Do I want to be a therapist?
September 6, 2013 8:38 AM   Subscribe

I'm thinking about becoming a therapist. Is this a good idea, and how do I get there if it is?

Therapy interests me because I am definitely a "helper;" I like learning about people and helping them through their problems. I feel like I tend to inspire trust in people and I'm a good listener. People describe me as being extremely calm and self-possessed, and I have a lot of experience in crisis situations.
So, I think that being a therapist would work well for me. (If I'm wrong and I sound like I would be a terrible therapist, tell me!) But I'm not sure what my next step is. I currently work at two social service agencies doing admin work--no direct support. I can start a Masters program next September, either in Social Work or Mental Health Counseling. Which one is better for me? The MSW is about twice as expensive, but I've heard that it is much more flexible.
In the future my husband-elect and I would like to live abroad, so I'm hoping to be able to practice in other countries as well--either providing services to other expats (who, god knows, often need therapy), or via Skype, working with people in the states who may need appointments at odd hours.
So, does this sound like a workable plan? Any current therapists want to weigh in?
posted by chaiminda to Work & Money (10 answers total) 7 users marked this as a favorite
It might work, but be aware (I am sure you may be) that either filed can have a high level of stress attached to it.
A few pitfalls to avoid:
-Anything remotely like what I call 'Jesus complex' that is you feel you want to 'save people'.
-Any form of 'us/me vs them' mentality.

Would you make a good counselor? No idea, haven't met you. You describe some of the key attributes, add to that, mental resilience, extremely good boundaries, ability to compartmentalize to a certain extent, having a good support network of your own, willingness to work with people you might personally find distressful, low level of judgementism, adaptability...

You might be a good counselor, but it really isn't for the faint of heart.

good luck
posted by edgeways at 8:58 AM on September 6, 2013

Therapists in the US are almost always licensed by the state, which means you can practice only in the state in which you are licensed. Some states, and some licenses, are more portable than others within the US. In the US, it would be illegal to provide services in one state for a client who lives permanently in another state (exceptions are usually made for regular clients who are on vacation or traveling temporarily). Therapists practicing illegally would be subject to having their licenses revoked, and would not be covered by their malpractice insurance for the illegal activity. (I know that therapists do it anyway, but they're really not acting legally, and they're putting themselves at risk.)

I don't know how it works in other countries, but if you're definitely looking to live abroad, you should research that specifically. I find it hard to believe that an American state license would allow you to practice legally outside the US, but I could be wrong and/or it might be easier to obtain foreign licensure than I'm assuming. But I certainly wouldn't count on it without getting definite answers from reputable sources (i.e., the agency or department that licenses mental health practitioners in your desired country/ies).

In the US, you can get away with calling yourself a "Life Coach" and evade some of these regulations. I don't know if that's something possible in other countries, or even how it works in terms of clients living in different states/countries, but it might be worth looking into as a back-up plan. (A good way of finding this sort of information is searching for information on therapist malpractice insurance. Insurance companies usually want the people they insure to be practicing legally and ethically as a way of avoiding lawsuits, so they tend to be good sources for finding out the laws and ethics.)

Another thing to look into is military mental health; I know the US military employs LCSWs to do roving mental-health work on foreign bases. They've been talking about opening up the employment to Marriage & Family Therapists, too, but I'm not sure if that's happened yet.

I love being a therapist, but the bureaucracy means that it's not at all a portable job. I love the state I live in and plan to stay here permanently, so that's not a huge negative for me, but I've been hearing friends' horror stories when they've moved within the US and I can't imagine how much trouble it'd be to move outside the US.
posted by jaguar at 9:17 AM on September 6, 2013 [2 favorites]

I have a masters in mental health counseling and haven't felt limited by not having a MSW. You're not going to get rich doing this work and, from my experience, I would pick the masters program that is the most affordable.

