NASW, APA, CACREP: Are They Viewed Equivalently?

[frozone112]

Hi!
I know the three accrediting bodies mentioned above are all recognized, but my question pertains to counseling, specifically. I am (planning) on going to graduate school this fall to get a MA in CMHC from a CACREP accredited program, and potentially getting a doctorate in either counseling psych or counselor education and supervision (so either teach or work at more of an organizational level) as my ultimate career goals. This post is basically because I've had anxiety throughout my MAs application process for continuously hearing pretty forceful information on "the best choice."

Multiple independent sources have told me to go the SW route, get a LCSW degee, etc. I've heard claims the degree can get better reimbursement thru insurance, it's "more appealing" to potential employers, and there's even a post on here about someone saying they're the best of the three in terms of network support from the org. I picked CACREP because my heart really is in counseling, and I know I could do it with SW too, but I rather invest in a program that is 100% dedicated to what I care about, as opposed to picking a similar but separate degree and trying to find one that most closely would match my goals.
It then gets a little more complicated because if I do get a doctorate, there's the choice between CACREP and APA having entirely separate accreditations, and from my understanding APA has had the history of being "the accreditor" for doc programs.

So, my request is this: to those of you who have personal experience/knowledge (or have heard directly from someone who has) in the reputability of each of these three orgs, could you share your thoughts? Whether it be how you've noticed applicants with a specific accreditation be treated, or any correlations in job placement/financial issues, anything you think that someone should know who's planning on committing to one of 'em, I'd like to know
And if your advice is "depends on the program, if you pick a _________-accredited program that has high placement rates you'll be fine," I'd be happy with that! The CMHC programs I've applied to are Vanderbilt, Northwestern, Wake Forest, and Adler, and based on my research they'd all be a solid starting point for entering the field of counseling.

Also as a last clarification, I know there's a distinction between, say, CACREP and the NBCC, but in my mind they're part of the "same path" (as compared to SW or APA) because one is the accrediting body for degrees, and the other is the national org that all it's members can join. So really I'm interested on any of your opinions on the three paths, whether it be the accrediting body for a degree type or the joinable org that represents them.

I've found similar threads on here, but not one that was specifically about differences between the three, and I'd also like to hear more varied and direct input. Thanks in advance !
*final final note, I'm sure someone will ask, so my bachelors is in bio and I have a ton of clinical experience but no academic work in psych, so I can get into a MA program now but not a PhD. I really don't want to work for another year to buy time to takes classes to get the academic background to apply straight to PhDs, and if I did choose a PhD in counseling education that would require a MA so no matter what I'm doing a MA first!

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[frozone112]

I should have posted this in Mental Health and Social Warfare... My bad!

 

[AcronymAllergy]

Mod Note: I've moved this into the Mental Health & Social Welfare forum

 

[sfgucadoc]

My .02. YMMV.

I'm licensed as a LP, LPC-S, LMSW. I would strongly advise against a master's in professional counseling or marriage and family therapy because they cannot take Medicare. The Federal government may change that at some point but for now, it's the reality. That means there are a SIGNIFICANT number of potential clients you can't see.

Do the MSW. Get good post-master's supervision. Get good, solid CEU's from places like Beck Institute, Marsha Linehan's group, Anna Freud Center, Menninger Clinic, Gottmans, Sue Johnson's EFT trainers, etc.

If you want to do systemic work, then consider the MSW at Tulane, which has the only MSW I know of that includes certification in family therapy. There are more than one way to skin a cat re: getting good therapy skills but don't block yourself a large chunk of potential clients.

 

[Lukewarm Counselor]

My .02. YMMV.

"I've applied to are Vanderbilt, Northwestern, Wake Forest, and Adler..."

**I should acknowledge my bias right off the bat here. I am a non-traditional student (age 43). I enjoy living a debt-free lifestyle and I HATE borrowing money for schooling.**

These are all fine programs I am sure. Just know that the brand name will mean much less after graduation. Licensure boards care about accreditation and content. In other words, a graduate from a for-profit school that is CACREP accredited is usually favored over a brand name school that is not accredited. (This is particularly true in the states that require CACREP for licensure.)

