Is therapy a good career choice these days?
December 11, 2012 8:55 PM   Subscribe

Is masters' level therapy a smart career choice right now?

I'm a psychology nerd who wants nothing more than to be a therapist. I'm about as sure about wanting this as one can be about any career. However, I have reservations. Regardless of my passion for psych/therapy, is this a good field to be getting into these days? Recent articles, i.e., the New York Times "'What Brand is Your Shrink'" article, have me scared.

Is therapy really a dying art? While I would prefer to do deep psychodynamic therapy, I'd also be OK with CBT and the like, but I worry that even that might soon fall out of favor.

Is it worth it to apply to grad school and work towards eventualy becoming a therapist? Will I ever be able to pay off my loans? Will I ever have a chance to practice psychodynamic therapy?
posted by sunrisecoffee to Work & Money (7 answers total) 5 users marked this as a favorite
My mom's a therapist, has her own practice, and has enough patients that she has to turn people down. If therapy is dying out, it hasn't touched her at all. (There have been some very positive developments keeping her afloat, in fact - the new mental health parity law has made it much, much easier for people to get care with insurance. Obamacare is also a good thing on this front.)

Now, colleagues of hers that don't take insurance at all are hurting - their clientele is hit by the economy like everyone else, and $150/hr out of pocket fees are not cheap for most people. But she made a point of staying in-network for most of the major insurers, and she has thirty years of contacts to get referrals from, and has zero problems getting patients. As I said, she's turning people away at the door.

Note that there are several different degrees you can get and end up doing psychotherapy - Mom's a MSW, but pure psychology or even psychiatry are options. I believe in Texas you can even get a separate counseling license with less school involved, but I have never examined the details all that closely.
posted by restless_nomad at 9:07 PM on December 11, 2012

Wow, you sound exactly like me! I earned my Master's degree in 2009. I went to a very experiential school and got a great education. I don't regret it. What I do regret is taking out private loans. I've found federal loans to be very forgiving in terms of bouts of unemployment, but private loans are absolute hell. Interest rates for graduate loans are pretty terrible... the best I could do was more than double the interest rate of my undergrad loans, at least with Sallie Mae. You're stuck with them until the day you die, no joke. No negotiating, no basing your payments on your income (ha!), nothing. I've heard that for those who don't pay, they harass you on social media sites and call friends, family, coworkers. Federal loans, on the other hand, are eligible for the Federal Student Loan Forgiveness Program. If you work in state service or a non-profit, you qualify for complete forgiveness after 10 years. Reps are easy to talk to, and as long as you communicate the hardships, they will work with you. Not a bad deal IMHO.

If you really want this as a career choice, you have to be very realistic about the job market, the rate of pay, and your time as an intern and whether you can swing that financially. Where I live, trying to be an intern is very difficult financially. Rates of pay from what I've seen (and I tried very hard to get a job for months) weren't even close to covering my student loans. I mean, like, $8-$15 an hour. Tough. And some internships required trainees/interns to pay a monthly rate for supervision and client loads, upwards of $500/month. Which isn't horrible when you think about how much you'll pay for an office space, but as an intern when you're not getting paid *anything*, that's a hard sell.

I don't think it *has* to be that way. I have a friend who got into a 40-an hour-a week position, qualified for the Federal Student Loan Forgiveness Program, and will have her licensure in a little over 2 years. Not bad at all. But.... it's rare. She's also working in a psych hospital and I'm sure it's very difficult work.

I have no idea what course my path will take. After months of unemployment and no luck finding anything that paid enough to eat AND pay my loans, I settled on a job that pays better than anything I could find in my field, is relatively related to the health field, and is a great working environment with awesome co-workers and a laid back boss. After the stress I've had in dealing with my career choice, honestly I needed it.

At some point I realized you have to put down a dream to pay the rent. I'm sorry if this sounds pessimistic - I don't mean it to be - I just wish someone had told me this before I started my journey. I wanted to focus on school full time because I wanted to get the most out of my education. Logical. But. What I didn't realize was how much that cost me in the long run.

Hope this helps, and again, I'm sorry if it came across as pessimistic. I LOVE working with clients. I specialize in adults/children with autism, and it is truly my passion. I wake up every day with the hope that I can get back in my field, and it's heartbreaking to have moments of financial overwhelm, feelings of failure, and regret about choices from the past. All that and I still can't break into the field at a reasonable pay. But making efforts in volunteering, networking, and knowing the population you want to work with goes a LONG way. It's saved my butt, in times of having zero connections, to be able to network and be optimistic and CREATIVE about the work you do. When you specialize, that means a lot (I also work in expressive therapies).

Best of luck to you! MeMail me if you want to chat.
posted by luciddream928 at 9:23 PM on December 11, 2012 [2 favorites]

I don't really know anything about it, but in addition to the Public Service Loan Forgiveness Program, there's another federal program that declares shortage areas for mental health professionals, including some kinds of therapists, and working in those areas seems to lead to loan forgiveness under some circumstances. California apparently receives only $1 million for that, which to my mind doesn't sound like it covers a lot of people, but it's a possibility if you're willing to live in a shortage area.

I know some career details for two people who got jobs as therapists. One went to work for the state right after graduation and dealt with almost nothing but child sexual abuse cases for a couple of years, which he understandably found to be soul-destroying work, so he quit and became a health care regulatory attorney at a time when that was a little easier than it is now. The other had a private practice that got referrals from her church, but her partner supported her until it really became a meaningful source of income.

