What Can You Call Yourself:  Social Worker? Therapist?

Are you a social worker? That depends, of course, on the definition of the term. The most obvious definition would seem to be that you are a social worker if you do social work. With the focus on the work rather than on the person, one might contemplate the difference between genuine social work – as practiced by Jane Addams and memorialized in the National Association of Social Workers’s Code of Ethics, among other things – and the decidedly poor reflection of those lofty ideals in contemporary social work education. In this reading, as elaborated in another post, you are a social worker if you do the broadly and highly conceived work that Addams and many others have emphasized – even if you do it as a member of some other profession.

In the world of American politics, however, the contemporary social work profession has obtained “title protection.” This means that, as described in a different post and detailed in various jurisdictions’ laws, you may have to be licensed as a social worker before you can legally call yourself a social worker. This sort of thing seems reasonable in the case of doctors and perhaps lawyers, although sometimes the work of either could be done at much less expense by paraprofessionals. Should teachers be licensed? Maybe, although what it takes to get a teaching license can be rather absurd.

At some point, the proliferation of licensure requirements goes well beyond what is needed for public protection. Licensure becomes a rather blatant cover for efforts to restrict the flow of newcomers into the field, so as to protect the jobs and income levels of those who are already there. Thus, in Illinois, for example, listed professions include athlete agents, barbers, auctioneers, cosmetologists, canine handlers, and numerous others whose licensure probably yields excessive costs for consumers in exchange for little additional protection. A New York Times piece describes how a 22-year-old immigrant from Sierra Leone was shut down, in Utah, for calling herself a hair-braider without a license. That piece says, “There are more than 1,000 licensed professions in the United States.” At this writing, I am not aware of an authoritative site clarifying which terms are open to legal use.

I will leave it to another post to discuss the embarrassment of a social work profession that has obtained licensure protection for experts and quacks alike, with scant effort to distinguish the two. Here, the focus is on the question of what we shall call others in the profession. This includes social work professors and PhD students who have MSW degrees, and who have gone on to develop advanced knowledge in various aspects of the profession, but who have not yet completed state licensure requirements. It includes, in addition, those similarly unlicensed BSW and MSW graduates who are working clearly or perhaps vaguely in a capacity amounting to a form of social work practice, or who hope to do so. It also includes people without social work degrees, with or without other degrees, who are essentially practicing social work, or are calling themselves social workers, maybe with years of experience and achieving good outcomes (or perhaps not), without necessarily realizing that what they are doing is illegal because they lack the requisite licensure. Incidentally, as noted in that other post, these categories appear to account for the large majority of nonwhite Americans who describe themselves as social workers.

It may seem, at first blush, that there must be a plethora of alternate terms one could use to describe the work of various kinds of social work practitioners. Surely they can be called therapists, counselors, advisors, consultants, or coaches? I end that statement with a question mark because, frankly, I do not know. It depends, again, upon the laws of the particular jurisdiction – which could include one or more of the jurisdictions in which the practitioner and/or client reside and where the services were performed.

There appears to be an additional problem. There is the question of what to call oneself; but then there is also a question of what one can do. A search leads, for example, to an Ohio state government webpage which says that unauthorized (i.e., illegal) practice includes “engaging in the practice of professional counseling” or “practic[ing] social work” or marriage and family therapy without a license. In other words, even if you don’t call yourself a social worker, you may be practicing social work, and perhaps that would be sufficient to support a criminal charge against you. It’s hard to say from that particular webpage; it does not appear to link directly to any definition of “social work” or “professional counseling.” Incidentally, that webpage also says it is unauthorized to use words or initials presenting oneself as a type of counselor or social worker (e.g., relationship counselor, career counselor, social work assistant). There appear to be some exceptions, but how those apply in a particular case is up to the individual and his/her attorney to figure out. To add another layer of complexity, that page appears to date from 2005; I have no idea whether it represents current law in Ohio.

