Train Professionals, Not Just Therapists

• Becoming Professional
• Not My Job
• Harsh Realities
• What Now?

Becoming Professional

After hundreds of class hours learning systemic therapeutic modalities and hundreds more working directly with clients in multiple clinical settings, I graduated from my master’s program in marriage and family therapy a competent clinician. I treat couples, families and individuals on issues ranging from depression to trauma to affairs. But graduating clinicians is not enough—graduate programs have a responsibility not only to train clinicians but to help them become professional therapists. And that task is far more complex.

A professional therapist entering the workforce must learn to navigate the employment landscape, land a first job, determine long and short-term professional goals, understand the financial and professional implications of each of those steps, and build the tools to curate a digital presence that supports professional growth. A professional therapist must learn how to conceptualize the digital boundaries between therapist and client in an ever-transparent world and integrate HIPAA compliant technology. The professional therapist must understand the ins and outs of the insurance industry, at least enough to intelligently interact with it. These are the elements of the professional. And currently, most new therapists are running blind.

I consider myself fortunate. By the time I entered graduate school to become a marriage and family therapist, I had worked in corporate marketing, built a resume consulting business, traveled the world, and gotten married. In my second year of graduate school, I published a book that became an Amazon bestseller. I had also been fired from a good paying job and struggled through six months of unemployment and under-employment. When I started graduate school, I did so with eyes wide open. I researched the elements of building a career as a therapist, not just as a clinician. I read books about entrepreneurship. I began writing and trying to build an online presence. But even I, far better equipped than the average student, had so much to learn about building a professional future. Particularly for those students that transition from undergraduate to graduate school, the intricacies and big picture conceptualization of one’s career can feel overwhelming and most feel ill-equipped.

Jumping into a career as a therapist comes with an incredible level of uncertainty. A student leaving a master’s level program must decide whether to pursue a doctoral degree. Upon hearing other students speak about their intention to pursue a doctoral study, I asked them about that decision and what they envisioned for themselves. Many said they did not know, it was just “what was next.” The trajectory outside of academia remains unclear, and involves understanding how to work in a hospital setting, community mental health or private practice, and decide whether to pursue an inpatient or outpatient role.

Job hunting. Entrepreneurship. Business ownership. Accounting. Marketing. Digital boundaries. Online therapy. Working in hospital settings. Whose job is it to teach budding professionals to navigate this landscape with finesse, confidence, and an understanding of what’s required to succeed? I believe that graduate schools need to play a much larger role in not only training competent clinicians but also in preparing professional therapists to enter their careers. If a degree is marketed as a professional degree, then a student has a right to learn how to become a professional. Why don’t graduate schools teach students about more aspects of professional life? I suspect the answer is multi-faceted.

Not My Job

Some argue that professional training related to the non-clinical aspects of a therapist’s career falls outside of graduate schools’ purview. In other words, not my job. We figured it out and you will too. This line of argument, akin to a verbal shrug of the shoulders, a relinquishment of responsibility, fails to compel me. That programs have yet to step up does not mean they should not. I am a student of systems, and to create change that reverberates down the course of a therapist’s career, the initial steps must include the tools necessary to succeed in the world. We can do better.

Some argue that, well, they had to figure it out, and you will too. Sure, I suppose that argument rings true. Every professional confronts a steep learning curve when they transition from school into the workplace. But let us not fall into an all or nothing thinking trap here. Teaching new therapists how to plan out their career progression, how to understand insurance systems, how to manage student loans, and how to approach the task of entrepreneurship for many who want to build practices, will not eliminate the steep learning curve. I argue not that the student should be coddled, but rather, that they should be equipped.

Many therapists struggle to connect their work with money. Training as a clinician aligns with the selfless task of helping others, while money, marketing and business models feel like its necessary seedy underbelly. At the agency where I work, a sign on one clinician’s door reads, “I do it for the outcomes, not the income.” While the sentiment is a lovely one, it only reinforces the minimization and vilification of financial success, and unnecessarily puts success and therapeutic work at odds with one another. This thinking also exposes a misunderstanding of the professional therapist. The professional therapist does not sell to sell, they sell to serve. The therapist who can build a successful enterprise, who can reach their target clients effectively (be they kindergarteners struggling with grief or couples on the verge of divorce), who can walk confidently into an interview to work at a hospital or community mental health setting, is a therapist that can effectively help more people. What would our sector look like if new therapists were armed with an arsenal of tools, ideas and resources to help them spread their message more effectively and reach the clients who need them. This model of service reframes the issue as one of great responsibility, deeply in line with the therapist’s work. This is the framework needed when thinking about the business of therapy.

