I frequently hear the argument (particularly here in California) that there are no meaningful differences between the mental health professions. Usually that is followed by a question: Why do we even have different licenses?
This argument usually comes from therapists who were trained and supervised primarily by members of other professions. To be sure, one can get licensed as an LMFT in many states without ever having been supervised by an LMFT. However, I would argue that being supervised outside of one’s own profession is not ideal preparation for one to really become a member of their profession. While there are certainly exceptions, LMFTs typically do not know how social workers are trained (and vice versa), what texts they read, and how they are brought into the social work field. The same could be said for any other cross-disciplinary understanding. While the masters-level mental health professions often perform similar work functions, they do so from very different underlying philosophies. As a result of those different philosophies, each of the masters-level mental health professions has a distinct history, skill set, and body of knowledge.
To understand the differences succinctly, let’s start from a problem. Let’s say that Stephen is a 38-year-old Latino man who is married and works in a bookstore. He comes to therapy with severe anxiety. The different mental health professions will likely start from very different places as they seek to answer the question, “Why is Stephen struggling with anxiety?” The answers below are traditional and purist ones, but they remain at the foundations of each profession today, impacting how the professionals are trained and the skill sets they learn.
Although this post does not focus on Psychologists, understanding their perspective can be helpful. A traditional Psychologist would examine Stephen’s inner world to find the root of his dysfunction. Whether looking to his childhood (as a Freudian would) or looking to his present (as a behaviorist would), the focus will be on Stephen as an individual. Furthermore, traditional psychology would focus on pathology – rooting out what is wrong with Stephen individually.
Professional Clinical Counseling
The professional counseling field emerged from school and career counseling. As such, LPCs (or, as they're known in California, LPCCs -- the extra "C" is for "Clinical," to denote that theirs is specifically a mental health license) are likely to see Stephen’s struggle as an individual, developmental issue. They may wonder whether his profession is the right set for his skills (following in the tradition of career counselors) and his current level of personal and professional development. Treatment will focus on helping Stephen adapt to that lack of fit.
Clinical Social Work
Clinical social workers place their focus on connecting people with the resources they need to function well. Those resources may be internal (such as personal skills and strengths, some of which Stephen may not be utilizing to their potential) or external (such as community resources and support groups). Traditionally speaking, LCSWs are likely to see Stephen’s struggle as a resource issue, and will work with Stephen to gather the internal and external resources needed for him to control and ultimately overcome his anxiety.
Marriage and Family Therapy
Marriage and family therapists look at behavior as adaptive to its social and relational context. Perhaps Stephen’s anxiety has emerged as a result of tension in his work or in his relationship. Perhaps his anxiety is even adaptive when considered in its context – for example, if he receives more support from his boss or from his partner when showing outward signs of anxiety. Ultimately, MFTs believe that no behavior exists in a social vacuum, and will work with Stephen – as well as other family members and other important people in Stephen’s life, if appropriate – to make the anxiety no longer necessary.
As you can see, none of these philosophies is any better or worse than the others, they’re just different. That matters a great deal as new professionals are being trained and socialized into their respective professions. Of course, the perspectives above are purist ones, and even looking at things from that purist perspective, there is significant overlap between these philosophies for dealing with many problems. If Stephen’s anxiety emerges primarily at his workplace, for example, LMFTs and LPCCs may treat it very similarly.
Each of these fields has also been influenced by the others. Using Psychologists as an example, there are now Community Psychologists (who share a great deal in common with LCSWs in their approach), Family Psychologists (who share a great deal in common with LMFTs), and Counseling Psychologists (who share a great deal in common with LPCCs). The professions all benefit from this cross-pollination, which helps us communicate with one another effectively and assess clients more thoroughly. But, using LMFTs as an example, one only needs examine the core competencies for LMFTs to see where the overlap ends; even just reading through the list of skills all LMFTs are expected to be able to do, they can be broken down roughly equally into three categories:
1. Tasks that all mental health professionals should be able to do, and that all would do about the same way (for example, suicide assessment).
2. Tasks that all mental health professionals should be able to do, but LMFTs would do from a different conceptual framework (for example, general mental health assessment; MFTs would approach this from a relational mindset).
3. Tasks that LMFTs should be able to do that other mental health professionals would not necessarily be expected to do (for example, a systemic case conceptualization).
My intention here is not to argue that LMFTs have superiority or greater job functions than the other professions; we aren't superior, and job functions vary by workplace and by state scope of practice. I’m just using LMFTs as an example. A list of core competencies for LCSWs or for LPCCs could surely be broken down into similar proportions. The point is, while we all do many of the same things, it is incorrect -- and quite a disservice to the professions -- to suggest we are all the same.
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From Basics of California Law for LMFTs, LPCCs, and LCSWs, Copyright 2013 © Benjamin E. Caldwell. Reprinted here by permission, which, yes, I gave to myself. Comments are welcome in the comments section below, by email to ben [at] bencaldwell [dot] com, or to my Twitter feed.