As a side note, the U.S. Small Business Administration (SBA, 2013), a federal government agency, notes additional concerns for people who want to start their own business, home-based or otherwise: “Virtually every business needs some form of license or permit to operate legally.” SBA provides a webpage offering to list the kinds of licenses and permits required for a given business within a given city or zip code. Among the 14 specific kinds of business listed there, I did not see any that would apply to social workers in particular, so I followed the site’s advice and chose “General Licensing.” Trying that yielded a list of eleven different licenses, permits, and registrations (e.g., “tax registration,” “local permits,” “doing business as”), none of which were at all specific to anything like social work. That is, it did not provide guidance on the particular questions of what can call oneself, and what one can do, that might involve social work.

A New York webpage offering consumer information says this:

The Licensed Clinical Social Worker may provide all social work services, including clinical services such as the diagnosis of mental, emotional, behavioral, developmental, and addictive disorders, the development of treatment plans, and the provision of psychotherapy. The Licensed Master Social Worker may provide these clinical services only under supervision of an LCSW, licensed psychologist or psychiatrist.

Social work services may also be provided by an unlicensed person with a Bachelor’s in Social Work degree, under the supervision of an LMSW or LCSW, although non-licensees cannot diagnose or treat mental illness or hold themselves out as licensed.

Those remarks convey the information that, in New York, if you have an LCSW, you can diagnose and treat mental illness in your own practice. If you have an LMSW, you can diagnose and treat mental illness only under LCSW supervision. If you have neither an LCSW nor an LMSW license, you cannot diagnose and treat mental illness. Unfortunately, it is not clear what counts as diagnosis and treatment of mental illness. New York licenses a number of professions, including acupuncture, massage therapy, medicine, nursing, creative arts therapy, occupational therapy, pharmacy, and physical therapy. With the exception of a few subspecialties (e.g., psychiatry, within the field of medicine), none of those eight examples is typically considered a core mental health profession on a par with clinical social work or psychology. Yet surely all treat mental illness (e.g., depression, anxiety) in various ways, as do others that are not included on that list of New York licensed professions (e.g., recreational therapy, bartending, astrology, prostitution, ministry). Of course, spouses and friends treat mental illness too. At a certain point, it becomes difficult to refrain from ridiculing the reach of licensing laws, but that is not the purpose here.

My guess is that you would be asking for trouble if you spent your day working under a neon sign as an unlicensed practitioner, charging high fees to serve people who showed obvious signs of severe mental illness, and selling random potions and activities with promises to cure them. At that point, you really might be a quack, and might thus deserve whatever the licensing authorities were dishing out. By contrast, pending more focused investigation, it would seem less risky (at least within the picture sketched out by the foregoing quote from New York) to restrict one’s practice to people who did not seem to display signs of mental illness, and to the provision of non-psychotherapeutic treatments. Such remarks suggest that, even for the unlicensed practitioner, familiarity with such things as the Diagnostic and Statistical Manual and the nature of psychotherapeutic practice might be a good idea, so as to have a sense of where various lines might be drawn. I would not infer that every person, and only those persons, who possess a BSW or MSW are competent to practice some form of social work, but relevant study could be helpful for the budding practitioner.

Perhaps a closer inquiry would identify court cases or other sources that explain how the lines are drawn in New York or elsewhere. Unfortunately, because of the broad licensing (and concomitant unaffordability) of legal practice, advice and insight in such matters often comes down to word-of-mouth commentary, in online chat groups among people who may or may not know what they are talking about. As a partial improvement on that state of affairs, there are sources for free or cheap legal advice. Unfortunately, “professions” are not included among Nolo’s list of topics, for example, though Nolo does offer some guidance on laws pertaining to the tasks of starting and running a nonprofit. Further searching might lead to books and other guides relevant to an individual’s situation.

