What Does a Career in Therapy Look Like?
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Counseling therapists enjoy a career devoted to supporting the emotional and mental well-being of clients.
A June 2020 study from the Centers for Disease Control and Prevention (CDC) found that 40% of U.S. adults reported "elevated adverse mental health conditions associated with COVID-19." Dips in mental health, increased substance abuse, and growing thoughts of suicide are all cited. The hardest hit include young adults, racial/ethnic minorities, and essential workers.
Now more than ever, U.S. counseling therapists are needed to support Americans of all races/ethnicities, cultures, gender expressions, sexual orientations, and disabilities as they work through pandemic- and post-pandemic-related mental health challenges. Therapists can help clients work through feeling uncertainty, grief, loneliness, burnout, and confusion to build healthier habits and empowered lives.
Below, we explain how to hone personal and professional skills needed for a career in therapy and how to choose the right program for your career goals. We also interviewed a practicing therapist, who shares her experiences and insights about the job.
What Do Therapists Do?
Therapists meet with patients regularly, typically in person or over video. They learn about their patients' mental health and personal histories, assess their well-being, offer coping strategies, develop treatment plans, and document patient progress. Therapists are not legally certified to prescribe medication.
Therapists may specialize in working with specific demographics, like children, or they may work with individuals, couples, and families. Common specializations for therapists include:
- Marriage and family therapy
- Cognitive behavioral therapy
- Child therapy
- Dialectical behavior therapy
- Psychodynamic therapy or psychoanalysis
Therapists can incorporate a variety of approaches and methods into their work, depending on the needs of patients. The most common methods are:
- Cognitive behavioral therapy (CBT)
- Behavioral therapy
- Humanistic/client-centered counseling
- Psychodynamic therapy
- Schema therapy
Therapists also employ these tools and techniques to understand and support their patients.
- Talk therapy
- Systematic desensitization
Where Do Therapists Work?
Therapists are usually employed in a private practice office, healthcare setting, or school. Therapists who have private practices often take on the responsibilities of a small business owner, which requires its own skill sets, like accounting and marketing.
Because of the COVID-19 pandemic, teletherapy is on the rise. Teletherapy providers offer therapy appointments via video, phone, and/or text. Therapists may even choose to work in a hybrid setting, accepting clients both in person and online.
Therapists can work during the day or at night, or some combination of both. Depending on their clientele, some therapists have on-call or emergency alert hours.
Therapists need strong emotional and interpersonal skills, as well as the ability to compartmentalize. Key soft skills include sensitivity, awareness, nonjudgment, and openness to diverse cultures, races, gender expressions, and sexual orientations. Therapists regularly practice active listening and may need to act quickly in high-stress situations.
In addition, therapists — especially those working in private practice — must have good business management skills and ethics, including confidentiality.
The most highly compensated therapy positions tend to be in clinical, counseling, and school settings. In general, marriage and family therapists earn $10,000 per year more than the average American worker. Those working in counseling, social work, and substance abuse or behavioral disorder counseling enjoy salaries just slightly above the national average.
|Median Salary (2020)
|Projected Job Growth (2019-2029)
|Counselors and Social Workers
|Substance Abuse, Behavioral Disorder, and Mental Health Counselors
|Marriage and Family Therapists
|Clinical, Counseling, and School Psychologists
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How to Become a Therapist
Individuals wanting to become a therapist should expect 5-8 years of higher education, including a bachelor's degree, a master's degree, clinical supervision hours, examination(s) for licensing and certification, and continued education to maintain licensure. Some roles, such as psychologist, require a Ph.D.
Specific education requirements to become a therapist vary across states, but the most common education path is as follows.
Four-Year Bachelor's Degree From an Accredited School
Bachelor's degrees may be in any subject, but students often choose subjects related to therapy, like psychology, recreational therapy, healthcare, ministry, or human resources. If students are able, they should consider attending a school in the state in which they plan to practice, since colleges and universities often craft their courses to fit their state's specific therapy licensing requirements. You may also wish to pursue a bachelor's degree in your specific field, such as a degree in music therapy.
