This is a great question and people ask it all the time. When I was starting out as a therapist I don’t know that I would have had a great answer for some of these things so I want to take some time and talk about this for people who want to know how might be best to work with or who they are working with.
First, I am a Licensed Professional Counselor in the state of Wisconsin, so I will be talking about these things from that perspective and my experience work for years in the field. There may be other abbreviations used in different states and even different roles, another reason why this can be so confusing. But, for the purpose of this I will be speaking about Wisconsin, and my understanding of the various helping professions and their abbreviations.
So when we ask what are the letters after a therapist’s name? There are a lot of places to start. But let’s start with education. Some therapists add this to their credentials so do not. Some of the more medical side of “therapy” psychopharmacological side, people who prescribe medications often have to.
MS, MA, or MEd – This means that the therapist has a Master’s degree in science, arts, or education science. Certain counseling programs have different degrees but this is pretty standard. Sometimes a therapist will indicate their education level often they won’t you need a master’s degree or higher to get a license so it could be not worth the space to have next to their name. However, if this is the only credential present this is someone right of college who has little to know experience as a therapist and is not licensed to practice without very close supervision. If they have NO credential they are an intern still in school in a Masters Program and they are gaining practical experience and also have little to no experience as a therapist. Interns, can practice as therapists under very close supervision from a licensed professional.
BSW or MSW – This is a Bachelor of Social work and a Masters or Social work. These are educational programs. A Bachelor of Social work has a Bachelor’s degree in Social Work and has no to very little training in being a therapist and cannot practice as a therapist unless as an intern during their Master’s Program under very close supervision from a licensed professional. The Master’s in Social work will provide more education around counseling theory, but is also broader typically, covering connecting client’s to services and assessing for services over just counseling theory. An MSW can choose to do therapy as part of their internship and practice as a therapist under very close supervision from a licensed professional.
MSN – APNP -These are educational credentials as well. Masters in Science Nursing and Advanced Practice Nurse Practitioner some others may use words like Psychiatric Nurse Practitioner. These credentials allow the provider to diagnose symptoms and prescribe medications. They are not therapists and have little to no education in counseling theory and little or no experience in providing therapy.
PshyD or PhD – These are doctoral levels of education. They usually mean that an individual is a psychologist although not necessarily. There is a test that needs to be taken to be a licensed psychologist and if that is also not present than they are not a psychologist they only have the education to possibly be one. Psychologists can do therapy and should have quite a bit of experience with it, but often a psychologist’s focus is on testing and diagnostics. So it is really important to know what a psychologist specializes in and what they have experience in. It is possible to be a psychologist for years and have very little experience doing any kind of therapy. In Wisconsin Psychologists cannot typically prescribe medications.
MD – A Medical Doctor that specializes in mental health is a psychiatrist while all MDs and DO’s can prescribe psychiatric medications it may not be their specialty. This is typically what psychiatrists do these days, prescribe medications based on diagnosis and symptoms. They are able to provide therapy, but it is very important to understand if that is something they have experience with. Again, like the psychologist it could be very likely that the psychiatrist has very little experience providing therapy and even more likely they have little experience with current models of therapy.
APSW – Advanced Practice Social Worker – So this is a therapist in training. They have a Masters level education, have done an internship which should have included some tightly supervised therapy experience and have taken a passed a test to get this licensure. They are able to practice as a therapist but have very little experience and must meet, bare minimum one hour, weekly for supervision by a licensed professional. Something important to consider when working with an APSWP is how often are they supervised and how. Some might meet weekly for group supervision so in the hour that they meet how much do they learn and how much do they get to share an be helped with cases that they have? While a therapist is in training there is no requirement for them to participate in any formal continuing education.
LPC-IT – Licensed Professional Counselor in Training - So this is also a therapist in training. They have a Masters level education, have done an internship which should have included some tightly supervised therapy experience, but do not have to pass a test to get this credential. They are able to practice as a therapist but have very little experience and must meet, bare minimum one hour, weekly for supervision by a licensed professional. Something important to consider when working with an LPC-IT is how often are they supervised and how. Some might meet weekly for group supervision so in the hour that they meet how much do they learn and how much do they get to share an be helped with cases that they have? While a therapist is in training there is no requirement for them to participate in any formal continuing education.
LMFT-IT – Licensed Marriage and Family Therapist in Training - This is also a therapist in training. They have a Masters level education, have done an internship which should have included some tightly supervised therapy experience, but do not have to pass a test to get this credential. They are able to practice as a therapist but have very little experience and must meet, bare minimum one hour, weekly for supervision by a licensed professional. Something important to consider when working with an LMFT-IT is how often are they supervised and how. Some might meet weekly for group supervision so in the hour that they meet how much do they learn and how much do they get to share an be helped with cases that they have? While a therapist is in training there is no requirement for them to participate in any formal continuing education.
