Psychology

How to Become a Clinical Therapist

How to Become a Clinical Therapist
Chances are, you'll enjoy career fulfillment and good work-life balance as a clinical therapist. Image from Unsplash
Christa Terry profile
Christa Terry February 5, 2020

There are a lot of ways to become a clinical therapist because the term 'therapist' describes many types of counseling professionals. Choosing an educational path that meets the requirements in your state can feel more complicated than earning the required degrees.

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If you enjoy interacting with others and want to find a way to turn your passion for helping people into a career, you may enjoy working as a clinical therapist. As a licensed clinical therapist, you’ll support clients dealing with everything from post-traumatic stress disorder (PTSD) to substance abuse to severe mental illness using a variety of therapeutic approaches. You may not make big money, but the rewards of becoming a clinical therapist go beyond salary and benefits.

Many roads lead to a career in clinical therapy. The term ‘therapist’ refers to a range of professionals who provide mental health counseling services to individuals, couples, and families. To become a clinical therapist, you need to understand who can legally provide clinical therapy and the licensing requirements necessary to become a part of this profession.

This guide to becoming a clinical therapist outlines everything you need to know to plan your career. It covers:

  • What is a clinical therapist?
  • How much do clinical therapists make?
  • How long does it take to become a clinical therapist?
  • What degrees do you need to get to be a clinical therapist?
  • What subjects do you have to study to become a clinical therapist?
  • Do clinical therapists need a license to practice?
  • What are the advantages of becoming a clinical therapist?
  • What are the disadvantages of becoming a clinical therapist?
  • Should you become a clinical therapist?

What is a clinical therapist?

The simplest answer is that the term ‘therapist’ describes many different counseling professionals who employ a variety of approaches. Psychologists, licensed social workers, and other counselors who can legally treat people individually and in group therapy are all clinical therapists. What they share in common is that they help people improve their mental health.

This can involve diagnosing and treating behavioral disorders, helping someone formulate strategies to address personal issues, or simply working with a person to enhance their quality of life.

From there, it gets more complicated. The rules and regulations about what a therapist is and is not can vary widely by state. In some states, ‘therapist’ is a protected designation that can only be used by a set group of professionals who are licensed by a state board and possess specific degrees. In others, however, the term is not legally protected, and life coaches, nutritionists, hypnotists, meditation guides, and other alternative practitioners can call themselves therapists without running afoul of the law.

In this article, the term ‘clinical therapist’ refers to licensed mental health counselors or psychotherapists. This group includes:

Psychologists

What sets these mental health professionals apart is that they have advanced degrees in clinical psychology (typically a master’s in psychology, PsyD, or PhD). While they are qualified to provide clinical therapy, they can also work in research or academics.

Licensed mental health counselors

Also called LMHCs, these providers offer time-limited and solution-focused therapy (including traditional psychotherapy and cognitive behavioral therapy) designed to get results while also being cost-effective.

Marriage and family therapists

MFTs do more than just provide marriage counseling services. They treat a variety of cognitive, mood, nervous, and behavioral problems in individuals using psychotherapeutic techniques and their understanding of family systems.

Licensed clinical social workers

These counselors have graduated from accredited MSW programs and are legally sanctioned to treat people with mental health issues. They can also help people enroll in Medicaid, arrange home nursing care, and find practical solutions to financial or professional challenges.

Licensed professional counselors (LPCs)

Also called licensed clinical mental health counselors or licensed clinical professional counselors, LPCs have completed a master’s degree program in counseling. They can provide mental health and substance abuse therapy in all 50 states.

Pastoral therapists

These therapists use both psychotherapeutic techniques and faith to guide people toward better mental and emotional well-being. They typically have either a master’s in mental health counseling or a graduate degree in marriage and family therapy.

Clinical therapists work in a variety of settings, including:

Community organizations

Clinical therapists can provide education or counseling support to children and adults in the community with disabilities, addictions, or mental health challenges.

Government agencies

State, federal, and local governments provide tax-funded programs to assist at-risk members of the community to help them find a range of health and human services.

Hospitals

Assist with building treatment plans for current patients as well as provide mental health support for those spending time in the hospital or making medical decisions.

The military

Therapists support members at all levels of the military to address common issues like PTSD and related mental disorders. Clinicians also may help resolve disputes or discuss communication issues.

Nursing homes

Clinical therapists can assist with the transition into a full-time nursing facility and help residents navigate medical or mental health concerns.

Religious institutions

Pastoral therapists may choose this career path to provide additional spiritual support within their church, local nonprofit, or school.

Prisons

Clinical work is very common in prisons, particularly in those with a focus on restorative justice. Clinicians can support incarcerated persons with their medication and counseling needs for rehabilitation.

Private companies

Many corporate offices now employ mental health professionals and career-focused counselors.

Private practices

As one of the more popular career options, many mental health clinicians choose to open their own practice or join an existing medical group.

