If you could do it all over again . . . .

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I'm hoping to start a masters in mental health counseling program at some point in the next year or two.

For those of you who have already completed your masters programs . . .

1) What do you wish you knew about the programs before you started, that you didn't know? Or perhaps you knew, but didn't understand the significance of?
2) What do you wish you did differently while you were in the program?
3) What other advice would you have given your pre-MA self before starting the program?

And now, for all you real, live professional therapists in private practice right now . . .

1) What do you wish you knew about private practice before you started that you didn't know?
2) What do you wish you had done differently at the beginning when starting your practice?

Thanks for your time, hope you are hanging in there during this strange and difficult period.

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I have a master's in counseling, am licensed as an LPC in multiple states, and I'm here to tell you that it's a terrible life choice. I doubt I'll change your mind enough to keep you from attending, but consider this your informed consent. I practiced as an LPC for a number of years before returning for a Ph.D. Here are things you need to know (edited):

1. The pay is low. Once you finish your degree, you'll make 32-35k at a community mental health clinic or less if you try to do private practice. Pre-licensed clinicians are typically only able to bill Medicaid so clinics tend to stack you with clients due to the low reimbursement rate. If you try the PP route, you'll have a rough time recruiting clients because you're competing with both licensed master's level licensed clinicians and psychologists. I wouldn't send my family member to an unlicensed twenty-something mid-level when there are plenty of licensed experienced people to choose from. This tough competition tends to squeeze out LPCs licensed or otherwise. If you want to make money as an LPC, the best ways are to either get a county contract doing some kind of mandated court work or move to a rural area from what I've seen. I've also seen LPCs do okay in UCCs, but they are the considerable minority on the staff.

2. Getting licensed is a hustle. Most psychologists won't touch you post-graduation because of the liability. If you choose a community clinic, make sure that the supervisor gives you AN HOUR PER WEEK. If you choose to try to get private supervision, you will have to pay for it. It costs as much as a therapy session out of pocket. I found a psychologist from a master's practicum who trusted me enough to take me on as a supervisee, but I was very very lucky, it was on the condition that I still had agency supervision, and attended trainings on evidenced based practices, and yes, I paid for it.

3. Once you're licensed, you'll deal with the perception problem LPCs have. LPCs are usually regarded as dilettantes by many professionals in the field. This is because LPC training maximizes supportive listening skills and minimizes training on evidenced based practices. Because of this, you end up leaving school with a theoretical idea of how some psychotherapeutic systems work, but very little experience actually practicing with them. The larger health care community has noticed this trend leading to the general consensus is that though some LPCs can stand out, many don't, and why take a chance on an LPC when there are many social workers and psychologists out there who have the training and want jobs. Many positions that hire therapists (mainly hospitals and VAs) will not consider your application. It was so demoralizing when I was an LPC to see my social work colleagues snatched up while my application was passed over again and again.

4. Your reimbursement rates are lower than psychologists in some states, but not all. Some insurance panels create a competitive process for LPCs to get paneled where they do not for other helping professions.

5. If you (as you likely will) to go through with this. Consider alternate career paths for a master's in counseling aside from therapy. Higher education administration, human resources, career counseling, research assistant/coordinator/interventionist, financial planning, psychometrist are a few that come to mind. I've known some who have gone to work for insurance companies. These kind of jobs might pay you more or at least provide you another source of income aside from just doing therapy. Be advised though: you'll be at a disadvantage as there are specific degrees for many of these paths so you'll be selling yourself. I'm thinking mainly of higher education administration and human resources.

6. Take this for what it's worth, but I would guess that about 50% of my master's peers whom I graduated with have left counseling completely for other industries. I'd guess that about an additional 25% are doing it part-time and have another gig on the side for money. These outcomes map on to salary data made available by the BLS and the most recent ACA salary survey putting mid-career LPCs in the high $40s. Just for a point of reference, the average elementary school teacher makes more than this according to the same database.
 
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I have a master's in counseling, am licensed as an LPC in multiple states, and I'm here to tell you that it's a terrible life choice.

