If you already know that you want to help people cope with personal problems and mental health issues, you might think that you have already narrowed down your career choices. That’s true to some extent, but the world of mental health professionals is larger than you might realize at first. Let’s dig into the differences between counselors and therapists and explore how they differ from other mental health professionals.
Counselor and Therapist: Two Names for Mental Health Professionals
It’s no wonder that many people – even prospective mental health professionals – aren’t sure what the differences are between therapists and counselors. The two job titles are often used interchangeably, according to Northeastern University, and their work is similar in many ways. Both counselors and therapists are highly educated practitioners who are trained to use evidence-based interventions to treat patients with mental health conditions and clients going through stress and problems in their lives.
What Is Counseling?
To better understand the similarities and differences between counselors and therapists, it’s important to distinguish between counseling and therapy. Both are interventions that can help people cope with mental and emotional health issues, difficult life events and stresses, grief, trauma, addiction and problematic thought processes and behaviors.
In its definition of counseling, the American Counseling Association notes the following key points:
- Counseling is a relationship – a professional one – that requires both (or all) parties to be engaged in communication, setting goals and working to reach those goals. It’s not a service or intervention that is simply given by the practitioner and received by the client but rather a collaborative effort.
- Counseling focuses on “empowering” the client to reach their goals, often by changing thought patterns and behaviors, identifying the causes of problems and potential solutions and coming up with strategies to cope with stressful situations or the symptoms of mental health conditions.
- The goals a client may pursue aren’t limited to mental health management. Counseling may also address wellness more generally, as well as personal relationship challenges and education and career ambitions.
What Is Therapy?
The term “therapy” means, simply, treatment for a disorder. There are many types of therapy. Physical therapy is used to help people with physical injuries or limitations improve their range of movement, strength and sensations of pain. Occupational therapy is used to help people adapt to physical or cognitive impairments and develop skills for daily living.
In terms of mental health treatment, therapy refers to the means and techniques used to treat mental illness. Psychotherapy or talk therapy is common in the treatment of mental illnesses. Cognitive behavior therapy techniques can help clients and patients change their thought patterns and their actions.
Both counseling and therapy are important aspects of mental health care. Think of therapy as the techniques used in counseling practice and counseling as the collaborative relationship between the client and the mental health professional in which therapeutic techniques are initiated. This distinction illuminates the nuances that distinguish therapists and counselors.
The Key Differences Between Counselors and Therapists
The differences between counselors and therapists are often subtle, but they can be important.
A Focus on Life Challenges vs. Mental Illness
First of all, counselors are generally more likely to help clients who are dealing with difficult life situations, while therapists are more likely to treat mental illnesses. If you’re going through a loss of some kind, navigating stressful changes in your career or education or having trouble in your interpersonal relationships, you’re more likely to seek out a counselor. If you need help managing the symptoms of a mental illness, a therapist may be a more suitable choice.
This isn’t a hard and fast rule. After all, the professionals who provide marriage and family therapy sessions through which they help couples and families try to sort out complicated feelings and build better family dynamics and communication styles are called licensed marriage and family therapists, even if no one in the family suffers from diagnosed mental illnesses. Additionally, mental health professionals known as addiction counselors provide addiction counseling services to people with substance abuse disorder, which is a diagnosable mental illness.
Short-Term vs. Long-Term Treatment
Addressing mental health challenges – whether they arise out of diagnosed mental illnesses, trauma, loss or the routine difficulties people encounter over the course of their lives – isn’t a speedy solution.
In terms of treatment progress, mental health counseling and psychotherapy have more in common with physical and occupational therapy, in which patients make progress over a number of sessions and exercises that they perform on their own at home, than with, say, undergoing a one-time treatment or taking a course of antibiotics for a strictly physical ailment. However, of the two mental health professionals, counselors are generally more likely to treat patients on a short-term basis, while therapists more commonly provide long-term treatment.
This difference may be due in large part to the differences in the types of clients they tend to treat and the problems they aim to help clients solve. Helping a person cope with the stress of a difficult life situation is a goal that can generally be achieved more readily than helping a patient cope with the numerous symptoms that result from a diagnosed anxiety disorder (or from another ongoing mental illness).
Again, we’re talking in general terms. A person who sees a great deal of value in counseling may revisit the counseling relationship when other life changes and challenges arise, while a person who feels that they have learned the tools they need to learn from their therapist may feel that they no longer need to keep going to therapy sessions on an ongoing basis.
A Focus on Actionable Solutions for the Future Over Understanding the Past
The goal of both counselors and therapists is to help the client. That means coming up with practical solutions for the problems that the client is facing now or will likely face in the future.
