What Is the Difference Between Counseling and Therapy?

Therapist talking with couple and taking notesSome people differentiate “counseling” from “therapy.” I have practiced in Washington and Texas and have found no clear differentiation in state law, the language of credentialing regulation, or the definitions provided by major national accrediting bodies for the respective professional licenses.

I am currently in Washington state, so I speak from a perspective within these borders. Here, there is no legal protection for the use of the terms “counselor”/”counseling” or “therapist”/”therapy” in and of themselves. Meanwhile, terms such as “social work”/”social worker” (see RCW 18.320), “psychologist,” and related titles and terms are protected by law (see RCW 18.83.020). Because of this, no explicit distinction has been made in law or regulation, that I am aware of, distinguishing “counseling” or “therapy.”

Rather, the scope of practice for particular credentials is deferred by states to the national bodies that accredit graduate counseling programs and provide guidance for standards of professional practice for mental health professionals with specific credentials (LCSW, LPC, LMHC, LMFT, LCPC, etc.). Examples of these accrediting entities include CACREP, COAMFTE, and the APA. Examples of organizations providing guidance for standards of professional practice include NBCC, NASW, AAMFT, AMHCA, and, again, the APA.

Beyond that, states treat these varying master’s-level clinical practitioners with legal parity, or equivalence, in scope of practice and legal protection.

In Washington state’s new credentialing law, passed in 2008 and rolled out in 2009, “psychotherapist” and “psychotherapy” were more clearly defined, but let’s be clear that the kind of regulatory accountability provided by these defined uses in the law does not apply to the terms “therapy” or “therapists.” I should note that the law also restricts the use of the term “private practice counseling” to sole use by two new categories of unlicensed providers, certified advisors (CA) and certified counselors (CC) (see RCW 18.19.020 and WAC 246-810-010). Can you imagine a law reserving such a term for unlicensed practitioners and placing licensed practitioners in legal limbo for using it?

Further, that 2009 law in and of itself did not explicitly regulate beyond providing new credentialing categories. It did result in executive recommendations in 2011 for scopes of practice, disclosure statements to be provided to people receiving services, and continuing education standards, but these recommendations still have not been translated into regulation (or even a great deal of clarity).

For instance, agency-affiliated counselors (AAC) are credentialed to provide counseling (see RCW 18.19, WAC 246-810), but Washington State Department of Health regulation does not require any academic degree as a minimum educational requirement for this particular credential, so the term “counseling” remains loosely defined and diluted (though not nearly as much as it was in the era of the state’s “registered counselor” credential).

And, whereas some regulatory bodies and insurance companies associate “counseling” with such services as skill-building, coaching, and varying forms of behavioral modification, all I have seen in the language of regulatory code and most insurance coding language are terms such as “skills training,” “psychoeducation,” “rehabilitation,” and the like, and a steering clear of the word “counseling” by itself whenever possible, due to its multitude of uses rendering it nearly descriptively meaningless.

One might think it best, then, to limit the words “counseling” and “counselor” to referring to non-degreed or bachelor’s-level mental health practitioners. Keep in mind, though, that the nature and scope of clinical practice for those credentialed as LPCs (licensed professional counselors), LMHCs (licensed mental health counselors), and LCPCs (licensed clinical professional counselors) has legal parity with master’s-level professions that prefer the terms “therapy” and “therapist” (such as LMFTs, or licensed marriage and family therapists). So while I think it’s fair to say the use of the term “therapy” is more limited, I’d bet LPC, LMHC, and LCPC boards would contend it is unfair to elevate it to a higher educational or professional plane in usage, which may result in viewing such clinicians as less qualified or as providing a less specialized treatment service than, for instance, LMFTs.

While it’s true that there are not, similarly, examples of bachelor’s-level clinicians who are credentialed under the terms “therapy” or “therapist,” it seems to me the terms are used so interchangeably as to be nearly synonymous from a regulatory perspective. Ultimately, I think calling a treatment service “psychotherapy” or “therapy” versus “counseling” has less to do with the methodology used or, in most cases, diagnoses rendered and more to do with permissions related to an as-yet-insufficiently defined scope of practice.

The terms “therapist” and “counselor” are often used interchangeably but are also sometimes used to highlight level of education or credentialing. A credentialed therapist may have had more extensive training and be more broadly credentialed. A counselor may not be credentialed, and may have a bachelor’s degree but no master’s. Of course, a counselor may indeed have a graduate degree and independent license yet simply prefer the words “counselor” and “counseling” to “therapist” and “therapy.”

For these reasons, I do not think there is a necessary distinction between “counseling” and “therapy” unless clear direction is provided for their usage by a local governing entity or other regulatory body that makes it so. Still, some are adamant that “therapy” is the realm of clinicians with a master’s-level education and above, while “counseling” is the realm of clinicians with a bachelor’s or below.

