Everyone will tell you that a licensed psychologist has a PhD and a licensed counselor has a Master’s degree. Fair enough. But if you’re looking for therapy, what can psychologists do that counselors can’t, and vice versa? And should you expect a better outcome with a PhD psychologist than a counselor with a Master’s degree? In short, what’s the difference between a counselor and a psychologist? And what about exempt, alternative therapists who have taken trainings, but don’t have a license or an advanced degree?
Is Conventional Wisdom True?
How many of these statements do you believe?
- A counselor deals with simple problems; a psychologist deals with complex problems.
- The difference in coursework between a counselor (with a Master’s degree) and a psychologist (with a PhD) is that a psychologist spends those extra years focusing on advanced therapy skills.
- Psychologists can diagnose “mental disorders”; counselors can’t.
None of those statements are true. Here’s the real deal:
- Counselors and psychologists deal with the same problems.
- The difference in coursework is that psychologists are trained to do scientific research. Therapy training is about the same.
- Both counselors and psychologists can diagnose “mental disorders.”
So, yes, I’m claiming that psychologists and counselors are the same thing, unless you’re looking for someone to run rats through a maze. Now, is this just my opinion, or do I have something to back it up? Perhaps something authoritative, like the legal definitions of the two professions?
Practically the Same Definition for Both?
Here in Oregon, state law defines counseling as follows (bear with me):
675.705(7)(a) “Professional counseling” means the assessment, diagnosis or treatment of mental, emotional or behavioral disorders involving the application of mental health counseling or other psychotherapeutic principles and methods in the delivery of services to individuals, couples, children, families, groups or organizations.
While psychology is defined like this:
675.010(4) “Practice of psychology” means rendering or offering to render supervision, consultation, evaluation or therapy services to individuals, groups or organizations for the purpose of diagnosing or treating behavioral, emotional or mental disorders. “Practice of psychology” also includes delegating the administration and scoring of tests to technicians qualified by and under the direct supervision of a licensed psychologist.
Seriously? Legally, counselors and psychologists do the same things, except maybe for stuff about supervision and delegating testing?
But wait, there’s more! Here’s the definition of marriage and family therapy:
675.705(6)(a) “Marriage and family therapy” means the assessment, diagnosis or treatment of mental, emotional or behavioral disorders involving the application of family systems or other psychotherapeutic principles and methods in the delivery of services to individuals, couples, children, families, groups or organizations.
So we’ve got three different professions with whose legally defined areas of practice are practically identical. It that weird, or what?
But Why are They Defined Identically?
Because, when it comes right down to it, talk therapy is talk therapy. There’s no such thing as “counselor talk therapy” or “psychologist talk therapy.” If you look at the different techniques, theories, or “schools” of therapy, they’re studied and practiced by people with all kinds of licensing.
For example, if you were to drop in on a course in working with people with complex trauma disorders, you’ll find that counselors, psychologists, marriage and family therapist, and clinical social workers are all attending the same course. Why? Because they all work with the same kind of people and use the same kinds of techniques.
Psychologists, in particular, often like to give the impression that they work with more complex problems and are better trained than the rest, but that’s wishful thinking. Their additional years of training taught them how to be scientific researchers, not better therapists.
How do I know? The irony is that it’s the research psychologists who have demonstrated that psychologists don’t get better results than counselors. More on that later.
The State of Oregon recognizes that these educational paths and licenses give interchangeable results, and that’s why Oregon law repeats the same basic definition for counselors, psychologists, and marriage and family therapists.
Even highly advanced mind/body techniques, like Sensorimotor Psychotherapy, aren’t limited to one kind of licensee, or even to talk therapists! Why? As with other mind/body therapies, talk therapists and body workers are both drawn to this “one foot in each world” modality, and each brings an appropriate (though different) prior training to mind/body work.
What About Differences in Training?
But a psychologist, who has a PhD and thus more schooling than a counselor with a Master’s degree, is as better therapist, right? Perhaps not. Here’s the abstract from a research paper on whether therapists with more training get better results (emphasis is mine):
“We examine major criticisms of studies comparing paraprofessionals’ and professionals’ therapeutic effectiveness. Such analysis does not support the contention that methodological weaknesses of the studies produced systematic biases against professional therapists. Thus, despite common beliefs to the contrary, the finding that formal training does not predict successful therapy appears sound. We discuss the implications of this finding for research, training, and clinical practice.”
–Faust & Zlotnick, “Another Dodo Bird Verdict? Revisiting the Comparative Effectiveness of Professional and Paraprofessional Therapists.” Clinical Psychology & Psychotherapy, 6/95, pp. 157-167.
Degrees and Experience Have Less Effect Than You’d Think
Psychological research has shown that therapy provides strong benefits to people. This should surprise no one, because we’ve all seen people benefit from therapy. But I was surprised to learn that psychological research has consistently shown that some things you’d think would be essential to good therapy don’t seem to matter much, and have little effect on outcomes in randomized clinical trials:
- The amount of schooling the therapist has: Little effect.