I've worked primarily with youth and while it can be very fulfilling it is also very stressful. One aspect of the job is helping people through their problems, being that compassionate listener, that trusted person for your clients. Other aspects that are less positive include: bureaucracy, paperwork, monthly productivity as far as number of clients seen / hours billed, telling people what they don't want to hear, being yelled at, spit on, physically assaulted (again, youth). It can be a lonely job--carrying others' issues.
posted by at 9:23 AM on September 6, 2013

Become a therapist. Going by this website alone, it's a growth industry.
posted by zadcat at 9:32 AM on September 6, 2013 [8 favorites]

You could be good in the role, it is hard to say. I am not a therapist but I've heard that most therapists don't go into private practice right away. They work with employer programs or government or hospital, then gain experience, then do private practice part time and finally transition to 100% private. There is a lot of pimping yourself out that happens at the beginning to attract clients. YEARS of building your practice. Also, working with a client is something you build over time, in some cases months and years, especially for deep work, so if you are moving around a lot this could be difficult.

Lori Gottlieb ("Marry Him" author, and Ms. Mental Issues Galore, but that's other story) wrote an interesting nyt article about the shifts & trends she's seen as she started her therapy practice. I can't endorse the author too much since I think she's supremely f*ed up as a person, but the article was interesting nonetheless.
posted by St. Peepsburg at 10:47 AM on September 6, 2013

Therapy is a wonderful profession to get into. I have a tremendous amount of respect for people who want to spent their lives helping others. I know someone who is trying to become a therapist, and there are a couple things to keep in mind if you're going into the profession:

You'll have to earn a certain number hours as an intern before you're licensed to practice on your own. This (I believe) is after completing grad school. I think the number of hours in our state is 3,000, but I could be wrong about that. All the hours you work won't count. These are direct client hours. You almost certainly won't get 40 direct client hours per week. There is time between clients, paperwork, no-shows, not having enough clients, etc.

Your hours require supervision. This is often 1 hour of supervision by a licensed therapist for every 10 client hours and must be done weekly. (You can't do five hours a week over two weeks and save the supervision for the second week). Some jobs include supervision as part of the internship. Some require you to pay for it out of pocket, usually at a reduced rate ($60 to $80 or more).

Intern jobs often pay either a little above minimum wage hourly or they are commission-based, but require you to give a set portion of your monthly income (like the first $1,000) and then they pay you the commission on anything you earn over that. The commission based jobs give you walk-in appointments, and/or ask you to find your own clients. When you do the numbers on these types of jobs, you need to see a lot of people to make more than minimum wage.

The person I know applied for a therapy job via Career Builder or another online site that tells you the number of applicants about two years ago. There were 383 applicants for the job. Obviously, that's not a good ratio.

State funded social services have been slashed drastically during the recession, and in my opinion, those funds aren't likely to be fully restored, or even partially restored in many cases. It also seems that individuals cut therapy during recessions, as it tends to be expensive.

Things probably look a lot different once you finish your hours, build a client base and can charge $100 per hour. But it isn't an easy road, and the best advice I can give is to not accrue huge student loan debt getting a degree. If you do accrue a large debt, it can effectively make it impossible for you to survive on low intern pay long enough to finish your hours.

Also, you're probably going to work until 7:00 PM or 8:00 PM every night and/or weekends if you're doing standard therapy. Most of your clients have jobs and can't make it until the late afternoon, or until after work.

Last bit - I'm not on the inside, so my facts may no be 100% correct, and I'm sure the rules vary by state. Verify everything you read and everything I said, but go into it with your eyes open.
posted by cnc at 11:25 AM on September 6, 2013

This is really the kind of question you should talk to a therapist about.

