Once you start thinking about going to graduate school to earn a degree in counseling or psychotherapy you are confronted with some important questions. Which professions should you look into? Which graduate programs will prepare you for those professions? What level of education should you seek? How hard is it to get into graduate school and which programs should you apply to?
These are daunting questions, and they can be difficult to answer. Trying to answer them may require a significant amount of research on your part. This is particularly true if you are interested in becoming a counselor or mental health professional. The "bad news" is that there are many factors you need to take into consideration in sorting though the complicated maze of professions that use counseling to help people. The good news, however, is that there are so many different routes into the helping professions that you have a good chance of finding one that is right for you. In this section I will give you some information that may help you to get started on answering these questions, if you have not already done so.
The first thing you need to ask yourself is what kind of helping or counseling you want to do. Some students are not especially interested in learning how to do counseling or psychotherapy in a formal sense; they just want to work in a situation or setting where they can be involved with people, helping others in one way or another. If this describes how you feel, you have a wide range of options. You may not need to go to graduate school at all because, as I noted on the previous page, even with a bachelor's degree you can work in a variety of social settings helping other people. However, I also noted that with a bachelor's degree your salary, status and influence will generally be limited. Therefore, you may need to consider going on to get a master's, a doctorate, or some other graduate degree in one of the professions described below. But keep in mind that the career paths described below are all aimed at doing various kinds of counseling, so if you are not especially wedded to the idea of counseling per se, there are numerous other fields in which you can also get advanced training in working with and helping others, including, for example, public administration, public health, environmental affairs, social welfare administration, nonprofit management, industrial/organizational psychology, and community development.
If doing psychotherapy or counseling is your main interest, you will need to go to graduate school. In the following discussion, keep in mind that the terms "psychotherapy" and "counseling" do not have exact technical definitions. They are often used interchangeably, but there are some differences in what they usually mean. "Psychotherapy" tends to refer to mental health treatment that is longer and more intense and that focuses more on psychopathology. "Counseling" is typically used to refer to treatment that is less intense and that focuses more on promoting ordinary development. Regardless of which of these terms appeals to you or which kind of treatment interests you the most, there are two levels (or contexts) in which you might work as a psychotherapist or counselor: (1) independent practitioner or (2) supervised professional.
(1) Independent practitioners are people who conduct counseling or psychotherapy in the traditional sense. They may have a private practice in which they see patients or clients (as individuals, or in couples or families, or in group therapy); but they can also work in private clinics or in public clinics, or in hospitals or other organized settings. They are licensed at the highest level in their profession and can make independent decisions about how to work with their clients. They can usually bill insurance companies and be reimbursed for their services.
(2) Supervised professionals are also licensed to do counseling or psychotherapy, but they usually do so within a clinic, hospital or other organized setting, and they have to be supervised by another professional who is fully licensed at the independent practitioner level. They may not be able to bill insurance companies (but may be covered under their supervisor). They typically make less money, have less status, and have to have their work officially supervised. In reality, counselors and therapists at this level do pretty much the same things that independent practitioners do (and sometimes even have private practices, though under supervision). However, they are, to some extent, "second class citizens" compared to independent practitioners On the other hand, they sometimes have more employment options.
If you wish to work as an independent practitioner, you are generally best able to do so if you have a the highest graduate degree in your profession. For example, in the field of psychology you generally need to have a doctoral degree (either PhD or PsyD) to become an independent practitioner. Degrees at the master's level in psychology generally qualify you primarily to be a supervised professional. There are, though, some routes to independent practice at the master's level, and they are tending to increase over time. For example, in social work it is possible to be an independent practitioner in many states with a master's degree (MSW), and many states allow independent practice as a mental health counselor if a persons has a masters degree in a counseling-related area (note, though, that as a mental health counselor you may still be paid less, have less status, have barriers to reimbursement by insurance companies, and be less marketable).
It is important to keep in mind that the exact privileges, pay and status that are associated with different levels of education in different professions vary in complicated ways from state to state (often slightly but sometimes significantly) and depend on each state's licensing laws, insurance laws, and a variety of other factors. To further complicate things, licensing laws change from time to time as the various mental health professions fight out their "turf wars." For this reason, if you are interested in a particular profession and you have a good idea of which state you are going to work in, it will be extremely helpful for you to find out what the exact licensing laws are in your state by contacting the professional licensing board in that state. It would also be extremely helpful for you to talk to someone in that state who actually works in the profession you are interested in. If you are able to do this, you should determine if persons at the level of education you are considering in the profession you are considering are legally able (1) to diagnose and treat psychological disorders, (2) to do so without supervision, and (3) to receive reimbursement from insurance companies for doing so. If you are unable to obtain such specific information, the general descriptions on this page will give you at least some idea.
If you are not especially interested in doing independent practice, then a supervised professional role may be right for you. Such a role still allows you the option to do counseling in an organized mental health setting, and, in many states, to work with clients one to one in a supervised private practice (or even independently in some states). As noted above, you may actually have more options for employment in such positions. However, your pay, status, upward mobility, and decision-making freedom may be significantly limited.
Regarding which profession or discipline you choose, there are five main professional avenues to becoming a counselor, therapist or mental health professional. These are: (1) medicine, (2) psychology, (3) social work, (4) education, and (5) specialized programs at the master's level. All of these professional routes provide training in counseling and/or psychotherapy, but each of them has its own particular emphasis and perspective.
