MD, Ph.D., LCSW, MFT: What Do These Letters Mean for Therapists and Why Should You Care?

In today's posting I want to explain about some of the different kinds of therapists, their initials and what they mean, the training and experience they go through, and what their specialties are. This is a kind of Cliff's notes to shopping for a therapist. I will list them alphabetically.

Before I do, a few words of introduction. Therapists are prone to turf struggles, ego bruising and insecurities just like people in any other profession. I will do my best to present things as I see them, but like everyone else, I am a prisoner of my own experience.

Which leads me to say that as a psychologist, I have to assume I have a natural prejudice in favor of this discipline, and probably less appreciation for other disciplines. Factor that in when reading the following.

LCSW: This stands for Licensed Clinical Social Worker. It is a master's level license that is recognized throughout the United States. In broadest terms, LCSW's are clinicians who are trained to look at psychological issues in a more social context: for example, the effect of poverty and prejudice on identity and achievement. LCSW's are more likely to see their career path in an agency setting or a community mental health facility. In recent years, many LCSW's have gone into private practice, though the social work schools still try to encourage their students to spend at least a part of their careers in community agencies. An LCSW has completed a master's degree in social work and at least 3,000 hours of supervised practice.

MD/Psychiatrist: A psychiatrist is a medical doctor who has specialized in mental health, much like a cardiologist is a medical doctor who specializes in the heart. Psychiatrists used to do "talk therapy" and prescribe medication regularly. In recent decades, most psychiatrists have been relegated to medication management. This is because of a variety of different factors, ranging from the explosion in use of psychotropic medication (this is medicine used to deal with mental health issues) to the economics of reimbursement by insurance companies. A psychiatrist goes through medical school like everyone else and then does a psychiatric residency. Most psychiatrists practicing today have more experience in prescribing than they do in talk therapy.

MFT/MFCC: This stands for Marriage and Family Therapist, formerly called Marriage, Family and Child Counselor. It is a master's level license that is specific to California and is not recognized throughout the United States. There is a new national equivalent to this license, seeking to create for MFTs what LCSW is to social work.  This license is called LPC (licensed professional counselor) and will be nationally recognized and likely eventually subsume the MFT license. An MFT has much the same training as an LCSW but with more emphasis on individual, family or couple issues than on social issues. The reality, however, is these two programs are much more similar than they are different. An MFT also needs a minimum of 3,000 supervised hours prior to licensure. MFTs are more likely to focus on family or couple's work in addition to individual therapy and are more likely to want to be in private practice than in an agency.

Ph.D/Psy.D/Psychologist: Psychologists are doctoral level clinicians: that is, they are people who have completed a doctorate in psychology and gone through 3,000 hours of supervision prior to licensure. A Ph.D. is the degree which used to be awarded, but this has tapered off in recent years because of the recognition that a Ph.D. is primarily a research degree and most psychologists have a clinical focus. The Psy.D. stands for "doctor of psychology" and is what is awarded at most schools which are graduating people who go on to become clinical psychologists.  The one specialty psychologists have primarily is in administering psychological tests, but there is no law which says that only psychologists can do this -- it is simply included in their training. Psychologists can and do work in any of the settings that MFTs and LCSWs do. In two states (New Mexico and Louisiana), psychologists are allowed to prescribe psychotropic medication.

Who should you choose? How should you choose?

The right person is more important than the right degree or license. With that said, here's how I think about it:

Most psychiatrists have less training in talk therapy than any of the other disciplines. While there are some psychiatrists doing excellent talk therapy, it is a mistake to assume that just because they are doctors they are better at therapy than a master's level clinician. They simply had to spend the bulk of their time on courses like anatomy and biology and they didn't get as much training and experience sitting with people doing regular therapy.

I did 3,000 hours of supervision and got my MFT and then another 3,000 hours of supervision and got my psychology license so I think I can appreciate both disciplines. In addition, I did all of my personal therapy with master's level clinicians so obviously I thought highly of them.

With that said, in the broadest terms I think that MFTs and LCSWs can be thought of as nurses while psychologists can be thought of as doctors. Nurses are more practical and hands on.  Doctors usually have the conceptual understanding of why things are as they are, even while they may have less practical experience in giving shots than a nurse. I think this is true of psychologists as well.  Psychologists usually have a more academic understanding of issues and will usually rely more on insight than on technique when working with people.

These are of course very general outlines and there always exceptions. But in general it's how I've come to understand the field and I wanted to share it with you if you're in the market for a therapist. 

Next week: "Rightness of fit" in choosing a therapist.

Do you have a question about your marriage or relationship? Is there a particular topic on relationships or individual psychological issues you would like addressed in this blog? Ask Josh in the comments below or email him at josh@joshgressel.com.

Josh Gressel, Ph.D., is a couples and individual therapist based in Pleasant Hill, CA. Visit his website at joshgressel.com.  He is currently accepting referrals.