What's the Difference Between Counselors and Therapists?

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Some people differentiate “counseling” from “therapy" and "counselor" from "therapist." I have found no clear differentiation in state law, the language of credentialing regulation, or the definitions provided by major national accrediting bodies. In my state (Washington) and in most states, 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” (e.g. RCW 18.320), “psychologist,” and related titles and terms are protected by state law in many states (e.g. RCW 18.83.020).

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 (e.g. LICSW, LCSW, LPC, LCPC, LMHC, LMFT). Accrediting entities include CACREP, COAMFTE, and the APA. Organizations providing guidance for standards of professional practice include the APA, as well as NBCC, NASW, AAMFT, and AMHCA.

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

In House Bill 2674, Washington state’s 2008 credentialing law which significantly restructured mental health professional credentialing, “psychotherapist” and “psychotherapy” were more clearly defined, but the kind of regulatory accountability provided 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? No need to imagine: There it is.

HB 2674 was supported by the implementation of new credentialing regulation in 2009; it also resulted 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 have not been translated into regulation or 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 as much as it was in the era of the state’s “Registered Counselor” credential, which created much of the mess that led to the success of HB 2674).

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.

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"Counseling” and “counselor” are terms used by many non-degreed and bachelors level practitioners. Yet the clinical scope of those credentialed as LPCs (licensed professional counselors), LMHCs (licensed mental health counselors), and LCPCs (licensed clinical professional counselors) is the same as other masters prepared clinicians who prefer the terms “therapy” and “therapist” (such as LMFTs, or licensed marriage and family therapists). So while I think it’s fair to say that 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 "counselors" as less qualified or as providing a less specialized treatment than, for instance, LMFTs. Apples to apples?

Many bachelor's- and associate-level, and in some cases even non-degreed, substance-use disorder treatment providers use an approach called Moral Reconation Therapy. Clearly, calling a treatment service “psychotherapy” or “therapy” versus “counseling” has less to do with the methodology used or, in most cases, the diagnoses rendered and more with permissions related to an as-yet-insufficiently defined scope of practice.

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. Still, some are adamant that “therapy” is the realm of clinicians with a master’s-level education or higher, while “counseling” is the realm of clinicians with a bachelor’s or less.

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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—one must also meet the state’s legal definition of "mental health professional" (WAC 246-341-0200). 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.”

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If you have any questions about a practitioner’s level of education, credentials, or experience, ask them. Especially 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.