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On Choosing a Therapist (Part 1 of 3)

If you have made the decision to seek psychotherapy, congratulations on taking this first step! The journey on which you are embarking can offer a world of possibilities. Despite its many benefits, however, the subject of how to find a therapist may not yet be a conversation at your dinner table or on your favorite social media site. In what may seem like a vacuum of information, how do you find the right person to work with? What should you be considering when making your decision? In this series of articles, we will explore some of the things that may be helpful to think about as you begin what will hopefully be a useful, fascinating, and enlightening exploration.


It helps to know the language.

Like most professions, the world of psychotherapy has its own language, which can be daunting to people who are looking for help. How do you sort the MFTs from the LPCCs and the Behaviorists from the Analysts? We will begin with a brief introduction to some of the terminology so that you can make an informed decision about whom you might want to see and how that person may be able to help you.

It starts with a license.

California has five different kinds of licenses for therapists: psychiatrist (M.D. or D.O.), Marriage and Family Therapist (LMFT, MFT, or MFCC), Licensed Professional Counselor (LPCC), social worker (LCSW), and psychologist (Ph.D. or Psy.D.). What are the differences and why should you care? While people who hold any of these various licenses can all practice psychotherapy, there are differences that could be important with respect to obtaining the help you are seeking.

If you are interested in medication, the person to talk to is a psychiatrist. While your regular doctor may write prescriptions for any medication, psychiatrists are medical doctors who have extensive training in the use of psychotropic medications, the medications that are used to help people with depression, anxiety, and related problems. Most psychiatrists see people who are seeking prescription medications, although some also offer general therapy services. More typically, psychiatrists work in conjunction with psychotherapists: the psychiatrist manages the medication and the psychotherapist meets regularly with the patient for psychotherapy. Psychiatrists work in hospitals or in a group or private practice.

Although the name is confusing, Marriage and Family Therapists (MFT) work with a wide range of people, including individuals and children, as well as couples, families, and groups. MFTs usually hold master’s level degrees in counseling psychology and their training focuses on providing psychotherapy; in fact, the path to MFT licensure is the only one that focuses primarily on the practice of psychotherapy. Most MFTs are in private practice, but they can also be found in agencies and hospitals. This license is the most common mental health license in California.

The Licensed Professional Clinical Counselor license is new to California (although it is very common in other states), so you are not likely to run across it very often, at least not yet. The training of LPCCs is very similar to that of MFTs: they hold master’s level degrees in counseling psychology and work with primarily with individuals in private practice. They also have special training in working with career issues. One difference between LPCCs and MFTs is that LPCCs must complete additional training in order to work with couples and families, as LPCC training focuses on working only with individual adults and children.

Social workers (LCSW) have a master’s degree in social work. They are trained to work with people who are in need of assistance from the community. While many social workers are in private practice or work in a setting where they may see clients for psychotherapy, they are more likely to be employed by agencies where they do child welfare assessments, assist people with getting help from social service agencies, or otherwise connect people with resources. Many social workers do not practice psychotherapy at all and, instead, are in leadership roles in community and mental health service agencies.

Psychologists hold doctoral level degrees that are designated by the initials Ph.D. or Psy.D. following their name. A Ph.D. usually indicates training that focused primarily on research, while a Psy.D. indicates training that focused primarily on clinical practice. Both Ph.D.’s and Psy.D.’s have extensive experience with psychological testing. Psychologists work in a variety of settings, including private practice, hospitals, and agencies. While some psychologists choose to focus on testing, many practice psychotherapy.

In California, psychotherapists are required to be licensed to practice. A psychotherapist in training who is working on qualifying for licensure must work under the supervision of a licensed psychotherapist and must disclose this information to you prior to beginning therapy. Pre-licensed psychotherapists are called trainees, interns, associates, or assistants, depending on which license they are seeking and where they are in the licensing process.

Wait, there’s more!

Many therapists have considerable post-licensure training that allows them to include additional credentials after their names. Analysts are licensed therapists who have spent an additional four or more years studying psychoanalytic theory, usually focused on the unconscious. Therapists may say that they have a “psychoanalytic approach,” even if they do not have full training in psychoanalysis. This means that they have an interest and background in psychoanalytic thought, which may be helpful to you if, for example, you are interested in understanding some of the underlying motivations to your thoughts, feelings, and behaviors.

In Part 2 of this series, I will talk more about how to choose a therapist. Keep in mind that no matter what license a therapist holds or what their theoretical orientation may be, there is nothing more important than how you feel when you sit down to talk. Often, people seeking therapy are doing so during a difficult time in their lives, but taking the time to make sure you are working with the right person can make all the difference in getting the help you are seeking.

(Editors note:  Click here for Part 2 ; Part 3 (still to come))

Marla Cass

Marla Cass

Marla Cass, LMFT, is in private practice in downtown San Francisco where she works with individual adults and couples. Her interactive approach is informed by relational, neuropsychological, attachment, and depth perspectives. She is also a group supervisor, and leads groups for students and post-graduate interns who are in training to become psychotherapists.

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