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.
Early Psychology
The apprenticeship model of therapist training dates to the early days of psychology as we know it. Freud’s followers studied under him for years before branching out on their own, as did Jung’s – and Jung had once been a student of Freud. As the ranks of early psychoanalysts grew, the custom was to be in therapy as a subject of analysis while you were also seeing your own cases. This worked to ensure that you understood yourself and the process of being a client. To this day, many graduate programs in the mental health professions either require or strongly encourage their students to go to therapy as a patient, regardless of whether the student actually has any mental or emotional problems.
Ed. note: This post is a lightly-edited excerpt from Saving Psychotherapy, available here and on Amazon. Thanks to Jeff Liebert for editing assistance. It’s “Part 1” because it’s the first in an intermittent series we’ll be running about how various elements of psychotherapy practice came into being.
Of course, for those who were developing their skills as therapists and were attending therapy at the same time, the temptation to use their own therapy as a place for talking about their cases was simply too great. That makes sense: As you are starting out as a therapist, you naturally want support and confirmation that you’re doing well (or at least well enough), and you want to consult with an expert therapist on cases that you’re struggling
with. If you’re already meeting regularly with an expert therapist, wouldn’t you use the time for some case consultation?
Newer therapists did so with regularity, to the frustration of their more seasoned therapists — who wanted to do more intensive analytic work on the patient in front of them, and did not want to waste time discussing the patient’s own patients. The more experienced analysts got tired of hearing about their patients’ cases, and wanted to separate case discussion (or, as we now call it, supervision) from therapy. That way they could focus on doing therapy with younger clinicians, and leave the supervision to someone else. So, as experienced psychoanalysts gathered to set early supervision standards for the field, they rather arbitrarily decided on two years as the amount of time one should practice under supervision before being allowed to practice independently.
That length of time (again, many states quantify it today as 3,000 hours of experience, or thereabouts) was first published in 1924, and has stuck in the mental health world now for almost 100 years.
Keeping the field exclusive
It may help to understand what was happening around that time in other advanced professions: Namely, too many people were entering them. Medicine is the best example; a 1910 report declared that the US suffered from a tremendous overproduction of doctors, and needed to raise training requirements not so much to improve clinical care as to reduce the number of new doctors. The report was advocating the creation of hoops for new professionals to jump through simply for the hoops’ own sake, to keep doctors’ incomes high and their profession exclusive. It is reasonable to similarly suspect that early supervision requirements in psychology were as much about keeping the field exclusive and protecting incomes as they were about ensuring practitioner effectiveness.
How LPCs, LMFTs, and LCSWs set their standards
Other mental health professions including clinical social work, marriage and family therapy, and professional counseling have emerged in the decades that followed. These new professions have sought state licenses that would also allow them to practice psychotherapy, but with less academic training than psychologists receive. (All states require doctoral degrees, which typically take four to five years to complete, for licensure in psychology. Master’s degrees are required for the other professions and are significantly shorter, often completed in just two or three years.) Psychologists, for understandable reasons, were concerned about the emergence of these master’s-level therapists. Their field operated under the assumption that less training simply wasn’t adequate for safe and effective clinical practice.
These arguments have faded over time, but haven’t disappeared. It was only in 2009 that professional counseling and family therapy completed the task of achieving licensure laws in all 50 states of the US. As these newer professions worked toward this goal, it was common for psychologists to oppose MFT and LPC licensure bills on the grounds that the master’s level professions had scopes of practice that were too broad given their lesser training. In order to achieve licensure, the master’s-level professions fought to avoid psychology’s doctoral-level educational requirements, but compromised by adopting essentially the same standard for apprenticeship that psychologists had been using: 3,000 hours, or roughly two years of full-time supervised experience. The tradition in psychology thus permeated the other professions without ever being subjected to meaningful critical examination.
Today, most states in the US still use something close to the two-year standard for both psychology and the master’s-level mental health professions. It varies a bit from state to state and license to license, but 3,000
hours of experience or thereabouts is the norm. However, there is little to no evidence that two years of supervision time is better than one year or worse than three, and surprisingly little evidence that supervision actually impacts the quality of client care at all. Two years is a long time to ask new professionals, with significant student debt loads, to work at reduced wages before they can practice independently – especially when there isn’t any demonstrable benefit of keeping a supervisor over them for so long.