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.