Because New York City needs another therapist
August 3, 2010 9:03 AM   Subscribe

I'm interested in becoming a certified therapist. What's the easiest way to do this? What books should I pick up to get an idea of various practices? What are the most reliable ways to get training?

I applied to grad school last year, and during a dreadful month of waitlisting anxieties, I thought I didn't get in. Then I got into my first choice school and couldn't bring myself to actually enroll. I realized that while grad school seems like fun (ha ha), working as an underpaid professor in Shit Town, USA does not.

Right now I'm stuck in a temporary career black hole that I stepped into because I thought it would only last until grad school. While I adore my job, it no health insurance and no real future. My employers know this and are willing to work around my schedule if I decide to go back to school.

The internet has an overwhelming wealth of resources in terms of becoming a therapist, but it just seems like the industry is scarily unregulated. I'd like to get the proper training and certification that would make me at least somewhat competitive, rather than say, being a life coach. But I simply don't know how to start: should I look into expensive and well-known schools like NYU? Should I just take a training program that fits into my schedule? What should I expect to pay? What should I look for in a training program?

All the degree terms mean little to me right now: MSW, PsyD, etc. Please don't assume I know what they really mean in the real world of therapy, or what they entail. I'm superficially more interested in something along the lines of CBT as opposed to psychoanalysis, but as I have so little idea of what that means within the industry, I need resources.

Also, if I'm not exactly a great math and science person, I should stay away from pursuing a PhD in psychiatry, right? This seems obvious, but I figure I might as well ask while I'm at it.

In short, what books should I pick up that either explain different methods of therapy, their relevance in modern practice, or how to get started with my training? What training programs might work best for someone with a college degree (liberal arts, not psychology)?
posted by zoomorphic to Work & Money (22 answers total) 22 users marked this as a favorite
Also, if I'm not exactly a great math and science person, I should stay away from pursuing a PhD in psychiatry, right?

You get a PhD in psychology.

A psychiatrist has an MD, is a medical doctor, and can prescribe medicine.
posted by dfriedman at 9:12 AM on August 3, 2010

As I understand it, the people who are generally referred to as "therapists" here in New York (including my own) hold either a LCSW (Licensed Clinical Social Worker) or an LMSW (Licensed Master Social Worker). There is information about both of these designations on the website of the New York State Education department, which oversees them.

While psychologists and psychiatrists do similar work to therapists, my understanding is that they are not the same.
posted by ocherdraco at 9:14 AM on August 3, 2010

The FAQ at the site I linked will be particularly helpful, I think.
posted by ocherdraco at 9:16 AM on August 3, 2010

I am biased towards social work because I am a social worker in the mental health field... But an MSW might meet your needs. Most programs aren't heavy on math and science and you can pick programs which focus on your area of interest. Mental health related social work is typically called "clinical social work" and there are some programs which focus specifically on that and on training therapists. You can complete an MSW in as little as 2 years full time. MeMail me if you have questions; I was working full-time in the field after being hired during my first internship and I graduated in 3 years. Pros: I'm a recent graduate so I'm familiar with how grad school is lately. Con: Only 2-3 years of social work experience. :)
posted by ShadePlant at 9:16 AM on August 3, 2010

Don't pay top dollar for an MSW. MSW programs are not academic programs, they are professional training programs, so going to an academically top notch private university does not exactly put you in any better position in terms of what you're going to learn. Bottom line: MSW programs are not very competitive. The jobs don't pay well and even programs like Columbia's where I attended have very high acceptance rates. Columbia's School of Social Work at least when I applied didn't even require taking the GREs. I was not impressed with the graduate students in terms of academic background or intellectual capability. I don't mean to sound like a jerk in making that kind of statement, it's a well known fact in the field that low salaries make it difficult to attract the brightest minds so this is actually a lot less controversial than it sounds. Those who can will go to PhD clinical psychology programs, but those programs are CRAZY competitive. Many who can't go clinical psych will fall back PsyD programs, which are slightly less competitive and take less time to complete but also don't carry quite the prestige of a PhD. MSW programs are comprised of people who couldn't make it into PhD and PsyD programs as well as a smaller number of people like myself who went to top undergrad programs and are nuts enough to want to spend their lives as dirt poor trench level poverty fighters. There is no prestige attached to an MSW, no matter where you get it from.

