What are the differences between mental health professionals?

February 21, 2022 | General

When you’re seeking mental health support, it might be confusing to find out that psychologists are not the only mental health professionals available, and that not every mental health professional can do the same as a psychologist. In this post I break down the differences between mental health professionals in Alberta. Some of these might apply to other provinces and countries as well. If you’re in doubt, it’s best to consult with the appropriate regulatory bodies in your area.

This is a revised version of a post I shared in February 2021 on social media in honour of Psychology Month. An initiative of the Canadian Psychological Association, this is an opportunity to educate people on how psychology works and the ways in which it can improve our lives, our relationships, and our communities; to draw attention to the work and contributions of our psychologists; and to appeal to our governments for more policies and resources to guarantee equal access to mental health services.

Differences between mental health professionals

In broad terms, we can divide mental health professionals into three general categories: psychiatrists, regulated counsellors, and non-regulated counsellors.

Psychiatrist

Psychiatrists are medical doctors who specialized in mental health and mental disorders. They have the training and license to:

• Differentiate mental health problems from other underlying medical conditions.
• Monitor the effects of mental illness on other physical conditions.
• Monitor the effects of medication on the body.
• Write prescriptions.

Some psychiatrists might provide psychotherapy as well. Psychiatrists are the only mental health professionals who can prescribe medication.

Non-regulated counsellor

The word “counsellor” in Canada is an umbrella term for all kinds of mental health professionals. Within this field, counselling is a relational service that aims to promote human change and enhance self-knowledge and well-being. However, counsellors can be regulated or non-regulated. This is a very important difference.

Non-regulated counsellors engage in some of the same activities as regulated counsellors, but they have not applied to or met the requirements to be part of a regulated profession. While they can legally provide counselling, they cannot use protected titles (like “psychologist”).

This type of professionals are not required to have minimum training nor held to practice standards. This means that they may choose how to do their work, and how to assess and treat presenting issues without any considerations but their own. While this doesn’t mean they will cause harm, or that they don’t know what they’re doing, or are bad at their jobs (there are amazing non-regulated counsellors!) the lack of standards can put some clients at risk. This is due to how difficult it is to know if a non-regulated counsellor has the knowledge and experience necessary to engage in counselling in a way that will be safe enough for all of their clients, if they will be able to assess accurately, and there is no accountability if they do cause harm.

In addition, insurance or extended work benefits usually don’t provide coverage for them; you need to pay out of pocket.

Regulated counsellor

There are many types of regulated counsellors, but all of them have to meet minimum requirements and follow a set of rules as to how they do the work of counselling and other tasks associated with their field.

They are regulated by a college that sets the standards, rules, and requirements. In Alberta, they are recognized under the Health Professions Act.

Some types of regulated counsellors are:

Psychologist

They have a Masters or PhD in psychology. In addition, they must have passed the examination for professional practice in psychology, which assesses foundational knowledge specific to the practice of psychology; an exam on ethics and standards of practice; 1,600 hours of supervised practice, plus other requirements.

They have the training and license to:

• Evaluate and treat mental and emotional disorders.
• Provide counselling and psychotherapy.
• Perform psychological testing.
• Provide treatment for mental disorders.
• Work with a psychiatrist or other medical professionals who provide medical treatment.

Certified Canadian Counsellor (CCC)

They have a graduate-level degree from a counselling-related profession, and must have taken additional specific courses, done 150 hours of supervised face-to-face counselling work, have a clinical reference, on top of other requirements they must meet.

They are regulated by the Canadian Counselling and Psychotherapy Association (CCPA), which sets their own requirements and permissions.

This type of professionals are licensed and qualified to:

• Evaluate and treat mental health problems.
• Provide counselling or psychotherapy.

Clinical Social Worker (CSW)

A professional with at least a Master’s degree in social work and additional training in evaluating and treating mental illnesses.

They are registered with their own college, which has their own set of requirements. Only professionals who are registered with that college can call themselves CSW.

They are licensed and qualified to:

• Provide psychotherapy.
• Do case management.
• Help with hospital discharge planning.
• Advocate for patients and their family.

ACTA Counsellors

They are professionals regulated by the Association of Counselling Therapy of Alberta (ACTA).

Only people who meet their requirements and complete the necessary steps can use their protected titles, which include:

• Counselling therapist
• Child and Youth Care Counsellor
• Addictions Counsellor

Does a title make us good at counselling?

As you can see by now, the title a mental health professional holds is an important indicator of the kind of services they are or are not qualified to provide. What type of mental health provider you should choose depends on your own particular needs at any given time. However, we may ask: does having a protected title make us good at counselling?

Personally, I don’t think so. Counselling training is a complex field, and we’re still not sure about how the number of years of academic training and experience predict therapeutic outcomes. On the other hand, we know that the relationship between a therapist and a client in itself is the most important aspect of a successful therapeutic process. Distilled to the most basic skills, anyone can learn how to use a therapeutic relationship for the purpose of wellness. Titles are protected, but counselling itself is not.

So what can I offer as a psychologist that makes me different from other regulated and non-regulated counsellors?

Benefits of working with a psychologist

In my opinion, a psychologist’s training provides an extensive knowledge and practice base that offers an integrative view of the self. The training teaches us to assess, evaluate, and assign relative weight to what we see in the client. It’s one of the reasons why psychologists are the only professionals permitted to perform psychological testing.

This background also teaches us to speak the language of culture, identity, statistics, medicine, and triaging. If a client comes to us with a goal in mind, we can look at them and the systems they move in from many angles. We may notice signs that a client needs a medical or psychiatric follow-up, or think about the Venn diagrams that may help describe the client’s experience as influenced by biology, society, and history.

Furthermore, having to prove our capacity through examinations and supervision and to practice within strict regulations result in protection for our clients. The fact that I’ve met this criteria may offer people a distinct access to knowledge and experience informed by peer-reviewed science, philosophical and medical approaches, sociological models, statistical studies, etc. For people with particular needs, or for those unaware of the cause of their distress, this may be invaluable. This is also one of the reasons why other professionals (e.g., psychiatrists, lawyers, physicians, etc.) prefer to work with regulated counsellors: we have been tested to ensure we meet minimum requirements. In turn, this preference allows us to advocate for our clients in a more equitable way.

The above also helps explain the standard fee for a psychologist. That fee helps cover not only the hour of therapeutic work, but also the cost of expenses incurred in obtaining our depth and length of training, the integrative and standardized ways in which psychologists are supposed to apply it, and the responsibility we carry in this role. Of course, there are other factors, such as the many trainings we attend to maintain competency, administrative tasks, professional dues and fees, insurance, rent, and several others. As a good friend says, lawyers and dentists are expensive for a reason. The same applies to us psychologists!

In conclusion

We can divide mental health professionals into three broad categories: psychiatrists, regulated counsellors, and non-regulated counsellors. Some types of regulated counsellors in Alberta are: Psychologists, Certified Canadian Counsellors, Clinical Social Workers, and ACTA Counsellors. It’s important to keep in mind the differences between all these mental health professionals to know the kind of services they have the training and license to provide. None of these types of professionals are inherently better or worse, but some can be more suitable to a person’s specific needs at any given time. Having a protected title doesn’t guarantee a better or worse therapeutic relationship, as that depends on many other factors. However, it does guarantee accountability for the services provided, as regulated professionals have to meet a series of requirements and regulations that attest to their training and experience.