What all those letters mean…
Back in the day, I was in search of a therapist. Psychology Today had its search function, so I filtered what I was looking for, scrolled through what felt like an ocean of names, and within seconds realized I had no idea who to pick. I thought I knew what I was looking for, but how could I parse between all the letters behind people’s names?
I wanted to provide something I needed when I started looking: a brief little explainer for what my credentials are, and other letters you may come across in your search for the right therapist. From the outset, though, I want to note there is tremendous overlap between all these licensures when it comes to therapy. Any “distinguishing features” noted below does not mean practitioners with different licenses do not also share knowledge and experience held with other licensures.
They all require:
1) graduate-level education
2) a lot of supervised clinical hours
3) training in different therapeutic styles (“modalities” or “theories”).
The purpose here is to provide general information, but every therapist’s practice and influences are nuanced. While I will expand on LCSW training below, I will provide brief summaries for the other licensures.
One more note: none of the licenses below permit prescription of psychiatric medication in New York State. Medicine is prescribed by Nurse Practitioners (NP), Physician Assistants (PA), and Medical Doctors (MD) can prescribe psychiatric medication in New York State.
My credentials: LCSW, CASAC
LCSW
Licensed Clinical Social Worker is a professional license that allows social workers to independently diagnose and treat mental health conditions.
The first step to licensure is graduating a Master of Social Work (MSW) program at an accredited university. Social work is a broad field – you can find social workers doing individual therapy, running community organizations, coordinating care at hospitals, assisting companies in developing and implementing social programs, creating policy for government leaders, and much more. The MSW exposes students to the breadth of social work practice, so they are equipped to move forward confidently in their social work niche.
Most graduates will then take the exam for Licensed Master of Social Work (LMSW). This licensure permits social workers to counsel individuals under supervision of an experienced LCSW, or sometimes another qualified mental health professional. (It also opens other doors to community- and government-based work, but we don’t have to get into that here.)
LCSW’s are eligible to take the board exam after at least 3 years’ experience as an LMSW. These years must contain a certain number of hours devoted to diagnosis, treatment planning, individual counseling, supervision, etc.
Distinguishing features: Training covers a broad scope, from mental health to systems. Strong emphasis on how our environment impacts us as individuals (and vice versa) in our development and day-to-day life. Social justice and systems thinking are other highlights.
CASAC
Credentialed Alcohol and Substance Abuse Counselors are found mostly in substance use programs providing counseling focused on assisting individuals who have problems with various substances. Gambling Disorder is also under the CASAC purview.
CASAC’s take a series of courses, then complete hours of supervised substance counseling and take an exam to earn the credential. CASAC’s are not permitted to provide independent counseling like the other licenses on this page; it is a credential noting experience and specialization in substance use treatment.
CASAC’s in New York are trained in a harm reduction approach, making room for the individual to decide what their goals are in their relationship with substances. Client-driven goals can include abstinence, moderation, and risk reduction.
Other Licenses in New York
LMHC
Licensed Mental Health Counselors primarily focus one individual and group counseling, but many also specialize in working with couples and families. And LMHC-D designation means the individual is allowed to diagnose and treat mental health disorders.
LMFT
Licensed Marriage and Family Therapists specialize in relationships and systemic patterns in relationships (couples and families). They bring valuable training in theories around family systems, relational dynamics, and communication. They can also diagnose and treat mental health disorders.
PhD in Clinical Psychology | Doctor of Psychology (PsyD)
These are doctorate psychologists with deeper training in testing and specialized modalities.
DSW
Doctor of Social Work is an educational degree and not a different clinical license from LCSW. Many DSW’s are also LCSW’s. The degree offers education and opportunities to research social work issues of the candidate’s choice.
Each license represents rigorous training, clinical dedication, and thousands of supervised practice hours. Each one can hold the education and experience needed to work with you. In other words, the letters don’t matter all that much.
What does matter is the therapist/client relationship, fit, and dynamic. Those are the strongest predictors of growth.
I hope this explainer has been useful for you! If so, please feel free to share it with anyone looking for a brief(ish) explanatory guide to common mental health licensures in New York State.