To a large degree, this applies to most employers, as well. Few of them will care about the school name on your diploma. They will want to know you went to an accredited program and that you possess the knowledge and skills necessary for the job. Beyond this, your clients will care even less about the brand name of your school. Most clinicians can count on one hand how many times a client/patient inquired about which school they attended.

Anyhow, you might just keep this in mind when considering the price tag for some of these brand name schools. Again, you will almost certainly get a quality education at these places. And if money is no object, then, by all means, go for it!! But just know there are some very high-quality programs out there from the lesser-known schools, at a fraction of the price.

Also, as you are looking ahead and may consider a doctorate program, later on, the brand name of the school might carry SOME weight here, but likely not a whole lot. I know a person who got their MA through Capella and was later accepted into a Harvard doctorate program. I also know a person who got his MA from U Penn, who then could not gain admission into Capella's doctorate in clinical psych.

At the end of the day, the only advantage a CACREP diploma will give you in regard to doctorate admission will be in the CACREP PhD-CES route. (No huge shock that CACREP favors their own credential, right?) But to the best of my knowledge, the CACREP endorsement means very little to the APA admissions boards at the doctorate level. (I could certainly be wrong here, and I am curious if anyone might correct my thinking on this.)

 

[frozone112]

I'm licensed as a LP, LPC-S, LMSW. I would strongly advise against a master's in professional counseling or marriage and family therapy because they cannot take Medicare. The Federal government may change that at some point but for now, it's the reality. That means there are a SIGNIFICANT number of potential clients you can't see.

Thanks for the feedback! I know the process is still ongoing, but the mental health access improvement act of 2019 was passed by a house committee earlier this year. It would allow Medicare to accept both those degrees. It still needs a presidential signature and whatever else in the process, but I feel as though there's a good chance of this happening within the next presidential cycle. We're talking a 3 year-minimum before I'd be able to practice, so I optimistically hope this shouldn't be a long term issue?

 

[theSteppenwolf]

Your path forward is contingent on your ultimate goals. If you want to teach in a CACREP-accredited counselor program, then seeking a CACREP-accredited masters and doctorate is the obvious choice. However, if clinical work is your focus, then whatever masters and then an APA-accredited counseling psychology doctoral program (I say counseling psychology because that is the specialty you mentioned) might be the better choice. Some things to consider: 1. Only individuals that graduate from CACREP-accredited programs can teach at CACREP-accredited programs for the most part. 2. Aside from teaching at CACREP-accredited programs, there really is no benefit from a PhD in Counselor Education. There is no additional bump in earning as a clinician. 3. Graduates of APA-accredited doctoral programs can teach at any APA-accredited program or MPAC-accredited masters program or non-accredited research-based masters or doctoral program. 4. The number of masters programs with MPAC-accreditation is growing.

A lot of this exclusionary stuff is due to historical territory conflicts between masters-level and doctoral-level organizations. It's a mess, but it is what it is.

 

[foreverbull]

I got a counseling master’s degree prior to a doctorate in counseling psychology. Mine was not CACREP-accredited, but I also knew I’d go straight into my doctorate afterward.

In terms of master’s programs, what matters most is your career goals, including your doctorate choice. If you are CERTAIN you won’t be practicing much or at all before going into a doctoral program, then what matters most is which doctoral program you go into: counselor Ed or counseling psych. As someone said earlier, the former really favors MA in Counseling and goes by CACREP, so that’d be your best bet on that path.

But I would challenge you to consider how narrow that path is, because counseling psychology allows for more career flexibility (academia/teaching, research, assessment, therapy, supervision/admin) but is much harder to get into than counselor Ed programs, I believe. And yes, counselor Ed programs go by CACREP, and psychology goes by APA, a different set of practice standards (they’re similar but not the same at all). They are two very different career paths, only one of them leading to licensure (counseling psych).

If you think there’s some chance you might stick with practicing with a master’s and not go on (and want to teach at the adjunct level only if at all) it’s less risky to go with a clinical SW degree because
1. Licensees are nationally licensed, essentially, which makes moving across states MUCH easier and smooth,
2. You can perform more roles/duties (straight social work in places OR psychotherapy), and
3. You can take more insurances.

