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Feb 27 2013

Training Therapists: We’re Doing It Wrong.

Becoming a therapist should not take two degrees. If we want to create a program to train therapists, it needs to be one degree that actually intends to make good counselors. We need a vocational school styled approach, explicitly focused on licensing in four years or less.

Getting a grab bag of undergraduate psych experience–which may or may not relate to counseling people, and a year of graduate school before you start interning (read: doing therapy with supervision) is useless. It’s expensive, it limits who can become a therapist in the wrong ways, and lets people who should not be practicing slip through the cracks and emerge with a license.

So We Can Stop Making Therapy a Wealthy Person’s Privilege

Look, the cost of an undergraduate degree is really high. The average public university costs per year is $15,918 [source]. So you go there for four years, and you have a degree in psychology. That’s great, except you can’t do therapy with that.

So you need a graduate degree. That’s $6,000-$15,000 [source] per year in tuition again for two years (assuming a Masters program). Of course, you also have living expenses–even assuming that you don’t have kids or a partner or a car accident or a major illness–the majority of therapists start out in debt. So what they charge for services matters. They can’t afford to spend time giving away therapy sessions, because they need food on their table. It’s harder to do sliding scale sessions if that’s not how your repayment plan works. (Sliding scale is a pay-as-you-can model.) Therapists want to be on an insurer’s list, so they can get a stream of clients.

So therapy costs money, and cheap(er) therapy requires insurance. See the problem here?

Burnout/Weeding Bad Therapists Out:

Premise: Some people who want to be therapists will actually make terrible therapists.

Arguments? No? Okay.

Undergraduate psych isn’t a lot about actually working in psych services. It’s “Look at this cool brain thing! And what about this one?!” “Stroop tasks!” “Neurons!”

And I like all of those things. I like them a lot. But they don’t tell you about how much paperwork comes from being a counselor. Or what the hours look like (hint: it’s not a 9-5). You don’t spend hours practicing how to listen and think and avoid asking “Why?” questions* all at the same time. Not everybody can do this, and that’s fine. But maybe we shouldn’t make everybody figure that out on their own. A program that mirrors the practice of mental health care lets those who can’t do it drop out early (before they get a an expensive set of degrees, hate it, feel obligated to use their education, irritate and harm clients, and then burn out.)

In undergrad, psychology is an ‘easy’ major. Being a counselor is not easy. Let’s match the training to the reality.

Intersectionality & Real Life.

I learned a lot of things about brains and people and microskills and heuristics and biases and writing a concise abstract in my major. I like all these things–I don’t like psychology just because I want to be a therapist. I love statistics and reading research and neuroscience.

You know what I didn’t learn about, beyond a passing mention that they exist?`

Gender & sexuality minorities

Why most people return to abusive situations.

Harm reduction

What systemic poverty looks like

Incest

Rape

Child abuse

What the foster system looks like in practice

Chronic illness as it relates to mental health

Bullying

Suicide prevention

Psychopharmocology (Psych medication)

Asexuality

How to ask for preferred pronouns/getting used to gender neutral pronouns

Polyamory

…or how any of these can intersect.

I would have liked to.
I want budding counselors to begin their education by learning about ALL kinds of people and systems. I want to stop assuming that living in the world gives you enough life experience to counsel anyone. Because you know who can afford to go to college for two degrees, who are encouraged and supported in doing so? Mostly privileged people. Do you know who we’re really bad at providing mental health services for? The underprivileged.

What Psych Services Jobs Can You Do With A Psych Undergrad Degree?

Seriously. Somebody.

You can work at a crisis center or hotline or be a research assistant or or or…yup, I’ve got nothing.

Tracked Classes Are Better Than Pick ‘N Choose

Psychology majors usually have a basket system for major completion. This isn’t a terrible idea, and it’s how most humanities majors work. You get some intro level classes, some intermediate classes, a handful of special seminars, and a few required things like statistics  and Writing a Paper a Specific Way That Will Be Quickly Outdated (aka Research Methods. Yes, I’m bitter). You don’t really have to get them in any order, except you might need Intro Psych first, and research seminars might need you to understand statistics and paper writing. Other than that, you take what you want, in whatever order works for you class schedule.

