Wading through all the available information to find support for your mental health concerns can be overwhelming. This is the second in a 2-part blog series on the topic of choosing the right mental health provider for you. You can read Part 1 here – head on over, I’ll wait.
As I mentioned in the previous post, I have consulted with others who have various roles within mental healthcare. I appreciate the assistance of those who contributed to the information I share, and have linked to their sites where information was provided. Please consider checking out any of these contributors if the description of their training and/or services sounds like a good fit for you. Also, just a reminder that I am writing from the perspective of a licensed professional who is located in North Carolina, USA. Some of the these that are included in this post may not apply outside of the USA, as laws and ethics can vary from country to country.
Providers of Talk Therapy and Beyond…
Counselor (LPC, LPCC, LCMHC)
Licensed Clinical Mental Health Counselors (LCMHC in NC) are also known as Licensed Professional Counselors (LPC) or Licensed Professional Clinical Counselors (LPCC) in various other states. This is the professional license that I hold, and therefore, the one I have the most first-hand knowledge about.
The education required for this license includes a bachelor’s degree and then a master’s degree in mental health counseling. This graduate degree may be an MS (master of science) or MA (master of arts) depending on the specific school one attends. But all mental health counseling programs are required to include certain courses in order to fulfill standards for someone to become licensed in NC. Some of those courses include counseling ethics, helping skills, group therapy, lifespan development, and diagnosis. Graduate studies also include internships, where a counselor-in-training provides counseling services under supervision of both a licensed professional at the site where the student is interning, as well as a licensed professional associated with their graduate program.
After graduation, a counselor candidate then applies for an associate license (read more about this in Part 1) from the state licensing board. Securing this license depends on passing a national exam related to the practice of counseling. The associate counselor is then required to complete 3000 hours of supervised counseling practice, which generally takes about 2 years if they are working full-time as a counselor. This means they are regularly meeting with a qualified supervisor who has years of experience in counseling, as well as additional training, to ensure the associate counselor is providing ethical and appropriate services.
When those hours of supervision are complete, a counselor can apply for independent licensure. This means they can practice without regular supervision. However, they must complete a set number of hours of continuing education annually and renew their license every other year.
One of the licensed counselors I spoke with described their work in the following way: “Focus solely on helping clients with their personal growth. Little testing or assessments [and] more of being with the client in the moment and helping them work through issues and find solutions to better their lives.”
Counselors are often trained more intensely in being present with a client and focusing on personal growth/change than some other types of providers. Many counselors are now also focusing at least a portion of their work on understanding the impact of societal systems and implementing social justice work.
At this time, the work of counselors is limited by licensure laws that require a counselor to hold a professional license in the state in which they practice (i.e. where they provide counseling services to people). This can be restrictive with the growing popularity of telehealth and the increase in folks who relocate throughout life. There is legislation in the works – The Counseling Compact – to make it more accessible for counselors to practice across state lines and for clients to continue working with their counselor when they relocate. However, the earliest this would begin to take effect is 2024.
Social Worker (LCSW)
Social Workers are one of the more well-known types of providers within mental health. You may come across one of the various types of Social Workers in various settings, ranging from hospitals to child protective services to your local school. The NC Social Work Board’s website states that there are “three voluntary certifications for non-clinical social work practice (CSW, CMSW, CSWM), and one license (LCSW, LCSW-A) which is required for clinical social work practice in the state of North Carolina.”
The work of Licensed Clinical Social Workers (LCSWs) frequently looks similar to that of counselors, especially for those who provide therapy in a private practice setting. Based on the information on the NC Social Work Board’s website, the requirements to become an LCSW are also similar to that of an LCMHC. This includes completion of at least a master’s degree is social work, a minimum of 3,000 hours of supervised experience, and passing a national exam. LSCWs are also required to complete continuing education each year, and to renew their license every other year.
Social Work programs have historically included courses focused on systemic factors and how to assist folks from a wider perspective.
Marriage & Family Therapist (LMFT)
Licensed Marriage and Family Therapists (LMFTs) generally have additional training and focus on couple and/or family dynamics. They will address the needs and challenges within the systems. “MFT’s take a systems perspective, seeing clients’ presenting problems as symptoms of issues in their families of origin and/or present-day relational systems,” said Deborah Klinger, LMFT, CEDS-S, who is located in Durham, NC.