If you go MSW, go to Hunter, or get cool with being massively in debt for a long, long time paying off a high priced degree that wound you up making no more money than anyone else in a no money field is making.
posted by The Straightener at 9:27 AM on August 3, 2010 [8 favorites]

The word "easiest" is a bit of a red flag--how about--How do I become the best therapist I can, in the shortest possible time, and do it in such a way as to be employable. There are a variety of degrees but some of the most common are:
1) Psychiatrist--I am assume you are not interested in going through medical school and a 3-4 year residency
2) Psychologist--in most states this requites a Ph.D. in Psychology and a supervised residency
3) Master in Social Work--A Masters in Social Work from an accredited school of social work--2 years and a supervised experience post graduate experience.
4) Master in Nursing-- A Masters in Nursing with advanced certification in psychiatry
4) A licensed professional Counselor--usually a masters and some supervised experience
All of these degrees require a bachelors plus graduate education, supervised experience and passing a standardized test (most states)

There are a variety of idiosyncratic degrees that might approximate some of these but the above are the degrees that have some level of broad credibility. There are also ways to become a "therapist" by taking targeted courses of relatively shorter duration. The real issue is if you want to be come a "real"therapist you need to be licensed in the state in which you practice--this establishes credibility, proof of appropriate education, and possible reimbursement under State, Federal and Private Insurances.

Any program that promises a shortcut to being a "therapist" is probably taking shortcuts. will not meet appropriate licensing standards and/or offer limited scope of practice. This can be OK is certain circumstances but should be looked at very critically. The bottom line is if you want to be a therapist to real people with real problems you should expect to go through a training curriculum that prepares you to assume a significant professional responsibility and liability for those who entrust themselves to you.

I am biased but as an employer of many therapists over the years--The four most portable, widely applicable and credible are a MSW, Psychiatrist, MSN and PhD Psychologist. Of these the MSW and MSN can be achieved in the least amount of time. BTW--there are some targeted degrees for those who work exclusively with substance abusers.
My personal preferences are a MSW or MSN. The degrees that concern me the most are those that train you to be a therapist in( you name it, or in X # of month, ). Remember--you have to make money after you get the degree--that almost always requires credibility and a license. Please feel free to write if you have questions.
posted by rmhsinc at 9:36 AM on August 3, 2010 [1 favorite]

There are several degrees that result in you being a licensed therapist. As a general rule, you want your degree to be broad rather than specific. Don't try to get a degree in the theoretical orientation you like best. You want a degree that exposes you to all the orientations (so, psychoanalytic, cognitive-behavioural, Rogerian, etc--I know you don't really know what these mean, but a good program will teach you) and allows you to really learn them before committing yourself to any one theory or approach.

The three main types of degrees are a Master of Arts in Counseling, a Master's in Social Work (MSW), or a Psy.D or Ph.D in Psychology/Clinical Psychology. The MA in Counseling takes two to three years and will culminate in you sitting for the licensing test in your state. The MSW is more broad--there is SO much you can do with it. You could sit for the licensing test in your state and open a therapy practise, but you could also be a traditional social worker, work in a hospital, teach--the MSW offers many options. It's also a two-to-three year program.

The Psy.D and Ph.D, being doctorates, are longer courses of study and much more indepth. You can be a therapist with these degrees, but you're going to spend a minimum of five years in school. A Psy.D is more applied--so, yes, you'll be doing some academic-type research, but the emphasis is really on practice, applying research, and seeing clients/patients. The Ph.D generally has a more research/academic-based focus. You'll be conducting more research and doing less practice.

Ultimately, no matter what degree you choose, you have to make sure it is ACCREDITED. This means that it has met standards set by national/regional boards. And don't be tempted, like I was, by those shiny for-profit online schools. I asked a question here awhile back about those, and the opinion here and by those in my life was a resounding DON'T. You really need an accredited brick-and-mortar program--they're the most well-respected, have the longest track records, and can best prepare you for licensing.

You're also going to want to make sure that the school you're going to is preparing you for licensing in the state where you want to practise. You don't want to go through years of school and lots of $$ to find out that you need to take additional classes to sit for your state's exam. The easiest way to ensure that you'll meet the requirements is to go to a school in or near the state where you want to practise.

In terms of learning more about the different theoretical orientations, I wouldn't worry too much about that--read up on it for your interest, but don't go into a program with your orientation set. A good practitioner often combines orientations, and a good program will give you healthy exposure to all of them. I'd recommend getting a good History of Psychology textbook--buy it used to save money. It may be a little dry, but you'll get an overview of the field as well as all the major players through history, and the development of the various theoretical orientations.

On preview, disregard the MSW hate. It's a really well-respected degree and has many applications, including as a therapist. I've worked in the field for several years, and when I was considering grad school, nearly everyone I worked for or was taught by recommended the MSW.