On the whole, this doesn’t seem unreasonable. You don’t really need to understand 200-level Social Psychology to understand 200-level Cognitive Psychology. I do, however, think you should take Developmental Psychology before you take Developmental Psychopathology. You should also take Psychopathology before you take Counseling, and you should know a little bit about neuroscience, developmental problems, and brain injuries before that too. You should definitely take more than one class about counseling people, and the second, third, and fourth classes should build on each other.

I want a program that plans classes, that puts them in the most useful order, that builds on knowledge to create a well rounded counselor by intention, not by accident.

Look, I’m going to get my two degrees and become a therapist. I would hope that I’ll be a good one. But we need to create a system that makes that the most common outcome, that doesn’t put potential therapists into debt, and that treats mental health work like a career with real requirements in terms of personality, skills, and devotion.

*With the exception of Rational Emotive Behavioral Therapy, therapists are highly discouraged from asking questions that begin with “Why…”, because they come across as implicitly judgmental, even if that’s not the intent. 

35 comments

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  1. 1
    Miri, Professional Fun-Ruiner

    *applause*

    For me it’s about $120,000 (with financial aid) for four years of undergrad, about $50,000 (also with financial aid) for two years of grad school, and then I still have to work under supervision for about three years before I can get licensed as a LCSW (licensed clinical social worker) and practice independently.

    I don’t really know that it’s necessarily possible to fit all this in four years given how much practical experience is necessary; I needed internships to get into grad school, and for each of those years I’ll be doing a 9-5 internship three days a week, and then those three years of supervision. But yes, there definitely needs to be a more consolidated system than there is now.

    And for the love of fuck, there’s no reason I should be required to take calculus. :P

    For me, the most important part of this whole post was that list of things your classes didn’t teach you. SO TRUE. How can someone be a counselor–or even know for sure that they want to be one–without having at least a passing understanding of such things?

  2. 2
    Kate Donovan

    I think if we remove the extraneous classes and have the expectation of more time spent in school–I average ten hours a week in class and my engineering friends average twenty–we could make a four year program happen. (Keep in mind other readers, Miri and I go to a school on quarters, so hours are calculated differently). Maybe requiring another internship in the fifth year.

    Besides, most of my current classes don’t relate at all to being a therapist in the first place.

  3. 3
    Stephanie Zvan

    Heh. Was just reading this when you tweeted it at me. Intruiging. I’ll need to think about this some more. I’m not sure what of the education I received (aside from the bits that nobody should have been taught because they were out of date) I would want potential therapists to give up.

    I would actually like to see internship-type experiences start earlier, possibly in conjunction with local schools and special-needs students. Knowing you can keep working at this sort of thing even when progress is slow and uneven and when your clients are cranky and unhelpful is going to be crucial.

  4. 4
    Kate Donovan

    I’m iffy on the part of internships that are with students–because I’m terrible with children & adolescents, and really don’t want to work with them in therapy. But I do want more internships and more real-world training, beginning with play acting therapeutic techniques (it’s HARD!)

  5. 5
    michaelbusch

    I can understand having a more focused program, but I’m wondering:

    Could you put the positions the graduates of such a four-year program would fill in analogy to something in the physical (rather than mental) health system?

    I ask because the psychologists (and psychiatrists) I’ve known have almost all been PhDs/MDs or both, so it is easy to equate them with GPs or specialists who deal with things other than the central nervous system. Where do therapists with masters and with this notional four-year degree fit in?

  6. 6
    Stephanie Zvan

    One of the advantages of students is that they’re everywhere. Another is that they don’t usually object to young adults being in their business. That’s definitely not the only opportunity, though. There are plenty of chances to shadow counselors and social workers, if nothing else.

    Mostly I want people to have an opportunity to see what the job looks like. While I was planning to go into counseling/therapy, I realized by the time I was done with college that even working in customer service had told me it was a bad idea.

  7. 7
    DearAnia

    Another issue to address is that Psychology undergrads also weed out people who would make great therapists but are not great at multiple choice exams. I have a professor who hates multiple choice and grading. he wants to make us think, but is forced by the university to follow certain protocols.

