Streamlining licensure. Banning reparative therapy for minors. Fixing problems in child abuse reporting. Changing “interns” to “associates.” Saving Psychotherapy.
I’ve spent years now fighting for major changes in the world of mental health care, and winning. Many of the changes I’ve played a role in were ones that I was told would be impossible.
Today we launch Ben Caldwell Labs, the most important project of my career. The change I’m fighting for this time involves you.
Student loan debt has been a regular topic here, as it should be. Mental health professionals need to have graduate degrees, which often means taking on significant debt. The American Psychological Association reports that PsyD students in psychology now graduate with a median of $200,000 in student debt just from their graduate studies. The federal government offers loan forgiveness for those who work in government and nonprofit organizations, through its Public Service Loan Forgiveness program.
Recently, there’s been some concern over the fate of that program. Therapists and counselors currently working in nonprofit settings wonder whether they will in fact be eligible — or whether the program will still exist — by the time they complete 10 years of service. But their concern is (at least so far) not supported by what’s actually been happening.
In every state, and for every psychotherapist license, there is a supervised experience requirement. Those requirements differ a bit from state to state and between license types, but they all hover around the same place: two years of full-time experience or the equivalent, typically operationalized as 3,000 hours. Where did that standard come from, and how has it changed over time? You may be surprised.
It’s nearly 100 years old.
I’m a young therapist. I started my graduate program at 23 years old and finished at 25. When I first started seeing clients in a school setting, I was 24, and their parents were often in their 40s or 50s.
I also have a young face. When people guess my age, I get anywhere between 17 and 23. I’ve been told that this is a good attribute to have, yet I am not yet seeing the benefits in my career. Several of my clients were taken aback when they first met me. Addressing my age and experience has become a norm, and I’ve accumulated a handful of recited professional responses when this occurs.
Over the years, I’ve seen a lot of applications. Caldwell-Clark, a nonprofit I co-founded, regularly hires prelicensed MFTs for paid positions. We tend to get good interest in those openings when they happen, with many good candidates applying. And in the years I spent as core faculty for a graduate program, I saw hundreds of applications from students eager to get in to that program.
In both contexts, the application process can be nerve-wracking for applicants, and frustrating for people like me who are responsible for evaluating the applications. People who would likely be great students, great employees, and great therapists can easily be overlooked on the basis of a few mistakes in their application materials.
Here are some things you can do to make your application for a prelicensed therapist position as strong as it can be.
We can’t say we didn’t see this coming. In the first edition of The Heart and Soul of Change: What Works in Therapy, published in 1999, authors Mark Hubble, Barry Duncan, and Scott Miller predicted that psychotherapists would soon be facing a new era of accountability for their work. Clients, payors, and policymakers would all demand hard evidence that psychotherapy was effective. That era is well underway, and so far we have provided a wealth of the kind of information these parties have demanded.
We can demonstrate that therapy works as an overall conclusion, and within the contexts of specific problems and populations. Proving the effectiveness of specific models has been helpful in many ways (showing that model-based treatment is superior to no treatment) and enlightening in others (showing that, for most problems, the model of therapy has little to no impact on outcome). The brain research discussed by Siegel, Cozolino, and others explains why therapy works. Psychotherapy in general is being held accountable, and it is passing the test with flying colors.
The same cannot be said of specific therapists, or of therapy training programs – yet.
Therapists, as a group, are pretty friendly people. We entered into a helping profession, one that relies on our ability to connect with a wide range of people. Generally speaking, we try to assume the best of others, whether friends or strangers. We go to great lengths to avoid jumping to negative conclusions. These are all great traits, and useful in the therapy room.
These same traits can also leave therapists and counselors vulnerable, though. Our desire to be on good terms with those around us can make it difficult when their behavior doesn’t line up with what we want or need. We’re trained and skilled at reducing conflict, so we’re typically not eager to jump into it (or create it).
Often, the frustrating things that other people and organizations do to therapists aren’t personal. They result from those other people and organizations doing exactly what they are supposed to do. They aren’t your friends, and they aren’t supposed to be. Understanding that can make it a lot easier and less stressful to deal with them.
Therapists and counselors in private practice find all kinds of creative ways to keep clients coming back. Some therapists offer clients package pricing, which they might also call a prepayment discount. For example, a therapist who charges $100 per session might offer five sessions for $450 if the client agrees to pay up front. Under either name, the therapist agrees to a price cut in exchange for a commitment to a certain number of sessions.
At first glance, everyone wins with such an arrangement. The therapist has cash in hand, the client saves money, and the client’s commitment to therapy may reduce dropouts and missed sessions. But such arrangements carry meaningful risks for therapists. These discounts can wind up costing therapists much more than they are worth.
Prelicensed therapists and counselors face a difficult road. Getting to licensure is a long and expensive process, so much so that even many well-qualified people drop out.
All of us here at Psychotherapy Notes want to make your path to licensure a little easier. So we’ve collected resources here that can help you along the way. You may already be familiar with some, but hopefully some are new and useful to you. Here are some essential resources for prelicensed therapists.
If you have a recognized disability, you can apply for a quiet room, additional time, or other appropriate accommodations for your licensing exam. Exact rules, and the process for applying, will vary by state. But every state has to make reasonable accommodations in the exam process under federal law.
Though there is little hard data, I’ve heard from multiple people who work for state licensing boards around the country that requests for disability accommodations are becoming more common in license exams for psychologists, counselors, social workers, and family therapists.