PM me if you have more questions, I'm happy to talk about it. I've done a lot of research on the subject while considering grad schools and programs.
posted by catwoman429 at 9:43 AM on August 3, 2010 [3 favorites]

As one of the "not brightest minds" I disagree with the Straightener about the PHD. programs in clinical psych. He is right--they are super competitive at the best good/better/best universities. One of the practical problems is that psychologists have in many ways priced themselves out of the market--they are often competing with psychiatrists for reimbursement and, with some exceptions, do not have the array of tools available to physicians. Plus, from an economic point of view psychologists offer very little more to a potential employer than a MSW or MSN. Be very very careful if you should decide to become a psychologist. Schools of social work are not as academically vigorous as psychology and psychiatry--and I must admit that I am disappointed at the intellectual discipline of some of the grads I have seen in the last 20+/- years. Of course, as a University of Michigan graduate that does not apply to me. The sloppiest programs, I think, are those offering one year programs in "counseling" . These are often designed to meet the needs of the school rather than the marketplace.
posted by rmhsinc at 9:52 AM on August 3, 2010

I agree with The Straightener about social work programs' general lack of academic rigor. However, if social work is something you still want to do, don't let this stop you. If anything it allowed me to coast through my classes while working full time. I learned most of the important stuff at work and at internships, not in the classroom.
posted by ShadePlant at 9:54 AM on August 3, 2010

The word "easiest" is a bit of a red flag--how about--How do I become the best therapist I can, in the shortest possible time, and do it in such a way as to be employable.

Yes, thank you for rewording that. I just know there are easy ways to fall into so-called "training programs," so by "easiest" I meant "least problematic and trustworthy." I'm tentatively interested in one day joining and/or opening a private practice.

A Psy.D is more applied--so, yes, you'll be doing some academic-type research, but the emphasis is really on practice, applying research, and seeing clients/patients.

This is, honestly, what I most expected the process to be like, maybe because I'm so unversed in industry training that I'd immediately jump for an intensive training program. I'm also fairly analytical and feel comfortable pursuing a route that combines an academic background with an applicable way to use my training in a private practice. That said, rmhsinc's answer seems to suggest something like an MSW would be a better fit?

Is it possible, or usual, to first get an MSW, join a private practice, and then chip away at a Psy. D? Or is that nuts?
posted by zoomorphic at 10:01 AM on August 3, 2010

my LCSW-R therapist is in private practice and doing pretty well, as far as I can tell. It's not always a no money job. He's also very good at what he does but isn't constantly knocking me out with his brilliance, well, because he doesn't have to. He went to Fordham.
posted by sweetkid at 10:04 AM on August 3, 2010

"Is it possible, or usual, to first get an MSW, join a private practice, and then chip away at a Psy. D? Or is that nuts?"--In my experience it is very unusual and I seriously doubt if there is any long term economic advantage. I do not think it is "nuts" but it sure is a lot of work to not get very far. If you are committed to being in private practice there may be a financial advantage. Seriously, some of the more successful private practice therapists I know have been MSN's who work in collaboration with a psychiatrist. I understand this is not what you want but MSN's have an almost instant credibility with physicians, and not surprisingly, patients. I have found that psychologists and social workers some times ( perhaps often) are dismissive of them. Private practice is a very competitive field--it is not to be entered without your eyes wide open and limited expectations unless you are a psychiatrist.
posted by rmhsinc at 10:15 AM on August 3, 2010

There are also, in a lot of states, Marriage and Family Therapists (MFTs) and/or Licensed Professional Counselors (LPCs).

In California, the difference between an MFT program and an MSW program is that MFTs learn a systems orientation--that is, how the individual works in the context of a family, community, society, etc. and have components of our education involving psychological testing, research methods, and diagnosis. Friends of mine who went through MSW programs did NOT receive focused education/training in those three areas, and had far less of an emphasis on clinical counseling skills and techniques, and theoretical orientation (these friends of mine were at a nationally-recognized "good school", too, not some sketch hole-in-the-wall). I knew about this variation in focus going into my education, so I chose the MFT route. Therapy and social work are fairly different, in my understanding and opinion, and at least in California.

To be an MFT in California, you need a master's degree (in psychology or counseling) with 150 or 180 or something hours of supervised practice while in the program. After you get the degree, you do 3000 hours of supervised practice, take a licensing exam, and then get a license if you pass. Licenses are renewed regularly, and require continuing education in various basic areas (law and ethics) as well as topics of your choice (art therapy, trauma therapies, CBT, whatever you like to do). From what I understand, this process is pretty similar to LPC licensing across the US.
posted by so_gracefully at 10:37 AM on August 3, 2010 [3 favorites]

Thanks so much for weighing in, everyone.