    Great article. I will pass this along to some of my profs and fellow Psych students. My own attempt at becoming a therapist is to go to med school and do a double specialization in gynecology and psychiatry (I want to be a sexologist, and the gynecology spec. will help me address physical aspects as well as psychological)

  8. 8
    Miri, Professional Fun-Ruiner

    I’m not sure that that’s a relevant comparison. Although there are many analogies between mental and physical health, the reason doctors (and psychiatrists) need all those years of education and practice is because, as someone who treats physical health problems, you actually need to know about all the parts of the body and how different chemicals affect different parts and what to do when someone’s having a heart attack or choking or having shortness of breath or whatever. And although doctors do internships, they need to learn a LOT of stuff before they can even touch an actual patient, or else they may kill them or cause permanent physical damage to them.

    Although therapists have a huge amount of responsibility in what they do, it’s just not the same. And no amount of learning about the names of brain regions can make you a good therapist.

    Also, psychologists with PhDs do not receive more/better training on how to work with people than people with masters degrees do. In fact, arguably, they receive less training. The focus of most PhD programs is research and publication, not building counseling skills.

  9. 9
    Kate Donovan

    That’s true–I hadn’t really thought of students as easy experience-builders, but you’re right. I actually started a program where I was a TA working with gifted children to check and see if I like working with the younger set (I don’t, and I got paid to find out).

    But to your second point..YES THAT…we also need to stop talking about careers in health services as if anyone can do them. It’s just not accurate. Some people don’t have the spare emotional energy. Some people get bored, or hate listening.

  10. 10
    Kate Donovan

    Gosh, it’s weird that they require multiple choice. I would do awfully.

    I know very little about sexology, sadly, but I’m excited to know a future one. What year are you in your education?

  11. 11
    cortex

    It does seem that there might be much to gain from building more specific tracks instead of having a psychology major that’s so general. I’m a social psych grad student, and I certainly could get along just fine without ever having taken a psychopathology or neuro course.

    Some schools are starting to develop more targeted undergraduate majors that do focus more on human and family development and services, etc., but I think departments are a little hesitant to separate things too much because we are hoping to develop a little unity within the field one of these decades, and we can’t do that if the different faculty never have any meetings (parties) together.

    At the very least, though, we could stand to make psych programs a lot more demanding. If undergraduate stats majors can be taught multiple regression, there’s no reason psych majors can’t be required to take it. And discussion-based courses are great and all, but maybe we could wait for the students to have actually learned something about psychology before they discuss it?

    For what it’s worth, I don’t think anyone should be awarded *any* undergrad degree without learning about a majority of the topics you’ve italicized above. It’s ridiculous that a person gets to consider themselves educated without knowing how a large portion of the world – of their own city, even – lives.

  12. 12
    michaelbusch

    Fair point about the different skill set. I was trying to translate the idea into a framework I’m more familiar with, but that is probably not the best idea.

  13. 13
    Cuttlefish

    running this post (and comments) by a friend in the psych faculty, there is entirely too much to respond to at once, but I’ll start here…. the thing about psychology (the clinical specialization, as opposed to the science–though, frankly, it applies to both) is that it looks like a Jackson Pollock painting until you view it through the lens of history. Psychology (both, this time) is the bastard child of three parents–philosophy, natural science, and witch-doctory (there are easily traceable lines connecting clinical psych to Freud to Charcot to Mesmer, and experimental psych grew naturally out of philosophy departments when James and Wundt independently thought to make the old questions empirical ones).

    You complain that PhD’s don’t have the training that masters degree holders do, and you are quite right. For some schools, anyway. Historically, though, psychiatrists (before we had clinical PhDs) were MDs with a specialization afterward (and, historically, it was Freudian). When Clinical Ph.Ds came along, their more specific training (though not medical training) meant that they knew considerably more than the psychiatrists–about theory, about brain activity, about psychoactive medications (though they could not prescribe them, and psychiatrists could–stories abound of clinics where the shrinks deferred to the PhDs in matters of what treatment was needed, which the shrinks would then prescribe and bill for). A PhD in clinical psych (then, a PsyD, although that is no longer specifically clinical) was by far a better preparation than an MD with a psych specialization, and (at that point, in those schools) considerably better than a master’s.