I'm not trying to be flip. I really wish I'd spent more time talking to professionals in my own profession before setting my heart on joining them. As well, it's my understanding that being a therapist and helping other people to work through their trauma and their stuff has a high likelihood of bringing out your own trauma and stuff. Accordingly, you will want to have your own emotional well-being well tended-to before you start taking clients.
posted by gauche at 12:20 PM on September 6, 2013

I'm not sure HOH really emphasized how hard being on the other side of the couch can be. (This will all differ depending on your exact type of practice, etc) You will lose people. You will see the same kinds of people with the same kinds of problems over and over and over. You will hear unbelievable horror stories, some of which are still happening in the present tense. You will lose sleep. You will lose sanity. You may lose some faith in humanity. You seriously can't take your work home with you. Your job will make you need a therapist. Helping people can be addicting. The hours ARE terrible. Emergiences can pop up at any time, any hour, during any of your family events. Some people will lie. Some will not work at all. Some will try to put you in horridly awkward positions. You will make mistakes. You will say dumb things. You will have your heart bleed. You will have a patient come in a few times and vanish and wonder about them for years. You will always want to do more than you really can.

Is it worth it? Yes. But DO go into it with your eyes open- nothing is better than breakthrough moments, but there is a LOT of work, sweat, tears, and blood to get there.
posted by Jacen at 5:08 PM on September 6, 2013 [1 favorite]

Best answer: I am considering a similar path and have spent a large part of the past several months talking through these things with my therapist, financial adviser, academic advisers, and friends. Therefore all my advice is only what might work, not what is 100% guaranteed success.

Your specific questions:
1) Skype/overseas: You can't practice in states where you aren't licensed. My therapist's friend is a therapist who gives seminars on therapy and technology, and says restrictions around things like Skype might change in the coming years, but don't hold your breath.

2) MSW vs LPC/CMHC/MFT, etc: Friends with MSWs have encouraged the MSW route because it's easier to get a job, especially a government job. Counselors and counselor educators say "if you want to be a therapist, go to school to be a therapist." They also said since there was some insurance change that made it so therapists could accept insurance, the job imbalance between MSW and LPC/CMHC/MFT has started to adjust in therapists' favor.

Note that NONE of the programs here will provide me ANY data on employment and income of graduates of their programs. All of the programs here require students to pay for all of their internships as if they were just another course.

You may also be able to take graduate-level coursework in the field, for credit, at your local schools without applying to their programs. Find out if you like the faculty. Find out if you like the student body. Price out what each school would actually cost you. Find out if you can work full-time while in school; all the schools here say working full-time during the first two years is no problem.

If taking courses in the program itself is not possible, investigate local community colleges. For example, here, one can become a level I/II/III CADC Addiction Counselor at the local CC. This can be a low-cost way to get engaged in the field.

You can figure out how much you actually like to help a lot of people by volunteering at a local crisis line, LGBTQ center, youth center, etc. I am sure your local schools would be happy to point you to such opportunities.

Our local suicide/addiction/youth/veteran crisis line provides 56 hours of engaging classroom group training for free in exchange for a commitment of 4 hours per week of your volunteer time taking phone calls for a year. If you attend the supervision days, those hours count towards a CADC. Something like that would be a great way to test the waters without changing everything in your life.

My own therapist and several friends who are therapists or psychiatrists all recommended I consider just becoming a life coach or explore some of the non-licensed varieties of therapy, like M.E.T.A. and others. Their reasoning was that they quite often want to tell people what to do, but the normal patient-centered approach prohibits the therapist from doing so, and that they think I'd be good at telling people what to do. A M.E.T.A. therapist I know makes $90/hour, gets a lot of work, isn't licensed, and didn't go to school for therapy.
posted by MonsieurBon at 6:06 PM on September 6, 2013 [4 favorites]

I am a psychotherapist (a clinical psychologist). I strongly agree with the advice to do the program or training that most closely aligns with your actual intent. So if you know now that you want to be able to provide services internationally, I would advocate for something non-licensed, like coaching (as MonsieurBon mentioned). It's not a totally unregulated field, as there are some professional bodies that provide training and certification, but would give you loads more leeway in being able to provide virtual services and you could be up and running much more quickly.

My experience as a psychotherapist has been different than Jacen's, above. Your work, and its impact on you, will naturally vary according to the setting, population, compensation, and work-life integration. Just like any other field, there's variety in people's specific career trajectories and job satisfaction.
posted by aspen1984 at 9:49 PM on September 6, 2013

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