In many places, authorization to diagnose sets apart master’s- and doctoral-level clinicians from bachelor’s-level clinicians, although within the community mental health system in Washington, a master’s degree alone is insufficient for diagnosis. According to Washington state’s Access to Care Standards (2015) for Medicaid enrollees, one must also meet the state’s legal definition of MHP, or mental health professional (WAC 388-865-0150). Nearly every linguistic distinction and practice limitation has been forged into regulation in order to provide consumer protections requiring that practitioners practice reasonably within their scope of education and training.

The terms “therapist” and “counselor” are often used interchangeably but are also sometimes used to highlight level of education or credentialing. A credentialed therapist may have had more extensive training and be more broadly credentialed. A counselor may not be credentialed, and may have a bachelor’s degree but no master’s. Of course, a counselor may indeed have a graduate degree and independent license yet simply prefer the words “counselor” and “counseling” to “therapist” and “therapy.”

If you have any questions about a practitioner’s level of education, credentials, or experience, ask them. When I was in private practice, I periodically received phone calls to consult about the nature of the services I provided as well as to inquire about my background and qualifications. I was grateful for these opportunities to provide people with helpful information ensuring that if they did choose to see me, for counseling or for therapy, they would do so with eyes wide open.

A few questions: Do you differentiate between “counseling” and “therapy”? Does your state? Especially if you’re a master’s-level practitioner, do you value one term over the other? Please share your thoughts below.

References:

  1. Revised Code of Washington 18.19.
  2. Revised Code of Washington 18.83.
  3. Revised Code of Washington 18.320.
  4. Second Substitute House Bill 2674, 2008. 60th Legislature, State of Washington.
  5. State of Washington (January 2015, revised September 2015). State of Washington access to care standards for regional support networks/behavioral health organizations.
  6. Washington Administrative Code 246-810.
  7. Washington Administrative Code 388-865.

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  • Peg

    Peg

    April 2nd, 2016 at 11:41 AM

    Does it really matter what label you wear as long as you know that what you are doing helps other people?

  • Judy C.

    Judy C.

    April 3rd, 2016 at 10:01 AM

    The word “counselor” is protected in the State of Georgia but not enforced.

  • buck

    buck

    April 4th, 2016 at 8:39 AM

    I would assume that in many cases it is going to be more about what the provider and the client (?) feel comfortable with, and not necessarily the terminology that is used by the state.

  • JaCoB

    JaCoB

    April 4th, 2016 at 4:00 PM

    If something that I am doing is helping me then frankly I do not care one bit what label one attaches to it. I am sure that most professional people will have their preferences and if I am working with them then I would try to honor whatever label it is that they would prefer that I use. And if they don’t care, then that is cool too.

  • J B

    J B

    April 4th, 2016 at 4:32 PM

    Therapist and counselor are interchangeable. There should be some clear definition between the two not only for the therapists/counselors but also the public in general.

  • Blaise

    Blaise

    April 5th, 2016 at 2:55 PM

    Isn’t it weird how things can be synonymous in certain places and then in others they are not so interchangeable? Or if you get a degree form one university it may be a BA but from somewhere else it could be a BS? It would make things soooo much easier if there was some consistency don’t you think?

  • Deirdre

    Deirdre

    April 6th, 2016 at 3:21 PM

    In New York State, which began licensing in 2004, in order to be called a “Social Worker” you must have an LMSW. Someone with a LMSW can not practice psychotherapy but can practice counseling. I believe psychotherapy is seen as including counseling but not the equivalent to psychotherapy. In order to practice psychotherapy a social worker must put in 2,000 clinical client contact hours under the supervision of a LCSW (clinical social worker)over at least a three year period but not more than six. Following that they are permitted to sit for the clinical licensing exam. LMSWs working toward their clinical license can only work with medicaid insured clients. If they put in another 3 years of clinical work they are given the “R” privilege which means they can work with any insurance company they choose. Eight years in total in order to reach their highest licensure. Many of us think it might be easier getting a Psy.D or Ph.D.

  • ryan P

    ryan P

    April 7th, 2016 at 3:04 PM

    could be important to some people because pay scales could be different depending on the education and the title

  • Sandy

    Sandy

    April 10th, 2016 at 6:05 PM

    Therapist and Counslor are the same. Very few people would argue that. As far as the rest, each one has a different focus while learning and a different job. All try to help but in different ways. A social worker for example has as his or her goal to find and offer local agencies which could help in the long term such as homeless shelters or home health for an elderly patient. Or reporting a child that is possibly being abused. A psychiatrist can prescribe medication for mental health issues. A psychologist uses thereby to try and resolve your issues. CNP can do therapy and prescribe medications because of the specialized education.

  • Alyssa v

    Alyssa v

    May 3rd, 2016 at 1:43 PM

    I didn’t read the article in its entirety so I can’t comment on the legal piece. However, in my culture where Western-defined mental health is still a new concept, counseling exists but not therapy. What that means to me is that folks will seek counseling from elders, which is in the form of advising. They do not see mental health therapy, which to me is “treating a mental health condition through processing, guiding, and educating.”

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