Counseling, therapy, and psychology careers: What's the difference?

Learn the differences among counseling, therapy, psychology, and psychiatry, and what to consider to make career decisions like psychologist vs. therapist.

Counseling, therapy, and psychology share a common focus on treating mental, emotional, and behavioral health conditions. However, each field offers a distinctive approach with varying education and licensure requirements. In this Psychology.org article, you can find out the key differences before choosing which mental health career path works best for you.

Counseling, Therapy, and Psychology: Key Similarities and Differences

Counselors, therapists, psychologists, and psychiatrists occupy unique niches in the mental health field, although the job titles are often used interchangeably. All these professions require graduate study and advanced supervised training. Significant differences in education, licensing, and practice exist between these practitioners.

Similarities

These mental health careers all require state licenses, though the specific requirements vary by state. All also offer support for mental health and well-being through applied psychology. Each requires at least a master's degree that includes extensive supervised work. While you must have a master's degree or higher to work in these roles, most master's programs do not require a specific undergraduate degree.

Differences

• Counselors: In general, counselors help clients deal with a specific issue affecting their mental well-being rather than ongoing mental health issues. Though they may use both, counselors are more likely to offer solution-focused support than psychotherapy. Depending on the state and specialty, substance use counseling may require a license but not a master's degree.
• Therapists: Therapists and counselors have similar training and roles, though therapists specialize in providing psychotherapy. Many therapy programs focus on marriage and family issues. Therapists must have at least a master's degree to practice.
• Psychologists: Psychologists have a doctorate in psychology, either a Psy.D. or a Ph.D., giving them a deeper knowledge of psychology than counselors or therapists. They also typically earn more, which can influence the psychologist vs. therapist career decision.
• Psychiatrists: Among this group, psychiatrists are the only professionals able to prescribe medications in all states. Psychiatrists are medical doctors who specialize in mental health, so they have the longest education period in these professions. They also earn the highest salaries.

Compare the Educational Requirements for Mental Health Professionals

Each career requires at least an undergraduate and graduate degree that includes an internship or practicum, typically six years for full-time students. Your undergraduate major rarely matters as long as it includes at least some coursework in the social sciences, though psychology is one of the most common choices. You will learn specific techniques in your graduate study, which include a master's degree for counselors and therapists, a doctoral degree for psychologists, and a medical degree for psychiatrists.

Counselors

Counseling graduate studies comprise human development, different counseling techniques, and how to deliver effective and culturally competent counseling to groups and individuals. Some counseling specialties, such as substance use disorder counseling, may require less education but have a smaller scope of practice. You need at least a master's degree, including a practicum and internship, and you must practice under the supervision of a licensed counselor before earning your independent license.

• Education timeline: Six years
• Minimum degree required: Master's degree in counseling, psychology, or social work
• Internship requirements: Graduate fieldwork involves observing and then performing counseling work, under the close supervision of a licensed counselor. This comprises 100-200 hours of observation and 600-700 hours of active internship work. The number of hours can vary by specialty.

Therapists

The master's program covers issues in human psychological development, different approaches to psychotherapy, identifying mental health issues, and how to deliver culturally competent therapy. After you graduate, you must work under the supervision of a licensed therapist for a set period before you can practice independently.

• Education timeline: Six years
• Minimum degree required: Master's degree in marriage and family therapy, social work, psychology, or a related mental health field
• Internship requirements: Most graduate programs require at least 100 hours of observation and at least 600 hours of internship work. You must practice under a licensed therapist before obtaining your own license.

Psychologists

Psychologists must earn a doctorate in psychology, either a Ph.D. or a Psy.D. to practice. A Psy.D. generally focuses more on applied psychology practice, while a Ph.D. program emphasizes research in psychology and pedagogy. Depending on whether you attend full time and the program's pace, it typically takes 3-5 years to complete a doctorate. These educational requirements can affect the psychologist vs. therapist vs. counselor decision.

• Education timeline: 9-11 years
• Minimum degree required: Ph.D. or Psy.D. in psychology or a psychology specialty, such as clinical psychology
• Internship requirements: You can expect to spend approximately 1,500 hours in supervised fieldwork in your graduate program and approximately two years of supervised experience after you graduate.

