Ben Caldwell

Even many professionals don’t understand what the difference is between their profession and another. State laws vary when it comes to scope of practice, but the professions are distinctly licensed everywhere in the US for good reason.

Note: The following is a slightly-modified excerpt from my chapter on Scope of Practice in Basics of California Law for LMFTs, LPCCs, and LCSWs. Learn more about the book or purchase the current (2018) fifth edition here.

I frequently hear the argument (particularly here in California) that there are no meaningful differences among the mental health professions. After all, each of the master’s-level mental health professions can assess, diagnose, and treat the full range of mental and emotional disorders in the Diagnostic and Statistical Manual through the use of psychotherapy. So 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 or LPCC without ever having been supervised by someone in the same profession. (Clinical Social Workers in California do have to have some of their pre-license experience supervised specifically by LCSWs.) 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 that profession. LMFTs typically do not know how social workers are trained, 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.

The act of defining these professions for the sake of licensure is hardly a distant memory. LMFTs and LPCCs each had states where their professions were not licensed until 2009, when Montana (LMFTs) and California (LPCCs) passed laws that completed 50 states of licensure for each profession. In the years before, as LPCCs and LMFTs went around the country arguing for distinct licensure in each state, both professions regularly made the argument that the two operate from distinct histories, distinct skill sets, and distinct bodies of knowledge.

To understand the differences succinctly, let’s start from a problem. Let’s say that Diego 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 Diego struggling with anxiety?”

Psychology

Although this article does not focus on Psychologists, understanding their perspective can be helpful. A traditional Psychologist would examine Diego’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 Diego as an individual. Furthermore, traditional psychology would focus on pathology – rooting out what is wrong with Diego individually.

Professional Clinical Counseling

The professional clinical counseling field emerged from school and career counseling. While they focus today on mental health, LPCCs are likely to see Diego’s struggle as an individual, developmental issue. They will examine his psychological and social development and his current functioning, and treatment will focus on helping Diego improve overall development and wellness (including treatment of mental illness).

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 Diego may not be utilizing to their potential) or external (such as community resources and support groups). Traditionally speaking, LCSWs are likely to see Diego’s struggle as a resource issue, and will work with Diego to gather the internal and external resources needed for him to control and ultimately overcome his anxiety.

Marriage and Family Therapy

LMFTs look at behavior in its social and relational context. Perhaps Diego’s anxiety has emerged as a result of tension in his work or in his relationships. 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, LMFTs believe that no behavior exists in a social vacuum, and will work with Diego – as well as other family members and other important people in Diego’s life, if appropriate – in an effort to make the anxiety no longer necessary.

Areas of overlap

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. When handling adjustment issues with children, for example, LMFTs and LPCCs may work 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 effectively with one another 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).

Of course, LMFTs are not superior to the other professions, nor do they have greater job functions. 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 in assessing, diagnosing, and treating mental illness, it is quite a disservice to the professions to suggest we are all the same.

# # #

This post is a lightly-modified excerpt from Basics of California Law for LMFTs, LPCCs, and LCSWs (fifth edition), © Copyright 2018 Benjamin E. Caldwell. Reprinted here by permission.

Originally published October 15, 2012. Last updated January 7, 2019.