Professional sports leagues

Both the American Psychological Association (APA) and the Association for Applied Sport Psychology welcome trained sports psychologists and counselors to help athletes with the rigorous demands of their field.

Schools

School psychologists in elementary, middle, and high schools are some of the first encounters children have with a mental health professional. Graduate or doctoral students take very targeted coursework for this career path.

Substance abuse clinics

Provide support to patients facing the challenges of addiction by managing medical treatment options, group therapy, and individual support.

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How much do clinical therapists make?

The average salary for a clinical therapist, according to PayScale, is $55,606. This number is somewhat misleading; therapists work in many settings, some of which are much more lucrative than others. For example, a clinical psychologist working in a government job could make about $85,330, while a licensed clinical social worker in a healthcare setting might make just $55,350. A mental health counselor in a residential facility could make as little as $49,000 in many parts of the country, while a marriage and family therapist in Provo, Utah could make over $90,000.

These disparities can’t be chalked up to education level alone. Also contributing are institutional biases that favor some types of therapists. Licensed clinical psychologists can earn the most (even when their highest degree is a master’s, the same level degree required for lesser-paying therapy practices). Social work therapists, mental health counselors, and pastoral counselors tend to earn the least.

If you already know you want to work with specific populations when you become a clinical therapist, then money may not matter much to you. But if you’re hoping to land one of the more lucrative roles in clinical therapy, make sure you get the right education.

How long does it take to become a clinical therapist?

It depends mostly on what degree pathway you choose. All clinical therapists complete a four-year bachelor’s degree program plus either a one- or two-year master’s degree or a four-year doctoral program. That’s already five to eight years of schooling.

From there, clinical therapists of all kinds spend time working under the supervision of a licensed therapist to satisfy their state’s supervised practice requirements. Each state has its own requirements for different types of therapists. In all states, for example, marriage and family therapists must work under supervision for at least two years. Many states require licensed mental health counselors to have 3,000 hours of supervised clinical experience. It typically takes clinical psychologists two years to complete the required supervised practice.

In all, you can expect to spend at least seven or eight years of training to become a clinical therapist.

What degrees do you need to get to be a clinical therapist?

First, you will need to earn a bachelor’s degree. Many master’s programs don’t require applicants to have a specific undergraduate degree, but if you’re sure you want to become a clinical therapist, choose a major like psychology, sociology, or behavioral science. You also should take advantage of any opportunities that come up to complete internships in settings where people are treated for mental health issues or emotional problems.

From there, aspiring clinical therapists can explore several possible advanced degree pathways. They can consider:

Psychology graduate programs

Enrolling in a master’s degree in psychology program. As noted above, some states don’t require clinical psychologists to have a doctorate to practice independently.

Doctoral degrees

Enrolling in a PhD in Psychology or PsyD program. Most clinical psychologists have one of these degrees.

Marriage and family specialization

Enrolling in a master’s degree in marriage and family therapy program. Look for degrees that are accredited by the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE), because graduating from an accredited program will make it easier to fulfill the licensure requirements to become an MFT.

Master’s level social work degree

Enrolling in a Master of Social Work (MSW) degree program. You can practice as a clinical counselor with a one-year MSW, making this degree path one of the fastest routes into clinical therapy.

Master of arts in counseling psychology

Enrolling in a master’s degree in counseling program. There are various clinical counseling degrees, like the MA in Mental Health Counseling and MS in Clinical Mental Health Counseling.

Pastoral counseling career path

Enrolling in a Master of Pastoral Counseling program. Look for programs that offer a clinical track and will prepare you to apply for state licensure.

What subjects do you have to study to become a clinical therapist?

MSW programs, mental health counseling programs, and psychology programs can vary quite a bit from school to school. Don’t assume there are no standards, however. The Council for Accreditation of Counseling and Related Educational Programs (CACREP) has outlined core subject areas that all mental health education programs should touch on. These include:

Counseling theory

Students learn the major theories of modern psychology, approaches to care, and how to interpret ongoing research.

Diagnosis and psychopathology

Explore both the signs and symptoms of common mental health illnesses as well as their root causes.

Group counseling

Many settings, from schools to substance abuse clinics, utilize the benefits of discussing mental health challenges in a group. Students learn how to navigate group discussions with proven counseling theories and tactics.

Human growth and development

Move through the development process of young children and teenagers in relation to the brain and common psychological challenges.

Life and career development

Counselors often assist with daily issues unrelated to or affected by mental disorders, such as in everyday life, personal growth, and career goals.

Professional orientation

This course works through the everyday on-the-job challenges faced by counselors. The course may explore different career paths, managing ethical issues on the job, and logistical challenges in today’s field.

Psychological testing and assessment

Study the top personality and mental illness measurement tactics used today that help counselors mark their patient’s progress and current needs.

