Mental health counselor vs. therapist: Key differences explained

Finding mental health support can feel overwhelming, especially with the wide range of providers available. Titles like counselor and therapist are often used interchangeably, but they don’t always mean the same thing. While both are highly trained and licensed professionals, their methods and approaches to care can differ significantly.

Whether you’re looking for mental health support or are interested in pursuing a career in the field, understanding the difference between a mental health counselor and a therapist will ensure that you make the right choice.

This article explores the roles of mental health counselor and therapist and how to choose the professional or career path that's right for you.

Definition of roles

A counselor is a trained mental health professional who typically helps clients address specific life challenges. Counseling is generally a solutions-focused path to address a specific issue or challenge in your life. You may see a counselor for a relatively short amount of time and stop treatment when you have accomplished your goals.¹

A therapist is a clinician who treats mental health concerns, including mental illnesses. Treatment with a therapist is generally long-term. Instead of working through situational concerns, treatment with a therapist might take a holistic approach to mental and emotional health.¹

Education and training

Counselors typically earn a graduate-level degree, such as a Master of Education in Clinical Mental Health Counseling, where they study topics including individual and community behavior, personality and human development, and counseling theories.

In order to practice as a counselor, graduates must be licensed by their state, a rigorous process that involves supervised practical training. Common certifications for counselors include Licensed Mental Health Counselor (LMHC) or Licensed Professional Counselor (LPC).²

Therapists pursue graduate work in psychology or social work, often earning a master's or doctorate.³ In order to practice as a therapist, they must be licensed by their state. The process of licensure involves meeting strict qualifications and undergoing supervised practical training. Therapists often hold a certification as a Licensed Clinical Social Worker (LCSW) or Licensed Marriage and Family Therapist (LMFT).^3,4

Approaches and specializations

Clinical counselors and therapists focus primarily on talk therapy. Some specialize in certain types of care. For example, marriage and family counselors work with couples and families to improve their relationships by addressing issues like communication, expectations, and infidelity. Addiction counselors assist people who are trying to overcome substance use disorder.

During treatment, counselors and therapists may employ a variety of evidence-based tactics, including the following:

• Cognitive behavioral therapy (CBT): A technique that helps clients identify and reframe negative thought patterns⁵
• Person-centered therapy: A therapy tactic that supports the client's ability to find their own solutions. The counselor offers support and guidance throughout the process⁶
• Trauma-focused therapy: A process that uses trauma-informed practices to help clients process and recover from trauma⁷

Treatment settings and services

Counselors and therapists can work in a variety of settings. It varies greatly depending on who their clients are and the best place to connect with them. Many counselors and therapists work in private or group practices. They have office spaces that clients can visit for appointments, and many now offer virtual sessions.

Organizations, such as schools, rehabs, or hospitals, may have counselors on staff to support students or patients as needed. In these settings, they may have designated spaces in the facility to see clients, or they may come to the client's classroom or hospital room.

Scope of practice and responsibilities

Neither therapists nor counselors are medical professionals, and they are limited in the scope of practice. Their role is to provide talk therapy and other select treatments to clients to help them overcome mental health challenges. They are bound by a code of professional ethics and must follow all laws regarding privacy and confidentiality.

Many therapists and counselors are trained in psychology and have familiarity with the signs of mental illness. However, not all states allow them to make diagnoses. They may refer you to a psychiatrist or psychiatric nurse practitioner. Psychiatrists and psychiatric nurse practitioners have medical training, and they can diagnose mental illness and prescribe medication if needed.

Cost, insurance, and accessibility

According to Psychology Today, most therapists and counselors charge about $100–200 per appointment. A health insurance plan may cover mental health care, which can bring some out-of-pocket costs down significantly. You may only need to pay a per-visit co-pay.⁸

However, clients are always advised to check their coverage carefully. Insurance plans may only cover care from certain providers and may have a limit on the number of covered appointments per year.

Some employers offer Employee Assistance Plans that give workers access to mental health services at no cost. Your human resources department can tell you if that benefit is available to you.

If you do not have insurance and cannot afford the cost, check with your state or local department of health. They may have a list of low-cost mental health resources near you. You can also reach out to the National Alliance on Mental Illness (NAMI) helpline at 1-800-950-6264 to find resources in your area.

Choosing the right professional

Choosing a counselor or therapist is a highly personal process. Start by clarifying your needs and goals, and then look for a professional whose expertise aligns with the areas you want to focus on.

Research the clinician's credentials before making an appointment. Counselors who have appropriate licensing have undergone extensive training and have thousands of hours of practical experience. They understand their legal and ethical obligations to their clients, and they will protect your privacy and work in your best interest.

You should feel comfortable and safe with your counselor. Schedule introductory visits to meet with a counselor and see if you have a good rapport. You can decide whether or not to continue working with them after that meeting.

When to seek help

You may benefit from seeing a therapist or counselor if you are experiencing an unusually distressing situation, such as the death of a loved one, a relationship change, or job loss. In addition, you may need mental health care if you are experiencing symptoms of emotional distress, such as the following:⁹

• Excessive worrying or fear
• Excessive feelings of sadness
• Extreme mood changes
• Excessive feelings of irritability or anger
• Changes in sleeping habits
• Overuse of substances like alcohol or drugs
• Difficulty carrying out daily activities or handling daily problems

If you are having thoughts of self-harm, you can call or text 988 for immediate help.

Take the next step toward a healthier you

Both counselors and therapists play an important role in supporting mental health. If you’re navigating a specific challenge and want practical guidance to create solutions, a counselor may be the best fit. If you’re seeking deeper, long-term exploration of your emotions and overall mental well-being, a therapist might be the better option.

No matter which path you choose, seeking help is a powerful step toward growth and healing. Working with a qualified professional who understands your goals can equip you with the tools and insights you need to build a healthier, more balanced, and fulfilling life.

If you are interested in a career helping others, consider the online Master of Education in Clinical Mental Health Counseling from Oklahoma City University. Visit our admissions page to learn more, and schedule an appointment with an admissions advisor today.