Wow Matey. I suspected some of this, and is part of why I went the LCSW route, but holy moly. Some LCSWs I know had a very similar experience to yours, but their practicum/internship choices helped inform that. Most often it happened to those who went the policy or child welfare route and changed their minds after graduation. In my state there is requirement for schools to be accredited for the LPC so I thought the poor outcomes for LPCs were local. I'm pretty sure you aren't in my same state so it's dishearting to hear that this isn't just local.
 
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So I'm not in private practice, but 100% clinical time. Before I went back to school in 2010 for my bachelors, I was a biller and coder. Because of those experiences I knew 1) I didn't want to be in private practice 2) I wanted to work within the realm of health psychology -- chronic illness/pain etc. Difficult for sick people to show up to their appointment so I'd have a high canx rate or no-show rate. So the places I chose to work post-graduation either were all salary or reduced salary + percentage of billed. I get benefits and PTO and make a little less (in my current position -- others might be way less) than someone in private practice, but it's a great balance for me. So the point of this rambling paragraph is to advise you to know population you want to serve and start working on experiences related to that before graduation.

You know, I'm really pleased with how my career has turned out so far (grad school in 2015, licensed in 2018). I feel like I got really great advice from these boards haha. I didn't end up going clinical psychology PhD route, but really glad for my BS in Psych as I think it really rounded out my education with an MSW. I think the BSW-MSW grads really missed out on some core therapy concepts, and I feel like the Psych-Counseling route also has some clear gaps as R. Matey outlined. I think I might be biased though, so your mileage may vary :) I'm also just not sure that how I stumbled into several things is actually reproducible hahaha.

Know that your program matters. If it has a terrible reputation in the community, you likely won't have good job opportunities. Ask someone (in a reputable practice or agency) and ask if there is a local program they won't hire from.
 
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Wow Matey. I suspected some of this, and is part of why I went the LCSW route, but holy moly. Some LCSWs I know had a very similar experience to yours, but their practicum/internship choices helped inform that. Most often it happened to those who went the policy or child welfare route and changed their minds after graduation. In my state there is requirement for schools to be accredited for the LPC so I thought the poor outcomes for LPCs were local. I'm pretty sure you aren't in my same state so it's dishearting to hear that this isn't just local.

My experience as someone who has practiced as an LPC in multiple states is that it's not a local thing. The ACA is the newer, smaller kid on the block and so far hasn't played nice with the other kids. The net result of that is fewer opportunities for LPCs in traditional therapy roles outside out community mental health, mandated treatment, or private practice.
 
Regarding private practice considerations, search threads in the psychology forum—I’ve discussed the pros and cons at length there.

One example:

Private practice is a huge undertaking that requires a lot of money, energy, time, and consultation with other professionals just to start. LPC’s, LCSWs, and LMFT’s are at a slight disadvantage compared to psychologists because some folks right off the bat might look for those with more education. The ones who don’t care may find their way to you. Private practice is HUGELY saturated at the master’s level, even more so than the doctorate level because we have so many master’s programs across the country with large cohorts. Start browsing Psychology Today in your zip code to get an idea of how many folks are practicing (this isn’t even everyone, just the ones who choose to use this site to market themselves). Private practice also requires schedule flexibility (be prepared to work evenings!), a specialty, a good reputation in the community, a reasonably high SES community to work in, a VERY good grasp of ethics, etc. so it’s not something one can be half-hearted about. You have to really want it to be your career and be in it for the long haul before it could provide any real returns. For example, for a person to make $70K salary (before taxes) in PP plus retirement and benefits like health insurance (Sounds reasonable, right?), you have to actually make around $110k+ in gross income (over $9k/month) to offset the benefit costs, business/operating expenses, and any time you take off that will be unpaid. Each week you take vacation you could lose thousands. You won’t get this income by being paneled on insurance, so you’d have to have a very steady stream of cash-paying clients to get there. A colleague who’s been in PP for years sees ~20 clients per week, but the majority are insurance clients, so the pay is lower than the colleague would like—these are common issues.

A lot of people don’t know any of this starting out and just assume it will work out.
 
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For example, for a person to make $70K salary (before taxes) in PP plus retirement and benefits like health insurance (Sounds reasonable, right?), you have to actually make around $110k+ in gross income (over $9k/month) to offset the benefit costs, business/operating expenses, and any time you take off that will be unpaid. Each week you take vacation you could lose thousands. You won’t get this income by being paneled on insurance, so you’d have to have a very steady stream of cash-paying clients to get there. A colleague who’s been in PP for years sees ~20 clients per week, but the majority are insurance clients, so the pay is lower than the colleague would like—these are common issues.