Psychotherapy

Aspiring counselors will explore the basic approaches to therapy itself, specifically the major varieties used today such as cognitive behavioral therapy, psychoanalysis, and humanistic therapy.

Research and program evaluation

Cover the data-driven aspects of qualitative and quantitative research to analyze changes in patients, a community, or mental health challenges on a larger scale.

Social and cultural foundations

This course explores cultural backgrounds of various groups to discourage bias and build a greater understanding of viewpoints and experiences from around the world.

Additionally, the master’s or doctorate program you choose should have a supervised practicum and internship component.

Do clinical therapists need a license to practice?

Almost all clinical therapists need a license to practice, although requirements for therapists vary from state to state. To earn a license, therapists typically must:

Meet a state’s minimum education requirements

State requirements and your level of education will depend on your desired licensure and career goals.

Complete a set number of supervised clinical hours

Most programs require on-the-job work experience under the guidance of a professional clinical therapist in the state.

Pass one or more state exams

There are several levels of comprehensive examinations, typically administered by the National Board for Certified Counselors (NBCC).

Pay a fee

The fee for licensure varies by state, but typically ranges between $50 and $400, and will depend on the level of certification.

All states require that clinical therapists regularly renew their licenses after a certain number of years. Most of the time, therapists need to complete a set number of continuing education hours before they can renew.

One thing to keep in mind is that therapist credentials by type can also vary by state. A licensed clinical social worker might be an MSW, LGSW, LCSW, LMSW, LCSW-C, LISW, or LSW. A licensed marriage and family therapist might be an MA, MFT, LMFT, or LCMFT. A licensed mental health counselor might be an LPC, LCPC, LMHC, CPC, LPCMH, or LCMHC.

Pastoral counselors are (sometimes) the exception. Only a handful of states require pastoral counselors to hold a license to practice therapy, which means it’s technically possible to become a pastoral counselor without an advanced degree in mental health counseling or any other specific credentials in some parts of the country. However, many pastoral counselors choose to become LPCs, MFTs, or LMHCs anyway, because they want to be able to share the best mental health tools and strategies with their congregations.

What are the advantages of becoming a clinical therapist?

There are lots of reasons that people choose to become clinical therapists. For instance:

Variety and challenge

Every day is different when you become a clinical therapist. You’ll see many kinds of clients and work with people facing challenges that are complex and varied. You might get frustrated sometimes, but you’ll never be bored.

Salary in large metropolitan areas

It is possible to make good money as a clinical therapist if you work in the right region and/or get the right degree. If maximizing your income is important to you, your best bet is probably to get a PsyD or PhD and open a private practice in a busy city.

Impact

Research shows therapy is effective. When you choose this career, you can be certain that what you do each day is making a difference.

Flexibility

Your schedule will be very flexible if you open a private practice or group practice. You’ll be able to set your own hours and client load.

Reflection

As you help clients work through their issues, you’ll learn new ways to deal with your own problems.

Fullfilment

It’s a gratifying job. In a post on her blog, Tricia Miller, MEd LPC, wrote, “I really enjoy listening to people’s life’s stories”. I naturally develop close relationships with people, getting to know them beyond a superficial level, and letting them know I am there for them. It’s been an amazing, fulfilling journey both in the educator and private practice world, and… I consider myself so fortunate to wake up and feel passion in my work with people.”

What are the disadvantages of becoming a clinical therapist?

The disadvantages of becoming a clinical therapist typically revolve around the practical and emotional challenges of the job. They include the following:

Salary

Many clinical therapists earn less than they should given their training, the hard work they do, and the long hours they put in.

Pay disparity

Clinical therapists who are not psychologists tend not to receive the same level of respect. People may assume you are less qualified because you’re an LPC or MFT.

Job outlook unpredictability

If you end up in a group practice or a vast hospital network, you might feel pressure to take on more clients than you can handle, or you may be asked to meet unreasonable deadlines. In your own practice, you’ll have more flexibility, but you’ll also have to deal with the ups and downs of running your own business.

Workplace challenges

Working with people who are coping with mental illness, trauma, abuse, career challenges, fears, anxiety, and bad relationships can be emotionally draining.

Management issues

Some clients will be demanding. At some point in your career, you will have to deal with clients who repeatedly miss appointments, don’t pay their bills on time, or are angry that treatment is not progressing the way they want it to.

Should you become a clinical therapist?

If you want to spend your career helping people overcome mental illness and live better lives, then this could be the right career for you. More people than ever before are seeking mental health treatment, and so your expertise will be in demand.

Chances are, you’ll enjoy career fulfillment and good work-life balance as a clinical therapist. Mental health counselor has even made it onto US News & World Report’s lists of the 100 best jobs and the best social services jobs. And contrary to popular belief, you don’t need to have worked out everything in your own life. It may be that your own humanity (problems and all) will make you a more sensitive, more empathetic, and all-around better therapist.

(This article was updated on January 24, 2024)

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