So you have decided to go ahead and look for a therapist. As you look around, you noticed that some therapists are “licensed,” others are “interns,” while others are “trainees.” Perhaps, some fear can arise. Maybe you aren’t sure if you want to put the your mental health in the hands of a “trainee.” But at the same time, your budget is limited and a licensed professional is simply too expensive to hire. So what do you do? What are differences?
One of the most common questions with clients new to therapy is understanding those differences.
Here I will attempt to break down what the differences between the levels of training in a therapist, why it matters, and what is important to you as a client.
What are the differences?
All mental health practitioners are strictly regulated by some form of government licensing agency. In California for example, they are the Board of Behavioral Sciences. These agencies act as “gatekeepers” and set a standard of quality for the counseling field. This is important, because they, in theory, ensure that whoever carries the mantel of a mental health therapist is qualified to do counseling and held accountable for any actions that they do. Being a therapist requires a lot of responsibility.
One of the “gate keeping” aspects of licensing is ensuring that the therapist receive an adequate amount of real life experience. The amount of experience is broken down into titles such as “trainee,” “associate,” or “intern.” We call these types of therapists “pre-licensed therapist”. A therapist that completes their experience are given the title of being licensed which is the end goal for all mental health training.
Before getting into the differences, what is a “licensed” clinician? A licensed therapist basically means that the therapist can legally practice therapy. Licensed therapists have much more freedoms than pre-licensed therapists in addition to greater job opportunities. They can operate without mandated supervision, they can access higher levels of training, and can be fully independent. Many licensed therapists still continue to pursue specialty trainings or certifications such as EMDR. However, licensed therapists are required to complete a certain level of continuing education per year. Being a therapist is a career long learning experience.
Now what about pre-licensed therapist? There are 2 categories of pre-licensed therapist: trainee, and associate (sometimes called interns.) Pre-licensed therapists are in the process of accumulating a certain amount of hours of experience. In addition, all pre-licensed therapists are under a supervisor (more on this later.)
Trainees are the lowest level of pre-licensed therapist. These therapists are still in their respective graduate programs but have completed the prerequisite classes required before starting practice. Trainee also have more requirements for supervision. Often have their job supervisors and school as additional oversight. Therefore, trainees have the most handholding and are often held more accountable to others than associates.
An associate is a therapist that has completed their graduate program. They would be working towards licensure by completing a certain amount of experience. Its normally referred to as “working towards your hours.” In California for example, an Associate Marriage and Family Therapist needs a total of 3000 hours of experience before being licensed. After completing their hours, they take a board exam and when they pass they are given licensure.
Why is it important?
The different levels indicate the levels of experience a therapist have. But it goes beyond just levels of experience. One of the most important distinguishing factors is the cost to do therapy. If you have done any amount of therapist shopping you will realize that therapy is expensive. But there is a way to reduce costs which is to hiring a trainee or an associate. They are usually cheaper because many of them are working for low wages, sometimes even for free. Thats because many pre-licensed therapist are more concerned about gaining their hours and experience than making a higher wage. So if you can’t pay a licensed therapist 140 dollars per session, you can go to a trainee and pay maybe 30 dollars per session. As a rule of thumb, the lower the level of experience, the cheaper the therapist will be.
But it’s important beyond the costs. Pre-licensed therapist also are under supervision. That means that they have a degree of oversight over them as part of their training. Licensed therapists on the other hand do not have supervision, but many attend consultation groups. The supervision is a good thing because the therapist is held accountable for their actions to their group and supervisor.
Pre-Licensed therapists are not poor therapists
Despite all the training, I will say that licensure or lack of is not an indication of the quality of therapy. A person might have more experience, but that does not mean that they are a good fit for you. As stated in my previous blog, one of the most important factors in successful therapy is the relationship between the therapist and the client. A person might have more experience but if they can’t connect to you, therapy won’t be successful. There has been substantial support for how the quality of treatment is highly tied to how the therapist and client relate to each other.
In my personal experience, I have had clients personally tell me that I was more effective as a trainee than their previous therapists that were either associates or even licensed! That was because I was able to connect with my clients better than their previous therapists were. Sometimes the ability to connect with client has little to do with clinical experience but with the personality, life experience, and talent of the therapist.
It may also be due to the therapy modality of the therapist which works or does not work for you as a client. For example, a you may want a therapist that is focused on getting quick results. So it may be helpful to see an associate level therapist that uses Cognitive Behavioral Therapy, or Solution Focused Brief Therapy rather than seeing a licensed therapist that uses psychodynamics. A poor fit how a therapist executes counseling is just as frustrating.
Lastly, all pre-licensed therapists have some level of supervision. A supervisor is more than just a boss, but it is a mentor that helps provide the therapist with guidance in their growth process as a therapist. Even though a pre-licensed therapist lacks experience, they make up for it by having the support of peers and a more experienced supervisor which is mandated by the licensing board. Licensed therapists on the other hand, are not mandated to do any sort of consultation even though it is considered ethical and highly suggested to participate in consultation of some form. So there is simply less oversight when seeing a licensed therapist because they are not always mandated to consult about their clients compared to pre-licensed therapists.
Experience still matters
While I am saying that pre-licensed therapists can be as a good as licensed therapists, there is something to be said about experience. A therapist that has “seen it all” to some degree might know what type of treatment modality to use or are more confident in executing their clinical interventions. This is especially true for therapists that specialize in certain populations or issues. A therapist that works with in substance addiction for 20 years will be very familiar with how to interact with people with addictions such as knowing when they are lying or understand how substance usage affects the clients.
Therapist experience and level of training matters more depending on the type of severity or presenting problem. More severe diagnosis such schizophrenia, personality disorders, or severe trauma are best handled by those who have more extensive experience. This also includes specialized types of treatment such as EMDR which a therapist often needs a certification to perform. However in milder or more general types of treatment such as depression, anxiety, or stress, experience plays less of an important role and a pre-licensed therapist might be adequate for the job. Unfortunately, it is often common for clients to be seeing an undertrained therapist for a severe issue for financial reasons. On the flip side, there are many clients that often want a licensed therapist assuming that they would be better at treating their mild depression claiming that they “want the best” and writing off pre-licensed therapists all together.
What is the take away?
My hope is that as client’s you will make the best decision possible to fit your financial and treatment needs. But what is the most important is how well the therapist fits and relates with you rather than simply having a lot of experience. But experience does matter especially if you are seeking specialized treatment or for a severe diagnosis. It’s important to know before choosing a therapist what you want out of therapy and how much you want to pay for it. Lastly, you want an enjoyable experience from therapy, so picking a therapist that fits you and that you can build a good relationship from is very important. The differing titles in licensing and training are important to know but ultimately do not dictate whether that therapist is any good or whether it is a good fit for you.
If you are interested in needing tips of finding a therapist, or am interested in my services, feel free to contact me\
Alex Ly is a Registered Associate Marriage and Family Therapist under supervision by a licensed clinical supervisor. He provides services in Fremont, Los Altos, and Sunnyvale specializing in young adults and teens. Learn more about the services he provides.
Disclaimer: Any material written is not intended to be clinical advice or professional counseling. If you need support, please see a professional for help.
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