A lot of people don’t know any of this starting out and just assume it will work out.

It gets a little more complicated than this, as those business expenses can be deductible and lower the taxes on your income very substantially. But yes, you'll need to know what you're doing, and as @futureapppsy2 mentioned, it is a business. I had business experience before moving into some PP work, and that helped considerably. My hourly rates in PP are substantially higher than my institutional work, but I am also in neuro assessment, and my networking and friendships with others have enabled me to lower my overhead well beyond what most people will find. I think it'd be much harder at the masters level. One, because they don't really have access to in-depth assessment type cases, of which my area always has a long wait list, they are competing with doctoral providers which many people prefer (esp is insurance is covering), and they don't have much access to forensic work, which pays handsomely.
 
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As an LPCC , I’d say choose anything else.
 
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I went to a good school, but training is all theoretical. There are no in depth classes on how to practice CBT or narrative therapy or whatever your inclination is. Internship experiences let you learn some, but you’re really completely incompetent. I graduated with honors and had to teach myself everything I know (under supervision). I practiced for years but never felt competent no matter how much I read or practiced. I simply did not learn what I needed to learn in my master’s program to perform at a level I was comfortable with. I no longer practice and feel great relief and sadness. I was cheated out of a good education and career. Most people don’t care and feel competent with minimal education but I’m not like that. I won’t see an NP or PA and I won’t see an LPCC. If you’re going to do it, do it right and get the PHD. There are no shortcuts.
 
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I went to a good school, but training is all theoretical. There are no in depth classes on how to practice CBT or narrative therapy or whatever your inclination is. Internship experiences let you learn some, but you’re really completely incompetent. I graduated with honors and had to teach myself everything I know (under supervision). I practiced for years but never felt competent no matter how much I read or practiced. I simply did not learn what I needed to learn in my master’s program to perform at a level I was comfortable with. I no longer practice and feel great relief and sadness. I was cheated out of a good education and career. Most people don’t care and feel competent with minimal education but I’m not like that. I won’t see an NP or PA and I won’t see an LPCC. If you’re going to do it, do it right and get the PHD. There are no shortcuts.

Same. This is why I left for a Ph.D.
 
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I saw this title and came here to say my piece, but it turns out everyone has taken the words right out of my mouth. Do not do a masters in counseling. Do social work if you want to be a masters level therapist. Do the PhD if you are deeply interested in all facets of the human mind and want to do more than person-centered therapy (assessments are awesome!!)

If I could do it again, I wouldn't. It's not worth 2-3 years of your time just so you can make $40k starting salary and be treated like an automaton. My partner is a manager at a major grocery store chain and earns almost twice what I do. That position requires a high school diploma. At first we joked about it but as the years go on it stops being funny. I'm a masters degree holder making barely above minimum wage. Meanwhile my best friend who has a 2-year degree in nursing is making $80k, so **** me.

If I could do it again, I would have gotten my **** together in undergrad and applied for medical school to be a psychiatrist.

This is because LPC training maximizes supportive listening skills and minimizes training on evidenced based practices. Because of this, you end up leaving school with a theoretical idea of how some psychotherapeutic systems work, but very little experience actually practicing with them.

... wow. I knew I felt totally unprepared and dumb after graduating, but I have never been able to put into words exactly why. This is so accurate it hurts. We had prac in our a university-based counseling clinic, and my internship was at a great site, but I received very little feedback on how to "do therapy". Add to that my theoretical orientation being psychodynamic, and no professor knew what to do with me. I usually just got "performance" feedback (e.g. nonverbals, tone of voice, etc.) rather than feedback of my implementation of the therapeutic interventions themselves. This makes so much sense, ugh.
 
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I saw this title and came here to say my piece, but it turns out everyone has taken the words right out of my mouth. Do not do a masters in counseling. Do social work if you want to be a masters level therapist. Do the PhD if you are deeply interested in all facets of the human mind and want to do more than person-centered therapy (assessments are awesome!!)

