What's the difference: psychotherapist, psychiatrist, psychologist

What's The Difference? Marriage Family Therapist, Psychologist, Psychiatrist...

Have you ever wondered what the difference is between professional titles for those who offer psychotherapy and counseling services? At times it can be downright confusing, and yet if you need a professional helper it is an important question: Who is qualified to help me with some of my most personal, private and pressing problems? In this post I will try to shed some light on the key differences between the professional titles you are likely to find here in California when seeking out counseling or therapy from a mental health practitioner.

In California, the terms "psychotherapy" and "psychotherapist" are reserved for specific professionals who have met certain professional standards.  Often referred to as talk therapy, psychotherapy is a process used by a qualified professional to treat mental health problems such as anxiety disorders or depression, as well as stress and conflicts arising out of life circumstances, relationships, experiences, behaviors and thoughts.  The shape of the process will be influenced in large part by the underlying theories influencing the therapist. The client could be an individual, a couple or an entire family. Below are the main professional titles you are likely to encounter here in California, that commonly offer psychotherapy services to the public.

Alphabet Soup: LMFT, LCSW, LPCC

Licensed Clinical Social Worker (LCSW); Licensed Marriage Family Therapist (LMFT); Licensed Professional Clinical Counselor (LPCC): These three designations are all regulated by the California Board of Behavioral Sciences. Although the emphasis of each discipline is slightly different and therefore licensing requirements are a little different, all are qualified to practice psychotherapy. The basic requirements are the same: Each must possess a masters or doctoral degree from an accredited school in counseling, psychology or social work and have undergone a minimum of 3000 hours of supervised clinical work experience prior to licensure. The different licenses reflect the fact that each has grown out of different disciplines.  In my experience, when it comes to working in a clinical setting, the differences are subtle and often more academic than practical.

Licensed Psychologists

The term psychologist actually encompasses a wide range of specialties including applied psychologists, research psychologists,  academics, and mental health (clinical) psychologists who perform testing, and evaluate and treat emotional and psychological problems. Clinical or counseling psychologists are typically the kind of psychologist who perform psychotherapy. A licensed psychologist has a doctorate degree in psychology from an accredited school and must have attained 3000 hours of supervised professional experience prior to licensure. Psychologists are often less costly than a psychiatrist, but more costly than other psychotherapists such as LCSWs and LMFTs (reflecting the requirement of a doctoral degree vs. masters degree). If you have special requirements such as psychological testing for example, you may want to pursue a psychologist. Licensed Psychologists are regulated by the California Board of Psychology.


A psychiatrist is a medical  doctor who is educated and licensed to practice medicine.  A board certified psychiatrist is additionally certified as having successfully completed training and evaluation for a specialty or sub-specialty. A board certified psychiatrist is therefore a medical doctor who specializes in mental health and emotional problems and usually treatment is focused on addressing problems by prescribing medications. Typically psychiatrists do not conduct psychotherapy, although some psychiatrists do conduct psychotherapy. As physicians, they are certified by ACGME and the American Board of Psychiatry and Neurology. If you decide  to find a psychiatrist who also practices psychotherapy, the price will reflect their highly specialized medical skill set.  However, if medication is an important and/or complicated part of your clinical picture, then a good psychiatrist who is also a good psychotherapist is a terrific find and well worth the cost.

How to Chose?

First of all look for terms such as "licensed",  "board certified" or "registered" somewhere in their professional title to assure a basic level of qualification. Also, keep in mind that a number of titles such as coach or therapist are not regulated and anyone can give themselves such titles without necessarily possessing any specific set of skills, qualifications or education. Therefore it is up to you to determine minimum qualifications and basic fitness to help you. As with any profession, you are likely to encounter both good and bad practitioners.

Generally speaking, the regulated professionals described above are able to assess, diagnose and treat mental health disorders and conduct psychotherapy. At the same time, different professionals may focus or specialize in different areas of treatment. If you suspect you need a specialist then it is a good idea to scrutinize the focus and experience of the professionals you are considering. If you are not sure, don't be afraid to ask!

Beyond basic qualifications and special needs, the rest is more about how you feel with the person. There is a good deal of research which concludes the most important factor to successful outcomes in therapy is a good working relationship between therapist and client. Consider meeting with a few qualified professionals for a consultation (many offer a free consultation), and ask yourself: How do I feel in the room with this person? Do I feel safe? Do I have a gut feeling that this person is out for my best interest and can understand and relate to me and my issues in a non-judgmental way?  If the answer is yes, you may be off to a wonderful relationship that can help you in many ways.