What is a therapist? What do therapists do?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.


Photo courtesy of Pixabay.com

Why this word therapy might be confusing.

When I used to tell people I was a therapist they kept giving me blank stares. I got the feeling that they did not understand what I do. Personally, I tend to call myself a counselor more often than I call myself a therapist despite the fact that I am licensed here in California as both a Marriage and Family Therapist (MFC45390) and as a Licensed Professional Clinical Counselor (LPC15.)

One intern asked me why in so many blog posts I seem to use the word counselor rather than the term therapist. I think there are two reasons, I think of myself as doing more “Counseling” and the word therapist seems to need more explanation than the word counselor to avoid misunderstandings.

Both of these words can involve activities outside mental health. Lawyers are referred to as “counselor” for example. There are other professions, financial and lifestyle workers who get to use the words counselors or therapists when appropriately attached to some other description. What we need to do is prevent the term becoming so generic as to mislead people.

What about Substance Abuse Counselors?

Substance Abuse Counselors also do similar work but they are restricted in most places to only working on the substance use disorders. Mental health issues are outside their “scope of practice” meaning the things they can legally do.

Correctly used both counselor and therapist should be part of a license title rather than standalone names, as in Licensed Counselor, Licensed Clinical Counselor, Mental Health Counselor or Marriage and Family Therapist.

To add to the confusion many School counselors or School Psychologists are often not licensed and work on issues surrounding graduation requirements, getting into college or school behavior rather than treating mental illnesses that are more common than previously thought among school students.

So how did mental health practitioners come to use the title of therapists?

Originally this term was psychotherapists. Many mental health practitioners, Marriage, and Family Therapists, for example, practice “applied psychotherapy.” This is a reference back to the time when most mental health work was being done by psychiatrists who did some form of talk work with their “patients.” Most of this work was psychodynamic or Freudian type work. Today most therapists do briefer more directive work and do not choose to emphasize the “psycho” part of the psychotherapist name.

What about other kinds of therapists?

Two types of therapists,  occupational and physical, get confused with the psychotherapists that do mental health work.

Physical therapists, as the name implies work on rehabilitation of the body. So if you are in a car accident and lose a limb they could help you regain your abilities, adjust to a prosthetic limb or strengthen remaining muscles. This is my understanding and if there are physical therapists out there who would care to add to that understanding feel free to leave comments.

That same person, grieving and depressed over the loss of the limb might also see a rehab counselor who would help them with the psychological adjustment to living without that limb. That rehab counselor might also help with career counseling to find that person a new job they could do despite the loss of a body part.

In California rehab counselors as well as Career counselors might elect to get licensed as Licensed Professional Clinical Counselors providing they meet the requirements for that license.

There are also people who function as “occupational therapists.”

This one still confuses me a bit. Per the Bureau of Labor Statistics “Occupational therapists treat patients with injuries, illnesses, or disabilities through the therapeutic use of everyday activities. They help these patients develop, recover, and improve the skills needed for daily living and working.” Most occupational therapists have master’s degrees and work in the offices of physical therapists.

So when I tell someone that I am a therapist they sometimes ask if I know of an exercise that will help their shoulder mobility. No, I do not. That is not the type of therapy that I am licensed to practice.

So has that cleared up the confusion? Or have I just added another layer of mud to the waters?

Point is that you need to be sure that the type of counselor or therapist you are seeing is doing the type of work you need.

Best wishes on your journey to a happy life. (I think of myself as a happy life therapist or counselor but can’t find that listed in any of the statute books.) I do try to stay well within my scope of practice.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

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For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.