Hawanya B. Miller, LMFT, who is located in NC and holds a license in multiple states, said the following about her work: “As a LMFT, my training and philosophy of change is that the client is empowered to be the expert, partnering with individuals, couples and families to join them in their change process, and that their identity is not a problem but a strength and asset. LMFTs also excel at discussing and identifying systems that influence and/hinder change for clients and work the client to address their needs and challenges with systems.”
The LMFTs to whom I spoke indicated that requirements for a license in NC included a 2-year graduate program, 1000 hours of supervised clinical practice, and passing a national exam.
Licensed Clinical Addiction Specialist (LCAS)
There are a variety of professionals who focus at least a portion of their work on supporting those struggling with addiction. Licensed Clinical Addiction Specialists (LCAS) often hold a master’s degree and professional license in general mental health in addition to their LCAS credential. Additional training in and supervised clinical work related to substance use disorders is required to qualify for this credential.
Psychologist (PsyD, PhD, LPA)
Many folks think of a psychologist when they think of various types of testing for learning differences and/or things like ADHD (attention deficit hyperactivity disorder) or ASD (Autism Spectrum Disorder). Yet there are a variety of types of psychologists, having different educational requirements and focuses in their work.
Christopher Weintrob, PhD, a psychologist in the Triangle area of NC, commented the following about his work: “My role includes psychological testing and evaluation in addition to psychotherapy, and with that, a greater emphasis on thorough diagnosis.” He indicated that the requirements for his credentials included 5 years of graduate school, passing a national exam and state exam, and 2 years of practicum (practicing skills while under supervision).
Brittany Bate, PhD (she/her) described her preparation to include 6 years of graduate school, including 4 years of clinical experiences. She also completed an additional year of supervised practice after graduation from her PhD program, and was required to pass both a national and state licensing exam.
Brittany’s focus is a bit different than what Christopher described. She had this to say about her role as a psychologist: “I am a forensically trained licensed psychologist and consider every case and, especially, informed consent and documentation through the lens of “how would the client feel if I had to read this aloud in court.” Any client can find themselves in court, and their therapy notes possibly could make their way there too.” Additionally, Brittany is a PSYPACT provider and is able to serve clients in over 30 states and jurisdictions based on this credential.
Another type of credential that a psychologist may have is as an LPA (Licensed Psychological Associate). Amber Margaretten, MA, LPA, HSP-PA helped me understand some of the roles of an LPA. As an LPA, “You can provide psychological assessments that other license types cannot provide. These can assist in court cases, diagnostic clarification, pre-surgical requirements, medication management, and more. I’m also indefinitely supervised which is unique and unfortunate.” Some of these services can be provided by all psychologists; however, the ongoing supervision aspect is unique to LPAs.
Amber spoke more on the topic of ongoing supervision when she described the requirements to become an LPA. Those requirements include a master’s degree in clinical psychology (only in-person programs accepted in NC at this time), passing both the state and national licensing exams, and receiving ongoing supervision throughout your career.
Amber also provided some additional information regarding those trained as psychologists. She informed me that a PsyD program is typically 4-6 years long, including a year-long internship, and this type of doctorate generally has a greater focus on clinical work than on research.
Registered Dietician (RD)
In my experience, dieticians are frequently overlooked as mental healthcare providers. Yet, they work with some of the most high-risk mental health concerns in the form of eating disorders.
Christy Maloney, RD, LDN, CEDS-C, CPT said, “My role as a dietitian has me uniquely qualified to understand the nutrition status of individuals. While I am able to understand the psychology of eating (as I do have a degree in psychology, although this is not a requirement as an RD), I am able to fairly quickly assess if someone is eating adequately, appropriately for any disease state, and determine if they have a strained relationship with food.”
What was required for Christy to be qualified to work as an RD? She had to complete a bachelor’s degree in nutrition, a 1200-hour supervised internship, and pass the RD exam.
The support of a dietitian can be helpful on its own, or in coordination with other providers of mental and physical healthcare.
Psychiatric Care
Those who provide psychiatric care include Psychiatrists, Psychiatric Physician Associates (PAs), and Psychiatric Nurse Practitioners (NPs). These folks have education and training in addressing mental health from a medical perspective. These are the providers who are able to prescribe medications to address mental health concerns.
