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; however, 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. It also doesn’t stop them from having stigmatized attitudes about mental illness, but that’s a whole other issue.
Still, it’s good to know what kind of baseline body of knowledge and skill a given provider has. Credentials, as long as they’re from a reliable source, can give you at least some of that information. So let’s take a quick meander through some of the common options.
Educational background
Different mental health professions have different degree requirements for entry to practice. That may be a bachelor’s, master’s, or doctoral degree, while unregulated mental health fields may require something like a diploma program. At the doctoral level, a PhD is a research-intensive degree. Other doctoral 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 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). They also define the scope of practice, i.e. what kind of tasks a profession can do (e.g. diagnosing).
Restricted titles are reserved by law for members of the regulated profession. The purpose of this is to assure the public that they know what they’re getting. If I haven’t maintained my nursing registration but 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). They’ll probably also release a public notice warning of a sketchy person calling herself a nurse. The titles “nurse” or “RN” 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 psychology or they’re a guinea pig. While guinea pigs make great emotional support animals, 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 it’s also used by people who have a doctoral degree in any field. Aside from doctor being a bit hazy, mental health credentials related to professional registration are temporary, whereas someone has their education, they can use the associated letters after their name forever.
Regulated mental health professions
Psychiatrists
Psychiatrists have an MD degree, just like any other physician. Following med Schoo, they complete a residency, which typically lasts 5 years, to specialize in psychiatry. Their training encompasses both pharmacotherapy (medications) 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.
Psychologists
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 some places, they can also prescribe some medications.
Nurses
In the past, a lot of nurses were trained in hospital schools, and nursing was typically a diploma rather than a degree program. Recently, 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. In many places, they’re 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 no prescribing for me. Some advanced practice nurses work in private practice.
Social workers
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 master’s-trained social workers aren’t clinical social workers.
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 some people calling themselves therapists (like my guinea pigs) who don’t belong to any professional organization, That means that they don’t have any sort of requirements that they need to meet to qualify or keep current for their practice.
Free-for-all territory
There’s a wide range of different mental health support providers who aren’t members of a regulated profession. Some are likely excellent at what they do, while others, not so much. 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 may 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 the kind of person you’d be interested in getting services from.
Connection matters
Regardless of someone’s mental health credentials or lack thereof, the therapeutic relationship counts for a lot. A whole 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?
Visit the Mental Health Resource Directory for a collection of useful mental health websites and apps.
Very sadly true! Thank you for this unfortunately very needed post.
I wouldn’t swear to it, but I’m pretty sure psychologists don’t diagnose in the UK. I don’t if that’s a legal thing or an informal NHS demarcation/administration thing. I also haven’t heard of nurses diagnosing or prescribing in this country, but I haven’t had much experience with psychiatric nurses.
I was just trying to track that down, and it appears to be a scope of practice thing for psychologists rather than being an NHS thing. The Royal College of Nurses site talks about some nurse independent prescribers, but there doesn’t seem to be the nurse practitioner role the same way there is North America.
“…And there’s always a risk that Casper will be too busy trying to hump her sister to listen to a client’s problems.” 😂😂 That hit the old humerus hard.
My experience has been that the amount of education a therapist has obtained isn’t necessarily equivalent to their skill level in practice. A PhD doesn’t replace empathy and compassion. That being said, I’ve had one psychologist who wasn’t an arrogant jerk. All of the others were. Maybe I’ve just been unlucky. I have had much more success working with SW’s overall, as they’ve been much less likely to pathologize what’s going on in my life.
That makes sense, with social workers coming at it from a different angle.
All it takes is the wrong person to say the wrong thing and bam… straight on your arse. I think the best practitioners are the ones with personal experience. I’ve had so many nurses, psychs, therapists… when I first went for EMDR last year the nurse was so inexperienced she retraumatised me and I ended up back on the psych ward… just because she didn’t know what she was doing. I don’t think it’s done on purpose by any stretch but.. something that nurse put down to experience and possibly learnt as a lesson.. tipped me over the edge, and took me months to recover from! Xx
That’s brutal. Yeah, it can do some much harm when people don’t know what they’re doing, especially if that’s combined with arrogance and insistence that they do know what they’re doing.
Thankfully I found a really good trauma therapist who was very honest with me when she felt helpless. She didn’t know how to help me with disassociation or self harm etc.. she told me straight and that’s what pushed me to try EMDR again. The guy I see is very experienced and very honest.. which I think is crucial! Xx
Definitely!
I had a terrible man once who got his degree from “Cambridge University” in Boston. Sounds prestigious but I googled them and their selling point was 100% acceptance rate of applicants!
Sweet! I wonder if there’s a sketchy Harvard somewhere selling degrees.
I was fortunate to have a great psychiatrist! She helped me and I could sense that she does care about her patients. If she sees me around the hospital she always takes a few minutes to stop and chat. I owe her my gratitude for the help she provided.
That’s fantastic!
You’ve got to shop for the right fit just like buying a pair of shoes. Sorry if that’s crass but has been my experience. Three horror stories when trying to get help for my daughter. First one fell asleep during the assessment. Second said bipolar after 5 minutes. We left with a pharmacy of confusing prescriptions that we never filled. The third one diagnosed depression and anxiety. She put her on Prozac (since a teen at the time) and saw her for a while but this doctor was habitually late on purpose. Had lots of her own issues. Then my daughter ended up asking her PCP for meds switching to Zoloft saying Prozac never worked. She weaned off Zoloft after graduating from college and is back in a world of hurt looking for a new doctor again. I don’t think her original diagnosis of bipolar was accurate but this seems so much worse than depression and anxiety. Takes more than 5 minutes of one session to figure out what’s wrong don’t you think?
Yikes!!!
Thanks for that! I was actually quite curious about this, since I’ve been looking around for a therapist recently. ❤️
There is such truth here. One can have a number of letters behind their name but true lack in understanding and connection. It is so important to research providers and to look for goodness of fit. As always, Thank you.
That goodness of fit is so crucial.
We’ve seen psyD, LMFT, LPCC, and worked with Psychiatrists and MSW. The interpersonal relationship matters most to us. Still, we’ve found doctorates have resulted in providers who know their shit. That counts for something, too. Our current two Ts include a PsyD and an LPCC.
Your humor showed in this informative post. We laughed. Thanks
It sounds like what you’re missing is a horny guinea pig thrown into the mix. 😉
Duh 🙄 😂
Lol
I don’t know where to begin and I may not say all that I want in this comment. You are right, it comes down to the individual with the credentials and how they run their practice and execute their bedside manner. I noticed that psychiatrist all are basically taught the same things. No one ventures to explore other reasons for behavior or feelings. They tell you, You can step right up and get your diagnosis and medication, fall in place to get your same treatment.
It also costs to change and revamp brain disorders, mental health and psychiatry programs to see what’s most effective. I wish it was not look at like this, but it is. However I still believe in the field, I believe there are professionals that care and want to change how they diagnose and practice medicine. Its just rare to find them. I believe that all professionals in the field are relevant. Its important to advocate for yourself or have someone advocate for you when seeking mental health care. As someone mention above that you have to search for the right fit for you or your love one. Whether you are seeking a psychiatrist or nurse practitioner or therapist. They are all relevant in getting care.
I agree, they’re all relevant, it’s just a matter of finding the best fit.
Nice
I find that, at least here, the addictions field outside of the health care system tends to have a substantial chunk of people calling themselves counsellors with minimal qualifications. That would be fine, except I don’t think the average person knows the difference between that and the real deal.