As a practicing (“licensed”) psychologist, this issue comes up frequently. What are the differences among the myriad of mental-health professionals and does it even matter? As a researcher, as well as a clinician, my first inclination is always to look at the literature when seeking answers. What have others written on whatever topic it is that I am trying to better understand? Did someone else already answer my question? So, I did that first. The descriptions of the various mental-health professionals that I read about do not seem to me that they would be of help if I was looking for psychotherapy for the first time, perhaps in a crisis, or at the very least feeling a lot of distress. The descriptions of the different professionals basically all say the same thing: They describe the training and then conclude with the type of psychotherapy that the professional is qualified to do. Are they? And by whose standards? How would a potential patient, ever be able to sort through all of this information? I certainly wouldn’t be able to do it. And why, as a professional, would anyone trust my conclusions in answering this question over someone in another profession? What makes me right?

I decided to use my own experience to answer this question. Why was training to be a psychologist the best choice for me to do psychotherapy? How can I convey that decision to the public? For me, as for the rest of us, this is from where my opinions originate. I try to be “objective” but I, like everyone else, make my own choices based on what I perceive to be the important facts and issues. In this case, I chose to go to graduate school in psychology because training as a psychologist, rather than as a social worker or as a nurse, seems more directly relevant to doing psychotherapy. Getting accepted into graduate school in psychology was very competitive. I had to take additional coursework and earn an additional, not-particularly-wanted, master’s degree before I got accepted to a doctoral program. This is not totally unusual, although not everyone has to go to these lengths. After acceptance into a graduate program, the road to training completion is challenging and long. I acquired significant debt along the way and I gave up years of my youth in the service of getting an education. Years later I still feel that the sacrifice was well worth it.

The courses offered in psychology graduate school seemed to be a better preparation for doing psychotherapy than courses on community relations and resources, adult and child welfare, case management, casework, administration, or nursing, discharge planning, and community outreach, all of which are important. Although some social workers now get doctorates that focus on psychotherapy rather than community relations and resources, adult and child welfare, case management, casework, or administration, earning a doctorate in psychology still seemed to me to be the most focused, direct, and thorough route to reach my goals. The classes in psychology graduate school are small, typically eight to ten students, and the attention received from professors is personalized and intensive. It took a long time (seven years) to complete the program and earn my doctorate. This is fairly typical, in that psychologists earning at least a doctorate (Ph.D., Ed.D., Psy.D.), usually take between seven and eight years to complete it. This means that psychologists earn a master’s degree and then study several years longer in graduate school to earn a doctorate degree. As part of earning a doctorate, I was required to select a specific topic (pediatric diabetes), and design and complete a research project under the guidance and examination of a committee of four professors. This allowed me to put my broad and general psychology foundation to work, using the example of a specific topic. Then I could apply those skills to other topics about which I wanted to learn more as I developed and expanded my career.

By training as a psychologist, I built a thorough foundation in different aspects of development such as social, emotional, physical, intellectual and learning processes, memory, language development, behavior, and family and other relationships, health psychology, information processing, central auditory processing, and problem solving in addition to those on mental health, psychotherapy, intellectual and personality testing. Learning about the entire lifespan (from infant to child to adolescent to adult) was part of my training. Building on this foundation, I expanded my training and practice to include coping with chronic illnesses, recovering from trauma and abuse, and managing learning and neuro-developmental difficulties (ADD, ADHD, various learning differences). This is in addition to my more general areas of practice such as coping with depression, anxiety, and stress. Please visit my website drpeggyrothbaum.com for more information. Having this solid foundation allows me to look at the big picture of what patients bring into my office. Specific topics were not viewed or taught separately from a foundation of general principles. For example, I don’t see sensory integration, social skills, parenting, adolescence, obsessive compulsive disorder, insomnia, panic attacks, grief, and other such issues, as separate issues that stand alone. Rather, they are part of a whole picture of a person’s life, which must be integrated to allow for greater understanding, to give a full, thorough, more complete understanding of the patient’s life and to produce holistic solutions.

A further part of the appeal for me of getting trained as a psychologist was that psychologists are the only professionals trained and licensed to give standardized psychological evaluations, which can provide details to help with psychotherapy. I learned a lot from doing these evaluations when I was on a Child Study Team. It still helps me to tailor psychotherapy and find the right services for my patients. I experienced the difference in a very personal way between having a master’s degree and a doctorate when I was in school. In graduate school, I decided that I wanted to do research as well as psychotherapy when I graduated, so I needed to get some additional training. While I was earning my Ph.D. in psychology, I earned a master’s (Ed.M.) in Educational Statistics and Measurement. It required 30 hours of additional coursework. I would have loved to continue on to earn that doctorate, but financial and time constraints would not allow it. I knew many of the students who were continuing on, and one fall semester, as I was taking one of my last classes for my Ed.M., many of them were in the same class. But they were also taking courses working toward the doctorate at the same time. I remember that about halfway through the semester, they were already so far ahead of me. They had learned things that I had not learned, and in fact still haven’t learned, and they understood the coursework in much more depth. It was obvious to me, at that early date, that there was a significant difference between my Ed.M. and their Ed.M. plus Ed.D. I fell behind quickly. It still makes me somewhat sad that I do not have all of those research skills.