    Currently, some schools put out clinical PhD’s or PsyD’s, others put out experimental psych PhDs. Your comment about the relative preparation of masters is absolutely the case in comparison with experimental psych Phds–even those who research topics of clinical interest get little exposure (or training) to clinical situations.

    On The Other Hand…. There are schools that focus on putting out therapists, but which have little or no interest in experimental psych. And frankly, this is a turkey shoot. Take a look at how many different sorts of therapies there are, including those that are fundamentally incompatible with one another at a theoretical level. Cuttlefish U. had (until very recent retirement) a couple of profs teaching the school of therapy they had been trained in (I’m not naming it because it is rare enough that CU might be identifiable), which basically took Freud as a starting place and took a left turn into batshit crazy. (seriously, this therapy was once associated with orgone generators, which you might now find in the museum of medical hoaxes.) The regulation of the term “therapist” or “psychologist” or “counselor” varies from state to state, and it is absolutely possible to get a degree, believe yourself to be properly trained, and yet in fact know absolutely nothing worthwhile in this area.

    Which is why my friend is a staunch advocate of an actual grounding in scientific (experimental) psychology before additional training in clinical. Methodology courses (done right) allow one to distinguish well-supported claims from rubbish (John Edward Mack, anyone? Psychiatrist at Harvard Medical School? Proponent of a theory that mental illness was actually the side effects of alien abduction? Yeah.) Social and cultural psych courses (properly done) help to put behavior in context–this person might not be ill at all, but acting on a different set of norms. Behavioral classes (do they still teach those?) have an observational rigor and empirical grounding that pave the way for clinical observation.

    Can we teach what we need to in less time? Sure. But remember, we do that at the expense of flexibility, and we end up with therapists who made the huge decision that this would be their life’s work… at 18 years of age.

    Miri, I have clearly gone beyond commenting on your comment alone–please don’t take it as unloading on what you have said. Once I got started, I kinda replied to a lot of stuff at once here, and I beg your forgiveness.

  14. 14
    Kate Donovan

    Cuttlefish, I want to address a specific part of your response:

    “Therapists who made the huge decision that this would be their life’s work… at 18 years of age.”

    I’m really not sure why this is a problem. People often make decisions about their career at this age or earlier (I was sixteen when I did). That’s the age where you decide to enroll in nursing school (And I’d argue that a bad nurse has the ability to kill you much more easily than a bad therapist). That’s the age when you pick a college, when you start a pre-med or engineering program.

    And it’s possible to change careers–I’d argue that right now it’s harder to change careers from therapy to another–if you’ve invested the cost of two degrees, you’ve got to get out from under that debt first. I want people to know at 20 that they’ve picked the wrong career–not at 26.

  15. 15
    trazan

    Maybe you want something like Problem-based learning? There are psych educations that use it. http://en.wikipedia.org/wiki/Problem-based_learning

  16. 16
    Kate Donovan

    Upon a fourth reading, I’d also like to add that the first four paragraphs aren’t new to Miri or I–they’re actually what’s taught in the first two weeks of any psych course…ever. That means every class I take wastes one fifth (ten week quarters) of the time covering the same material, which, though arguably useful to know, could be taught once, rather than (for my current degree progress–I just checked my transcript) twelve times.

    I’m not saying there’s a lack of reasons we got to this point–I just think we need a massive overhaul if we’re going to serve the people we should be serving. I’m not an education reform expert, and the majority of this piece is written in the “if I had wishes and a genie” thought. :P

  17. 17
    A

    Not sure where you went to school, because I took courses, in my undergraduate studies, on almost every subject matter you listed . I loved the psychology degree I received and feel more prepared to be a counselor coming out of my psychology bachelors degree, than I think I will be getting my counseling master’s. The master’s degree I am receiving now is just a hoop to jump through to get my licence.

  18. 18
    DaveL

    For what it’s worth, I don’t think anyone should be awarded *any* undergrad degree without learning about a majority of the topics you’ve italicized above. It’s ridiculous that a person gets to consider themselves educated without knowing how a large portion of the world – of their own city, even – lives.

    I appreciate where you’re coming from, I really do. I have often found myself mentally compiling lists of just such things that functioning adults really ought to have a basic grasp of.

