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For a discipline that’s less than 150 years old, psychology has a lot of practitioners sporting a variety of different titles (and I’m not talking about the local bartender down the street, although they are often quite excellent listeners). I’m talking about psychotherapists, therapists, psychologists, psychiatrists, social workers, psychiatric mental health nurse practitioners, marriage and family therapists, and counselors. What’s the difference and why so many titles?

This post aims to provide a little more clarity about the differing psychological services among practitioners and describes how one discipline grew to focus on mental health while the other initially concentrated on mental illness. In addition, there are answers to some of the common questions people have when seeking therapy services.

While many think of Sigmund Freud as the first psychology practitioner, it was Wilhelm Wundt who opened the first psychology lab in 1879. Wundt sought to examine human consciousness using an experimental method he called introspection (for interested researchers, he did not use the scientific method as experiments weren’t able to be duplicated). Like its shaky scientific beginnings, the field grew to have a varied background—some of it contains a solid scientific background, and others are a bit more airy-fairy, so to speak.

Perhaps the ethereal aspect of airy-fairy isn’t so far off as psychology literally means “study of the soul” (psychē means “soul, spirit or breath” while logia means “to study”). A more modern definition means to study human behavior and thought, but we’re going to come back to that definition in a bit. A blessing of psychology’s birth as a discipline was how mentally ill (or perceived mentally ill) people were treated. Just prior to the late 1800s in Western culture—long after people with "visions" had been regarded as oracles or shamans—it was believed that people suffered from mental illness because God had cursed them. Consequently, mentally ill people were punished with severe beatings, chainings and/or ostracism. Psychology helped change such views and a more holistic (and humane) approach to treatment was adopted.

Many of the first practitioners in the field were Medical Doctors (M.D.s). A medical doctor has attended medical school. Today’s M.D.s in the field are called psychiatrists and they can provide therapy services while prescribing medications. Psychologists are practitioners that have received their Doctor of Philosophy (Ph.D.) or Doctor of Psychology (Psy.D.). A number of other mental health fields offer graduate and Ph.D. degrees in social work, marriage and family therapy, various forms of counseling and counseling psychology—which brings me to the title of this post. What is the difference between counseling and psychology?

Going back to a bit of history, World War II put a big spotlight on mental health as the war had serious mental health impacts on soldiers (war impacts everyone and it has a trickle-down effect through the generations with inherited trauma at the epigenetic level). The National Mental Health Act was first passed in 1946 and the U.S. government began funding research and programs related to mental illness and health. In the 1950s, prevention and early detection of mental health problems became a focus. Slowly, a shift in perceptions occurred where people could safely seek treatment for adjustment, transitions, and relational issues without feeling stigmatized. (Clearly, we are still working on shifting those perceptions—in addition to war, old belief systems are passed down through the generations).

As part of the shift, psychology tended to treat mental illness whereas counseling psychology was born to address mental health issues. (Please note the field of psychology continues to expand and now encompasses positive psychology as well as other disciplines like media psychology, environmental psychology, neuropsychology, and a host of other disciplines that can be viewed by the list of 56 divisions within the American Psychological Association.)

Some of the fundamental tenets of counseling and why I tend to embrace a counseling philosophy (as depicted by this “Counseling Keys” blog) are:

• People should be treated with respect.
• If given the opportunity, normal growth will occur.
• The goal of treatment is to promote healthy growth.
• Counseling is an educational process where the client is part of the process and actively participates.
• Counseling builds on strengths as opposed to attacking weaknesses.
• Counseling uses empirically validated procedures (scientifically proven via research using scientific method).

I hope this helps illustrate a little of the history and explains some of the differences in the professional titles and orientations. Regardless of the titles, many practitioners adopt similar a positive growth orientation. Even trauma work now has amazing research backing up the notion of posttraumatic growth and resilience. Simply ask your practitioner for their philosophy and therapeutic approach.

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In addition, just about all psychology practitioners get these common questions:

Answers to Some Common Questions

Why are you called a shrink?

Shrink comes from shrinking the issue. Notice how we can sometimes get so overwhelmed by everything that it feels like the sky is falling. When overwhelmed, it can feel like everything is a problem, therefore, a good therapist/counselor can help you shrink the issues down to single root causes. Sometimes it is a perception issue, boundary issue, unresolved trauma, relationship dynamic, communication issue, cultural experience, medical condition, or a combination. When solutions are identified in chunks, it becomes easier to respond from a place of empowered wisdom versus reacting from confusion, fear, despair, and anxiety.

Are you analyzing me? (When just meeting me at a social occasion.)

No. Well, maybe. Seriously, the therapeutic process follows a particular process of information gathering and analysis. Unless you’re in the office (or on a web conferencing call) and experiencing that process, you’re probably not getting analyzed. Therapists/counselors cannot see through you or read your mind.

Have you ever been through therapy?

Yes. Good training requires that you do. Plus, I believe in it. I confess I have also experienced some not-so-great folks out there as well. Like all fields, there are good professional matches and not so good matches. Don’t let the rotten apples deter you from seeking good service. Interview them, ask about their approach, and pay attention to your gut and intuition as you seek someone you can respect and trust.

Did you go into the field to work through your problems?

There isn’t a person alive who hasn’t taken a job to work through a problem (e.g., "I have bills to pay"). I also don’t know anyone who hasn’t been wounded in some way by life. For me, yes, I would call myself a wounded healer. I’ve experienced a number of things in life that I believe ultimately helps me to be more empathetic and understanding of my clients.

Do you date your clients?

No. It’s not like the movies or TV shows. All therapy professionals are prohibited from having dual relationships. If you have had your therapist ask you out or make you uncomfortable with inappropriate flirting, stop seeing them and report them. It’s an abuse of power and your vulnerability.

To find a therapist, please visit the Psychology Today Therapy Directory.