I understand you want counselor training—I was stubborn about that too, but in the end, the end career path will dictate what is best for you, so again, think about what you really want to do, and the reality may be that you want to practice before getting a doctorate, and if so, you may find that you want to stop there. If that happens, the SW degree will be your best bet.

It sounds like you need to narrow down which type of doctorate you really want first, if at all so that you can best prepare. You can get into counseling psych with any master’s (EXCEPT online ones!), but with the caveat that you have to have some research experience under your belt and a solid resume—in short, you need to be competitive for a scientist-practitioner type of program if you go that route. Acceptance at these APA-accredited programs is ~11%.

 

[frozone112]

Just wanted to post a comment to thank all of you for your feedback.
You've provided a lot of info that will help me feel confident in making an informed (and reliable) decision

 

[chicandtoughness]

Oh my. How did I miss this post and the opportunity to make my favorite statement!

CACREP sucks and it doesn't mean ****.

There, I said it. Yes, it is the hill I will die on.

APA and NASW, while both flawed in their own ways, have done much more for their professions than ACA has. Granted, APA has been barking up the wrong tree for the past several years (*cough*RxP*cough*), but at least they have not blatantly smeared other professions in their climb. When I first started getting involved in ACA and AMHCA, it was so common to hear the refrain of, "We're counselors, not psychologist. We believe in holistic wellness, not the medical model. We treat the whole patient, not just the symptoms." Like come on. Yes, counseling and psychology are two different fields with different approaches, but whole-person wellness is not the great divider. I hate how ACA ****s on psychologists and I never renewed my membership after that first year in grad school. I went through my (well known in the state, well respected) CACREP program being very vocal about how I planned to do a PhD afterwards, and was blatantly ostracized by professors and peers.

Counseling is also still the Wild West. We don't get taught how to be a scholar-practitioner and how to be good consumers of research. This leads to ALL sorts of, "Well, I think this is self soothing so it should work for my patients!" or "I saw this done once so I can use it!" So many people out there claiming to do "art therapy" (nope, you need a separate masters for this one) or combining counseling with other healing arts (Reiki, "energy healing", astrology). One of my classmates is currently offering Tarot cards and runes readings during her counseling sessions. Says it all.

(I'm not ****ting on Tarot or astrology; they can be fun and they can also be healing for people. BUT THEY'RE NOT PSYCHOTHERAPY FFS SO STOP BILLING 90837'S FOR THEM.)

YMMV of course, but my experiences with ACA and the counseling field have been nothing but crap. Should have gone social work.

 

[R. Matey]

lso as a last clarification, I know there's a distinction between, say, CACREP and the NBCC, but in my mind they're part of the "same path" (as compared to SW or APA) because one is the accrediting body for degrees, and the other is the national org that all it's members can join.

NBCC administers the NCE that many states use for licensure and is the board certification arm for counselors. It's board certification in name only as no additional requirements (aside from giving them extra money) are required to be an NCC. That's different than being an ACA member, which is the professional org for counselors. There's also subgroups in counseling like the AMHA, NCDA, ACES, etc... Ya know, lots of ways to give people money.

A younger and naïve R. Matey was an NCC for longer than I care to admit, and honestly, the credential is nearly worthless. It came in handy once to expedite my licensure from when I moved to a new state and was able to use it to show that I had met the training requirements of that state, but that wasn't worth the renewal fees. I ultimately dropped the credential when I got a letter from the NBCC stating that I should advertise myself as a "board certified counselor" because research has shown that people trust board certification.

There was a sticker. I threw it in the trash.

 

[Goobernut]

Thanks for the feedback! I know the process is still ongoing, but the mental health access improvement act of 2019 was passed by a house committee earlier this year. It would allow Medicare to accept both those degrees. It still needs a presidential signature and whatever else in the process, but I feel as though there's a good chance of this happening within the next presidential cycle. We're talking a 3 year-minimum before I'd be able to practice, so I optimistically hope this shouldn't be a long term issue?