    Unfortunately, you might have noticed in one of Kate’s comments that her friends in the engineering program already spend twice as much time in class as she does. There just isn’t going to be time for them to cram in extra courses about human sexuality and suicide prevention. Likewise, as an engineer myself my own list of such “must have” topics includes more of the ‘hard’ sciences, probably a lot more than students on a “therapist” track have the time or inclination to take.

    It’s frustrating, but I think we’re going to have to live with the fact that whatever we do, at the end of an undergraduate program we’re going to end up with a few bright individuals like Kate who show insight beyond their years, many who will require several more years of life experience to reach the same point, and some who never will.

  19. 19
    evilDoug

    And I’d argue that a bad nurse has the ability to kill you much more easily than a bad therapist)

    But there is a huge difference in the way nurses and therapists work, at least in my experience.
    In most cases, a nurse is a member of a patient care hierarchy. Most work in close proximity to other nurses and to physicians. Much of what they do is by order. Procedures done by nurses are pretty well defined. Most work in an environment where adverse events are expected and people, equipment and process are in place to deal with many such events. There are certainly errors made by nurses that can kill patients regardless – administering excessive intravenous potassium chloride is one such error.
    Therapists, from what I have seen, are more likely to be “sole providers” who deal with clients in situations that are often very deliberately away from the scrutiny of others. Unlike a potassium error, an fatal error in psychotherapy can’t even be determined at autopsy. Lesser damage may take years to manifest.

  20. 20
    evilDoug

    p.s. Many years ago I was an occasional TA for a nursing microbiology course. I left me quite frightened of the idea of being in a hospital.
    I also worked with guy who had a masters in electrical engineering, a PhD in physiology and an MD. I made me afraid of damned near everything.

  21. 21
    evilDoug

    p.s. Many years ago I was an occasional TA for a nursing microbiology course. I left me quite frightened of the idea of being in a hospital.
    I also worked with guy who had a masters in electrical engineering, a PhD in physiology and an MD. He made me afraid of damned near everything.

  22. 22
    evilDoug

    Third time lucky?! MAYBE I’ll click prevue properly this time AND get the words right.
    p.s. Many years ago I was an occasional TA for a nursing microbiology course. It left me quite frightened of the idea of being in a hospital.
    I also worked with guy who had a masters in electrical engineering, a PhD in physiology and an MD. He made me afraid of damned near everything.

  23. 23
    freemage

    A: Well, that was part of her point–the Master’s degree seems to be an unnecessary (and expensive) tack-on that doesn’t really affect skill as a therapist (it’s about mastering research techniques and publishing papers), but DOES mean you get to go into the field with an extra debt-load, which must be passed along to the patients.

    While a vocational/certificate model CAN work for some fields, I’d definitely be a bit leery of such a set-up prior to proper vetting by a board of experts. The for-profit education industry in this country has bred a number of rather hideous scams in other fields in the course of the last couple decades. There’s some good programs out there, too, but it can be tough to sort through them.

    (Aside from program reform: Personally, I’d like to see a public student loan system for virtually all the ‘healing professions’ that did a 10% loan forgiveness for every full year spent working at public free/sliding-scale clinic. 10 years of public service after graduation, and you’re debt-free AND have a trial-by-fire field experience you can take to the for-profit centers. A student can get out of the clinic program early if they’re willing to start making the debt payments they normally would for whatever remains, too.)

  24. 24
    JCarr

    Perhaps a Human Services degree would be more appropriate, if you just want to do therapy and counseling? Those courses and undergrad practicums address the issues you brought up in this blog, but the obvious downside is the lack of depth into the inner workings of human behavior.

    A colleague of mine earned a PhD in clinical psych and an MA in Human Services. I thought of her when I read your post, because she constantly insists that the Human Services coursework gave her the best preparation for working with a variety of people with a variety of problems.

    Valid points in your post and the above comments, nonetheless.

  25. 25
    Kate Donovan

    I’m actually getting a dual major in Human Development & Psych Services as well as Psychology. Still having almost all of the issues listed.

  26. 26
    JCarr

    Interesting. It must depend on the faculty and the program, then. Most of the things mentioned in the above blog were covered during my undergraduate years, and others were learned in my experiences as a volunteer and licensed foster parent in the foster care system.