Right now I'm leaning toward a MSW. rmhsinc, after reading up on Wikipedia (I know) about psychiatric and mental health nursing, I still don't see myself working in a hospital setting or making in-home visits, dealing with anything from ECT to sponge baths to administering shots. Everything except psychosocial interventions just sounds way off the mark from what I want to do. Perhaps I'm just intimidated by the idea of applying to nursing school - it's just not something I've ever imagined I could or should succeed in doing.

While browsing a local college's department of social work (Spring 2011 application deadline is Oct. 1), I noticed that they, quite understandably, want "experience in the profession through volunteer, internship, or paid experience." I have exactly none of this, since A) I work 55 hours a week, and B) I've been building up to get a PhD in up until March or so.

Should I wait for the next Fall 2011 term and build up my volunteer resume? Or, as one friend suggested, show up at the department and talk to them myself about these reservations and requirements?

Perhaps for another AskMe day: I also fear that my undergrad professors, who kindly wrote glowing letters of recommendation for my grad school applications, will be less than thrilled to know that I blithely changed my mind about this silly English PhD business and instead want to get a MSW now, la la la la la
posted by zoomorphic at 10:53 AM on August 3, 2010

Can not give up--See what I mean--I do not not know where you got that information about MSNs--but that is so far from my experience.. I am talking about private practice--doing therapy, prescribing medication ( in more and more States). This has nothing to do with hospital work. I find the misconceptions about independent nursing somewhat staggering. Not at all trying to talk you into nursing--just wanting to clarify that independently licensed nurses can have an incredible range of skills, training and practice opportunities. Good Luck in what ever you do
posted by rmhsinc at 11:14 AM on August 3, 2010

Focus less on being "competitive" and focus more on being competent. Then set your mind towards being excellent. This isn't law school. You will be dealing with people's hearts, minds and souls. All of your training should orbit around the utmost care and respect for this. Forgive me if I'm misreading your post, but it doesn't sound as if you've given this line of work much thought. That's okay for now, you're still in the exploratory phase. Just don't jump into the field without a rigorous internal reckoning for why you want to do it. Pay as much attention to this as to the school you choose.

Keep a few things in mind if you want to proceed. Most importantly, research has consistently shown over time that the quality of the therapeutic relationship is the single most important factor in helping people make meaningful, long term changes in their lives. A therapist's global level of functioning has a direct bearing on the growth of his/her clients. Technique and orientation are important, but in my opinion are secondary to this dynamic.

As in other fields, the fanciest schools aren't always the best schools. Look for programs that combine a high degree of academic rigor and ample opportunities to practice the craft. No amount of academic study will prepare you for the moment when you sit down with someone in pain and you have no idea what to do. This will happen, many times. No amount of reading will help you deal compassionately with someone you find offensive and distasteful. This too will happen. Only practice and flailing will help you deal with the panoply of human messiness. Look for programs that place a high value on supervised clinical work. In school you'll have the luxury of sucking at what you do before getting good at it. Once you invite a client into your office and close the door, you not longer have that privilege.

A good place to start looking is to ask other professionals - the ones you would trust with your heart, mind and soul. They might be your most helpful guides.
posted by space_cookie at 11:45 AM on August 3, 2010 [2 favorites]

Also, get going! Volunteering with people who have mental health issues will let you know if you could deal with that 40+ hours a week instead of just 3 on a Saturday. Many, many places need competent volunteers. For example, I've volunteered at a center for victims of torture and at a rape and sexual abuse center before I even started my MSW. Sounds like fun, eh? My main research interest at the time was trauma; it makes sense! I learned a lot! I was no fun at parties!
posted by ShadePlant at 12:34 PM on August 3, 2010 [1 favorite]

The Ph.D generally has a more research/academic-based focus. You'll be conducting more research and doing less practice.

Not really true. It completely depends on the program. Even in my Ph.D. program, which is one of the most heavily research-focused programs, I'd say more than half of our graduates become licensed therapists. A Ph.D. program should be more grounded in a scientific approach to treatment which uses evidence-based practices (like CBT) than a Psy.D program. A lot of people in the field would argue that this kind of rigorous science-based training is strongly preferable if you want to be an effective therapist, since you are taught to strive to understand what works, for whom, and why, rather than only learning how to do therapy. Moreover, as a therapist, you will need to stay on top of the empirical literature about therapeutic interventions- your training will have to be lifelong. To do this, you really need a nuanced understanding of statistics, research methods, etc. Ph.D. programs prepare you for this. Ph.D. students can get training in a variety of kinds of psychotherapy, with the exception of psychoanalysis, which is rarely done in top Ph.D. programs these days. You will probably have to pay for a Psy.D. program, while you should not have to pay for a Ph.D. programs (if you choose wisely); rather, they should pay you. Also, to be licensed, you will probably have to do a year of internship after getting your degree, so keep that in mind.