One- to Three-Year Graduate Degree
No matter your bachelor's degree subject, you are required to pursue a master's program that centers on therapy-related subjects, such as marriage and family therapy, child development, counseling psychology, social work, psychological theories, research methods, or clinical psychology.
At this point, you should have a general idea of what type of therapy you would like to practice -- general social work, counseling, or psychology -- and then choose your graduate program accordingly. It's common to specialize more later, after you've begun working.
Depending on the structure of your program and what concentration you choose, you may earn a master of arts or a master of science. The main difference is that a master of science program will include courses in statistics. Master's degrees typically include a dissertation or research project, and they often include practicum hours, too. By the end of your bachelor's degree and graduate degree, you will have taken courses in psychotherapy concepts, lifespan development, and professional healthcare issues.
Practical and Clinical Hours/Internship
These are typically completed during or after a graduate degree. You'll need to earn a set number of hours -- generally between 2,000-4,000 -- of working under supervision in a professional therapy work setting. It's common to finish clinical hours within the first two years of professional work.
Most graduate programs include some clinical/practicum hours -- usually up to 1,000 -- in their curricula, but not all programs do, so it's important to check. If a program doesn't include any practicum hours, that's a red flag that it isn't up to educational standards.
Region-Specific Standardized Clinical Licensing Exams
After graduation, you'll need to take licensure exams through your local state board. There is more information in the "Licensure and Certification" section below. After studying for and passing these exams, you will need to purchase liability insurance and pursue job opportunities.
Optional: Four-Year Ph.D., Psy.D., or M.D.
A Ph.D., Psy.D., or M.D. is not required to become a practicing therapist, but you may choose this path if you would like to become a researcher, educator, or supervisor. If you wish to become a psychologist, you will need a Ph.D. Earning a Ph.D. may also increase your chances of getting hired, even at jobs that only require a master's degree.
Licensure and Certification
To become a practicing counseling therapist in the U.S., state licensure is required. Licenses and their exams vary by state, and they also depend on the type of therapy you want to practice. The following counseling titles are the most common.
- Licensed Professional Counselor (LPC)
- Licensed Mental Health Counselor (LMHC)
- Licensed Clinical Professional Counselor (LCPC)
- Licensed Professional Clinical Counselor of Mental Health (LPCC)
- Licensed Clinical Mental Health Counselor (LCMHC)
- Licensed Mental Health Practitioner (LMHP)
- Licensed Marriage and Family Therapist (LMFT or MFT)
After students complete a master's degree in therapy or counseling from an accredited school and earn their clinical supervision hours, they must undergo the following process.
Depending on the state in which you want to practice, you will need to pass one or both of these exams:
- The National Counselor Examination for Licensure and Certification (NCE)
- National Clinical Mental Health Counselor Examination (NCMHCE)
Both are available through the National Board for Certified Counselors (NBCC).
If you are planning to work with individuals with physical, mental, developmental, and/or emotional disabilities, some states may also require that you pass the Certified Rehabilitation Counselor Examination (CRC).
Purchase Liability Insurance
Additional Certifications for Specialties
Depending on your specialization, you may need to earn additional certifications.
Here are a few of the credentials and certifications that therapists can pursue to set themselves apart.
- Distance Credentialed Counselor (DCC)
- Certified Alcohol and Drug Counselor (CADC)
- Master Addiction Counselor (MAC)
- Military and Family Life Counselor (MFLC)
- Music Therapist - Board Certified (MT-BC)
NBCC offers certifications in becoming a Certified Clinical Mental Health Counselor (CCMHC), Masters Addictions Counselor (MAC), and National Certified School Counselor (NCSCS). To hold one of these specialty certifications, you must also be designated as a National Certified Counselor (NCC).
In order to renew licensing and credentials, most states require therapists to continue earning education credits. Usually these credits must be earned every 2-4 years, though exact time frames vary by state and credential.
