Kyle: So from my understanding, mental health providers are broken up into two big categories, those that can prescribe and those that cannot. Let’s first talk about the ones that cannot prescribe medication. Let’s start with psychologists.
Dr. Sportelli: Alright, so a psychologist. First of all though, I wanna back up one second.
I wanna say that every single one of these providers has a very important place in behavioral health. I don’t want the viewers to think that one is better than the other, or one is more important than the other because I honestly feel…and this is just my experience in the behavioral healthcare field, that it is a team effort.
And unfortunately there can be some turf wars between psychologists and psychiatrists and caseworkers and social workers. And to me, I think that’s silly. I think it’s very important to acknowledge that, to get the best help everyone has to work as a team. And one is not necessarily more important than the other.
That’s what I just wanna get out there.
So…speaking of psychologists, so important in the process, psychologists as we spoke are PhDs or PsyDs, it’s a doctorate level of training. These are people that went to four years of college and then four years of graduate school. And a lot of psychologists that I worked with or work with on a daily basis are just amazing at what they do.
And they tend to focus on therapeutic interventions. So you can either be a clinical psychologist, which means that you interact with patients or you can be a research psychologist, right? So there’s a little bit of a broad spectrum as to what a psychologist does. I know plenty of people that are PhDs in psychology but don’t see patients, but they love being in the lab.
And they gather data and do research and do papers and it’s wonderful. Like research papers, clinical psychologists deal with patients and in most cases they tend to find a paradigm that they and we’ve talked about – CBT and DBT or ACT, all these different sort of therapeutic interventions and they tend to specialize in some.
Now there are psychologists that are a jack of all trades too. But keep in mind that psychologists or clinical psychologists is gonna be a highly trained individual that is gonna focus on therapeutic intervention if you’re gonna see one.
Kyle: Okay, and just in case this is someone’s first time at MedCircle, CBT, DBT, and ACT are all different types of treatments.
We have series on all three of those. They’re available at medcircle.com. All right, so what kind of training would a psychologist and clinical psychologist undergo?
Dr. Sportelli: So the training that they’re gonna undergo is…so first they’re gonna go to an undergraduate college, right? So you graduate high school in the United States, and the next step is we’re gonna go to a four year college.
And a lot of you can major in whatever you want, basically. It can be a psychology degree, it can be an economics degree, it doesn’t matter. But you’re gonna apply to a graduate school in psychology that offers a PhD degree. And then what they’re gonna do is they’re gonna go to a four year program of training in the behavioral sciences and there are different tracks.
There’s research-based tracks, there’s clinical-based tracks. So it really depends on the school that you go to as to what the direction your career is gonna go, basically. So psychologists are gonna get that four years of training, maybe even some internship experience after that four years working with an established psychologist or a neurologist or whatever it may be.
So it’s extensive training for sure.
Kyle: Now what is the role of a counselor?
Dr. Sportelli: Counselor’s a funny word, right? It’s a vague word because you can call a PhD psychologist a counselor. However, when we talk about counselors, it’s like an umbrella term.
And under that umbrella can be a psychologist, a PhD, or a PsyD. You also have master’s level of training, which means in the United States, at least four years of college, and then about a two year master’s program in either licensed counselor, like a licensed clinical social worker, or an independent licensed counselor.
Right? And that’s usually a master’s level program. And these are people that focus on therapeutic interventions. Family counseling, marital counseling, interpersonal psychotherapy. And they provide therapeutic intervention.
Kyle: And are they using things like CBT and DBT?
Dr. Sportelli: They certainly can, yeah. They can certainly do training in that.
Kyle: And then they’re seeing patients?
Dr. Sportelli: Sure.
Kyle: So what’s the difference then between a psychologist and a counselor?
Dr. Sportelli: So a psychologist can be a counselor. A social worker can be a counselor. That basically means you’re seeing patients for psychotherapy. So we’re kinda splitting hairs with the words, but the important thing is they’re all providing a therapeutic intervention for the patient.
Psychologists have a doctorate degree, so it’s a little bit more of an intensive degree. They may have spent a lot of time focusing on a certain research-based sort of field. They could be like very profound, proficient in CBT for example, right?
