Psychotherapists: Who Does What Anyways?
The ABC’s of M.D.s, Psy.D.s, Ph.D.s, M.S.W.s and MFTs…. WHAT????...And How Do You Choose?...Get the 3 Takeaways!
I have been asked many times what it is I do exactly, and what’s the difference between and meaning of all the initials that come after a therapist’s name. “Are you a psychiatrist or a psychologist,” is usually the selection I’m offered to choose from. I am actually neither, and I have a bunch of those mystifying initials after my name. Those initials are enough to make anyone, including the initiated, crazy! In this article, I intend to answer these questions. I also offer my recommendation on how to find the right therapist for you.
What does a psychotherapist do?
A therapist is there to help you understand and move emotional, intellectual, relational, professional and behavioral roadblocks so you can live the life you want. Usually these are all connected. A therapist is there to help you. You are not there to help the therapist. As a Psychoanalyst my fundamental “rule” is that you bring up the thoughts and feelings you have in any given moment during a session, without editing them, as best as you can—and along the road we will develop your ability to think and work through your pain and difficulties.
Hopefully, mostly what a therapist does is listen very attentively to help the client or patient achieve what they are after. The first goal is to find out what problems, pain, and concerns bring you in and are getting in the way of your happiness. Next is the work of helping you work through your problems and heal your pain while developing your ability to feel confident that going forward in the future, you are ready and prepared.
Different therapists work differently using different schools of thought. Some are more grounded in “behavioral” work, others in “cognitive”—thought-based— theory, and others like me, are “psychoanalytic” or “dynamic” and work more with the deep inner world of the “mind”—comprised of intellect and emotions. A deeper explanation of these would require another expose in itself and is for another day. But suffice it to say that there are many different types of theoretical backgrounds that therapists come from and all work differently.
What’s with the “psychotherapy” alphabet soup?
Many people think there are two “kinds” of therapists: psychologists (Ph.D.s) and psychiatrists (M.D.s). Newsflash: There are more!
Psychiatrists, are medical doctors, M.D.s, who can prescribe medication. They receive training as doctors in medical school and then go on to specialize in Psychiatry. In today’s world fewer psychiatrists offer psychotherapy as was once the standard. Now, most psychiatrists offer psycho-pharmacology—meaning they prescribe medications to help support healthy brain chemistry.
My dad became a psychiatrist in the 60’s when the emphasis was on talk therapy. At that time pharmaceutical therapy was considered an adjunct to ‘talk therapy’, very different from what you will find today. However, if you think you need help with drug therapy and want ‘talk therapy’ too, there are wonderful psychiatrists out there who are also trained as “talk” therapists and can balance the two. Just be sure to ask. Often, people will see a psychiatrist for medication and another therapist for ‘talk therapy’.
Psychologists, are non-medical doctors. They are professionals who have received doctoral training and degrees. They either have a Ph.D. or a Psy.D.
— Ph.D, Doctorate of Philosophy (in Psychology)
There are different areas of interest that a person may be trained in with the Ph.D. There may be minimal “clinical training” as the emphasis would be based on experimental or research psychology. Other programs or tracks may emphasize behavioral, cognitive, psychodynamic/psychoanalytic, existential, spiritual or any number of other theoretical areas of emphasis —
The Ph.D. has traditionally emphasized a scientist-practitioner model and may place a greater emphasis in its training of therapists on research, in its methodology, than other training modalities, such as with the Psy.D, M.D, M.S.W, or MFT.
— Psy.D, Doctorate in Psychology
I have this certification in Psychoanalysis where I was trained in British Object Relations and Primitive States of Mind, yet another theoretical model. An important distinction here is that my doctorate in psychology for psychoanalysis makes me a Psychoanalyst not a Psychologist. Finding out from a practitioner what their Masters or Doctorate or even Psychiatric training is in might be very helpful and important information.
The Psy.D. is usually a more “clinically” oriented program (vs. “scientifically” oriented for the Ph.D). The emphasis is on the actual practice of psychotherapy.
Social Workers are also psychotherapy providers. Those in private practice who offer therapy often have a master’s degree. In this case it would be an M.S.W. (this was my first professional degree). Other Social Workers might have pursued the profession of Social Work further, receiving doctoral level training distinguished by the D.S.W. (Doctorate in Social Work).
The master’s level training in Social Work focuses on the practical application of psychology with an emphasis on the social context that we all live in. Social work can be just as psychotherapy-focused as a degree in psychology, but again, the training begins with understanding theories in sociology.
The doctoral level Social Work training tends to be a more academic and scientific/research based training, and again this is not always true.
Marriage and Family Therapists (M.F.T.) have a master’s degree. The emphasis is made clear in their title. They are trained to provide psychotherapy and have studied with an emphasis on the family and marriage.
And what about having a license?
All therapists must be licensed to offer psychotherapy in private practice. If they have multiple degrees, they only require licensing in one area of distinction but are permitted to acquire as many licenses as they qualify for.
I was licensed as a social worker over 30 years ago in California, again adding to my credential and alphabet soup: L.C.S.W. (Licensed Clinical Social Worker). A licensed M.F.T. has the additional credential of L.M.F.T. When I became a psychoanalyst a few years ago, I was not required to sit for another license, but I am required to maintain my earlier license as a private practitioner. The Psy.D. in Psychoanalysis is an “academic degree” and does not have a licensing board.
In Conclusion
Generally, a client won’t be able to distinguish a clinician’s training by merely working with them. A well-trained therapist from any reputable program who has been in practice for an extended period of time may be more clinically capable than a fresh graduate regardless of their training—MD, MFT, MSW, Psy.D, or PhD. Prior to receiving my doctorate, there were patients who might instinctively called me Doctor. I felt flattered but also reminded them that I wasn’t a doctor but had my master’s degree in social work.
The most important factor in finding a therapist in private practice, secondary to the fact that they must be licensed, is that you feel there is a good fit between the two of you. There is no one style that fits all, and every practitioner brings their own style to whatever theory have learned. You may be more comfortable with someone who gives you homework or focuses on your behaviors. Or you may want someone who lets you lead the way and helps you to understand your unconscious mind, and doesn’t offer homework.
Therapy is very intimate and brings up many feelings including those of vulnerability. It is important to feel comfortable and that you trust the person you work with implicitly regardless of the alphabetic garble after their name. My formal title is “Briar Flicker-Grossman, Psy.D, L.C.S.W., M.S.W., F.I.P.A. (Fellow of the International Psychoanalytic Association)”…. And who on earth cares about all those initials if I don’t connect, resonate with, and help the folks who come to see me?
The 3 points I hope you take away from this article:
There are many classifications and degrees that therapists receive and carry, and hopefully I have helped you to decipher the alphabet soup better. (If you come across a credential that you don’t understand or recognize be sure to ask about it and do your own research.)
In addition to Psychiatrists and Psychologists there are also Psychoanalysts, Social Workers, and Marriage and Family Therapists, all providing different types of therapy.
How do you find a therapist? If you are interested in seeking psychotherapy investigate to see what style might best suit you. Then find a perceptive trustworthy licensed therapist you feel good with, who works in that lane (it generally doesn’t matter which degree they have or what title they hold). Don’t be shy about interviewing a few people so you can compare and contrast.