Lydia Ramos, MMS, PA-C, Psych CAQ provided some insight into her preparation and training to become a Psychiatric Physician Associate. This included 2,000 hours of direct patient contact, passing the GRE (exam for grad school), and completing prerequisites for PA school. “Then a 2-3 year graduate degree to obtain a Master’s of PA studies while passing a licensing exam after graduation to become a licensed PA. For a PA to obtain a Psych CAQ, it requires 2,080 hours of experience practicing in psychiatry, passing a Psychiatry CAQ exam and having a supervising psychiatrist attest to the quality of care provided to patients.” She explained that, “PAs, like MDs/DOs, receive a general medical model of education – meaning that they learn in their schooling about ALL the major bodily systems and have to rotate clinically through many different core fields of medicine in addition to choosing specialties.”
Lydia described her role by saying, “Psychiatric PAs, like MDs/DOs and Psychiatric NPs, can diagnose psychiatric conditions and prescribe medication, in addition to providing brief supportive psychotherapy. MDs/DOs in psychiatry (Psychiatrists) receive the most extensive training. However, once a PA has been practicing for about 3-4 years, they typically have the same knowledge base as Psychiatrists except Psychiatrists receive a little more training in psychotherapy.”
Lydia also helped clarify some of the differences and similarities between PAs and NPs. “Psychiatric NPs DO NOT receive the general medical model of education, but rather follow the nursing model of education and have training more limited specifically to their field of interest. NPs can only be certified to practice in 3 different fields – Family Medicine, Psychiatry and OBGYN.
Within psychiatry though NPs receive more training than the typical PA – but PAs can also choose to do post-graduation residencies/fellowships or will most undoubtedly gain lots of knowledge just by practicing within Psychiatry.”
Lydia continued, “Practically, NPs and PAs are very similar and have similar training and knowledge. In most states, NPs and PAs have to have a supervising psychiatrist in Psychiatry, though there are increasingly states granting autonomy to NPs and PAs who have a certain number of years of experience in their field.”
Next Steps…
This post presented a lot of information to help you understand the various types of providers who may offer mental healthcare services. You may need some time to let it all sink in. You can even bookmark this post and come back to it later.
When you’re ready to connect with a provider, here are some helpful questions to consider:
Am I seeking therapy, testing, or medication?
The answer to this question can help you narrow down what type of provider you may want to look into first. For therapy, you’ll likely look toward an LCMHC / LPC, LCSW, LMFT, and possibly a psychologist. For testing, a psychologist is likely going to be the person you need. For medication, you will want to connect with a Psychiatrist, Psychiatric Physician Associate, or Psychiatric Nurse Practitioner. Note that some general practitioners will prescribe certain mental health meds, but you may find it most helpful to work with a provider who specializes in mental health. If you have concerns related to eating and/or nutrition, you may seek out an RD first to discuss your concerns.
How can I find a local provider?
One of the top ways to find a provider now is an online search. There are large, online directories for providers – Mental Health Match, Psychology Today. There are also directories with a specific focus – Open Path Collective for lower cost services, Reclamation Collective for therapists specializing in religious trauma, Inclusive Therapist Directory for therapists who have and/or are committed to working with those with marginalized identities.
You can also do an internet search for “therapists near me” and check out the results. Let’s say you are specifically looking for someone to help you with your anxiety. You can search “anxiety therapists near me” and check out those results.
What’s the most important thing to consider?
Studies have shown that the relationship between you and your provider is the most important factor in determining the effectiveness of mental health therapy. Look for a provider that you connect with. You should feel heard and supported (also possibly challenged, but in a supportive way) in a beneficial therapeutic relationship.
You can get a feel for the provider via their website or bio in a directory. But it’s also important to notice how you feel when interacting with them. Some providers offer free consultations prior to scheduling, which can be a great time to get a feel for what it might be like to work with them.
So, remember, while education, training, and credentials are important, the connection you feel with your healthcare provider is also an integral part of healing.
A Note for Providers…
If you are a mental healthcare provider and either notice an incorrect statement about your credential/licensure or are able to provide some insight into one of the provider types for which I was unable to connect with someone previously, please contact me. I’d love to ensure a variety of providers are included in this post, and that the presented information is accurate.
Thank you once again to all those who provided information and insight regarding your own credential/license to help make this post possible.
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