One of the issues a new Mental Health Professional (MHP) faces is deciding how to ethically and appropriately identify their professional identity. There is a confusing array of titles and descriptions that are used by mental health professionals. Each of the titles or descriptors that MHPs use has a different connotation. The issues to keep in mind include the population it serves, and the kind of work the MHP focuses on.
According to two local university professors who teach professional ethics, it would be ethical and appropriate for graduates with a Masters Degree in Counseling to use any of the following: Mental Health Professional, Mental Health Practitioner, Therapist, Counselor, Professional Counselor, Mental Health Counselor, Mental Health Therapist, or Marriage and Family Therapist (if they have family systems training).
Licensed Marriage and Family Therapists, Licensed Professional Counselors, and Registered Interns through the Oregon Board of Licensed Professional Counselors and Therapists use those titles on their Professional Disclosure Statements. However, a MHP may also use a variety of other descriptors. The purpose of using any title or descriptor is to clearly, legally and ethically denote who the MPH is, what they do and to help people understand their professional competency.
Recent interviews with a number of experienced mental health professionals found that this was a common issue all of them had faced. Below is a compilation of the discussion as to why they choose to describe themselves with which specific terms. Beginning with the title used for the people served.
Who do MHPs serve, clients or patients?
Client is a word that connotes a professional relationship, but not necessarily a superior/inferior relationship. The implication is for a consultative model, not a prescribing model. It is an empowered relationship; clients hire professionals to provide specific services. The relationship is seen as more relational and less medical. The client is paying for a service, and together with the professional they have developed a treatment plan. They are in this work together. Although most MHPs have some type of a diagnosis for clients, a client is not necessarily seen as “ill.”
Patient is a word that connotes a medical model. It is also seen to imply a superior/inferior relationship. The connotation is that there is an “illness,” that a patient has something wrong medically, and needs medical help. Therefore the implication is to be dependent on a “cure.” Treating a “patient” has the connotation of working with someone who is diagnosed as “ill.”
How do Mental Health Professionals use titles and descriptors?
Mental Health Professional, Mental Health Practitioner are generic terms that may refer to anyone with professional credentials in the mental health field including social worker, psychologist, marriage and family therapists, drug and alcohol counselors, licensed professional counselor, etc. Mental Health Practitioner is the designation used by the IRS to describe all mental health professionals with the exception of physicians.
Therapist is a term can apply to a number of occupations (i.e. physical therapist, occupational therapist, massage therapist, or mental health therapist.) Many MHPs use this term because it is descriptive in that a therapist is one who does therapy. Therapy is the process where the therapist and the client work diligently towards a goal. Some MHPs won’t use this term because they feel the client may experience the term as intimidating. The connotation may be seen as while “anyone might need wise counsel, only those who have big problems need therapy.”
Counselor is a term that many MHPs find it less intimidating to use the term counselor when they want to avoid clinical language. Some MHPs only use this word as their title or description. The rationale is that sometimes you do therapy and sometimes you counsel (give wise advice). Some MHPs never use this word because they felt it connotes school counselor and teaching. The generic word counselor is also used to describe a variety of other people such as: summer camp counselor (teenager), a lay counselor, or even an attorney.
Professional Counselor is a title that many MHPs really like (particularly when they can finally put “licensed” in front of it). They like that it can mean so many things. What they did not like is that it leaves so many questions unanswered about the kind of work that they do. MHPs who are not Oregon State Board licensed as Licensed Professional Counselors (LPC), or State Registered Interns working towards LPC need to clarify with their clients that they are not practicing as LPCs when they use the term Professional Counselor.
Marriage and Family Therapist is a title or description that has a connotation that the MHP has specific education and training in order to work systemically with marriage and family issues. However, it can also give the impression that a MHP only works with marriage and family therapy and perhaps not any other mental health work.
Mental Health Counselor or Mental Health Therapist are names that have a clinical connotation. The term mental health can give the impression that a MHP does not do marriage and family work. Some MHPs feel that they don’t want to use this term because they do emotional and spiritual work also. Using the term “Mental health” was seen by some MHP to be intimidating to clients, having a connotation of only working with mental illness.
Psychotherapist is a term often seen by MHPs to connote a relationship to a psychoanalytical (Freudian) model of therapy. The word was seen as having the risk of sounding intimidating to some clients. There is some question as to whether Oregon Revised Statues (ORS) identify this as an appropriate descriptor for use by professional counselors and marriage and family therapists. According to ORS 675.705 (for licensed professional counselors and marriage and family therapists) the practice of marriage and family therapy involves the application of psychotherapeutic and family systems theories and techniques. (Is one who applies psychotherapeutic theories and techniques therefore a “psychotherapist”?) However, ORS 675.010 – 675.150, state that the use of any title or description of services incorporating the word psychotherapist is statutorily restricted to psychologists and psychiatrists.
Many of these titles and descriptions for mental health professionals may have both positive and negative connotations depending upon the usage. A number of the MHPs interviewed stated that they use the title or description that seems most appropriate to the audience at the time. The common goal is to provide a clear understanding of the MHP’s competency in that situation. Therefore, when consulting with doctors, lawyers and other MHPs clinical language is often preferred. When speaking to clients the softer, less intimidating phraseology may be preferable and then if appropriate they may layer on increasingly more clinical language until it seems to fit the situation.
Each MHP should find appropriate legal consultation to determine what is legally and ethically appropriate for their own credentials and situation in order to provide an accurate representation of their professional competency. Nothing in this article is designed to identify the legal use of specific titles or descriptors. This article is simply a discussion of the way MHP in the community use language in their practice and the reasons they give for such use.
©2003 by Faith Winters. Published Fall 2003 in The Source, Oregon Mental Health Counselors Association membership publication.