    It’s disheartening to learn that so many important issues aren’t being addressed in your undergrad coursework. I imagine the discussion revolves around causes, assessments, presenting problems, and treatments, without discussing how to interact with the client, and that’s unfortunate.

    An excellent way to counterbalance this is to involve yourself in a clinical practicum with an MSW or LPC working at a local guidance clinic, believe it or not. Most mental health care services in the US are provided by these professionals at these sort of facilities, not by psychologists or psychiatrists, as many believe. Getting involved with a facility that services lower income families, referrals from CPS, and adolescents in the Probation department is an excellent way to “get to know” how to handle most of the things on your list.

    But, overall, I agree with you. These are things that your facility, faculty, and program should be addressing, especially if your focus will be counseling.

  27. 27
    mildlymagnificent

    beginning with play acting therapeutic techniques (it’s HARD!)

    Yup! Anyone who’s trained as a volunteer for Lifeline or domestic violence or sexual assault or other-specialised-service knows just how hard this really is. For some people, just changing an apparently simple thing like their preferred habitual relaxed posture or phone voice is a problem all of its own – but it has to be done.

    Personally, as a non-USAnian, I see the core problem here as being the way the American higher education system is “organised” – there is no word in existence that conveys my view of these mysterious workings.

    Though it is, in some ways, a bit like the problems we have here with nursing training. One of our clients was involved in an agency placing workers in various health facilities. They were very keen to have student nurses do some part-time work as cleaners and aides (rather than just doing their intermittent ‘placements’) – because they’d found some nurses got themselves fully qualified before finding out that they just couldn’t stand being, let alone working, in many health facilities. Simple things like the smell of the place they found intolerable, along with dealing with distressed or angry relatives. (My fully qualified, nurse educator daughter did an outstanding version of the angry relative standing her ground the other night – I wasn’t there to see it, but it would have been worth it.) The ones who’d acclimatised themselves by spending a lot of time in the environment coped a lot better.

    Of course, when it comes to therapy, Australia has problems all of its own. http://www.hospitalandagedcare.com.au/news/clinical-psychs-gravely-concerned-over-pretenders-standards
    Including this nasty statistic ….

    “Around 75% of Australian psychologists would not be permitted to practice as psychologists in any other Western jurisdiction. The confusion and blurring of psychological qualifications for those who have, and have not, obtained training in recognised areas of practice endorsement is of grave concern and need to be identified
    and clarified, ” she says.

  28. 28
    Rol

    If you guys are as mentally ill as you claim, why do you want to become therapists? It reminds me of the Nietszchean critique of Socrates:

    I have given to understand how it was that Socrates fascinated: he seemed to be a physician, a savior. Is it necessary to go on to demonstrate the error in his faith in “rationality at any price”? It is a self-deception on the part of philosophers and moralists if they believe that they are extricating themselves from decadence when they merely wage war against it. Extrication lies beyond their strength: what they choose as a means, as salvation, is itself but another expression of decadence; they change its expression, but they do not get rid of decadence itself. Socrates was a misunderstanding; the whole improvement-morality, including the Christian, was a misunderstanding. The most blinding daylight; rationality at any price; life, bright, cold, cautious, conscious, without instinct, in opposition to the instincts — all this too was a mere disease, another disease, and by no means a return to “virtue,” to “health,” to happiness. To have to fight the instincts — that is the formula of decadence: as long as life is ascending, happiness equals instinct.

    12

    Did he himself still comprehend this, this most brilliant of all self-outwitters? Was this what he said to himself in the end, in the wisdom of his courage to die? Socrates wanted to die: not Athens, but he himself chose the hemlock; he forced Athens to sentence him. “Socrates is no physician,” he said softly to himself, “here death alone is the physician. Socrates himself has merely been sick a long time.”

  29. 29
    Ed Cara

    K.

  30. 30
    wanda

    Sorry if this is too basic to be addressed, but what percentage of psych majors actually want to go into counseling? I’ve met a lot of people who were psych majors because they figured that “learning about people” was a good foundation for life and did not otherwise have anything specific they wanted to do.

  31. 31
    Kate Donovan

    no, this is a really great point: not all psych majors want to be therapists. Is it reasonable to have a group of people whose interests are “major that helps with life”, “want to go into research”, “want to go into a grad degree like law or communications”, “want to do advertising” and “want to be a therapist” all learning the same things? Have we stretched ourselves too thin?

