Does Maryland require a license to call yourself a 'therapist' or 'psychotherapist'?

Plain-English summary

A state delegate asked the Attorney General to sort out whether Maryland law regulated who could call themselves a "psychotherapist," "therapist," "consultant," or "personal consultant," and how those terms were defined. The opinion found that none of these words were defined anywhere in Maryland statute or regulation, and none of them required a license or certification to use, unlike terms such as "physician" or "psychologist."

That did not mean the terms were free of legal consequence. The opinion explained that someone using the title "psychotherapist" or "therapist" while actually performing services that fell within the legally defined "practice of medicine" or "practice of psychology" (both of which required a license) could be pursued for the unauthorized practice of a regulated profession, regardless of what title they used. Separately, the opinion turned to the Maryland Consumer Protection Act, which bars unfair or deceptive trade practices, and concluded that an unlicensed person holding themselves out with a title like "psychotherapist" in a way that misleadingly suggested they were a licensed psychologist could run afoul of that statute, even though the title itself was unregulated. The opinion was careful to note this did not mean only licensed psychologists could ever describe their work as psychotherapy, since the term is broad enough to cover psychiatrists, social workers, clergy, and others depending on the actual services provided.

Currency note

This opinion was issued in 1991. Subsequent statutory amendments, court decisions, or later AG opinions may have changed the analysis, including whether Maryland has since created licensing or certification requirements specifically for counselors, therapists, or related titles. Treat this page as historical context, not current legal advice. Verify the current Health Occupations Article and any professional counselor licensing statutes before relying on any specific rule described here.

Common questions

Could anyone in Maryland call themselves a "therapist" without a license, according to this opinion? According to this 1991 opinion, yes, in the sense that "therapist" and "psychotherapist" were not protected titles requiring a license to use, unlike "physician" or "psychologist." But the opinion cautioned that if the person was actually performing services within the legally defined practice of medicine or psychology, using an unregulated title would not shield them from unauthorized-practice sanctions.

Was it illegal to call yourself a "psychotherapist" if you weren't a licensed psychologist? Not automatically, according to the opinion, since the term was not legally reserved to psychologists. But the opinion found that doing so in a way that misleadingly implied you were a licensed professional could violate the Maryland Consumer Protection Act's ban on deceptive trade practices.

What titles were actually protected under Maryland law at the time? The opinion noted that terms like "Dr.," "doctor," "physician," "D.O.," and "M.D." were restricted by statute to licensed practitioners, unlike "psychotherapist," "therapist," "consultant," and "personal consultant," which had no such statutory protection.

Background and statutory framework

The opinion found that "psychotherapist," "therapist," "consultant," and "personal consultant" appeared throughout Department of Health and Mental Hygiene regulations, such as references to a "consultant dietitian" or a group home resident's "therapist," but none of these regulations defined the terms or imposed licensing requirements tied to them. By contrast, Maryland law required a license to practice medicine or psychology under §§14-401 and 16-301 of the Health Occupations Article, overseen respectively by the State Board of Physician Quality Assurance and the State Board of Examiners of Psychologists under HO §§14-201 and 18-201. The "practice of medicine" was statutorily defined to include diagnosing, healing, treating, or preventing physical, mental, or emotional ailments, HO §14-101(j)(1) through (3), and the "practice of psychology" was defined to include applying psychological methods or procedures for interviewing, counseling, psychotherapy, behavior modification, or hypnosis, HO §18-101(e)(1)(ii). The opinion reasoned that a person who was actually providing psychotherapy through psychological methods was, by that statutory definition, practicing psychology and needed a license, whatever title they used.

If a licensing board suspected an unlicensed person was practicing medicine or psychology under the guise of a title like "therapist" or "consultant," the opinion noted it could refer the matter for criminal sanctions under HO §14-607 or §18-404, or seek a civil injunction, though it stressed a case-by-case factual assessment was required. Turning to consumer protection law, the opinion explained that while the State could not ban terms that fairly and accurately described the lawful activities of an unlicensed person, citing Comprehensive Accounting v. Md. State Board, 284 Md. 474, 489, 397 A.2d 1019 (1979), the State retained authority to prohibit deceptive or misleading commercial speech about professional services, citing a line of First Amendment commercial-speech cases and Maryland's own Barnett v. Maryland State Board of Dental Examiners, 293 Md. 361, 366-67, 444 A.2d 1013 (1982). The Maryland Consumer Protection Act, Title 13 of the Commercial Law Article, prohibited false or misleading representations and material omissions intended to induce reliance in connection with a consumer service, and the opinion concluded an unlicensed person holding out as a "psychotherapist" in a way that suggested licensure could be deceptive under that Act, subject to close factual scrutiny of the specific claims made.

