Sadly, there are plenty of incompetent mental health professionals and other helpers out there. A degree, a professional designation, and other mental health credentials are indicators of a certain level of knowledge and skill, but that doesn’t stop someone from having a bad attitude, having their head too far up their ass to do anything productive, or just generally sucking.
Still, it’s good to know what kind of baseline body of knowledge and skill a given provider has, and credentials can give you at least some of that information. So let’s take a quick meander through some of the common options.
Different mental health professions have different degree requirements for entry to practice, whether that be a bachelor’s, master’s, or doctoral degree. At the doctoral level, a PhD is a research-intensive degree, while other degrees may have more of a clinical focus, such as MD, PsyD, or DNP.
Degrees may or may not be particularly meaningful to what the provider has to offer. Even something that seems obvious, like a psychology, isn’t always going to be all that relevant. Psychology is a very broad field, and a psychology major might include coursework in clinical psychology… or it might not; you have no way of knowing that based solely on the degree. Also, an advanced degree in one field doesn’t necessarily confer expertise in another; a PhD in organic chemistry isn’t going to contribute a whole lot to someone setting up a counselling practice.
Professional registration and scope of practice
Certain health professions, like physicians and nurses, are regulated for the protection of the public. Once someone gets their degree, they need to register with their local regulator to be allowed to practice. The regulator will stipulate what the requirements are to obtain registration (getting a certain degree, passing a licensing exam, etc.) and maintain registration (such as continuing education) as well as the scope of practice, i.e. what kind of tasks that profession is able to do (such as diagnosing or prescribing medication).
Restricted titles are those that a state/provincial/etc. regulator decides can only be used by members of the regulated profession, to assure that the public knows what they’re getting. If I haven’t maintained my nursing registration but I continue calling myself a nurse, my provincial nursing regulator will hunt me down and beat me with a rubber chicken (that’s just a guess) and release a public notice that there’s some sketchy person named Ashley Peterson calling herself a nurse but she’s full of crap. I can still list my nursing degrees after my name, by I couldn’t call myself “nurse” or “RN” because those can only be granted by the regulator fairy.
Restricted titles aren’t the same everywhere. If a title isn’t restricted, that means anyone can use it. My guinea pigs could set up shop as counsellors, because “counsellor” isn’t a restricted title where I live. Yet it makes a big difference if someone has a master’s degree in counselling psychologist or they’re a guinea pig. And there’s always a risk that Casper will be too busy trying to hump her sister to listen to a client’s problems.
Use of the title “Doctor” may be restricted in the context of providing health services, but the same title is also used by people who have a doctoral degree in any field.
Regulated mental health professions
Psychiatrists have an MD degree, just like any other physician, and then complete a 5-year residency post-med school to specialize in psychiatry. Their training encompasses both pharmacotherapy and psychotherapy.
Some psychiatrists will further specialize in medication treatment and may call themselves psychopharmacologists. Neuropsychiatrists typically complete a post-residency fellowship for further training.
The minimum degree required to be registered as a psychologist can vary by jurisdiction, but it’s typically a doctoral degree. A PhD has a stronger research element, while a PsyD is more clinically focused. Psychologists can diagnose mental illnesses, and in a few places, they also have prescriptive authority to be able to order medications.
In the past, a lot of nurses were trained in hospital schools, and nursing was typically a diploma rather than a degree program. Now, the move has been to a bachelor’s degree as the entry level degree.
Nurse practitioners are registered nurses who have done a master’s degree (and/or a doctor of nursing practice degree) to prepare them to practice as NPs. NPs have diagnostic and prescribing authority, and in many places are able to practice autonomously, although in some jurisdictions they must practice in conjunction with a physician.
There are also advanced practice nurses who have done a master’s degree other than an NP program. I have a master of psychiatric nursing degree, but it wasn’t an NP program, so it didn’t put me in a position to be able to prescribe.
Social workers practicing as therapists typically have a master’s degree in social work. In some areas, licensed clinical social worker (LCSW) is the professional registration that requires masters level preparation. Whether or not they can diagnose depends on local regulations; where I am, a clinical social worker can diagnose, but most masters-trained social workers are not registered as clinical social workers, and therefore can’t diagnose.
Counsellors and other therapists
There’s a lot of variation depending on where you live. Counsellors may have credentials from a voluntary professional body or through a state/provincial regulator. Credentials like licensed professional counsellor (LPC), and licensed marriage and family therapist (LMFT) require master’s level education.
However, there may also be counsellors/therapists (like my guinea pigs) who don’t belong to any professional organization and don’t have any sort of requirements that they need to meet.
There’s a wide range of different mental health support provider who aren’t members of a regulated profession. Some are likely excellent at what they do, while others, not so much. But while you can assume a certain level of background training and basic skill level with a regulated professional, when it comes to providers working in non-regulated fields, it’s more incumbent on you to do your research.
Because this heterogeneous bunch isn’t using restricted titles, be prepared to take fancy-sounding titles with a grain of salt. I could call myself a Certified Professional Blogger, Adept Level III, and it might sound fancy, but it’s meaningless. It nay be worth digging a bit deeper to find out where the title actually came from.
Probably what’s a lot more relevant is what the person says they can do to help you, who has trained them in whatever it is they do, and whether that trainer seems like someone you’d be interested in getting services from.
Regardless of someone’s mental health credentials or lack thereof, the therapeutic relationship counts for a lot. So don’t forget to pay attention to your spidey senses.
Have you had any challenges finding the right support people to meet your needs?