So You Want to Be a Shrink?

Psychologist, psychiatrist, therapist, what's the difference? The mental health field is a maze of career paths and a forest of degrees. Welcome to the guided tour.

By Carl Sherman, published on July 1, 2004 - last reviewed on June 9, 2016

Say the word shrink and Dr. Melfi of The Sopranos may come to mind: a coolly detached professional, listening attentively and occasionally interjecting, "How did that make you feel?" One way to become a practitioner of this sort is to earn a doctorate in clinical psychology. Traditionally, this has meant a Ph.D. (and less commonly, an Ed.D. or doctor of education), but in the last 30 years the Psy.D. (doctor of psychology) has become an increasingly popular route; it now makes up more than half of new clinicians.

The difference? The Ph.D. is an academic degree: You'll get clinical training but you'll also learn more about theory as well as tools like statistics and data gathering. These skills are good preparation for a career in research and teaching as well as in the private practice of psychotherapy. This educational track could also land you in a government agency or even in a corporation. The Psy.D., on the other hand, is focused solely on work with patients, so you'll spend more time studying psychotherapeutic approaches...

With either degree, you can practice therapy with individuals, families or groups on your own, in a hospital or clinic; or with schools, courts or corporations. Psychologists, though, are outnumbered by social workers: The last head count (in 2000) found 77,500 psychologists and 192,800 social workers. According to the National Association of Social Workers, that number is expected to increase some 30 percent by 2010.

Social workers practice therapy on their own or in a variety of settings—schools, clinics, even charities like the United Way. They may help individuals get the medical attention they need, or they may help them navigate the criminal justice system. To enroll in a two-year master's degree program, you don't need to major in psychology or any other particular subject in college.

And then there are psychiatrists. While psychiatrists may also practice psychotherapy, they are of a different stripe altogether. First of all, they are medical doctors (M.D.s) knowledgeable about physical as well as mental health. But many of the 40,700 psychiatrists who work in the U.S. spend the bulk of their time treating mental illness with medication. (Like all physicians, psychiatrists are licensed to prescribe drugs.)

The only other medically trained professionals licensed to do psychotherapy and prescribe medication are psychiatric nurses. These master's degree-level registered nurses (R.N.s) may also work as case managers or consultants, usually in hospitals or clinics.

Increasingly, however, it's the nation's 80,000 counselors who provide a good share of today's mental-health care. To be licensed, you'll need a master's level degree in psychology or counseling. Counselors often treat people in crisis or with problems like drug or alcohol abuse, and usually for short periods.

But in truth, you don't need any training whatsoever to offer services—just call yourself a psychotherapist and "treat" whomever answers your ad. You won't be subject to state regulation, but health insurance won't pay for your work, either.

The same goes for life coaching, one of the fastest growing areas of psychology. Anyone can become a coach (many psychologists cross over for the higher pay). Individuals seek life coaches for guidance in achieving professional or personal goals. No certification or education is necessary, but there are training programs offering the skills you'll need.