Clinical vs Counseling

“I know I would like to pursue a graduate program in psychology, with a focus on mental health, but should I choose clinical programs or counseling programs?”


Clinical Psychology and Counseling Psychology programs share many characteristics. There is more variation within type of program than between. Especially within APA-accredited programs, there is probably upwards of 90% similarity in content and experience. And don’t forget about School Psychology programs which are also very closely related! Note, however, that Counseling Psychology is not the same as Professional Counseling.

Why the Labels?
Clinical Psychology and Counseling Psychology do indeed have their own technically distinct histories, professional societies, and training programs. In the past, the primary distinction was that clinical psychologists worked with those suffering from severe mental disorders (e.g., OCD, PTSD, Schizophrenia, Bipolar) whereas counseling psychologists worked with those struggling with normative-but-difficult life experiences or transitions (e.g., divorce, grief, injury, retirement). It was also the case that, regarding ethical concerns, clinical psychologists were more focused on individual-level issues such as client rights and autonomy, while counseling psychologists were more focused larger-scale issues such as social justice initiatives and advocacy. The separation of these training models rested on the assumption that mental health care for severe psychopathology was qualitatively different from that of mild/moderate distress, and that the other focus areas aligned themselves appropriately for the professionals seeking those forms of work. That notion has found criticism in the decades since the development of these programs, and indeed the training and expertise of clinicians and counselors today tends to be mostly overlapping.

Current Differences
There are still some differences today which may be worth noting. Clinical Psychology training programs are going to be more likely to include a focus upon neuropsychology, projective personality assessment, and severe psychopathology. Counseling Psychology training programs on the other hand are more likely to include a focus on vocational/career-related assessment and intervention, measurement of normative personalities, and stages-of-life issues in treatment. Some differences also exist with regard to preferred theoretical orientation to psychotherapy, with clinical programs often emphasizing cognitive behavioral therapy (CBT) and counseling programs often providing more training in a wider array of models (e.g., existential, interpersonal, multicultural, humanistic), although both types will certainly offer some variety of exposure. So if you’re passionate about studying the psychological effects of intimate partner traumatic violence, the MMPI, suicide and self-harm, or using CBT to treat depression, a Clinical Psychology training program may be a better fit. If you’re passionate about studying the psychological effects of job loss, the Strong Interest Inventory, adjustment disorders, or treating anxiety with eclectically oriented psychotherapy, a Counseling Psychology training program may be a better fit. However, again, one could very plausibly study all those issues and much more at either type of training site.

The following are all true of both Clinical Psychology and Counseling Psychology training programs:
-Programs at the doctoral level can be APA-accredited.
-Courses will cover ethics, research methods, statistics, and the history of psychology.
-Students will learn about psychopathology, etiology, assessment, and psychotherapy.
-Programs will vary along a spectrum from very research-focused to very practice-focused.
-Graduates can be eligible to pursue licensure as practicing psychologists.
-Licensed practitioners from these backgrounds can apply mental health diagnoses to clients, charge for services, and bill insurance.
-Training will prepare students for: a variety of job settings including schools, hospitals, in-patient units, private practices, agencies, jails/prisons, military complexes, community centers, and more; a variety of clientele specializations including children, adolescents, adults, and older adults; a variety of modalities including individual therapy, couples’ therapy, family therapy, and group therapy; and a variety of roles including psychotherapist, professor, researcher, supervisor, consultant, author, manager, and more.

It’s not an exaggeration to say that these models are largely overlapping. “The differences between the two professions are mainly related to history and philosophy,” but “the differences that you see become very watered down as time goes on, and the differences today are much less substantial” (Metz, 2016, p. 29). There is no such thing as a “licensed clinical psychologist” or “licensed counseling psychologist,” at least not in Michigan or any other US state–there is simply the label of “Licensed Psychologist.” The APA accreditation standards for training programs and licensure options are identical for clinical and counseling psychologists. And the job prospects are almost entirely overlapping as well–it is quite rare for a job ad to specify that one must have one or the other background. During my training, I had supervisors with a PhD in Counseling Psychology who worked full-time in hospital settings seeing folks in severe distress, and I had supervisors with a PhD in Clinical Psychology who worked full-time in outpatient counseling settings seeing primarily folks with mild/moderate symptoms. Far more of the differences in your eventual career outcomes will result from the nuances of your personal interests, the training opportunities you seek, and the connections you build, than whether your degree says “clinical” or “counseling,” really!

Know what a client calls their clinical psychologist? A psychologist.
Know what a client calls their counseling psychologist? A psychologist.
Most people seeking services have no idea the difference, and they never will.

Application Differences
For those seeking admittance to graduate programs at the doctoral level, there may be some strategic things to be aware of. First, Clinical Psychology programs are more common than Counseling Psychology programs. Of the several hundred graduate training programs for psychology in the USA and Canada, the ratio of clinical:counseling is approximately 3:1. [By the way, the ratio of clinical to school psych is about 2:1.] Second, for some reason, the “Clinical Psychology” label often seems the most popular with applicants, hence clinical programs tend to receive more applications and are therefore more competitive (not always, but often). It seems as though clinical is presumed to be more prestigious or more desirable by applicants–ignore all that, do not build your career based on faulty assumptions. The program which fits you best will have faculty conducting research on topics of your interest, nearby practicum sites which excite you, a training philosophy or theoretical focus matching yours, a desirable financial package, a locale in which you would like to live, and other indicators that you belong. The words “clinical” or “counseling” alone do not determine your level of fit.
The most desirable training program is the one which matches your career goals!

Don’t Forget School Psych!
Lastly, I need to make one more plug for School Psychology training programs. Basically everything written here about clinical and counseling applies similarly to school psych. Students are trained in the science of mental health and the professional practice of therapy and assessment skills, but the key difference is that there is a training focus on children/adolescents in the context of school systems. Does that mean one can only ever work in schools? No! Again, the degree level and license options are the same as clinical and counseling (with the exception of the “School Specialist” degrees), and career pathways vary widely. Read more about School Psychology here.

Take-Home Point
In applying to graduate programs and trying to decide which route is best for you, the labels “clinical” and “counseling” (and “school”) are probably less important than ensuring that you fit well with the programs to which you are applying. So, consider each kind of program in your search for an appropriate training site!