Client Beware: Protecting Yourself from Un(der)qualified “Therapists”

By Chris Sorrentino, MS, LPC, NCC

Chris Sorrentino is a combat and disabled veteran, retired military officer, and licensed professional counselor with over 30 years of experience and education in clinical psychology and cognitive-behavioral therapy.  Chris was an Assistant Professor of Behavioral Sciences and Leadership and Counselor at the United States Air Force Academy from 1988 to 1993.  He is the author of the future New York Times Best Seller Get Off Your Buts And Live A Value-Driven Life ... That's A Freakin' Order".

Many people seek the expertise and advice of “professionals”, paying top-dollar for, what they believe, is psychotherapy.  I have been a licensed psychotherapist (licensed professional counselor, or LPC, actually) for 20 years, having seen literally hundreds of clients, but very few ever asked me about my qualifications.  Of course, I am obligated, morally, legally, and ethically, to inform my clients about my education, experience, licenses, and approach to treatment (legally known as “informed consent”), and do so consistently.  However, there are multitudes of individuals and groups out there advertizing themselves as “therapists”, “life coaches”, “healers”, and other creative titles, hoping the public (you) will believe that they are qualified to help you with your psychological baggage.  Client beware!

This is the first in a series of articles I will write that will take some of the mystique away from psychotherapy.  Many people understand therapy based on what they have seen in movies, on HBO, in books, and on TV (e.g. Dr. Phil) and have no idea of what goes on behind closed doors.  My goal is to help you understand what psychotherapy is and is not, so you can make an informed decision about whom you can trust with your deepest, darkest secrets and pay hundreds, if not thousands, of dollars to in the process. The purpose of this first article is to inform you about who is qualified to provide psychotherapy and who (in my opinion) is not.

At the most basic level, there are specific requirements in each state for practicing psychotherapy and therapists are regulated by the state in which they practice.  There is a governing body for each specialty (e.g. LPCs, social workers, psychologists, psychiatrists) which specifies the requirements to practice in that state and we (therapists) are required to meet those requirements prior to seeing a single client.  For example, an LPC (like myself) in the State of Missouri is required to hold a master’s degree from an accredited institution with an emphasis in ten core areas (counseling theory, human development, diversity, testing, etc.) completing a supervised practicum and internship as well as 3,000 hours (over a two year period) of supervision under a qualified, licensed clinician (therapist).  Additionally, an LPC must take and pass the National Counselor Examination, an extremely difficult, comprehensive, nationwide exam in addition to passing a background check (to make sure we are not murderers, child molesters, or rapists).  Only then, if the board sees fit, do you receive a license to provide psychotherapy in the state.  Most states have similar requirements for each profession, but some variation exists from state to state.  You can check the requirements for each profession in your state by going to your state’s website.  In the case of Missouri, the Missouri Division of Professional Registration oversees licensure for all of the psychotherapy professions and you can find the requirements for yourself by visiting  http://pr.mo.gov/default.asp.  This brings me to my next topic, the professions.

Titles vary slightly from state to state, so I will focus on Missouri guidelines to simplify the discussion.  Again, you can check with your state’s regulatory body for the specifics of the state in which you reside.  In  Missouri, individuals qualified and licensed to provide psychotherapy are called licensed professional counselors (LPC), licensed clinical social workers (LCSW), psychologists, or psychiatrists.  Let me explain briefly the differences between them.  LPCs and LCSWs are master’s-level (normally, a two-year post-baccalaureate degree) clinicians having completed their graduate degree in the field of study in which they are getting licensed from an accredited institution (not a diploma mill), completed supervised practicum, internship, and clinical supervision (3,000 hours – 24 months), successfully passed the required national or state exam(s), not be a felon (remember the background check? – this will be important later), and be approved by the state board governing their specialty.  Finally, we are all professionally and ethically required, above all else, to “do no harm” and to protect your confidentiality.

So what is the difference between an LPC or LCSW and a psychologist?  I am glad you asked!  A psychologist goes through an almost identical, if not more rigorous, qualification process, with the difference being that they have completed a doctoral program instead of a master’s, normally consisting of three to four years of post-baccalaureate education in a School of Psychology (PhD), School of Education (EdD), or Professional School (PsyD).  Doctoral-level clinicians, beside the additional 1-2 years of school, have more course work and experience in research design and psychological testing than master’s level clinicians do.