Harsh Realities

Perhaps another obstacle in the way of open communication around therapist career building is the stark economic realities it would force professional graduate programs to face. One imagines the discomfort it would cause to have professors, teaching in programs charging ten to sixty thousand dollars per year, openly discuss the financial reality of most early career therapists. Students who find full-time positions with benefits (scarce in the mental health arena), often struggle under the sheer weight of student loans.

Community mental health positions often come with a rude awakening of fee for service work, extremely low pay, high no-show rates, high incidences of client trauma, and overworked supervisors incapable of meeting the needs of their outpatient therapists. Launching and maintaining a private practice involves daunting start-up costs along with the often bewildering and complex tasks that accompany the effective marketing of the practice, renting or finding a space, learning about billing, purchasing malpractice insurance, ensuring HIPAA protected note storage, and accounting.

Indeed, many programs discourage students from jumping straight into private practice, believing in the growth potential and importance of working in community spaces. Perhaps the prospect of asking students buried under tens or hundreds of thousands of dollars in student debt to take a low paying job for the experience would be a tough sell, or at the very least, an awkward one. I wonder how it would go over for students to learn that professors in their fields either still have student debt or benefited from high-earning spouses who enabled them to work despite the early career steps. These conversations force still more difficult conversations about the access to education and the capital needed to get going.

Alas, the professors and teachers best equipped to imbue their students with clinical skills may feel or be the least equipped to prepare students to operate in the digital landscape. Clinicians with more than 20 years of clinical practice have at most a bare-bones website. Their digital footprint may be limited to Psychology Today. They may not be adept at utilizing modern marketing tools, lead generators, and using SEO technology to bring in more referrals through google and other search engines. They may not know how to manage mainstream social media and address the realities of increased online transparency that translates into the therapy room. Many did not come of age professionally in the digital area, navigating the public and private boundaries that are a constant challenge for new clinicians. New therapists require mentorship from clinicians who have been in the field from five to ten years to learn the trade in its most recent form.

At present, there is little pressure for graduate programs to reconceptualize their role and implement sweeping changes. Without pressure, schools are unlikely to change. Without a roadmap, schools would need to dedicate themselves wholeheartedly to the task and not only implement new measures, but also create them.

During my final year of graduate school, I and many of my classmates struggled not only under the weight of coursework, but the questions about what would happen after we graduated. Some of us wondered how to translate our clinical experience into a resume that would attract employers. Others wondered whether to prioritize the stability of a full-time job with benefits or the position that enabled us to work with our target population in a position without benefits. A panel discussion of past graduates inevitably led to sheepish questions by students wondering if graduates would be willing to get specific about just how much they earned and how secure they felt. Now as a recent graduate, settled into a semblance of routine, current students approach me with the same panoply of questions. Year to year, the emotions underlying these questions remain: fear, confusion, frustration, excitement, and bewilderment. Guide us, we beg over and over. Please.

What Now?

Therapeutic training programs are hardly alone in their failure to prepare professionals. Law schools notoriously work their students to the bone learning legal intricacies while failing to touch upon the actual experience of working as a lawyer. When my husband Brian compared his experience of medical school with my late grandfather’s almost sixty years ago, he received more practical training related to charting and taking patient histories. He even had a class called “doctoring.” But medical students, who navigate a siloed version of the economy through their extended training, often complete their residencies with no training in financial management (despite averaging almost two hundred thousand dollars in debt), no training in private practice building or planning, and little understanding of the way that the changing healthcare landscape will impact their careers. Programs training other service oriented professionals, accountants, contractors, architects, artists, and hair stylists must provide their students with at least a starter kit of tools to help them navigate the realities of their craft.

The culture of training mental health practitioners needs a comprehensive overhaul to integrate professional training into the process of becoming a clinician. Some programs attempt to address student needs by bringing in the student career center to offer little more than talking points on general resume tips. These fixes fail to address the larger structural deficiencies and fall short of the students’ needs. Professionalism, entrepreneurship, finances and the like should be woven into the content so that one’s professional identity is forming alongside one’s clinical identity. For this to take place, academia needs to make room for the reality of the marketplace, something it historically struggles to embrace.

In the meantime, the private sector has filled the void left by educational institutions. Blogs, social media groups and businesses tout services aimed at helping clinicians build practices, market themselves, curate their social media presence, and guide new graduates through the job hunt and licensure process. There is absolutely a role for this market and the solutions created are often comprehensive and built by professionals who have been through it already. As most things in therapy, the answer likely is not one or the other. We need both.
 

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