    (I don’t have the data to answer your question with numbers, sadly”

  32. 32
    travisdykes

    So being a nurse, and not having much experience with therapists other than what I got on my psych rotation, (and having a Psych professor for a dad) It looks like it might be beneficial to track it similar to nursing school and the BSN degree where you have at least a year and a half of classes that are considered pre-clinical and you have to be impressive enough through those classes + experience (i.e. nursing tech, volunteering with disabled kids, ect) to get accepted into the clinicals program. once in clinicals, you take classes geared towards teaching you what you need to know to do any kind of nursing + you spend time in the hospital applying it. You do 5 semesters of that and you graduate, take the NCLEX, then when you get hired, you go through it all again (but greatly accelerated) in orientation where the hospital that hires you makes sure you actually do know what your doing and that you can do it to their standards/with their documentation and procedures.

    Perhaps there needs to be a new position that that track leads to like a therapists assistant that helps to see clients, so you can be employed and gain experience under a therapist before going on to getting a masters or doctorate and becoming a full therapist similar to how to become a nurse practitioner you have to work as a nurse for a year or two (usually at least two) before you can get accepted into a program.

  33. 33
    michaelbusch

    >>If you guys are as mentally ill as you claim, why do you want to become therapists?<<

    Perhaps because people who have benefited from mental health care better understand its importance?

    An observation:

    Between 10% and 25% of the adult population meet the diagnostic criteria for a mental disorder in any few-year period and between 25% and 45% of the population will meet those criteria at some point in their lives. The numbers are from Wikipedia and its sources, with the ranges depending on which particular cohort is sampled and on the exact diagnostic criteria used. I am not a psychologist and I will accept correction from Kate and Miri and anyone else if I have misunderstood the epidemology reports.

    So having or having once had a mental disorder of some kind is quite common. Psychologists should be more aware of their own mental state than the general population (although denial could be stronger), and may also be more willing to speak publicly about what mental disorders they may have had.

    And having dealt with a mental disorder does not disqualify someone from being an effective therapist, and can actually _help_.

  34. 34
    Student

    I agree that education and training in this field is a disaster. I do not necessarily jump onboard with the idea that we require too much education but I still agree that the pathway to a career in the field is badly designed. The most notable problem, as I see it, is the fact that Master’s level programs are letting anyone and everyone into them. This is, naturally, exacerbating the fact that people who like the idea of helping people decide to become counselors. MBA programs require experience before they will consider applicants. I was under the mistaken impression that was the same case for graduate programs in psychology. I wish I had been correct. I worked 2 and a half years as a residential counselor at a therapeutic high school for individuals diagnosed with major mental illness while I was pursuing my undergrad degree. It was only because of that experience, that experience which required 3-midnight shifts which frequently obligated me to sit in hospital waiting rooms while a suicidal client was being evaluated, that I knew, for certain, that I wanted to pursue a degree in psychology. When I was admitted to a graduate program in counseling psychology I was under the impression that my classmates would have some experience as well. I was wrong – to a disturbing degree. Now I am a doctoral student working with Master’s level students and I am constantly upset by the lack of experience entering Master’s programs. People romanticize the field until they enter into it. We must require potential counselors to enter into the field before they commit to it or else we’re left with incompetent therapists longing for that romantic dream.

  35. 35
    Rebecca M

    Actually, there is some direct service work you can do with just a BA in Psych. You can work as a residential counselor, as a supported employment specialist, as a rehab coordinator (does residential counselor type work, but visiting people who live independently).

    I did this for a couple years after I got my BA in psych.

    Here are the some of the places that hire this kind of position:
    http://www.stlukeshouse.org
    http://www.greendoor.org
    http://www.baycove.org

    I don’t think there are as many of these places as there should be, for clients in need of services, let alone to employ aspiring counselors. But google “mental health [your city]” and see what you find.

  1. 36
    Around FtB » Pharyngula

    [...] Kate makes the case that therapists are all wrong. [...]

  2. 37
    Occasional Link Roundup » Brute Reason

    [...] 2. Kate writes about how therapists are trained in the U.S. and what’s wrong with it: [...]

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