I don’t have exact years (goes back to 2007 I think), but I want you to know this is probably the 5th or 6th time a bill like that has been in exactly the same place as the 2019 bill. They attach the policy to some other flotsam and it never gets passed. I don’t know what the resistance is or if it’s a failure of the counseling lobby. I wouldn’t count on it changing any time soon. I decided back in 2013 I didn’t want to gamble on Medicare taking LPCs so went with MSW. And here it is 2020 and it’s still not happened.

And you know, I’ve learned a lot about both industries (counseling vs. social work). They both have their flaws, but I’m starting to believe the argument about it being “more focused on counseling” does not equate to better therapists. For many of the reasons others have already stated. SW programs can also do this poorly, but have the advantage of a strong licensing lobby.

Lots of good advice in this thread about finding good programs.

And as always, psychologists can bill for it all (mostly with caveats) with the least restrictions. For example as an LCSW I can’t bill for psychotherapy when I visit my patients in the hospital, but my clinical psychologist buddies can.

 

[R. Matey]

And you know, I’ve learned a lot about both industries (counseling vs. social work). They both have their flaws, but I’m starting to believe the argument about it being “more focused on counseling” does not equate to better therapists. For many of the reasons others have already stated. SW programs can also do this poorly, but have the advantage of a strong licensing lobby.

This. 100% I received pretty good therapist training in my master's program, but it ultimately didn't matter because I had a more restrictive license than my social work colleagues. The ACA's lobby is quite small in comparison to APA and NASW, partially because they have a difficult time imposing high member fees on professionals that makes so little money.

 

[frozone112]

I don’t have exact years (goes back to 2007 I think), but I want you to know this is probably the 5th or 6th time a bill like that has been in exactly the same place as the 2019 bill. They attach the policy to some other flotsam and it never gets passed. I don’t know what the resistance is or if it’s a failure of the counseling lobby. I wouldn’t count on it changing any time soon. I decided back in 2013 I didn’t want to gamble on Medicare taking LPCs so went with MSW. And here it is 2020 and it’s still not happened.

Ooh that is definitely good to know!! I still plan on getting a MA of course, but I'm thinking more about a PhD later on based on all this (and other comments). I know I'd be interested in all the extra theory I'd learn, and overall it sounds like it would be a "safe bet" long-term.

Theoretically I could wait a year to apply for the LCSW instead, but I'm still interested in avoiding that for logistical reasons, plus I really like the LPC program I've applied to. I'll do more research into doctorate options (like getting a PhD in Counseling Psych), but that sounds appealing to me since I love learning and wouldn't mind the extra time in school. *Plus the biggest factor personally is it wouldn't cost me $10,000s
Given that thinking if anyone has additional comments on why (LPC) MA--> (Counseling psych/psych something) PhD is bad please let me know that too . I'll start browsing the forums for more on that.

 

[chicandtoughness]

It’s not bad, it’s just not very effective or efficient. The MA in Counseling won’t make you a better candidate unless you’re apply for the few programs that require an MA (e.g. Northeastern for example). They would rather see you have more research experience than a masters in a purely clinical field. So, why would you spend 2-3 years and a sum of money for a masters that will not benefit your goal of getting the PhD?

 

[foreverbull]

It’s not bad, it’s just not very effective or efficient. The MA in Counseling won’t make you a better candidate unless you’re apply for the few programs that require an MA (e.g. Northeastern for example). They would rather see you have more research experience than a masters in a purely clinical field. So, why would you spend 2-3 years and a sum of money for a masters that will not benefit your goal of getting the PhD?

From what I’ve seen, counseling psych programs tend to give clinical experience/training a bit more weight than clinical doctoral programs, but the applicant still needs research experience to be competitive since research is still a big part of the training in either program.

 

[R. Matey]

Theoretically I could wait a year to apply for the LCSW instead, but I'm still interested in avoiding that for logistical reasons, plus I really like the LPC program I've applied to. I'll do more research into doctorate options (like getting a PhD in Counseling Psych), but that sounds appealing to me since I love learning and wouldn't mind the extra time in school. *Plus the biggest factor personally is it wouldn't cost me $10,000s
Given that thinking if anyone has additional comments on why (LPC) MA--> (Counseling psych/psych something) PhD is bad please let me know that too . I'll start browsing the forums for more on that.