Psychiatrists

Unlike the other professions in this guide, psychiatrists are medical doctors who specialize in mental health. They go through the most extensive education and training of all of these careers, following the standard medical school education and completing a psychiatry residency after they graduate.

• Education timeline: 12 years, including a four-year residency
• Minimum degree required: Medical degree (M.D.) or doctor of osteopathic medicine (D.O.)
• Internship requirements: Medical school includes at least 100 hours of fieldwork, with a four-year residency requirement afterward. You may also participate in a fellowship to further specialize after your residency.

Compare the Licensing Requirements for Mental Health Professionals

All of these mental health careers require state licensure to diagnose and treat mental health conditions based on the DSM-5. The specific licensing requirements vary by state, specialty, and job function.

For example, psychiatrists are licensed to prescribe medication in all states and must have a medical degree. Some states have different licensing requirements for substance use counseling than general mental health counseling. In many states, mental health licenses require passing a jurisprudence examination to demonstrate knowledge of the practice laws. License titles also vary by state and by level.

To become a licensed professional counselor, therapist, or psychologist who can practice independently, you must have a set number of experience hours practicing under a licensed professional, often around two years of full-time experience or the part-time equivalent.

Counselors

The National Counselor Examination (NCE) is a 200-item multiple-choice examination that must be completed within 255 minutes. The passing score varies slightly by year, based on difficulty. Your state may instead require the National Clinical Mental Health Counseling Examination (NCMHCE), a set of 10 counseling simulations you must complete within three hours, plus an additional 15 minutes of administration time. Both exams cost $275.

• Supervised Experience: 1-3 years
• Total time to become licensed: 7-9 years
• Where can I learn more about the licensing requirements for counselors by state? National Board for Certified Counselors and American Counseling Association

Therapists

Depending on your state's requirements and specialty, you may need to pass the NCE, the Association of Marital and Family Therapy Review Board's Marital and Family Therapy National Examination (MFT), or some other examination. The MFT fee is $365. It takes four hours to complete and comprises 180 multiple-choice questions.

• Supervised Experience: 1-3 years
• Total time to become licensed: 7-9 years
• Where can I learn more about the licensing requirements for therapists by state? Association of Marital and Family Therapy Regulatory Boards and Association of Social Work Boards

Psychologists

Most states require a passing grade on the Examination for Professional Practice in Psychology (EPPP) for psychologists to earn licensure. Passing grades vary by state, but test-takers generally need a 70% score. The EPPP includes 225 multiple-choice questions and takes four hours and 15 minutes to complete. The exam costs $600, and the Pearson Vue testing site requires an additional $91.88. Many states also require a separate jurisprudence examination.

• Supervised Experience: 1-2 years
• Total time to become licensed: 10-13 years
• Where can I learn more about the licensing requirements for psychologists by state? American Psychological Association

Psychiatrists

Psychiatrists are trained medical doctors who have earned a medical license by passing either the United States Medical Licensing Examination (USMLE) for M.D.s or the Comprehensive Osteopathic Medical Licensure Examination (COMLEX) for D.O.s. 

A license to practice psychiatry requires a four-year post-medical school residency and an acceptable score on the American Board of Psychiatry and Neurology (ABPN) examination. The ABPN exam, which takes 8.5 hours to complete, comprises 425 multiple-choice questions. The exam does not specify a pre-determined passing score, and the test standards are not norm-referenced. Test-takers pay an exam fee of $1,945.

• Supervised experience: Four-year residency
• Total time to become licensed: 10-13 years
• Where can I learn more about the licensing requirements for psychiatrists by state? American Psychiatric Association and American Board of Psychiatry and Neurology

Compare the Practice Differences for Mental Health Professionals

All mental health professionals apply the principles of psychology to help clients address their mental health needs. However, there are significant psychiatrist vs.psychologist vs. therapist vs.counselor differences, especially within their scopes of practice.