What to Look for in a Program
Follow these tips to make informed decisions about the program you decide to pursue.
Whatever your field, be sure to look for a program that is fully accredited for that profession. Programmatic accrediting agencies in the counseling and mental health fields include:
- American Psychological Association
- Council for Accreditation of Counseling and Related Educational Programs
- Council on Rehabilitation Education
- Masters in Psychology and Counseling Accreditation Council
Review your state's licensing requirements to be sure your target program qualifies.
- If you are interested in online college programs, ask yourself which schedule works best for your lifestyle: a synchronous schedule (classes meeting at a set time on a regular schedule) or an asynchronous schedule (completing coursework on your own time). For example, will you have to balance part- or full-time work with your degree? If so, an asynchronous course may work better for you.
- If you already have a firm idea of what type of therapist career path you want to pursue, look through the curriculum of each program in which you are interested. This will help you determine which one best matches the skills and experience that you need for your chosen career.
- Consider the location of the program. Again, many therapy programs tailor their courses to the licensing exams used in their state, so if you live somewhere else, those classes may not be the ones you need.
Other Important Questions to Ask Yourself
Is this a regionally accredited school?
Will your desired program meet state licensing standards for your prospective career?
How do costs compare across programs? Are any of your target schools unreasonably expensive when compared to your salary prospects after graduation?
What is the transfer credit policy for this program?
What is the background of the faculty? Do they specialize in the areas where you would like to take your therapy career? Is there a potential for mentorship?
Social workers are similar to therapists, but they focus more on connecting clients — who may be oppressed or living in poverty — with resources in their communities. However, licensed clinical social workers can open private practices to deliver therapy, and they can accept Medicare insurance. They can also more easily access jobs with the federal government than licensed counselors can.
Social workers must earn a bachelor's degree and graduate degree (master of social work or licensed clinical social worker), complete supervised clinical work, and pass the Association of Social Work (ASWB) exam.
Psychiatrists resemble therapists in that they provide mental healthcare for clients. The difference is that psychiatrists have medical backgrounds, allowing them to consider the physical aspects of mental health in addition to psychological aspects. They can also offer diagnoses and prescribe medication. Unlike therapists, psychiatrists must earn a medical doctorate and complete a psychiatry residency.
Physical therapists are not mental healthcare providers. Instead, physical therapists diagnose and treat individuals with physical pain, functional impairments, and limited mobility. Similar to counseling therapists, they can assess and help patients, but they only address physical or fitness issues — not mental health.
Physical therapists must earn a doctorate in physical therapy (DPT) from an accredited institution, pass the National Physical Therapy Examination (NPTE), and meet state-specific licensure requirements before practicing.
Ask An Expert
To understand what a career as a therapist looks like, we interviewed an expert. Read about her experience and advice below.
Karol Ward, L.C.S.W.
Preferred Pronouns: she, her
Karol Ward, L.C.S.W. is a licensed psychotherapist and confidence-building coach who helps her clients cultivate inner confidence in the areas of personal growth, business visibility, and communication. She is the author of "Worried Sick: Break Free From Chronic Worry to Achieve Mental & Physical Health" and "Find Your Inner Voice: Using Instinct and Intuition Through the Body-Mind Connection."
Ward is an award-winning speaker and delivered a popular TEDx Talk on the power of the body-mind connection at TEDx TimeSquare. She is regularly featured in the Wall Street Journal and her new book, "The Confident Practitioner," goes on sale in June 2021. www.karolward.com
Why Become a Therapist?
If helping others resolve emotional struggles appeals to you, becoming a therapist may be a rewarding career. This career requires an interest in human nature and a passion for helping others.
What Are Some Challenges and High Points in This Role?
The challenge of being a therapist falls into one category: burnout. The kind of burnout that affects therapists derives from the potential for becoming emotionally drained.