Another way that I learned firsthand about the ways in which the differences in training matter was actually through my experience as a psychologist. I had decided that I wanted to focus on development throughout the lifespan, not psychopathology or mental illness. So, I earned a doctorate in developmental psychology, as opposed to clinical psychology, and thus had to do extra coursework to get licensed as a psychologist. I like the perspective that I chose and I like looking at issues that the patients bring into psychotherapy as part of development: They are normal given the circumstances of the patient’s life and can be “caught up” and healed. This has positioned me well to work with various types of trauma, patients with learning disabilities, neurological impairments, and chronic illnesses. I love this kind of work. However, as a result of my chosen training, there are gaps in my knowledge which limit the way I practice and what I feel competent doing. I have no experience working on an inpatient psychiatric unit. I have no training in substance abuse, until I got some recently. I have very little training in standardized adult assessment, (although, as I mentioned earlier, I was on a Child Study Team for a year and a half). I have not worked with patients who have made suicide attempts in the past. I recognize these limitations and do not work with patients in my practice with these issues. I recognize what I cannot do and that I have other strengths. I suppose that if I went back to graduate school or took more courses at a training institute that might help to close the gap. But I am pleased with my chosen training. Further, I am fortunate to have a supervisor, a more experienced psychologist with whom I consult regularly, who has expertise in those areas that I do not, and can provide guidance as necessary. In addition to all of the unconscious material that the patient and psychologist bring into psychotherapy, there is intellectual competence and integrity that is required by a psychologist. Having expertise and recognizing when one does not have it is crucial, as is the importance of consultation with other professionals, when necessary.

Earning a doctorate is a good start, but continuing education does not end. After the two-year required supervised hours after a doctorate, as I mentioned, I continue to this day with weekly (paid) consultation with a senior psychologist (“supervisions”) and take continuing education courses. My first supervisor, who taught me a lot of what I know and still use as a psychologist today, and I worked together for 10 years. She was the best imaginable fit for a fledgling psychologist. I then worked with three others before finding the best fit with a senior psychologist for my current professional level, and we have been working together for 20 or more years. I cannot image doing psychotherapy without individual supervision post-licensure. I believe that I made the right choice for me in terms of being the most effective psychotherapist possible. Training matters. Type, length, breadth, and content of training matter.

Insurance and managed care companies often prefer professionals with less training than a doctorate. They are less expensive, may not have a broad background, or be able to do in-depth work that requires navigating treatment challenges such as disruptions to the working alliance, strong (often negative) emotions that patients feel and sometimes direct at the psychologist, or distressing, often long-term circumstances that patients often face, roadblocks to change (“resistance,” which we all have and which can get in the way of growth and change), thus saving companies money. I know that would not be able to navigate these tasks without a lot of training and continued supervision. If psychotherapy ends prematurely, instead of working through these rough spots, the patient may not progress past the point of entry into psychotherapy. Patients may feel that this is a failure or that they are doomed to be stuck in the same patterns. Further, if the bond between psychologist and patient, which is a crucial part of psychotherapy, has been weakened, or even ignored, this has a deeper impact than just on the actual psychotherapy, because a solid professional/patient relationship is crucial and leads to better health outcomes, while also saving money. So “quick” is not necessarily “better.”

Insurance companies, the internet, and various news outlets are often believed concerning psychotherapy, even when they are not being accurate or have inadequate information about what works, or what is involved with proper training. In addition, as part of the death of expertise, licensed professionals with advanced traditional training are doubted and dismissed. Instead, everyone is an expert. The mental health scene is also complicated now because there are a plethora of certifications, healers, counselors, providers, specialists, consultants, health and wellness experts, platforms, coaches, specialists, health solutions, online and one-off psychotherapies, Apps, and other therapies that have exploded outside of license-eligible disciplines. Licensing matters. The purpose of licensing is to monitor and regulate professionals and the services that they provide for the public good. When this doesn’t occur, there is no way to do quality control and effectiveness. I cannot even imagine how people who are already vulnerable and seeking psychotherapy could possibly navigate the current mental health scene.

Peggy A. Rothbaum is a psychologist.