Citations and references

Statutes:

• §§14-401 and 16-301 of the Health Occupations Article, requiring licensure to practice medicine and psychology
• HO §§14-201 and 18-201, establishing the State Board of Physician Quality Assurance and the State Board of Examiners of Psychologists
• HO §14-101(j)(1) through (3), defining the "practice of medicine"
• HO §18-101(e), defining the "practice of psychology"
• HO §18-101(e)(1)(ii), including psychotherapy, counseling, and behavior modification within the practice of psychology
• HO §14-607, authorizing criminal sanctions for unauthorized practice of medicine
• §18-404, authorizing criminal sanctions for unauthorized practice of psychology
• HO §14-602(b), restricting use of "Dr.," "doctor," "physician," "D.O.," and "M.D." to licensed practitioners
• HO §14-602(b)(2) through (5) and (c), limited exceptions to that title restriction
• Title 13 of the Health Occupations Article, the Maryland Physical Therapy Act, cited by comparison for its defined use of "physical therapist"
• Title 13 of the Commercial Law Article, the Maryland Consumer Protection Act
• COMAR 10.07.02.13.C(2), a health regulation referencing a "consultant dietitian"
• COMAR 10.07.06.05A, a health regulation referencing "Consultant for Medical Affairs"
• COMAR 10.21.04.05C(1)(d), a group home regulation referencing a "resident's therapist"
• COMAR 10.21.05.04D(8), a group home regulation referencing the "most suitable therapist"
• COMAR 10.21.05.04E(2), a group home regulation referencing "the therapist who signs the treatment plan"
• COMAR 10.27.12, the regulation defining and governing the practice of a "nurse psychotherapist"

Cases:

• Comprehensive Accounting v. Md. State Board, 284 Md. 474, 489, 397 A.2d 1019 (1979), Maryland Court of Appeals decision holding the state may not ban terms fairly describing an unlicensed person's lawful activities
• Friedman v. Rogers, 440 U.S. 1 (1979), U.S. Supreme Court decision on regulation of professional trade names
• Bates v. State Bar of Arizona, 433 U.S. 350 (1977), U.S. Supreme Court decision on commercial speech and professional advertising
• Virginia Pharmacy Board v. Virginia Citizens Commercial Counsel, 425 U.S. 748 (1976), U.S. Supreme Court decision establishing First Amendment protection for commercial speech
• Barnett v. Maryland State Board of Dental Examiners, 293 Md. 361, 366-67, 444 A.2d 1013 (1982), Maryland Court of Appeals decision on regulating deceptive professional advertising
• Hitchcock v. State, 213 Md. 273 (1956), Maryland Court of Appeals decision discussing the scope of the "practice of medicine"
• Aitchison v. State, 204 Md. 538, 105 A.2d 495, cert. denied 348 U.S. 880 (1954), Maryland Court of Appeals decision on the same topic
• Rock v. State, 6 Md. App. 618, 253 A.2d 401 (1968), Maryland appellate decision on the scope of the "practice of medicine"
• State v. Bruce Goldberg, D.D.S., Circuit Court for Baltimore County, Case No. 88CR1701, a Maryland trial court case on unauthorized practice of psychology
• Wei v. Bodner, 127 F.R.D. 91, 97 (D.N.J. 1989), federal district court decision describing "psychotherapist" as a broad, imprecise term covering multiple professions

Source

• Landing page: https://oag.maryland.gov/resources-info/Pages/attorney-general%E2%80%99s-opinions.aspx
• Original PDF: https://oag.maryland.gov/resources-info/Documents/pdfs/Opinions/1991/Volume76_1991.pdf (this opinion appears at printed pages 281-286 of the bound annual volume; Maryland's site does not publish a standalone PDF of this opinion)

Original opinion text

Best-effort transcription from a scanned PDF. Minor errors may remain, the linked PDF is authoritative.

HEALTH OCCUPATIONS

Consumer Protection - Use of Titles Like "Therapist" and "Psychotherapist"

April 24, 1991

The Honorable Michael R. Gordon
Maryland House of Delegates

You have requested our opinion about the use of the terms "psychotherapist," "therapist," "consultant," and "personal consultant." Specifically, you ask:

1. Are the terms "psychotherapist" and "therapist" protected in Maryland? If so, what are the prerequisites to their use? If there are no statutes or court opinions restricting the use of these terms, may anyone in Maryland claim to be a "psychotherapist" or "therapist" regardless of the person's credentials?

