.png)
by Keith Sonnanburg, Ph.D.
Clinical Psychologist
I find it somewhat surprising when clients are unsure what it means to call me a "clinical psychologist." On the other hand, I understand it can be confusing to distinguish among the variety of specialties that distinguish mental health professionals. There are many titles: psychologist, psychotherapist, counselor, social worker, nurse practitioner, physician, and psychiatrist. An alphabet soup follows names, memorializing academic training: Ph.D., Psy.D., M.S.C, M.S.W., A.R.N.P., M.D., or D.O. Additional letters designate legally regulated standards: L.I.C.S.W., L.M.H.C., L.M.F.T., or C.D.P. This guide is offered to help make sense of it all.
Even the title "psychologist" may not tell you enough. There is a myriad of roles assumed by different psychologists, based on specialized training. These include: cognitive psychologists, community psychologists, counseling psychologists, developmental psychologists, educational psychologists, experimental psychologists, health psychologists, organizational psychologists, neuropsychologists, school psychologists, social psychologists and sports psychologists. This list is not an exhaustive and doesn't even include my own field of clinical psychology. What all psychologists have in common is a commitment to extend the science of psychology in order to improve the human condition.
Clinical psychology focuses on evaluating and treating cognitive, emotional and behavioral disorders. Its goal is to integrate science and clinical knowledge to understand, prevent, and relieve distress, while promoting well-being. Lightner Witmer opened the first psychology clinic in 1896, at the University of Pennsylvania. There, he served children with disabilities. He coined the phrase "clinical psychology" in 1907. During World War II, there was an expansive growth in the training of clinicians to help the war effort. Following that war (in 1949), a standard for training was developed at a conference in Boulder, CO. It promoted a balance between science and practice. Scientist-Practitioner programs in Clinical Psychology award a Ph.D. degree. In 1973, a model for training professional practitioners was established at a conference in Vail, CO. The shift was towards emphasizing hands-on training while producing scholarly works. Scholar-Practitioner programs usually award a Psy.D. degree. The laws governing licensure vary by state. These are intended to safeguard the public by specifying minimal requirements to be fulfilled before obtaining a license. In the state of Washington, a doctoral degree (Ph.D. or Psy.D.) in psychology from an accredited institution, and at least 3,000 hours of supervised experience, are required of licensed psychologists. In general, it takes five to seven years after college to obtain a doctorate. In my case, I earned both a Master of Psychology degree and a Ph.D. in Clinical Psychology, after four years in college (a total of 14 years of training after high school). I also amassed over 13,000 supervised hours in a wide range of settings.
There are many other types of trained professionals in the mental health field. Clinical psychologists are most often confused with psychiatrists. Although both groups are trained at a doctoral level, they are trained in fundamentally different ways. A psychiatrist first earns a medical degree (an M.D. or a D.O.) and then practices under supervision as a psychiatric resident for an additional four years (a total of 12 years of training after high school). Psychiatrists specialize in the diagnosis, prevention, study and treatment of mental illnesses. In accord with their education, they employ a medical model for assessing and treating psychological problems. Although prepared to use psychotherapy, they often rely on psychotropic medications as the primary treatment for mental illnesses. Clinical psychologists are not generally entitled to prescribe medication. However, there are medical psychologists in Guam, Louisiana, New Mexico, and the military services who have prescribing privileges.
Both clinical psychologists and psychiatrists are independently licensed to diagnose the entire scope of psychological and psychiatric disorders. However, Washington issues a generic license in psychology. Whether one is an organizational psychologist or a clinical psychologist, the license is the same. This is similar to the medical license granted to physicians. A cardiologist does not have a different medical license from an obstetrician. Similarly, there are no special licenses for clinical psychologists or psychiatrists.
During their graduate school years, clinical psychologists specialize in methods of psychological measurement and assessment, and in the mechanisms that promote psychological change and growth. They also receive on-the-job training in clinical settings. During their medical school years, psychiatrists receive the same training as students preparing for other branches of medicine. Then, in their residency years, they receive training and practical experience tailored to their specialty. While doing my internship at the University of Washington Medical School, I trained alongside psychiatric residents.
People also seem confused about whether to call me their "counselor," or a "psychotherapist," and wonder how those roles are different from being a "psychologist." While all of these titles may apply to me, they have some subtle differences. Psychotherapy refers to a variety of psychological means used to improve mental health and well-being. A patient of Josef Breuer's described such interventions as a "talking cure." Both Counselors and psychologists talk with their clients to help them grow and change. I associate "counseling" with guiding people through ordinary challenges in life, like a job hunt, or grieving. In fact career counseling was how counseling psychology got its start. Clinical psychology, instead, has historically focused on those who find their lives disrupted by more pathological processes.
Additional mental health professionals trained at the doctoral level include: counseling psychologists with a Psy.D. or Ph.D., educational psychologists with an Ed.D. or Ph.D., clinical social workers with a D.S.W. or Ph.D., and psychiatric nurses with a D.N.P., or Ph.D. As with the difference between clinical psychologists and psychiatrists, the distinctions among these are determined by the characteristic emphases of each disciplinary tradition. To illustrate, educational psychologists have accentuated psychological development and individual strengths, social workers have focused on one's place in community and the availability of resources, and nurses have emphasized equipping patients with medical education.
Many mental health professionals practice with a master's degree (generally requiring two to three years of graduate school, after college). These include: counselors with a M.S., M.A., M.C. or M.Ed., social workers with an M.S.W., and nurse practitioners with a M.S.N. There are many state issued licenses that may accompany such degrees. For example, there are licensed marriage and family therapists (L.M.F.T.) and licensed mental health counselors (L.M.H.C.) in Washington. Additionally, there are certified advisors (C.A.) and certified counselors (C.C.) that require an Associate's or a Baccalaureate degree (respectively). Some licenses for that level of education can be further specialized (for example, a chemical dependency professional, or C.D.P.).
My graduate training at the University of Washington occurred in a clinical psychology program that adopted the scientist-practitioner model. I believe the emphasis on understanding and using the scientific method has served my clients well. Being able to draw upon evidence-based practices and scientifically supported theories assures a good chance for success with limited risks. However, each individual's journey is a unique puzzle. So, knowing how to measure problems and progress, as clients and I work together for improved well-being, provides a strong basis for recognizing what is helpful and what is not. Possessing broad experience with a range of people in many settings, a strong academic background from two graduate programs, and my undergraduate roots in the humanities, I am able to flexibly adapt my knowledge to help a great variety of folks in and around Seattle and Edmonds.