Counselors

Counselors provide advice and psychological counseling to clients, often to address a specific issue, such as dealing with grief or making career decisions. They help the client understand the nature of their problem and find the best way to solve it. Counseling can be short- or long-term, depending on the client's goals and needs.

• Common specializations: Addiction and substance use, career, marriage and family, mental health, rehabilitation
• Annual salary range: $36,700-$89,920 (BLS, May 2023)
• Projected job growth between 2022-2032: 18% (BLS, May 2022)

Therapists

Therapists provide similar services to counselors, primarily by applying psychotherapy, often to patterns or ongoing problems rather than a specific issue. Psychotherapy helps clients identify the psychological issues behind mental health or behavioral health concerns and to remedy the underlying issue. Therapy can take 1-2 years to achieve results, depending on the client's needs and progress.

• Common specializations: Art, depression, marriage and family, mindfulness, PTSD/trauma
• Annual salary range: $39,090-$104,710 (BLS, May 2023)
• Projected job growth between 2022-2032: 15% (BLS, May 2022)

Psychologists

Depending on the state regulations, only psychologists and psychiatrists can perform official psychological testing and diagnoses across the range of psychological disorders. Clinical psychologists specialize in diagnosing and treating mental health conditions, while counseling psychologists focus on counseling specifically. Psychologists and psychiatrists treat patients with more serious mental health issues, given their more extensive training. Psychologists may specialize in particular populations, such as children, or particular conditions or types of treatment.

• Common specializations: Child, cognitive-behavioral, forensic, health, organizational
• Annual salary range: $52,430-$151,880 (BLS, May 2023)
• Projected job growth between 2022-2032: 6% (BLS, May 2022)

Psychiatrists

Psychiatrists are medical doctors who can prescribe medications and often specialize in conditions that require medication or a combination of medication and counseling, such as depression. A counselor or psychologist may refer patients with more complex or serious needs to a psychiatrist, especially if they consider the patient may be in danger.

• Common specializations: Brain injury, child and adolescent, emergency, forensic, geriatric
• Annual salary range: $73,280 to greater than $239,200 (BLS, May 2023)
• Projected job growth between 2022-2032: 7% (BLS, May 2022)

Which Mental Health Profession Is Right for Me?

Your professional goals and personal interests can help determine the right mental health profession for you. How much time do you want to invest in your education? What are your financial goals? These are some distinctions to consider between psychiatrist vs. psychologist vs. therapist vs. counselor.

Counseling

• Advantages
  • Counselors, especially substance misuse counselors, are in demand, with an 18% projected job growth between 2022 and 2032, compared to 3% across all jobs. 
  • You can enter this field with a master's degree and proper licensure and earn a doctorate later to become a psychologist.
• Disadvantages
  • Many other fields that require equivalent education pay considerably more.

Therapy

• Advantages
  • Therapists can work in many settings within a variety of specializations. 
  • They can enjoy making a difference in people's lives, helping them understand themselves and their behavior.
• Disadvantages
  • Therapy can be frustrating for people wanting to see clients progress rapidly.

Psychology

• Advantages
  • The majority of psychologists are satisfied with their jobs. In fact, more than 90% of psychologists reported being very or somewhat satisfied with their careers in a 2017 survey. They were most satisfied with their level of independence and contributions to society.
• Disadvantages
  • You must invest time, money, and effort into earning a doctorate, which requires many years before you can begin practicing.

Psychiatry

• Advantages
  • This is the highest-earning mental health career. 
  • Being able to prescribe medication gives you more ability to help patients.
• Disadvantages
  • Medical school is tremendously demanding, and pay during residencies can be very low. The U.S. average is $46,670, according to Salary.com. 
  • You may graduate with very high debt that you cannot begin to pay off until after completing your residency. However, like psychologists, psychiatrists may be eligible for loan forgiveness.

Careers for Mental Health Professionals

There are common specialties among mental health professionals. For example, you can work with people dealing with substance use as a counselor, therapist, psychologist, or psychiatrist.

