Professional Licensing in Mental Health

Largely for historical reasons, the introduction of licensing laws and the development of general attitudes toward psychotherapy and counselling regulation have proceeded very differently depending on where you are in the world, especially in the United States.

Licensing in the US and Elsewhere

In some countries, most notably the United States, individual practitioners are required by law to be licensed in order to practise counselling or psychotherapy. Holding a license means that a practitioner has completed a level of training specified by the licensing board.

In the US, licensing is regulated at the state level, and it is illegal to offer services while physically within that state unless licensed by that state. If you are seeking face-to-face counselling in the United States, it is essential that you verify whether your practitioner is licensed — not because licensing provides any guarantee about the quality of the service you will receive (it does not) — but because a counsellor offering services in the US without a license is breaking the law. This would indicate either that the counsellor is unaware of the laws regulating their profession, or that they are deliberately undertaking criminal activity; neither alternative is acceptable!

Other countries, including Australia and the United Kingdom, do not regulate the profession by means of licensing; in the UK, there is no such thing as a ‘licensed practitioner’. (To put it another way, US licensing laws are no more applicable to the UK practice of counselling and psychotherapy than they are to the UK practice of driving.)

Notably, a recent 3-year study in Australia, dubbed “the most comprehensive and diverse study ever to be undertaken on the regulation of the Counselling Profession”, concluded that consumer protection would best be served by not introducing governmental regulation over and above the existing self-regulation via relevant professional organisations.

What Does Licensing Mean for You?

Licensing guarantees that a practitioner has completed a particular level of training specified by the relevant licensing body. Remember, however, that anyone can claim to be licensed, so a simple statement that a practitioner is licensed guarantees nothing. More importantly, licensing is not a guarantee of service quality. Indeed, scientific studies have repeatedly shown no positive correlation between the types of educational achievement required by licensing bodies and actual clinical effectiveness. (For an overview of some of those factors which are associated with clinical effectiveness, see the review of Hubble et al. (1999) at this site.)

Try Online Counseling: Get Personally Matched

In practice, the primary functional role of licensing is to ensure that a client who has been treated inappropriately by a practitioner has straightforward legal recourse against that practitioner. From the point of view of some practitioners, licensing also has the effect of increasing their status and prestige in the eyes of the public, enhancing the ‘professionalism’ and the degree of authority or exclusivity associated with the work. For a provocative argument that licensing and regulation actually have much more to do with some practitioners’ desire for status and prestige than with serving the public good, see Mowbray (1995).

Regulation via licensing often goes hand in hand with a philosophy that counselling or therapy represent something done to a client, in the way that heart surgery is done to a patient or a tooth extraction is done to a patient. (In fact, some practitioners who view themselves as doing things to people even refer to their clients as ‘patients’!)

What About Countries Without Regulation Via Licensing?

As noted above, there is no such thing as a ‘licensed practitioner’ in countries such as the United Kingdom. However, it is still possible to verify a counsellor’s training so as to achieve the same level of confidence — or, indeed, more confidence — in his or her qualifications as one might have from verifying licensure. (I say ‘verifying licensure’ because anyone can claim to be licensed, just as anyone can claim to have a PhD — in either case, to be certain, you should still verify that what the practitioner is claiming is for real.)

Also as noted above, academic qualifications are not positively correlated with clinical effectiveness — but when selecting a counsellor, this type of background information still contributes a part of the overall picture which you will form of them before deciding to try their services. (See the page “Selecting a Counsellor or Therapist” for more of this picture.)

Licensing and Ethics

Finally, in my view, a counsellor’s determination to adhere to a recognized ethical framework (such as that of the BACP) is more important than the specific details of their educational background.

Also see the Australian study cited above which concluded that governmental oversight did not serve the public good better than self-regulation via professional bodies.

Licensing and Online Counselling Services

For my part, I am a fully qualified counsellor and when in active practice was always a Member of the British Association for Counselling and Psychotherapy (MBACP); I previously offered online counselling services here at this site and later at one of our spin-off sites wholly in accordance with the ethical framework of the BACP. An archive of many of the materials from my private practice is still available over at TryCounselling.com. I also held Enhanced Disclosure from the UK’s Criminal Records Bureau (originally granted in the context of gymnastics coaching), a clearance level “reserved for positions involving the greatest degree of trust”. The CRB was later replaced, and I now hold the corresponding Enhanced Disclosure from the UK’s Disclosure and Barring Service, specifically as a martial arts instructor.

However, anyone anywhere in the world can in principle set themselves up with a website and claim to be an online counsellor or online therapist. Merely stating that one is qualified — or licensed — does not make it so, and therefore I would encourage every prospective client of an online counselling service to verify that their choice of practitioner really is who he or she claims to be.

• ethics
• in practice
• law enforcement
• therapy