Therapists not only provide emotional support to their clients, but they also sit on the receiving end of what their clients are working through. As a result, therapists need to be able to handle deep emotional expression and to listen to deep pain.
Therapists need to practice good self-care in how they manage their professional work and personal lives. Creating downtime and healthy habits, and receiving support from supervisors, coaches, and peers, helps keep therapists from burnout.
The high point of working as a therapist is witnessing patients and clients change their lives. Knowing you have helped someone through a difficult time and empowered them to make changes they need is gratifying.
Advocacy is also a high point of being a therapist. Knowing how to direct patients toward the concrete services they need so they can transform their lives is a worthy endeavor.
What Type of Person Does Well in This Role?
People who are empathetic, good listeners, and interested in why people behave the way they do make good therapists. Therapists are most effective when they have a curiosity about others and a desire to help their patients and clients understand themselves better.
Whom Does This Role Help? How Does This Role Impact Others?
A therapist provides a safe space for people to share and process their feelings. The ability to provide insight and guidance to someone who is emotionally struggling or stuck in their career is something therapists are trained to do.
The way a therapist's role impacts others is twofold. First, the therapist helps clients make concrete changes that positively affect the lives of the patient's friends, family, and colleagues.
Second, a therapist serves as a role model for their patients in terms of professional management. Being on time, handling money, navigating difficult conversations, and setting boundaries are important practices a therapist can demonstrate to their clients.
How To Get Hired
How Long Does It Usually Take Graduates With a Psychology, Social Work, or Counseling Degree to Get Hired?
Since the healthcare industry is growing, graduates with psychology, social work, and counseling degrees will be needed. Schools, social service agencies, clinics, employee assistance at companies, and private practice are all places graduates can find employment opportunities.
What Skills Do Employers Look for?
Clinical training, education, supervision, and licensing requirements are the basics required by employers. In addition, employers look for enthusiasm, flexibility, communication skills, and a willingness to contribute to workplace goals.
What Can Students Do to Make Themselves Look Better to Employers?
Articulate why you want to go into this profession. What draws you to helping people? Why is it important? What skills, other than what you learned in school, might be beneficial to working with clients? This last question is important because your activities, interests, and training will benefit future employers.
What Is a Normal Day Like for a Therapist?
What Tasks Do You Typically Work on?
My main experience is in private practice, and that involves meeting with patients, taking notes, scheduling sessions, and completing paperwork for invoices and insurance companies.
What Kinds of Hours Do You Keep?
As a therapist in private practice, I work four days a week, and my patient load varies. I try to keep a good work/life balance and honor the fact that starting in the late morning and working until the early evening works best for me.
When I first started my practice and was building my caseload, I adjusted to the needs of my patients and was willing to work different hours in order to accommodate them. Flexibility can help you build your practice. As you become more experienced and your practice grows, you can adjust your practice to meet your needs.
Who Are Your Coworkers?
I do not have coworkers in my private practice, but I do have colleagues in the profession whom I refer to and consult with when I need perspective.
What Knowledge Do You Utilize?
In addition to being a therapist, I am a coach who specializes in confidence-building. I work with high-level executives who are talented but struggle with self-esteem and confidence. I also coach therapists and other healthcare practitioners, such as nutritionists and fitness professionals, who want to build successful practices. Finally, I use my clinical skills as a speaker to address psychological issues people struggle with in today's world.
Therapist Professional Organizations
Reviewed by: Rayelle T. Davis, M.S. Ed., NCC, LCPC
Rayelle Davis is a nationally board certified counselor and a licensed clinical professional counselor. As a nontraditional student, she earned an associate degree in psychology at Allegany College of Maryland and a bachelor’s degree in psychology at the online University of Maryland Global Campus. Davis earned her master’s degree in counseling education with a concentration in marriage, couples, and family therapy from Duquesne University. She has taught several undergraduate psychology courses. She is currently a doctoral student and teaching assistant at Duquesne University and practices psychotherapy in Maryland.
Header Image Credit: SDI Productions | Getty Images
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