Kinds of Therapists: Who Does What, From LPCs to Psychiatrists

The main kinds of therapists in U.S. mental health care are licensed counselors, clinical social workers, marriage and family therapists, psychologists and psychiatrists, with psychiatric nurse practitioners and peer support specialists working alongside them^[7][2].

"Therapist" is an umbrella word, not a single license. The professions differ mainly in degree level, whether the clinician can prescribe, and what the training centers on. In 2025, 50.9% of the 54.6 million U.S. adults with any mental illness received mental health treatment^[8].

Counselors are by far the largest group. Substance abuse, behavioral disorder and mental health counselors held about 533,400 jobs in 2025^[1], compared with 76,300 for marriage and family therapists^[9] and 30,000 for psychiatrists^[10].

The word therapist also covers rehabilitation fields such as physical, occupational and speech therapy. This guide covers the mental health professions only.

These three professions require a master's degree, supervised clinical experience and a state license for independent clinical practice^[1][11][9]. Exact hour and exam requirements are set by each state.

Licensed professional counselors (LPC, LMHC)

Mental health counselors treat anxiety, depression, grief, stress and relationship problems in individuals, couples, families and groups^[1]. All states require them to be licensed, which involves a national examination and supervised clinical work under a licensed counselor^[1].

Addiction counselors are a related track. Substance abuse and behavioral disorder counselors typically need a bachelor's degree to enter the field, but those in private practice must hold a master's degree and a state license^[1].

Licensed clinical social workers (LCSW)

Clinical social workers diagnose and treat mental, behavioral and emotional problems, and provide individual, group, family and couples therapy^[11]. The license requires a master's in social work from an accredited program, supervised experience after graduation and a clinical exam^[11].

Social work duties also include connecting clients to community resources such as food assistance, childcare and healthcare^[11].

Licensed marriage and family therapists (LMFT)

Marriage and family therapists diagnose and treat cognitive, behavioral and similar disorders in the context of couples and other relationships^[9]. Even when treating one person, they focus on family systems and how relationships affect that person's mental health^[9].

Licensure requires a master's degree, a state-set number of post-degree supervised hours and a state-recognized exam^[9]. To enroll in Medicare, both marriage and family therapists and mental health counselors need at least 2 years or 3,000 hours of supervised post-master's experience^[4].

A psychiatrist is a physician; a psychologist is not. Psychiatrists hold an M.D. or D.O. and treat mental illness with psychotherapy, hospitalization and medication^[10].

Clinical and counseling psychologists typically hold a Ph.D. or Psy.D. and are licensed in every state^[12]. HRSA summarizes the split this way: psychiatrists can prescribe medication, while psychologists provide psychological assessments and therapy^[5].

BLS counted 81,300 clinical and counseling psychologist jobs^[12] and 30,000 psychiatrist jobs in 2025^[10]. Median pay in May 2025 was $100,580 for clinical and counseling psychologists^[12] and $281,870 for psychiatrists^[10].

Can psychologists prescribe medication?

In most states, no. As of July 2026, nine states allow specially trained psychologists to prescribe: Colorado, Hawaii, Idaho, Illinois, Iowa, Louisiana, New Mexico, Utah and Vermont^[3].

The added training is substantial. Vermont's law requires a licensed psychologist to complete a master's degree in clinical psychopharmacology, at least 14 months of supervised clinical rotations and a national certifying exam, with prescribing beginning in July 2029^[3].

Hawaii's law is narrower: a three-year pilot at federally qualified health centers on the islands of Hawaii and Kauai, for adults ages 18 to 65, under psychiatrist or physician supervision^[3].

SAMHSA lists two kinds of mental health specialists who can prescribe for mental health and substance use conditions: psychiatrists and psychiatric or mental health nurse practitioners^[2]. Primary care doctors, nurse practitioners and physician assistants can also prescribe for conditions including depression, anxiety and alcohol use disorder^[2].

Clinical social workers, counselors, psychologists, marriage and family therapists and peer support specialists appear on SAMHSA's list of professionals who provide counseling and therapy^[2]. Prescribing psychologists in the nine states above are the exception.

Psychiatric nurse practitioners are a large share of the prescribing workforce. HRSA estimated 39,354 psychiatric advanced practice registered nurses in 2022 and 52,164 psychiatrists in 2023^[5]. Psychiatric physician assistants are far fewer, at 3,224 in 2024^[5].

For what trials show about specific drug classes, see the guides to anxiety medication and ADHD medication.

Lists of kinds of therapists often mix two different things: the clinician's license and the method the clinician uses. CBT, DBT, EMDR and ACT are treatment approaches, and therapists may use one primary approach or combine several depending on their training, the disorder and the person being treated^[7].

Many therapies are variations of an established approach such as cognitive behavioral therapy, and there is no formal approval process for psychotherapies like the FDA process for medications^[7].

Approaches covered on this site include cognitive behavioral therapy, dialectical behavior therapy, acceptance and commitment therapy, EMDR, internal family systems and somatic therapy. Each guide reports what controlled trials show.

Peer support specialists

Peer support specialists and crisis counselors are on SAMHSA's list of professionals who provide counseling and support^[2]. HRSA describes peer providers as offering support based on their training and lived experience^[5].

The sources reviewed for this article do not compare therapy outcomes by license type, and none supports a claim that one profession gets better results than another. A better-studied factor is the therapeutic alliance, the collaborative bond between therapist and client^[6].

A 2018 meta-analysis of 295 studies covering more than 30,000 patients found an overall alliance-outcome correlation of r = .278 for face-to-face therapy^[6]. The association held across treatment approaches, patient characteristics, outcome measures and countries^[6].

That is a correlation, not proof that the alliance causes improvement. People who are already getting better may also rate the relationship more highly.

NIMH's guidance on finding a therapist makes a similar point: it calls rapport and trust essential and lists questions about credentials, treatment approach, evidence base and whether the therapist can prescribe^[7].

BLS projects employment of substance abuse, behavioral disorder and mental health counselors to grow 18% from 2025 to 2035^[1], and marriage and family therapists to grow 14%, against 3% for all occupations^[9].

That growth is not projected to close the gap. Under its status-quo scenario, HRSA projects 2038 shortages of 99,840 psychologists, 99,780 mental health counselors, 36,780 adult psychiatrists and 33,840 marriage and family therapists^[5].

Psychiatric nurse practitioners are the exception, with projected supply meeting 108% of demand^[5]. More detail is in therapist shortage statistics and the mental health workforce shortage.

Medicare coverage has widened. Since January 1, 2024, marriage and family therapists and mental health counselors can bill Medicare independently for diagnosing and treating mental illness, at 75% of what Medicare pays a clinical psychologist^[4].

Addiction counselors and alcohol and drug counselors who meet all the requirements for a mental health counselor can also enroll in Medicare under that category^[4].

Cost and access remain the barriers people report most often. Among adults who perceived an unmet need for mental health treatment in 2025, 61.4% said treatment would cost too much and 44.9% did not know how or where to get it^[8].

For prices and plan rules, see cost of therapy statistics and mental health insurance coverage.