Going back to the list of terms I tossed out (above), my own impression at this point – which would have to be verified with further inquiry and/or professional legal advice – is that it might be permissible to call oneself a therapist, in at least some states, at least if one does not include a licensed prefix (e.g., physical therapist, massage therapist). For example, a person might explore whether it would be OK to call oneself something like a “chi therapist,” “life therapist,” or “reality therapist.”

As with therapist, so also, perhaps, with counselor — except, apparently, in states like Ohio (above). For instance, the American Association of Pastoral Counselors indicates that “only six states actually license the title Pastoral Counselor.” The list of titles provided there includes Certified Clinical Pastoral Therapist and Certified Pastoral Counselor, among others. That page also provides links to the relevant licensing boards in each state. There might be other counseling titles that would not be licensed. For instance, a search raised the possibility that few states placed restrictions on the use of the title “camp counselor.”

Given the foregoing remarks, it tentatively appeared that what was licensed would be the broad term in some professions (e.g., attorney, physician) but only a narrowed term in others (e.g., marriage and family therapist). Pending detailed investigation within a particular state, it appeared that unlicensed individuals might begin by exploring vague terms: “personal advisor” or “life coach,” perhaps, rather than “financial advisor” or “athletic coach”; “adjustment consultant” but not “clinical mental health consultant.”

To emphasize, I had no way of knowing which if any of these terms would actually fly, within a given state; this just seemed to be the way the wind was blowing, based on the foregoing observations. It seemed advisable to bear in mind that the licensing authorities might be focused, not only on the title, but also on the work being done, and that both questions would have to be adequately researched before commencing work. Finally, there could be other questions that were simply not anticipated by the several sources cited here.

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Comments

  • Michael Allison  On January 7, 2017 at 4:03 PM

    This is one of my favorite topics. If I get a doctorate in psychology, but I don’t get a LICENSE to practice psychology, am I still a psychologist? I read on one site a while back, if I get a doctorate in psychology and don’t get licensed, am I still a “doctor”? These are funny questions, but they are actually pretty good questions. There is so much “protection” built around all this, it gets confusing. They make us get licensed to protect the public — good thing. They make us get licensed to protect the title — mostly good thing. We won’t talk about accreditation and stuff like that because we start to get in to regulating opinions. I am a Marriage and Family Therapist. I have specific training in systems theory and therapy with multiple people in the room and how to diagnose and treat relationships rather than people (although I have that as well). I spent two years in graduate school and in that time we did nothing except learn how to think about and provide therapy — except a great deal of personal introspection. One year of that also included an internship which required me to get experience working with 2 or more people in therapy working on their relationships. After that, I had two years of supervised experience, a good deal of that required to be working with 2 or more people in a relationship — all before I could get an independent license. A typical – but not all — social worker will probably have a good portion of their 2 year education learning about providing therapy and even a semester, or more, where they have to do therapy. Of course they are also learning other cool stuff that social workers need to know, but doesn’t necessarily apply to therapy. Then they have to do supervision as well to become fully licensed. NOW for the cool part. In Utah, that social worker could then open up a practice as a Marriage Therapist, or Family Therapist, or Sex Therapist, or Relationship Therapist. For the most part they would compete with me without anywhere near the amount of training and experience I have. Of course, the State really expects them to have some training, supervision and expertise in these things, but, the state is not organically going to protect my TITLE from them — although I would probably get talked to if I called myself a Social Worker. (Not to say that the Licensed Clinical Social Worker could call them self a Marriage and Family Therapist, either).

    At some point there is the caveat emptor — that the client needs to investigate their practitioners. Make sure they have the experience and expertise that they, the client, need, regardless of what the practitioner calls them self or CAN call them self.

    Since I’m not licensed as a psychologist, I cannot advertise services as a psychologist, although I may call myself a psychologist and my clients may even call me doctor. But I would be sure to make it clear to my clients that I am Licensed and qualified as a Marriage and Family Therapist … or a life coach, or family adviser, parenting specialist, sexologist, oh my, the list is long.

    Thanks for this entry, it is a fun topic…..

    Mike

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