2. How are the terms "psychotherapy," "therapy," "consultant,"
   and "personal consultant" defined?

   For the reasons set forth below, we conclude as follows:

   1. The terms "psychotherapist" and "therapist" are not protected
      titles under Maryland law. However, unlicensed individuals who use these titles in the course of providing services within the scope of a licensed profession could be subject to sanctions.

   2. Although the terms "psychotherapist," "therapist,"
      "consultant," and "personal consultant" have not been defined by either statute or judicial opinion, the misleading use of such titles is prohibited by the Maryland Consumer Protection Act.

                                 I
      
                       Regulation of Titles
      

The terms "psychotherapist," "therapist," "consultant," and "personal consultant" are not defined by Maryland statute or regulation.1 Nor do any statutes or regulations require either licensing or certification of a "psychotherapist," "therapist," "consultant," or "personal consultant."2

Rather, the terms are used in a general sense in various Department

of Health and Mental Hygiene regulations. For example, the term "consultant" is used in a variety of health care regulations, usually in conjunction with a specific practice area. See, e.g., COMAR 10.07.02.13.C(2) ("consultant dietitian"); COMAR 10.07.06.05A ("Consultant for Medical Affairs"). Similarly, the term "therapist" is used but not defined in certain regulations. See, e.g., COMAR 10.21.04.056(1) (referrals to "mental health therapists"). Regulations governing group homes for the mentally disabled contain several references to "therapist," including COMAR 10.21.04.05C(1)(d) ("resident's therapist"), COMAR 10.21.05.04D(8) ("most suitable therapist"), and COMAR 10.21.05.04E(2) ("the therapist who signs the treatment plan"). However, the qualifications of these "therapists" are not defined.

The title "psychotherapist" is not defined in statute or regulation.

Nor is it used in a regulation.3

 The terms "psychotherapy" and "therapy" are used extensively in

regulations and statutes, again without definition. In general, the word "therapy" is used with its everyday meaning of providing treatment for an illness or disability, for example, "individual and group therapy
[and] occupational and activities therapy." COMAR 10.21.02.101(1).

    1
      Terms like consultant, personal consultant, and therapist are often used

by providers of services unrelated to health, for example, tax consultants. This opinion will be limited to these terms as they refer to providers of health services.
2
The term "physical therapist," of course, is used throughout the
Maryland Physical Therapy Act, Title 13 of the Health Occupations Article.
3
The term "nurse psychotherapist" is defined, however, and the practice
of a nurse psychotherapist is regulated in COMAR 10.27.12.

Thus, the terms at issue are used generally throughout COMAR, but none reflects a specific licensing or certification requirement. However, with respect to the terms "psychotherapy" and "therapy," the actions and procedures to which these terms apply might well be regulated under existing law. For example, someone claiming to provide therapy or psychotherapy might be engaged in the practice of medicine or psychology, which are defined by statute and regulation. State law requires that an individual be licensed before practicing medicine or psychology. §§14-401 and 16-301 of the Health Occupations Article ("HO" Article). These practices are monitored by the State Board of Physician Quality Assurance and the State Board of Examiners of Psychologists, respectively. HO §§14-201 and 18-201.

The "practice of medicine" includes "[d]iagnosing, healing, treating, preventing, prescribing for or removing a physical, mental or emotional ailment ... by physical, mental, emotional or other process ... or by appliance, test, drug, operation, or treatment." HO §14-101(j)(1) through (3). Thus, many individuals practicing what is commonly understood as "psychotherapy" do so as licensed physicians.

 The "practice of psychology" includes "any service involving the

application of psychological principles, methods or procedures for understanding, predicting, or influencing behavior, including the principles that relate to learning, perception, motivation, emotion, organizational relationships and interpersonal relationships." HO §18- 101(e). Of particular note, under HO §18-101(e)(1)(ii) the practice of psychology includes "[a]ny service involving the application of psychological methods or psychological procedures for interviewing, counseling, psychotherapy, behavior modification, or hypnosis." While psychotherapy is not defined, a person offering "psychotherapy" by means of psychological methods or procedures would actually be offering psychology and therefore must be licensed.