- The “school” of therapy the therapist uses (Freudian, psychodynamic, CBT, whatever): Little effect.
- The years of experience the therapist has: Little effect.
This is not the universal result of all studies — unanimity isn’t something you get in research — but this unexpected finding has been repeated consistently for decades: too consistent and too repeatable to be an anomaly.
The “Dodo Bird Verdict”
This result has been dubbed “the dodo bird verdict,” because the original focus of the research was about which style of therapy was best, and they all came out roughly the same. This reminded someone of the scene in Alice in Wonderland, where the dodo bird announced, “EVERYBODY has won, and all must have prizes.”
The take-away seems to be this: conventional education, degrees, licenses, training, modality, and experience are not the source of superior therapeutic results. Therefore, source of superior results must be something else, and we must look elsewhere to find a way of identifying a good therapist.
The Common Factors Theory
The “something else” conclusion is called the common factors theory. The idea is that, since psychotherapy as been proven over and over to be effective, but the things people assumed caused this effectiveness don’t matter much, therapeutic results must come from elsewhere. The list of candidate for “elsewhere” are called “common factors,” because they are common to all effective therapies.
The list of therapeutic common factors varies. One commonly quoted model is from M. J. Lambert, and gives these estimates:
- Extra-therapeutic events (including the client’s life outside the office) 40%.
- Therapeutic relationship (empathy, rapport, unconditional regard): 30%
- Placebo and Expectancy effects (“Bedside manner,” positive expectations, suggestion, symbolism, rituals of change): 15%
- Therapeutic Technique: 15%
As you can imagine, these conclusions have been met with skepticism, hostility, and even distress by many therapists, who after all have invested a great deal of time and money — and perhaps part of their identity — into becoming credentialed professionals, generally with the promise that this was the only way of becoming an effective therapist.
Others have seen it as an exciting opportunity: there’s so much we don’t know about the human mind, but we’re living in a time where a lot of information is coming together, creating the building blocks for new and better therapies going forward. And as with any field where the paradigm is shifting, this is where the action is, here and now, and the playing field is more level than usual, favoring anyone who can deliver the goods. This is good for researchers, because fields have dull times and exciting times, and you’re more likely to make a big contribution in exciting times. And the practical, one-on-one therapeutic possibilities are equally exciting. Reminds me of my Silicon Valley days…
Career Implications for Budding Therapists
So with all that in mind, consider for a moment the different levels of investment in time and money for three career paths:
- A licensed psychologist who got a PhD and put in a lot of therapy hours under supervision before getting a license. (Note, by the way, that the PhD is a ticket to a career in research in addition to therapy.)
- A licensed counselor or marriage and family therapist who got an MA and put in a lot of therapy hours under supervision before getting a license.
- A counselor, marriage and family therapist, or other practitioner (hypnotherapist, NLP practitioner, somatic experiencing practitioner, etc.) who operates under Oregon’s educational exemption for counselors, and has taken specific, targeted, high-quality trainings for their modality of choice.
Not that there’s anything wrong with investing in advanced degrees. If that’s what you want, do it! I agree completely that the degree and licensure route has many advantages, advantages that are too well-known for me to enumerate here.
That said, if we focus narrowly on doing therapy in private practice — and, granted, private practice is just one small portion of the therapeutic world — you can see that the time and cost savings of the exempt/unlicensed approach can be substantial!
People mix and match, too. I’ve heard of people learning an alternative modality like hypnosis or NLP and using it to put themselves through school, emerging at the end with an advanced degree, a license, and no debt. That’s pretty cool.
And then there’s the reverse path, where licensed or licensed-track professionals switch to an alternative modality and were pleased with the results: everything from psychology grad students to licensed psychiatrists switching to an alternative or exempt modality.This happens all the time.
That makes four career paths in all:
- Conventional all the way (graduate degree followed by licensure).
- Alternative, followed by conventional.
- Conventional, followed by alternative.
- Alternative all the way.
All of these paths have their pros and cons. All of these paths are being followed, right now, by many people.
Wait, So How Do I Pick a Therapist, Then?
If research says that therapists with different levels of education, experience, and licensure still give, on average, the same kinds of results, what’s left for the consumer to choose from? Try these three things, each of which is helpful in its own way:
- Local reputation. Local reputation is the most reliable way of picking anything. Therapists with lots of satisfied clients are the ones most likely to be good therapists. If you ask around — and especially if you ask, “Who’s the best?” and not, “Who do you see?” — you’ll likely hear the same names over and over. See one of them!
- “Click.” If you like and trust a therapist, that’s an excellent sign.
- Approach. If you can’t stand the idea of hypnosis, don’t see a hypnotist. If you can’t stand the idea of “talking out” your problems, don’t see a talk therapist. There are many different therapeutic approaches and styles. Pick one that seems like it’s within your range.