LCSW – Licensed Clinical Social Worker – This is a fully licensed therapist, or maybe not. So typically, this means that an APSW has completed their supervised hours of training as a therapist, this should take about two years. They should have taken a test and passed and that will give them this LCSW credential. However, they are allowing temporary licenses which allow an APSW to become an LCSW before passing the test. This is a curtesy to the therapist to allow them to start working as a fully licensed therapist while they may have to wait to take their test. A LCSW no longer needs supervision, but is required to complete a certain amount of continuing education in the field every two years.
LPC - Licensed Professional Counselor – This is a fully licensed therapist, or maybe not. So typically, this means that an LPC-IT has completed their supervised hours of training as a therapist, this should take about two years. They should have taken a test and passed and that will give them this LPC credential. However, they are allowing temporary licenses which allow an LPC-IT to become an LPC before passing the test. This is a curtesy to the therapist to allow them to start working as a fully licensed therapist while they may have to wait to take their test. An LPC no longer needs supervision, but is required to complete a certain amount of continuing education in the field every two years.
LMFT – Licensed Marriage and Family Therapist - This is a fully licensed therapist, or maybe not. So typically, this means that an LMFT-IT has completed their supervised hours of training as a therapist, this should take about two years. They should have taken a test and passed and that will give them this LMFT credential. However, they are allowing temporary licenses which allow an LMFT-IT to become an LMFT before passing the test. This is a curtesy to the therapist to allow them to start working as a fully licensed therapist while they may have to wait to take their test. An LMFT no longer needs supervision, but is required to complete a certain amount of continuing education in the field every two years.
SAC-IT / SAC / CSAC – These are Substance Abuse Counselor Credentials - They require some college level education and experience working with people with substance use challenges. One obtains a training license (IT) and can work as a substance use counselor and after a lengthy supervision time can take a test and receive their SAC credential, they still must be supervised and after a longer period of time make apply to have a Clinical Substance Use Credential which requires less supervision. They may work longer and take further tests to become Independent clinical supervisors ICS and then they can supervise SAC and SAC-IT and CSAC people. All of this with nothing more that a high school diploma but A LOT of experience. In the past many therapists chose to also get this credential to be able to bill for substance use treatment so you often see therapists with one of these credentials as well.
SAS – Substance Abuse Specialty – was a credential a therapist could add to their license in order to bill for substance use treatment. It is no longer available, but many in Wisconsin still have it. It was an alternative to getting the SAC or CSAC credential.
NCC – National Certified Counselor - this is a credential that a lot of therapists carry. This credential is optional. It is put out by the National Board for Certified Counselors. This agency does a few things things; first it is the agency that creates the test that all LPCs in Wisconsin currently have to take and pass to become and LPC. Second it looks at educational background and assesses whether the institution that the counselor went to was held to a high enough standard when it comes to their curriculum. It also requires LPCs to participate and track their continuing education to a higher standard that the state of Wisconsin does and other states as well, some of which require no continuing educations. So what you know, if someone has this credential, they have taken and passed the NCC exam that all LPC’s currently have to pass (Some very old therapists have not had to take this test) and some have temporary LPCs. You know they have a high standard of education that has been checked and you also know they have to maintain a higher level of continuing education.
ATR – is an Art Therapist Credential. All therapists are able to utilize art and creativity in therapy. This is special credential that says a therapist has had a significant amount of training and education in this area. It is their specialty. In Wisconsin, it doesn’t seem to be something a therapist can “add on” so they have to learn this during their master’s program and do their internship in it. There would seem to be some benefits (they get really good at utilizing art as a therapeutic intervention) and some flaws (they maybe less practiced in talk therapy or other therapeutic interventions) at least early in their careers.
I think this covers all of the BIG ones you might see. There could be other letters that people add to their name, but these are usually just models of therapy or frameworks that they are trained in or certified in. This are unnecessary and, in my mind, somewhat telling of the person you are going to be working with. When people put this much stock in one model or framework of therapy it can often mean that they lack the flexibility to work in other ways. You may find yourself being pushed in the one direction in which they know how to work with people. This could be good, if you are looking for a certain model of therapy that you have researched and seems to really call out to you. But for a lot of people we are looking for healing and growth and want someone who has the flexibility to work with us in many ways so we can find the right fit for the direction that will suit us for grown and healing.
It is one of the reasons that I think experience and knowing what that experience means is so helpful when finding a therapist. I think it is important to work with someone who has experience and different and creative ways to work with people. I think it is important to know that my therapist is learning new and effective ways to work with people regularly. For example, working with someone who has had a training license for more than two years could mean a lot of different things. Maybe they are just moving slow and do not have a lot of clients and therefore are not gathering hours quickly toward full licensure. But maybe they have not been able to pass their credentialing test and then they have not been held accountable for any continuing education this whole time, so are they continuing to learn and grow as therapists?
In the end this is really just about educating people more about the people they are working with or who they might be looking to work with. There is nothing wrong with working with interns or training license therapists, it is how we learn. But it is important to know their limitations and who is supervising them and how often, because in the end that will affect the work they do. I hope this helps a little. I am happy to try and answer questions in the comments as well. Again, this is my understanding of these things and I may not have a full understanding of all of these things but it should be a good place to start.
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