However, counselors tend to look toward the future, while therapists often dig into the past. Part of counseling is likely to be thinking about practical steps and strategies for solving the problem that is currently bothering the client and similar problems that may arise later. On the other hand, therapists may ask their clients to think more critically about the events and exposures in their past that contribute to their current problems and behaviors.
Either approach is valid. While understanding what drives one’s own problematic behavior is valuable for avoiding the same patterns in the future, it isn’t always necessary to dredge up the details of the distant past just to modify behavior patterns when quicker, more efficient methods for change exist. A mental health professional bearing either title may ask clients to consider why they make the decisions they do (and what past experiences have shaped this tendency), as well as working on ways to challenge established thought and behavior patterns going forward.
What Do Mental Health Counselors or Therapists Do?
Despite the nuances that separate them, mental health counselors and therapists have more similarities than differences. This includes the job duties mental health counselors and therapists perform on a routine basis, such as:
- Meeting with clients to conduct assessments and therapy sessions
- Evaluating clients’ needs, problems and goals
- Putting together a treatment plan to achieve the desired goals
- Listening to clients’ thoughts and feelings, challenging thought and behavior patterns when necessary and asking the questions that lead clients to self-reflection and you to a deeper understanding of the client – all while creating a safe space where the client feels accepted and able to be honest
- Maintaining notes about sessions, progress and obstacles
- Referring the client to resources, programs, services and other mental health professionals – like those who are qualified to prescribe medication – as needed
- Managing scheduling, billing and other logistics as required by the environment (that is, a counselor or therapist working in private practice on their own will have more extensive scheduling and billing job duties than a counselor or therapist working for a large center or clinic that has dedicated receptionists and billing specialists)
Direct interaction with clients is a huge part of work for either mental health counselors or therapists, but you should also be prepared for the paperwork required for either of these jobs.
Therapists and counselors often meet one-on-one with individuals, but that isn’t always the case. They may also provide couples counseling, family counseling and group therapy services.
Types of Counselors and Therapists
Professional counselors and therapists work in many different areas of focus and with a variety of clients. Some of the types of therapists and counselors to become familiar with include the following.
Mental Health Counselors
A clinical mental health counselor treats patients with a variety of mental disorders, emotional health problems and life challenges, according to the United States Bureau of Labor Statistics (BLS).
Marriage and Family Therapists
Practitioners in the field of marriage and family therapy use a family-centered approach to helping clients. Family therapists are known for working with feuding couples and families in which the dynamics and communication styles have become stressful, but they may even provide individual therapy that aligns with this family-centered perspective.
Family therapy can help couples and family members understand opposing points of view, improve communication practices for better interpersonal interactions and find a middle ground from which to facilitate compromises and agreements.
Substance Abuse Counselors
If you want to focus specifically on treating substance abuse – as clinically diagnosed mental disorders, not merely bad habits or poor choices – a role as a substance abuse counselor is exactly what you’re seeking. Substance abuse counselors help clients recover from substance abuse disorder.
This doesn’t just mean stopping the use of substances but also developing healthier ways to deal with stress and negative feelings and putting in place strategies to rebuild the client’s relationships, career and life. Both individual and group counseling are common in the treatment of substance abuse issues, and counselors working in this field often conduct both crisis and noncrisis interventions, the BLS reported.
Behavioral Disorder Counselors
Not all addictions involve substance use and abuse. Behavioral disorder counselors address non-substance addictions, including gambling addiction and sex addiction, as well as behavioral issues and mental disorders that involve compulsions, such as eating disorders, Obsessive-Compulsive Disorder (OCD) and Attention Deficit Hyperactivity Disorder (ADHD).
School counseling entails building a counseling relationship with school-age children to help them meet goals that range from addressing behavioral disorders and accommodating developmental and learning disorders to enhancing academic performance and social skills. School counselors, especially those working in high schools, often help students plan for and prepare for their careers after graduation. They may guide students in choosing a college or major and navigating the college admissions process and financial aid system.
Career counselors help adults – from college students and recent graduates to older adults with more professional and life experience – reach career goals. A career counselor might help a client figure out their strengths, identify careers that align with their skills and interests and take steps to advance their established career or get started in a new occupation.
Rehabilitation counselors help people with all kinds of disabilities – physical, mental, emotional or developmental – to live a fuller and more independent life. Their work may include taking stock of the individual clients’ strengths and weaknesses, developing treatment plans to maximize these strengths and compensate for these weaknesses and putting clients in touch with the services they need for optimal health, well-being and functioning in their life.
A holistic counselor is any type of counselor who approaches mental health and behavioral therapy from a holistic perspective. Professional counselors who use a holistic approach treat the client as a whole person, not just a problem to be solved or a mental health disorder to be managed. They aim to help the client achieve whole-person wellness through therapeutic interventions that address the body, mind and spirit.
