Trying to figure out who can best help you with your mental health concerns can be quite the challenge. You may feel like you’re attempting to untangle a web just to begin the process.
There are often multiple letters behind a provider’s name, but what do they all mean? You may look at their website and see the acronyms for 5 different types of therapy listed, but still not be sure how they can help you.
This post is the first in a 2-part series that I hope helps answer some of your questions. I have consulted with others who have various roles in mental healthcare, and have attempted to provide accurate information regarding all aspects covered. If you have personal knowledge about any of the things discussed in these posts, and would like to assist me in updating details, please contact me here. Also, be aware that some of these things may not apply outside of the USA, as laws and ethics can vary from country to country.
Licensed and Not Licensed
LCMHC, LPC, LCSW, LMFT – That “L” at the beginning of all those means the individual holds a professional license to provide services related to mental healthcare. Providers who have a professional license to practice are held to certain ethical standards according to their licensing board. There is an entity above them (i.e. their licensing board) that keeps a check on their practice and provides a place for unethical behavior to be reported. Licensed professionals generally have to meet specific educational requirements, and have passed a licensing exam in order to identified as licensed in their field. Licensing boards also typically have requirements for continuing education to ensure that these professionals are continuing to learn and stay up-to-date on developments in their field.
There are also folks who do not hold a professional license, yet still provide some type of mental health support. This may include coaches, faith-based counselors, and social workers in various roles. It’s important to ensure that these folks are representing their credentials accurately and are not providing services beyond the scope of their training. For example, a coach may have specific training assisting folks in money management, which in turn may decrease their client’s anxiety. However, that coach needs to be clear about their training, their role in assisting with money management, and the fact that they are not treating anxiety. Additionally, some coaches or faith-based counselors also hold professional licenses related to mental healthcare.
Associate / Provisionally Licensed vs. Independently Licensed
Many states in the US differentiate between folks who are licensed, yet continue to be supervised by someone with more experience, and those who are independently licensed. I am most familiar with how this works in NC, as that is where I’m located.
In NC, many professional licenses include an “A” (for “associate”) at the end if the person is in their first 2(ish) years of practice and is regularly meeting with a supervisor who holds a license in the same field. For example, a mental health counselor in NC is initially licensed as an LCMHCA (Licensed Clinical Mental Health Counselor Associate) upon completion of graduate courses, internship hours, passing the national exam, and being accepted as an applicant by the state licensing board.
LCMHCAs are required to have a supervisor (LCMHCS) and to meet with them regularly to discuss their work and get guidance while accruing their first 2000 hours of direct work with clients. For someone working 40 hours per week, this often means at least 1 hour meeting with their supervisor each week, and it generally takes about 2 years to complete the required hours with clients. Then, the person applies to the licensing board with proof of their hours and supervision experience, and becomes an LCMHC – dropping the “A.” A similar process is also true for other mental health providers, so you may see LCSWA or LMFTA behind someone’s name.
Once a provider has completed all the requirements for supervised hours, they are known as being independently licensed. This means they can practice without regular supervision. However, I believe it’s always important for providers to have others in the field who they consult with to get input from another mental health professional. Client confidentiality should always be maintained in these consultations, unless a client has given written consent for a more in-depth discussion.
Interns
You might see marketing that indicates an intern is available to provide counseling for free or at a reduced rate. What does that mean?
I’m going to speak specifically to LCMHC interns because that is where I have experience, but other programs work in a similar way.
Full-time clinical counseling graduate programs generally include 2 years of study beyond the undergraduate level. One of the requirements during the 2nd year of graduate school is that the counselor-in-training have an internship where they are providing services directly to clients. The intern may have to record their sessions or have a supervisor present occasionally. This is to ensure that they are practicing appropriately, and the supervisor is not judging the client(s) in these sessions.
Interns have lots of supervision to help them learn and provide real-time support. They generally have an on-site supervisor – a licensed mental health professional who works at the site where the intern is meeting with clients. They then have a supervisor within their graduate program, who they meet with regularly to review their sessions and receive guidance. They also have access to the professors within their program, who are generally licensed mental health professionals, for additional support. Seeing an intern can be like getting the support of multiple providers at once.
However, interns generally have limits on the types of concerns they can work with based on their stage of training. They also offer time-limited services, as their ability to provide services often ends when their graduate program is complete.
Qualified Professionals (QPs)
Qualified Professionals are individuals who have the minimum of a bachelor’s degree, often in a human services field, and have at least 2 years of experience working with mental health, substance use, or developmental disabilities. QPs are regularly part of treatment teams for folks who need more support than outpatient therapy can supply, but who do not need to be hospitalized. These teams may work with minors or adults, and generally include both licensed professionals and QPs.
Peer Support Specialist
Peer Support Specialists are adults (18+) who have lived experience with mental health or substance use disorders, and are currently in stable recovery. These folks have completed a training program to be certified as Peer Support Specialists. They are available to offer support to those dealing with mental health or substance use concerns who may need a bit of extra encouragement or guidance in their recovery journey. Peer Support Specialists function somewhat like an extra knowledgeable friend.
Some of the ways that a Peer Support Specialist may help include: attending appointments with a client, attending an AA meeting with a client, meeting with a client in the community to help with a job search, sharing portions of their own story to give hope to a client.
Coach
Coaching is a field that is not regulated by any type of boards. Some coaches have completed training and received a certification as a coach, which they will likely list on their website or promotional materials. Some coaches are also licensed mental health professionals or have some other type of credential that is specific to the area of their services. There are also folks who decided to begin a coaching business around a particular topic and, without any additional training, began promoting their services.
A coach may be just the support that you need, depending on your concerns and goals. But it’s important to be aware that there is no overarching regulatory body for coaching and to do your due diligence in learning about any coach you may be considering working with.
Coaches generally work on present issues and help their clients create a different future. This is true regardless of what area(s) they focus on in their coaching. Coaches do not diagnose mental health issues, do not delve into discussions of the past, and should not claim to treat symptoms.
For providers who are both licensed mental health professionals and coaches, their website(s) and promotional materials should make a clear delineation between the 2 types of service. It should be clearly discussed and agreed upon by both parties whether the client is receiving coaching or counseling, and that should remain clear throughout the working relationship.
What’s Next?
I hope this post has provided some information that may be helpful in your search for mental health support. Head on over to the next post in this series, where I share some specifics about the training and focus of various types of mental health providers.
Michelle F. Moseley is a Licensed Mental Health Counselor in NC, and a Registered Telehealth Provider in FL. She believes ALL people deserve respect, compassion, and access to mental and physical healthcare. Michelle specializes in working with survivors of religious trauma and with those who have body image concerns, finding there is frequent overlap in these areas. You can learn more about Michelle by visiting her website at MichelleFMoseley.com or following her on Instagram – @therapy_with_michelle