Fitness for Duty Evaluations (FFDE)

A psychological Fitness for Duty Evaluation (FFDW) is typically employer driven and is initiated when an employee may be unable to safely or effectively perform their job functions and it’s reasonable to believe the cause could be ascribed to a psychological impairment or condition. It’s important to remember that a FFDE is DIFFERENT than a Pre-employment psychological evaluation, a stand alone clinical evaluation, or other types of forensic evaluations (like Worker’s Compensation). A FFDE is typically initiated for an employee that’s already been employed but his/her behavior has become troublesome. Some examples might include the following: 1) an employee has a history of good conduct but there’s a sudden onset of hostility, irrational speech, withdrawal, or isolation; 2) allegations of unexplained or excessive use of force; 3) threats of violence; 4) the employee displays behavioral problems that suggest difficulty with effectiveness or judgment; or 5) reports of bizarre off duty behavior. According to the American Disabilities Act (ADA), there are some conditions that allow the employer to initiate this type of examination of an employee. Notably, an employer can require a medical examination “as long as the examination or inquiry is shown to be job related and consistent with business necessity…or that an individual not pose a direct threat to the health or safety of other individuals in the workplace.” (ADA, Title I). After evaluating the employee, a psychologist can determine, that due to a psychological condition, it is reasonable to believe that the condition may prevent the employee from safely and effectively performing the essential functions of the position held by the employee. Alternatively, if the psychologist feels this standard is not met, the employee will be deemed able to return to their duties. 

How to Find a Therapist

I can imagine that trying to find a mental health provider might feel like a daunting task, especially with so many different suffixes. You’ll see PhD, PsyD, LMFT, LPC, or LCSW. You also might see M.D., MA or the term Psychoanalyst. What do they all mean, you might wonder? The following is my attempt at distilling the various options in a quick and concise manner. That way, you, the consumer, can be better informed about the various levels of credentials and corresponding training, enabling you to make the best choice.

Are all THERAPISTS the same?

The term " Psychotherapist" is actually an unregulated title, meaning that anyone can use it to identify the type of work they do. There are no legal restrictions on designating oneself as a psychotherapist. The training and experience of each of these professionals is different and therefore their approach to psychotherapy will most likely be different. Typically, psychotherapists are one of the following:

Clinical Psychologist
A Clinical Psychologist is an individual with a doctoral degree (usually a Ph.D. or a Psy.D.) in clinical psychology who has training and experience in understanding human behavior, brain-behavior relationships, and the diagnosis and treatment of emotional disorders. They may provide psychotherapy, psychological testing, supervise other mental-health providers, or teach. Clinical psychologists have acquired their skills through a rigorous graduate school curriculum that is accredited by the American Psychological Association, received substantial training experiences in mental health settings, extensively researched an area of academic interest, and written and defended a dissertation. Because of their doctorate level training, clinical psychologists can also pursue specialized training in neuropsychology, forensics, industrial psychology, expert witness, and family mediation for the court system. In order to become licensed to practice psychology, individuals must complete an approved internship, receive significant post-doctoral experience under supervision, and pass a series of licensing exams.

Psychiatrists are physicians who earned a medical degree (M.D.) and completed specialized training internships and residency in psychiatry (a medical specialty focusing on the study, diagnosis, and treatment of mental illness). They often go on to train in post-doctoral fellowships in psychiatry and have ample psychiatric hospital experience. Psychiatrists are specialists in the prescription of psychotropic medications, and are the only mental health specialists who can prescribe medications that treat psychiatric conditions (except in the US Army, Illinois, Louisiana, and New Mexico. Psychologists also have prescribing privileges in those states/jurisdictions).

Clinical Social Worker
A Licensed Clinical Social Worker (LCSW) holds a masters degree in social work. Many go on to secure further clinical training in areas of specialized interest. They are trained in both psychotherapy and social interventions aimed at helping the individual cope with problems in his or her environment and/or relationships with others. They may also provide case management and community consultation, but cannot do psychological testing, nor prescribe medications.

Marriage and Family Therapist
MFT’s (individuals with a Masters degree in marriage and family theory) may become licensed by the state to practice psychotherapy. MFT’s generally focus on diagnosis, treatment, evaluation, assessment, counseling, and management, of mental and emotional disorders, whether cognitive, affective or behavioral, within the context of marriage and family systems.

Counselors (usually individuals with a masters degree in education, counseling, or psychology) may become licensed by the state to practice counseling. Their designations are usually Licensed Professional Counselor (LPC) or a Master’s of Arts or Science (MA or MS) with a particular focus in Clinical Psychology. Counselors generally focus on problem solving, prevention, development, and adjustment. They often provide psycho-educational techniques focusing on lifestyle and career development, social, cultural, or family issues, and substance abuse.


Psychoanalysts already have a matriculated degree (such as a psychologist, MFT, or psychiatrist) but are interested in pursuing the study of psychoanalysis, which is often another 4 – 5 years of training! The psychoanalytic doctorate is made up of two parts: a clinical training component followed by a research component. The degree usually consists of undergoing one’s own psychoanalysis (meeting with a psychoanalyst 3 – 4 times a week), methodology seminars, research workshops and writing a thesis.