Job Titles for Licensed Counselors
A clinical mental health counselor who is licensed to provide mental health services may go by one of several official titles, depending on the state in which they practice. The American Counseling Association lists the following titles for fully qualified mental health counseling professionals:
- LPC: Licensed Professional Counselor
- LCPC: Licensed Clinical Professional Counselor
- LMHC: Licensed Mental Health Counselor
- LCMHC: Licensed Clinical Mental Health Counselor
- LMHP: Licensed Mental Health Practitioner
- LPCC: Licensed Professional Clinical Counselor of Mental Health
Before mental health counselors, marriage and family therapists and other types of counselors can become fully licensed, they need to complete a post-graduate supervised clinical internship. Some states award a special provisionary license, also called an associate license, to counselors who have completed their master’s degree and passed the licensing exam but are still working toward meeting their supervised clinical experience requirements. Associate license titles also vary by state but may include the following:
- LAC: Licensed Associate Counselor
- LPCA: Licensed Professional Counselor Associate
- Licensed Graduate Professional Counselor
- Clinical Resident
Other Types of Mental Health Professionals
Therapists and counselors are among the most common practitioners of mental health services, but other licensed professionals can also provide mental health treatment, including psychologists, clinical social workers,
Both therapists and counselors can provide the counseling services and therapeutic interventions that help people achieve mental well-being when dealing with difficult situations or more manageable effects of mental illness. However, licensed professional therapists and counselors aren’t equipped to handle all of the issues that appear in the mental health profession.
When it comes to clinical treatment of serious psychotic disorders, psychologists are the go-to choice of practitioner. Psychologists are experts in the field of psychology, the scientific study of the mind, thought and behavior.
Psychologists are trained at the doctoral level, although they are not medical doctors. Not all psychologists are mental health professionals, but two of the most common types of psychologists – counseling psychologists and clinical psychologists – are mental health practitioners.
Counseling psychologists apply their advanced knowledge of the theories and practices of psychology to counseling services.
They are the type of psychologist most closely related to counselors and therapists, using many of the same counseling techniques. However, a counseling psychologist approaches psychotherapy from the model of understanding the science behind thought and behavior rather than a focus on building the professional counseling relationship used to solve problems and achieve goals.
Clinical psychologists focus specifically on providing clinical mental health care to clients with diagnosed mental health issues. Clinical psychologist is the type of mental health professional who is qualified to manage severe mental health issues.
A clinical psychologist uses many of the same interventions as counseling psychologists and licensed professional counselors, including psychotherapy and behavioral therapy intended to modify behaviors. In a few states, licensed psychologists practicing clinical psychology are authorized to prescribe appropriate medications to clients. Otherwise, practitioners of clinical psychology work in collaboration with psychiatrists, psychiatric nurse practitioners and other healthcare professionals who are authorized to prescribe psychotropic medications.
Clinical Social Workers
Licensed clinical social workers (LCSWs) also provide clinical mental health care services, including diagnosing and treating mental illness and counseling individuals, couples and families. LCSWs are social workers with an advanced education and clinical training. They approach the field of clinical mental health interventions from a unique perspective: viewing the client as an individual within the social environment of their family and community.
Psychiatrists are medical doctors who work in mental health practice. Although they can provide psychotherapy, psychiatrists mainly treat mental health disorders through pharmaceutical means by prescribing psychotropic medications, leaving counseling and talk therapy services to psychologists and counselors.
Physician assistants, or PAs, are medical practitioners educated at the master’s degree level who provide care under the supervision of a licensed physician. A psychiatric/mental health physician assistant is the type of PA who specializes in clinical mental health treatment.
Psychiatric Nurse Practitioners
Nurse practitioners are advanced practice registered nurses (APRNs) who focus on providing psychiatric and mental health care. Like physicians, psychiatric nurse practitioners diagnose and treat mental disorders and prescribe medications. However, nurse practitioners differ from psychiatrists in two main ways.
Nurse practitioners are trained in the nursing model rather than the medical model, which means their emphasis is on patient-centered care rather than on disease diagnosis and treatment. Additionally, in many states, nurse practitioners cannot practice independently, as medical doctors do.
Mental Health Professional Educational Paths
To develop clinical skills in assessing conditions and treating clients and patients through techniques like talk therapy, behavioral therapy and other interventions, mental health practitioners need an advanced education and a great deal of experience. Some clinical mental health professionals must have a doctoral degree. Becoming a licensed mental health professional will typically require at least a master’s degree.
Becoming a Licensed Mental Health Counselor or Therapist
If you want to become a mental health counselor or a therapist, you need a master’s degree in the relevant area of counseling. Master’s degree programs for licensed mental health counselors include lengthy internships through which students gain hands-on counseling experience.