  If the Board of Physician Quality Assurance or the Board of

Examiners of Psychologists has reason to believe that an unlicensed individual is practicing medicine or psychology under the guise of "psychotherapy," "therapy," or "consulting," it may request the appropriate State's Attorney to seek criminal sanctions pursuant to HO
§14-607 or §18-404, or it may seek a civil injunction to stop the practice. Ultimately, a case by case assessment is required for a licensing board to evaluate whether an unlicensed individual has engaged in the unauthorized practice of a regulated profession.4

                                   II

                       Deceptive Use of Titles

The State has the right to limit the use of certain words as part of its

right to regulate the practice of a particular profession.5 However, the State may not ban the use of terms that describe the lawful activities of an unlicensed or non-certified individual. Comprehensive Accounting v. Md. State Board, 284 Md. 474, 489, 397 A.2d 1019 (1979). Thus, if the "therapy" or "consulting" being offered does not constitute the unlicensed practice of medicine, psychology, or another regulated discipline, the State may not prohibit the use of terms that fairly and accurately describe the service. Comprehensive Accounting at 489.

   At the same time, the State may ban deceptive or misleading

commercial speech. See, e.g., In re 455 U.S. 191 (1982); Friedman v. Rogers, 440 U.S. 1 (1979); Bates v. State Bar of Arizona, 433 U.S. 350 (1977); Virginia Pharmacy Board v. Virginia Citizens Commercial Counsel, 425 U.S. 748 (1976); Barnett v. Maryland State Board of Dental Examiners, 293 Md. 361, 366-67, 444 A.2d 1013 (1982). See generally 70 Opinions of the Attorney General 43 (1985) (restrictions on dental advertising).

The Maryland Consumer Protection Act, Title 13 of the Commercial Law Article ("CL" Article), prohibits "unfair or deceptive trade practices," including any:

    4
        For a discussion of the scope of the term "practice medicine," see,

e.g., Hitchcock v. State, 213 Md. 273 (1956); Aitchison v. State, 204 Md. 538, 105 A.2d 495 cert. denied 348 U.S. 880 (1954); Rock v. State, 6 Md. App. 618, 253 A.2d 401 (1968). A recent trial court decision dealt with the unauthorized practice of psychology. State v. Bruce Goldberg, D.D.S., Circuit Court for Baltimore County, Case No. 88CR1701.
5
For example, "a person may not use the words or terms 'Dr.',
'doctor', 'physician', 'D.O.', or 'M.D.' ... unless the person is licensed to practice medicine." HO §14-602(b). HO §14-602(b)(2) through (5) and (c) provide limited exceptions. If a person is not a licensee, the use of these terms is misleading. Cf. 70 Opinions of the Attorney General 43, 63-64 (1985).

         (1)   False, falsely disparaging, or
               misleading oral or written statement,
               visual    description,    or    other
               representation of any kind which has
               the capacity, tendency, or effect of
               deceiving or misleading consumers;

         (2)   Representation that ... [a] merchant
               has sponsorship, approval status,
               affiliation, or connection which he
               does not have; ...

         (3)   Failure to state a material fact if the
               failure deceives or tends to deceive;



         (9)   Deception, fraud, false pretense, false
               premise,     misrepresentation,      or
               knowing concealment, suppression, or
               omission of any material fact with the
               intent that a consumer rely on the
               same in connection with ... the
               promotion or sale of any ... consumer
               service.

  The Consumer Protection Act's prohibition of deceptive or

misleading representations could extend to advertisements that offer health care services by unlicensed individuals. For example, as discussed in Part I above, the practice of psychology encompasses "psychotherapy" by certain methods. Accordingly, an unlicensed person holding out as a psychotherapist might be regarded as deceptively suggesting that he or she is a licensed psychologist. Of course, any complaint of this type would need to be closely scrutinized in context to determine whether a violation had indeed occurred.6

    6 We should not be understood to be suggesting that only a licensed

psychologist may lawfully claim to be performing "psychotherapy." See generally Wei v. Bodner, 127 F.R.D. 91, 97 (D.N.J. 1989) ("Psychotherapist is a broad, imprecise term that can encompass psychiatrists, psychologists, social workers, clergy and others.").

                                III

                            Conclusion

  In summary, it is our opinion that:

1.     "Psychotherapist" and "therapist," unlike "physician" and

"psychologist," are not protected titles under Maryland law. Nonetheless, the use of such titles might be evidence that a person is engaged in the unauthorized practice of medicine or psychology, depending on the nature of the services provided.

2.      The terms "psychotherapist," "therapist," "consultant," and

"personal consultant" are not defined by statute. Although these terms are used in a number of health-related regulations, the terms are not defined nor is their use expressly prohibited. However, the use of these terms in a misleading or deceptive manner would be unlawful.

                                         J. Joseph Curran, Jr.
                                         Attorney General

                                         Susan Steinberg
                                         Staff Attorney

Jack Schwartz
Chief Counsel
Opinions & Advice