I went this route. I can answer any questions you have about it. I'd say that on the whole, it's becoming more rare since CACREP requires counselor educators rather than counseling psychologists to teach in their master's programs. Many Ph.D. programs in counseling psychology on switch to direct from BA/BS admit models following clinical psychology. I can think of at least two programs who made this switch when I was in grad school.

I'm grateful for my training and my perspective and on the whole, I really value the diversity of perspective that counseling psych offered me. You do face a bit of an uphill battle in some corners of psychology that counseling psychologists don't use evidenced based practices, know how to do statistics, don't do assessments. None of which are true, but it can put you at a disadvantage. I was turned down for a fellowship that I'm otherwise qualified for because the director told me that it was only for clinical psychologists This field is competitive and any disadvantage can have consequences.

 

[frozone112]

Ah I have heard the argument that getting the MA would essentially be pointless if I had the intended goals I stated *sigh*.
There is the option of going for the CES PhD, and since that requires a CACREP-accredited MA there'd be no net loss/inefficiency, but from what I've heard you guys and others post on this site, IF I wanted a PhD in the first place an APA/psych one would provide better options.

My background is basically all bio/environmental until two years ago, when I switched to health services (of course there's a story there haha) and I've managed to get a lot of solid clinical experience since, but am at zero research. I don't really know how to get my foot in the door for research in a field I don't have official academic experience in right now, if people even manage to swing that usually.

Hmmm I really appreciate the continued advice and support, but I am feeling a little bit lost on my overall career goals. Will do some more thinking and come back again.

 

[R. Matey]

here is the option of going for the CES PhD, and since that requires a CACREP-accredited MA there'd be no net loss/inefficiency, but from what I've heard you guys and others post on this site, IF I wanted a PhD in the first place an APA/psych one would provide better options.

Yeah, a CES degree would open a door for you to teach in a CACREP-accredited program, but that's largely it. If you want more research experience, I'd suggest maybe trying to find a research assistant/coordinator job in a lab somewhere. You may think about using your biology experience to sell yourself to a neuroscience lab

 

[chicandtoughness]

Ah I have heard the argument that getting the MA would essentially be pointless if I had the intended goals I stated *sigh*.
There is the option of going for the CES PhD, and since that requires a CACREP-accredited MA there'd be no net loss/inefficiency, but from what I've heard you guys and others post on this site, IF I wanted a PhD in the first place an APA/psych one would provide better options.

Also keep in mind the CES PhD will not come with a bump in license level. You will still maintain licensure and be paid in accordance with masters level licensure. Whereas the psych PhD will give you psychologist licensure, which will command higher reimbursement, salary, etc. If you’re interested in a largely clinical career this is something to keep in mind.

 

[frozone112]

Ok this is my current thought process:

1) I want to become a counselor, but I'm also very interested in theory (so I probs would want more than a MA unless you guys think CES courses can give me enough of an extended background in theory and extra EBPs)
2) Relatedly, I like research, but mainly learning about it. Part of why I left bio was I loved what I learned in seminars w/ research, but I hated conducting the experiments. I know getting a doctorate for psych would require research, and I'd be ok with that if I went to a program that had a "healthy balance" of research and clinical work.
3) My understanding is PsyD programs typically have that "healthy balance," but for all intents and purposes I'm avoiding PsyD suggestions because that produces the greatest debt by far from what everyone has said.

My experience in academia has been "if you want to learn theory and stay involved long-term, you'll do research, end of story." But what do you guys think would be a good fit for my interests? I think part of the reason I've been black-and-white in saying "I just want to be a counselor" is that past impression was "you're dedicated to research, or you're not." Is there a more middle-ground option?

 

[frozone112]

If you want more research experience, I'd suggest maybe trying to find a research assistant/coordinator job in a lab somewhere.

Hadn't thought about this, but a coordinator sounds like a short-term goal that would decently fit the criteria I'm looking for (being active in research, but not necessarily conducting an experiment). Wondering if you'd agree with that logic, and also similar opinions welcome!