If I could do it again, I wouldn't. It's not worth 2-3 years of your time just so you can make $40k starting salary and be treated like an automaton. My partner is a manager at a major grocery store chain and earns almost twice what I do. That position requires a high school diploma. At first we joked about it but as the years go on it stops being funny. I'm a masters degree holder making barely above minimum wage. Meanwhile my best friend who has a 2-year degree in nursing is making $80k, so **** me.

If I could do it again, I would have gotten my **** together in undergrad and applied for medical school to be a psychiatrist.



... wow. I knew I felt totally unprepared and dumb after graduating, but I have never been able to put into words exactly why. This is so accurate it hurts. We had prac in our a university-based counseling clinic, and my internship was at a great site, but I received very little feedback on how to "do therapy". Add to that my theoretical orientation being psychodynamic, and no professor knew what to do with me. I usually just got "performance" feedback (e.g. nonverbals, tone of voice, etc.) rather than feedback of my implementation of the therapeutic interventions themselves. This makes so much sense, ugh.
What would it have taken to get yourself together to apply, get in, complete med school, residency, 3 major licensing exams usmle, board certification abpn?
 
What would it have taken to get yourself together to apply, get in, complete med school, residency, 3 major licensing exams usmle, board certification abpn?
Hmm. I’m not quite sure how to interpret your question. When I was in undergrad, med school was not even on my radar. I was majoring in economics and prepping for a career on Wall Street. I simply didn’t have the knowledge or the interest for healthcare back then. After I graduated, I got bad information from folks who told me I would NEVER be able to get into med school due to my bad GPA and to settle for another career like nursing, pharm, etc. So I settled on counseling. Now I’m 31 and finally decided to get my **** together and do the med school thing after all. I just wish I had made that decision a decade ago.
 
Hmm. I’m not quite sure how to interpret your question. When I was in undergrad, med school was not even on my radar. I was majoring in economics and prepping for a career on Wall Street. I simply didn’t have the knowledge or the interest for healthcare back then. After I graduated, I got bad information from folks who told me I would NEVER be able to get into med school due to my bad GPA and to settle for another career like nursing, pharm, etc. So I settled on counseling. Now I’m 31 and finally decided to get my **** together and do the med school thing after all. I just wish I had made that decision a decade ago.
Did you have the prerequisites in undergrad for med school?
 
1. The pay is low. Once you finish your degree, you'll make 32-35k at a community mental health clinic or less if you try to do private practice.

2. Getting licensed is a hustle.

5. If you (as you likely will) to go through with this. Consider alternate career paths for a master's in counseling aside from therapy. Higher education administration, human resources, career counseling, research assistant/coordinator/interventionist, financial planning, psychometrist are a few that come to mind. I've known some who have gone to work for insurance companies. These kind of jobs might pay you more or at least provide you another source of income aside from just doing therapy. Be advised though: you'll be at a disadvantage as there are specific degrees for many of these paths so you'll be selling yourself. I'm thinking mainly of higher education administration and human resources.
@R. Matey I am an LPC-A doing exactly what I wanted to do... and I don't like it. For practical reasons above, but also the career itself doesn't fit me. My job is excellent, my coworkers are great, I could not ask for a better boss. Some people could "settle" here and work for another 20 years. But it just isn't a good fit. Any suggestions from your friends that have changed jobs to work in HR or administration?
 
I am an LPC-A doing exactly what I wanted to do... and I don't like it. For practical reasons above, but also the career itself doesn't fit me. My job is excellent, my coworkers are great, I could not ask for a better boss. Some people could "settle" here and work for another 20 years. But it just isn't a good fit. Any suggestions from your friends that have changed jobs to work in HR or administration?
These folks knew people who helped them make that transition, but I have seen counseling listed on a number of job ads for those kinds of positions. Also, psychometrist, financial planning, career counseling, care management for an insurance company are all jobs that a person with master's degree in counseling could do.
 
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Did you have the prerequisites in undergrad for med school?
Nope, I was an economics major! :) Started from scratch!

@goodlistener, are you in Texas (guessing from the use of “LPC-A”)? PM me, I can link you to some folks that can help you with the transition.
 
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Nope, I was an economics major! :) Started from scratch!

@goodlistener, are you in Texas (guessing from the use of “LPC-A”)? PM me, I can link you to some folks that can help you with the transition.
So right after graduation you wanted to go back to school to become a Physician and people told you not to?
 
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