I hope you don't take this personally, but the time you are going to be spending on getting the degree really shouldn't be the deciding factor here. If you are going to hate being in 6 years of grad school plus one year of internship, I would bet that you will hate being a therapist.

Please feel free to message me if you have any further questions.
posted by emilyd22222 at 12:43 PM on August 3, 2010

Oh, and PS- I am not strong at math and science. They're really just not my thing. But I'm thriving at a Ph.D. program, as are a number of my peers who are way worse at them than I am. A good Ph.D. program should make you feel like you are smart enough to grasp the hard science and math stuff.
posted by emilyd22222 at 12:46 PM on August 3, 2010

The industry of psychotherapy is actually tremendously regulated, thanks to managed care. The relevant degree for counselors and social workers is at the masters level, while psychologists must have a PhD to get certified in most states and psychiatry is MD-only. Whatever your ultimate choice, you'll be best-served by looking for a program certified by the profession's accrediting board; there are, for example, multiple counseling programs that are not certified by CACREP, which means that graduates of those programs have extra hoops to jump when it comes time to be licensed by their states of residence/practice.

I'd look up the New York licensure laws before making my decision, were I you. I know someone who practiced as a licensed counselor in NY before moving to Georgia, and she says the laws in NY are somewhat unique. Although the counseling licensure laws across the nation vary in requirements depending on when they were implemented, the current gold standard is a 60-semester-hour MS program which includes 700 hours of practicum/internship as a student, and then three years of supervised practice after graduation (as an employee) before one can (a) be a fully licensed mental health counselor and not a licensed associate MHC, (b) become an approved provider for various managed care entities, and (c) be in private practice. If you are interested in private practice, know that - at least in counseling, but I have been told this applies to social work as well - you may not be able to do so for at least five or six years after starting your MS-level work.
posted by catlet at 2:23 PM on August 3, 2010

Skimmed the current responses, so apologies if some of this information is repeated:

As a PhD psychologist who started out in clinical psych (but ultimately wound up in social psych), first I'd like to dispel the notion that there isn't a lot of emphasis on math or science in psychology. Yes, it depends on your personal goals and the aim of the program you're in, but those who are the strongest in the field have a very good understanding of mathematics (particularly statistics) and scientific principles.

That said, a very good resource when you are considering clinical work is the annual guide published by the APA. The intro sections provide a good rundown of what clinical and counseling psychology PhD programs entail and how they differ from other degrees. The rest of the book gives you an overview of all APA-accredited programs in the US and Canada, and can help you narrow down where you want to apply (or if you want to apply to these types of programs at all). Go to a bookstore and read at least the first part to help you decide if a clinical or counseling psychology PhD program is for you. If it still sounds intriguing, buy the book and research further.

Now, as a data point and a potential caveat, no matter how much you research what you want to do, sometimes you just don't know until you get into a program. As I said before, I started out in clinical psych and was really into the idea of being a therapist--until I actually started doing therapy. I really thought that was what I wanted to do, and had even considered applying to PsyD programs because I didn't think I'd be that into research. Turns out, I liked the research side much more, and ultimately switched into a social psych program to concentrate solely on that. And even more surprisingly, I learned that I was really good at the quantitative side of research; accordingly, my first jobs out of grad school were as a quant geek in market research. I would have never predicted that happening, especially when I was so set on becoming a therapist. Now I'm a professor (ultimately decided that I didn't like dealing with clients and students were more rewarding to work with), and I enjoy teaching a lot. Lesson? Getting a degree with a lot of options as far as career is a good idea, because you never know what you might end up liking.
posted by Fuego at 2:56 PM on August 3, 2010 [1 favorite]

I would strongly recommend getting some relevant volunteer work before you apply to a clinical program. Classes in psychology or counseling give you a foundation but there is a world of difference between being a student in this area and actually working with real people. An incompetent therapist can cause tremendous harm and one who doesn't really care about the work will burn out fast. (One good reason for the long internship requirements.) Don't waste your time and money on another degree until you have some confidence that you actually want to do the work that you are qualifying for.
posted by metahawk at 3:00 PM on August 3, 2010 [1 favorite]

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