Obviously, there has to be a way for it to work out given that, career-wise, it's just got to be better than a master's in history or something like that. But if you're making money now, it might be wise to save up before making the switch and/or alter your expectations such that pretty challenging public service jobs seem OK.
posted by Monsieur Caution at 10:32 PM on December 11, 2012 [1 favorite]

There are four stages to becoming a full-time therapist, as follows:

1) Graduate education (2 years)
2) Low-wage work toward licensure (2-3 years)
3) Starting your private practice (??)
4) Full time private practice

There are a couple of choke points here, with the biggest being the jump between steps 3 and 4. You may (or may not) be thinking of this in therapy terms, but the truth is you're starting a business. It has all the overhead of a business, most of which you have to pay whether you have patients or not. It can take quite a while, and a lot of networking, to build up a big enough client base to go full time as a therapist. My wife, who has been in private practice for 10 years, and knows everyone in town, AND has some fairly solid referral sources, AND is on two insurance panels, recently moved to just doing private practice for half the week, and she has not yet filled the 20 hrs per week she has allotted. I think she does not have more than 10 filled. She will eventually fill her schedule, but it all takes time.

So, the economics look like this:

Insurance pays ~$60 (some a bit more, some a bit less) for a 50 minute session. Ethical paperwork practices should take up at least the remaining 10 minutes. Billing varies a bit, but say that all accounting for each session together takes 15 minutes. You just got paid $60 for 75 minutes of work.

You need to pay office rent, utilities, health insurance, etc out of the money you make. Subletting office space, which is how everyone starts, runs between $7 and $15 per hour, depending on location.

You might find people willing, or needing, to pay full fee (not use insurance), and you charge them whatever your full fee is. This could really vary based on your location. But I actually expect parity laws to reduce the number of people who are willing to pay full fee.

You can see how the economics of moving from a part time practice to a full time practice are a bit daunting. It's just like starting any sort of business, when you let go of the trapeze you've got to hope you have enough momentum to carry you to the next solid handhold, or your landing might be rough. Of course many people do it, but many people also keep agency jobs while they have a private practice on the side so that they have health benefits and a steady paycheck. (re. steady paycheck: people drop in and out of therapy all the time. I'm paneled with two insurances, and referrals are not particularly steady, so when a couple of people finish at once, as has just happened to me, I'm stuck with a low case load for a month or two. By the time I replace those who previously left, someone else is ending their therapy...and so it goes.)

None of this is to say that you shouldn't pursue it as a career. I think people will continue to need therapists. I think different people will want different types of therapy, and you will find some people to do insight oriented therapy with. However, I do think you should consider your degree carefully (this will require research about your particular location) so that it is marketable in ways that are not just therapy. I think the MSW is the most transferable terminal two-year degree that allows you to be a therapist, but then I'm a social worker. I don't think you're likely to get rich doing it, and it really helps to have a spouse who can put you on their insurance. (Of course that means said spouse can never really consider moving to full time private practice himself, not that he's bitter or anything.)

Someone else asked a question a long time ago about the pros and cons of being a therapist. I had an answer in that thread as well, but the whole thread might be useful to you.
posted by OmieWise at 6:04 AM on December 12, 2012 [6 favorites]

It's a growing field. My mother just earned her LMHC certification after going back to school for a Master's in Mental Health Counseling. Whether you want to work for someone, or have a private practice, it should be relatively straightforward to get enough clients for it to be financially viable.
posted by fvox13 at 7:42 AM on December 12, 2012

My dad was a LCSW for decades before he retired a few years ago. So you have different options for the degree you'd like to pursue. MSW is a good way to go.

Dad went to UC Berkeley in the sixties, they paid him to attend. He had a wonderful career doing all sorts of wonderful things for the world.

Methadone Clinic, Family/Addiction counceling, Runing a Shelter Home for foster kids, running an in-patient with family rehab, ultimately he ended up working for the Federal Government on military bases counseling families and soldiers, airmen, sailors overseas. This allowed my parents to travel in Asia and Europe. Now they're retired and collecting pensions and Social Security and making more money now than they ever did working.

There are lots of avenues for getting the education; scholarships, grants, etc. Explore ALL of these, before taking out loans for your education. Student Loans are the next horrifying, financial crisis waiting to happen.

Private practice is probably the most financially risky way to go, but a good LCSW will ALWAYS have awesome job prospects. As long as helping people is more important than money. You'll do okay, but it won't be the same as a Freudian Shrink on the Upper West Side.
posted by Ruthless Bunny at 8:11 AM on December 12, 2012

My wife has this type of degree, and knows a lot of people in the same boat. Her problem is that she took out private loans (well, a mix of private and public), but the pay isn't in line with how much she owes for the education. Agency work (which is what you typically must do to get licensed) does not pay well, and fluctuates with whatever is going on in the government budgets. Those first few years of working for an agency can be pretty rough.

For example, while you're doing agency work, you'll need to deal with constant threats of your wages, hours and benefits being reduced (thanks fiscal cliff!) because of random economic events; things aren't too stable in that realm, but there are plenty of jobs if you're willing to move around for them. You're a bit more insulated from these things when and if you move to private practice.

If you need to get loans at all, check out the loan forgiveness programs and the areas that apply to them; your school should be able to help you find job placement in areas like this, which can change the economics of a degree like this pretty drastically, if you're willing to live somewhere economically depressed for a couple years.

Also, if you're looking at getting a degree in this area, pay attention now to the states and jurisdictions that you would like to practice in. We live in Maine, and my wife just had to get a license in New Hampshire to then get a reciprocal license in Oregon (where she got her degree and worked for several years, but didn't get her license there for a few reasons). The bureaucracy is insane if you're doing things across state lines. Straight up bananas.
posted by furnace.heart at 9:22 AM on December 12, 2012 [1 favorite]

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