Master’s in counseling programs accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP) include coursework in testing and assessment in counseling, counseling theories and techniques, crisis intervention and trauma, psychopathology and pharmacology, multicultural counseling, group therapy techniques, career counseling skills and research methods in counseling.
After graduation, new counselors must complete thousands of hours of post-graduate supervised clinical experience to qualify for licensure and pass a licensing exam, the BLS reported.
Becoming a Psychologist
If you want to treat more severe and complex mental health problems, you’re going to need a doctoral degree. The doctoral degree options for practitioners in counseling psychology and clinical psychology include both the traditional Doctor of Philosophy (PhD) degree and the professional, practice-oriented Doctor of Psychology (PsyD) degree.
Only a licensed psychologist is authorized to call themselves a psychologist in most states, according to the BLS. Licensed psychologists must meet requirements that typically include a doctoral degree, an internship, between one and two years of supervised clinical experience and a passing score on the Examination for Professional Practice in Psychology.
Becoming a Clinical Social Worker
A Master of Social Work degree that covers clinical coursework is the level of education required to become a clinical social worker. LCSW licensure typically requires a minimum number of hours of supervised experience and a passing score on a clinical exam.
Becoming a Psychiatrist
If you want to become a psychiatrist, you will need to go to medical school. Either a Doctor of Medicine (MD) or a Doctor of Osteopathic Medicine (DO) can prepare you for a career as a psychiatrist.
Medical school consists of four years of study and training. Generally, the first year or two years are considered the didactic years, which revolve primarily around classroom and laboratory education. The final two years of medical school typically consist of clinical rotations. After graduation, new physicians must complete clinical residency training. Psychiatrists typically complete four years of residency training, and those who want to further specialize their practice may spend an additional year or two completing a fellowship in their desired subspecialty.
Psychiatric/mental health PAs become qualified by completing a master’s-level program in physician assistant studies. This two- to three-year program includes clinical rotations in a variety of medical specialties, but those interested in mental health careers should complete additional rotations in psychiatry if possible. Some PAs complete one-year post-graduate fellowships in psychiatry to develop expertise in this area of specialty.
Becoming a Psychiatric Nurse Practitioner
Psychiatric nurse practitioners start out as registered nurses (RNs), most commonly with a Bachelor of Science in Nursing (BSN) degree. To qualify for the advanced practice registered nurse credential, they need at least a Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP) degree.
Coursework in a nurse practitioner program includes advanced studies in health assessment, pharmacology and pathophysiology, the BLS reported. For aspiring psychiatric nurse practitioners, coursework is likely to include psychopharmacology, the role and responsibilities of psychiatric nurse practitioners, assessment and management of common psychiatric symptoms, psychotherapeutic modalities for children and adults, group psychotherapies and fieldwork in clinical mental health practice.
Counselor and Therapist Employment
Are therapist and counselor good jobs to pursue? These, like all occupations, have their pros and cons.
Therapists and counselors work in a variety of environments, including general and psychiatric hospitals, residential psychiatric facilities, outpatient counseling centers and clinics, schools and private practice offices. Today, some therapists even work from home some or all of the time, delivering counseling services through digital means such as videoconferencing calls and app-based platforms. This is good news for prospective counselors who want to keep their options open because it’s possible to find a job in so many different settings.
In general, the job outlook for counselors, therapists and other types of mental health professionals is excellent. The demand for mental health services is on the rise, U.S. News & World Report revealed in 2022, and the Association of American Medical Colleges reported that psychiatrists, psychologists and clinical social workers are in short supply. Therapists and counselors are needed to fill the gaps. Between 2021 and 2031, the BLS expects jobs for mental health, substance abuse and behavioral disorder counselors to climb by 22%, compared to the 5% job growth rate expected across all occupations.
Therapist isn’t a lucrative career. The median salary for marriage and family therapists was only $49,880 in 2021, according to the BLS. Mental health counselors, substance abuse counselors and behavioral disorder counselors made just $48,520. That’s a lot less than the $249,76 median wage reported for psychiatrists and the $82,510 median wage reported for psychologists. On the flip side, though, therapists and counselors aren’t investing the extra time and money into earning a doctorate, as psychiatrists and psychologists are required to do.
There’s a lot to love about careers in counseling and therapy. You have the opportunity to make a huge difference in the lives of your clients. The strong job outlook means that your skills will likely continue to be in demand for some time. A lot of your daily job duties involve activities that you already enjoy and excel at, such as talking and listening to others’ problems and stories, treating them with compassion and acceptance and teaching them about how the human mind works and strategies that can help them manage life problems and negative thought patterns. Although it’s not the right fit for everyone, a career as a counselor or therapist can be rewarding as well as challenging.