Many people get psychologists and psychiatrists confused and I often get the question, what is the difference?  In a nutshell, psychiatrists are physicians (medical doctors – MD) who have completed a three to four year specialization in psychiatry whereas a psychologist calls him/herself “doctor” (because they have a “doctorate” degree), but cannot prescribe medicine.  Psychiatrists are an excellent choice if you believe you need medicine (anti-depressants, mood stabilizers, anti-psychotics, etc.), but, in many cases (and in my experience) have limited “clinical” expertise (think “talk therapy” like CBT) because they were trained using the “medical model” and believe drugs are the answer to most problems (more about that in a minute).

It really does not matter whom you choose (LPC, LCSW, psychologist, psychiatrist) as long as you can verify that they are licensed to practice in your state and you believe they can help you based on their individual training and expertise.  Fees obviously vary with LPCs, LCSWs being the least expensive in general, and psychiatrists being the most expensive.  All things being equal, the most important things to consider are: does the clinician’s approach make sense; is their approach compatible with your beliefs and values; and do you think you can get along with the person (can they be trusted)?

You might ask yourself, what is the difference between being licensed (e.g. licensed professional counselor) and being certified (e.g. NCC – National Certified Counselor)?  Licensure is a legal requirement mandated by the state.  Certification is a process in which a governing body (sometimes a state, county, or city and sometimes a private organization) develops requirements to give additional oversight and credibility to an individual or profession.  For example, I am required by the State of Missouri to be licensed (LPC) in order to provide psychotherapy to clients, but I have chosen to seek additional certification (NCC) through the National Board of Certified Counselors (aka NBCC - which, by the way, requires an additional 100 hours of continuing education every five years).  Each certifying body has their own requirements and processes, some very stringent (like NBCC) and others not so stringent, as I will highlight for you now.

As I mentioned in the opening paragraph, there are many people, some well-meaning, some not, who call themselves therapists or something similar, making you believe they are qualified to help you with your psychological problems.  Client beware!  These individuals go by titles such as “life coach”, “intuitive life coach”, “energy healer”, “psychic healer”, “hypnotist”, “spiritual counselor”...the list goes on and on.  There are individuals hosting radio shows and writing magazine columns, giving relationship and other advice to strangers with their only qualification being having been married for five years.  Another example are “certified” life coaches or spiritual counselors, who take as few as two or three courses (and pay a few thousand dollars) or complete as few as 16 hours of training, sometimes even less!  Some of these titles may sound impressive (what exactly is an “intuitive” life coach anyway?) and lead you to believe the individual has received the training to help you, but there is no state licensing body overseeing their “practice”, no stringent internship or supervision requirement (think 16 hours versus 3,000 hours), no continuing education requirement, and (remember what I said earlier?) NO BACKGROUND CHECK!  Many of these individuals may have good intentions, please do not get me wrong, but do you really want to pay someone with 16 hours of training hundreds or even thousands of dollars, confiding in them and sharing your deepest feelings and concerns?  I know that I do not.

There are some properly trained professionals (LPCs, LCSWs, psychologists, etc.) who may use titles such as those described above (e.g. hypnotist), the key difference being that these individuals have attained licensure in their state, completing the rigorous requirements defined by law (think LPCs, LCSWs, etc.).  So, when you decide you want help sorting out your problems, do not let titles and fancy names fool you and make sure you ask many questions, do a little research, and ensure you hire someone qualified to give you the help you so richly deserve.  Even among professionally licensed clinicians, there are good ones and bad ones, so make sure you understand the process, ask the right questions, and ensure you are getting what you are paying for, sound, professional assistance in helping you manage your life.  Notice I did not say anything about “advice”, because if they are giving you advice, even a licensed professional, turn and run as fast as you can.  More about that in a future article.

C.T. Sorrentino is currently writing a series of articles entitled You Think, You Are.  These articles take readers through ten steps toward better mental health, incorporating Kansas City Cognitive-Behavioral Therapy's proprietary, holistic, cognitive-behavioral approach to the treatment of anxiety and depression: Body-Mind-Behavior Therapy (BMBT).  These articles will also serve as the building blocks for his new book, also entitled Get Off Your Buts And Live A Value-Driven Life ... That's A Freakin' Order", a book that Chris hopes to publish in 2014.   He plans on writing a series of books focusing on the role of cognition, physiology (e.g. diet, exercise, and sleep), behavior (positive and negative), emotion, and values in maintaining a healthy mind and positive lifestyle.

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