(1) In the field of medicine, a person who completes medical school can go on to receive specialized training that will qualify him or her to become a psychiatrist. Psychiatrists are medical doctors who also may have training in psychotherapy. They are usually licensed as independent practitioners and are qualified to prescribe medications and perform other medical procedures (e.g. electroshock therapy). While they often have at least some training in psychotherapy, the medical training tends to be primary, and the psychotherapy training may be limited. Psychiatry is a relatively high-status, highly paid mental health profession, and psychiatrists are usually at the top of the "pecking order" in medical settings like hospitals. In other mental health settings they often do little or no psychotherapy and specialize instead in prescribing medications. Also within the field of medicine, nurse practitioners (RNs with additional master's or doctoral level training that may include aspects of psychiatry) may be qualified to counsel patients and/or prescribe medication, although important aspects of their practice may be limited and/or require supervision, especially for those with master's degrees.
(2) In the field of psychology, as noted above, one generally needs to have a PhD or PsyD to become licensed independent practitioner. The main thing that separates psychology from other mental health professions is an emphasis in one's graduate program on learning how to conduct research, particularly controlled psychological experiments. In fact, psychology originated as a discipline dedicated only to doing research, but eventually developed a specialty in clinical psychology for treating people. Clinical psychologists who have PhDs are trained to do research, but they are also trained to do psychological testing and psychotherapy. On the other hand, clinical psychologists who have PsyDs are trained primarily in psychological testing and psychotherapy, with some (but usually a bit less) training in psychological research. In academic settings like colleges and universities PhD psychologists have greater standing than PsyD psychologists. If you are interested in working in a college or university doing teaching and/or research, you will have few, if any, opportunities if you are a PsyD psychologist. In clinical agencies, too, PhD psychologists sometimes have more prestige than PsyD psychologists, but in my experience this is not a significant factor in most clinical settings. Clinical psychologists with master's degrees (MA or MS) are generally not licensed to function as independent practitioners in psychology (but see category #5 below). As psychologists, they generally work under supervision, often doing psychological testing, but in many places (including Indiana) they can do counseling or psychotherapy under supervision.
(3) In the field of social work, there is a focus on the social dynamics and issues that contribute to people's problems. Social workers are usually master's level MSWs. In most states MSWs can be licensed to practice at the independent practitioner level and can receive reimbursement from insurance companies (although it may be at a lower rate than psychologists and psychiatrists). Social workers also have many opportunities to work in hospitals and within the community mental health system. For this reason, social work is one of the most employable professions in the mental health field. Unfortunately, there is also a down side. The public mental health settings where social workers are often employed typically treat the most difficult clients. Furthermore, as members of a traditionally female profession, social workers are frequently relegated to lower status positions within the professional hierarchy (below psychiatrists and psychologists), which means that they are frequently overworked, underpaid, and often charged with carrying out irrational decisions and policies with which they may disagree. For this reason, social workers have a high level of "burnout."
(4) The field of education also offers routes to doing certain kinds of counseling. In fact, PhD programs in counseling (as opposed to clinical psychology) while often housed within graduate departments of psychology, are also sometimes housed in graduate schools of education. When counseling programs are located in psychology departments they tend to focus more on psychopathology and (traditional or clinical) psychotherapy, and when they are located in schools of education they tend to focus more on educational, guidance, and career counseling. However, the clinical and educational perspectives often overlap in the field of counseling. Other programs focus more specifically on the field of education. Doctoral programs in educational psychology (leading to the EdD or PhD degree) are also found in both psychology departments and schools of education. EdDs generally work in school systems doing assessment, consultation, program planning and intervention with children with special needs and problems. PhDs in educational psychology focus more on research in education and teaching in graduate schools of education. A more applied version of educational psychology is school psychology. School psychologists sometimes have master's degrees in education or school psychology, but are increasingly expected to have educational specialist (EdS) degrees, which are similar to master's degrees but with additional training and field experience. School psychologists Work with children in schools and school systems, often primarily doing educational and psychological assessment, but also sometimes doing counseling.
(5) A final avenue to becoming a counselor is via specialized training at the master's level in a variety of different fields. These fields include not only clinical psychology and counseling psychology, but also marriage and family therapy, mental health counseling, addiction counseling, and a variety of other fields. Depending on the state, there are various kinds of certification or licensure associated with these professions. One option that has become popular in the last few years is licensed mental health counselor (LMHC) which requires a master's degree in mental health counseling or a related field (such as psychology, social work, marriage and family therapy, etc.). Most states allow for at least some degree of independent practice as an LMHC. Another set of options is via expressive therapies, such as art therapy, dance therapy and music therapy. In art therapy, for example, a number of colleges and universities offer master's degrees. Board Certified art therapists are sometimes hired by hospitals or other institutions to work on mental health treatment teams. Another professional route is to combine training in one or more expressive therapies with mental health counseling, which allows one the possibility of working in independent practice in many states.
As you can see, there are many options and many issues to be considered. Once you have decided on a career path, however, you will find thinking about graduate school a much more manageable task. On the next page i will give you some tips about picking a graduate program.