And I’m not saying that the master’s level is not good. It’s certainly great. Of course, it’s an amazing level of education. But psychologists tend to be very research-based. I’m painting with a very broad brush here. So the difference is the length of time and training between a master’s level clinician and a psychologist.
Kyle: Now, you just said the word clinician. Can that be interchanged with counselor or is that a separate entity?
Dr. Sportelli: Yeah. This is so funny, right? So I think the interchangeable words here are counselor and clinician.
Kyle: Okay. What about therapist?
Dr. Sportelli: And therapists! There you go. You just found three. And that’s why it’s so confusing because honestly, I’m a psychiatrist.
You can call me your therapist. You can call me your counselor. So the truth is, if I’m providing therapeutic intervention for you, like psychotherapy, and you’re seeing me once a week and we’re doing CBT then I’m your CBT counselor.
Kyle: Got it. Or my CBT clinician or my CBT therapist. Got it.
Dr. Sportelli: Now, and the way these words are adopted though, in most cases, if I’m working at a hospital, for example, and I’m the psychiatrist and someone says, “Hi, the clinician would like to talk to you.” I’m going to assume that it’s a master’s or PhD level individual in behavioral health that’s involved in the team. Right?
So usually a clinician is geared towards the individual that’s doing the therapy on the team.
Kyle: Now, social workers. What is a social worker and is there a difference between a social worker and a clinical social worker?
Dr. Sportelli: So the degrees are licensed clinical social worker.
And there are social workers that focus on a pathway for more clinical therapeutic intervention too. Social worker means that they did a lot of the training that a licensed therapist, like a, like an LPC, a licensed professional therapist, meaning a master’s level type of care, but social workers also learn the unique way to do what’s called case management and care planning and disposition planning for people that are in the hospital.
Social workers really know the intricacies of available resources in the community. Discharge planning for patients at hospitals, things like that. So social workers have that sort of specialty under their belt as well.
Kyle: Interesting. Now between psychologists, counselor, clinician, therapist, clinical social worker, and licensed professional counselor, are there any other assessment and therapy providers that we’re missing out of that group?
Dr. Sportelli: I think you could certainly have a psychiatrist that can do that for you, and we will talk about that. You can even have an APN or a nurse practitioner or an NP that provides therapeutic intervention as well, so they can fall under that category too.
Kyle: Understood. Understood.
Dr. Sportelli: But I think a good distinction is the way you broke it down – prescribers and non prescribers. I think is a pretty good way to go because that’s the most clear delineation.
Kyle: So if someone has bipolar disorder, for example, that is something that requires a medication to be treated, they could see any number of the individuals that we discussed, but in addition to that, they would have to see someone who can prescribe medication?
Dr. Sportelli: Most likely. Of course there are circumstances where someone with bipolar disorder can be managed with just psychotherapeutic intervention.
As you climb the ladder of care or acuity of care and you start with, let’s just say a therapist, which could be, let’s just say a master’s in clinical social work or a licensed professional counselor, if that counselor feels you know what? This looks like a diagnosis of bipolar disorder and it looks like medication would probably help you.
Then they might refer you to a prescriber. And then that’s where we get involved with a team effort that I was talking about. That’s very important.
Kyle: Are there any circumstances where a psychologist could prescribe medication?
Dr. Sportelli: Yeah. Now, as you and as our viewers probably know, it’s actually pretty hard to find behavioral health providers in the United States right now. It’s a shortage.
So there are certain areas of the country that have a shortage of prescribers because we know that medication does help a certain part of the behavioral health community for sure. And we have a shortage of prescribers. So certain states…I believe right now there are about five states and certain areas where psychologists can actually prescribe non-controlled substances, meaning medicines for depression and bipolar disorder, for example, but non-addictive medicines or medicines that aren’t considered dangerous by the CDS or DEA.
Kyle: Wonderful. I needed that so bad. I’ve been talking to you and our other doctors and patients and I was always just what is the difference between all of those?
That was so clear. Thank you for providing that.
