positive changes (even small) in the way I view or approach life?

If the answers to these questions are "yes," then, great! If an answer is no, then there are a few things you can try before giving up on your therapist and starting the therapist search all over again.

First, remember that we all come to therapy with baggage that can blind us to the truth of whether the therapy is working for us. Sometimes, our baggage can make us feel like everyone is judging us, no matter what they say or do. In that case, no therapist will feel like a good fit because we would assume anything they say is judgmental. Sometimes we come to therapy with baggage that makes it hard to open up and make the changes that are necessary for growth. In that case, we usually find an outside reason (like money or scheduling) to say that therapy won't work out 'right now.' Sometimes, we come to therapy with baggage that makes us critical of everyone, so in that case, we try several therapists for a couple of sessions each and then give up because we couldn't find a good enough therapist. In each of these cases, it is easy to say, "I tried therapy, and it didn't work." So, if you are having doubts about whether your therapist is a good fit, you may be right. But first check in with yourself to see whether you brought any baggage that would blind you to the truth of whether it is working or not.

A crucial but difficult strategy when the counselor doesn't seem to fit, is to approach your counselor about the issue you have with them. For example, if you answered no to the question "Does the therapist accept me non-judgmentally?" it is vital that you tell the counselor you are having these feelings. Once you do that, then the way that the therapist responds to these feelings and the way the two of you work together to improve the relationship can help you know whether this is the right place for you.

At the end of the day, therapy is about change that helps us get unstuck. If we see a change in ourselves and our relationships, we know therapy is working for us. The pace of change is different for everyone. Sometimes change can be small and incremental, and sometimes it can come in bursts. So, be ready for the change, work for the change, and watch for the change. Therapy works if you do. There is hope and healing for you!