Careers in Counseling

• Substance Use Counselor: Substance use counselors provide advice and support in helping clients with substance use disorders. These professionals are in demand in many communities, especially as a result of the opioid crisis. Substance use counselors work with clients and may collaborate with family and friends to help the client.
• Licensed Mental Health Counselor: Licensed mental health counselors provide counseling and advice for people who want to address a mental health issue. They may help clients process a particular event or address a longer-standing condition. Some mental health counselors specialize in specific issues, such as phobias, grief and loss, or anxiety.
• Behavioral Counselor: Behavioral counselors help clients address specific behaviors, such as addictions, impulsive behavior, or behaviors associated with autism spectrum disorders. They may help clients identify triggers for certain behaviors or how to substitute another behavior for a maladaptive one.

Careers in Therapy

• Marriage and Family Therapist: Marriage and family therapists help couples or families understand patterns behind family conflicts or dysfunctions and how to address them effectively. These therapists may help individuals discover underlying issues, but the primary focus remains on the family and its functions.
• Licensed Clinical Social Worker: Licensed clinical social workers (LCSW) are licensed to provide therapy to social work clients. While many work for government agencies or nonprofits, an LCSW can also work as an independent practitioner. They may either work with referred patients with pre-existing diagnoses or diagnose mental health issues and provide talk therapy.
• School Counselor: School counselors work in schools at all levels to help students and their families. They may address issues, such as bullying, interpersonal skills, or educational and career choices. For K-12 schools, they typically work with teachers, parents or guardians, and students. Like other mental health professionals, they may refer clients to specialists, such as learning disability professionals.

Careers in Psychology

• Clinical Psychology: Clinical psychologists emphasize diagnosing and treating more severe or complex mental health conditions. They administer tests and perform diagnoses. However, with limited exceptions, they cannot prescribe medication. Many clinical psychologists specialize in a particular condition or type of patient.
• Counseling Psychology: Counseling psychologists emphasize counseling to help clients understand and address issues in their psychological well-being. These professionals work in various settings, including private practice, hospitals, other healthcare facilities, and schools.
• Forensic Psychology: Forensic psychologists work where law and psychology overlap. They may focus on mental wellness assessments for legal purposes, consult on jury psychology and analysis, or otherwise work within the justice field.

Careers in Psychiatry

• Consultation Psychiatry: Consultation psychiatrists, also known as psychosomatic or liaison psychiatrists, specialize in psychiatric care for people with medical conditions. They may work in hospitals or other healthcare facilities to optimize general care or provide care directly to patients.
• Geriatric Psychiatry: Geriatric psychiatrists work with older adults, particularly clients experiencing age-related mental health conditions, such as dementia, or those who need support in the transitions that come with aging.
• Child and Adolescent Psychiatry: Child and adolescent psychiatrists specialize in treating children and teens. They may work with children and youth who have not reached age-appropriate developmental milestones, those experiencing mental illness, or those who have experienced trauma.

Frequently Asked Questions About Psychology, Counseling, and Therapy

Is there a difference between counseling and therapy?

The difference between counseling and therapy is not always distinct. Still, in general, counselors help address specific issues, usually in the short-term, with advice and counseling. Therapists help clients identify the underlying psychological roots of behavior through psychotherapy methods, and therapy tends to be longer term.

Is being a therapist emotionally draining?

Being a therapist can be emotionally draining. During your education and fieldwork, you will learn techniques to minimize the emotional toll it takes on you. Depending on your personality and background, you may also find some branches of therapy more or less emotionally draining.

Can psychologists, counselors, or therapists prescribe medication?

In most states, psychologists, counselors, and therapists cannot prescribe medication; only physicians, physician's assistants, or advanced practice registered nurses can. A few states allow psychologists to become prescribing psychologists, typically requiring extensive advanced training in medication and prescribing. This is one of the main psychologist vs. therapist differences, as therapists cannot prescribe in any state.

What separates a good therapist from a bad one?

The skills and attributes separating a good therapist from a bad one are a major part of the counseling curriculum. To be a good therapist, you must develop strong listening and observational skills, uphold patient confidences, communicate effectively, demonstrate cultural competence, and understand and maintain ethical standards. You should be able to maintain self-control in emotionally charged situations and show consistency and reliability.