 

[summerbabe]

if I went to a program that had a "healthy balance" of research and clinical work

You'd be surprised at how many funded PhD programs could fit that balance.

I have a PhD and work as a VA staff psychologist. I have zero interest in leading another independent research project but value what I learned as part of the PhD and could be convinced to play a support role for projects in the future.

Where I've seen that balance be skewed is if you end up in a mentorship model program and your mentor is super serious about cranking out volume because they are ambitious and want to be recognized as an expert in their subfield and thus pushes their students to do the same and support their efforts.

But not all PhDs in academia are geared this way. A quick review of authorship stats will likely give you a sense of who falls under what category.

 

[chicandtoughness]

Ok this is my current thought process:

1) I want to become a counselor, but I'm also very interested in theory (so I probs would want more than a MA unless you guys think CES courses can give me enough of an extended background in theory and extra EBPs)

When you say theory, what are you specifically referring to? Counseling theories? Psychological theories? I do believe that there is a difference in terms of “I want to understand how the mind works” vs. “I want to understand how to best do counseling”

 

[foreverbull]

PhDs often get stereotyped incorrectly as research degrees. They’re not; they’re usually 50% practice, 50% research in terms of coursework split, and most graduates end up doing clinical work rather than research. But on top of that, we get to understand how to critique and how to understand the limitations of research really well with research methods classes and by doing our own original research. I found that my PsyD peers didn’t have that background or intensive training in that area. In fact, during comps 4th year, we had to write about the flaws and strengths in methodology of a study we’d never seen before and with no notes as part of evaluating how well we understood research.

For my research requirements, I did a predissertation and a dissertation (I also did a bit extra that wasn’t required, but not much). That said, my program wasn’t necessarily on the high end of research productivity, but it’ll vary by each program.

Most programs should have a “healthy balance” of clinical vs. research work by default.

 

[frozone112]

When you say theory, what are you specifically referring to? Counseling theories? Psychological theories? I do believe that there is a difference in terms of “I want to understand how the mind works” vs. “I want to understand how to best do counseling”

Fair point!
Based on how you put it, I think I'm going for the "I want to understand how to do better counseling," but I'd think both those statements would apply. Learning greater depth on theories of counseling would enable me to have more counseling tools and use them more effectively, but "understanding the mind" would still be part of that process, no?
*Like to some degree, you'd have to understand some level of the mind/psych/etc. to be able to see why said counseling practices are in fact effective in whatever circumstance, I'm assuming.

 

[chicandtoughness]

Fair point!
Based on how you put it, I think I'm going for the "I want to understand how to do better counseling," but I'd think both those statements would apply. Learning greater depth on theories of counseling would enable me to have more counseling tools and use them more effectively, but "understanding the mind" would still be part of that process, no?
*Like to some degree, you'd have to understand some level of the mind/psych/etc. to be able to see why said counseling practices are in fact effective in whatever circumstance, I'm assuming.

Gotcha. I agree that an understanding of the mind would lead to better understanding of counseling... to a point. There are lots of counseling theories that are based on a more... philosophical approach to psychology than a cognitive/neuroscience approach. If you're really interested in, for example, existentialist therapy, I think you'd probably enjoy working in counseling much more than going to a PhD program. Also, totally possible to be a theory nerd and only be a masters level clinician! I LOVE theory -- object relations theory in particular -- but would NEVER choose to go to a PhD program to explore OR theory in more depth. Many masters level clinicians choose to pursue specialized certifications to delve into their theory of choice.

 

[frozone112]

Gotcha. I agree that an understanding of the mind would lead to better understanding of counseling... to a point. There are lots of counseling theories that are based on a more... philosophical approach to psychology than a cognitive/neuroscience approach. If you're really interested in, for example, existentialist therapy, I think you'd probably enjoy working in counseling much more than going to a PhD program. Also, totally possible to be a theory nerd and only be a masters level clinician! I LOVE theory -- object relations theory in particular -- but would NEVER choose to go to a PhD program to explore OR theory in more depth. Many masters level clinicians choose to pursue specialized certifications to delve into their theory of choice.

Admittedly I asked my question without looking into specialized certs or CE/CEU so the degree of "customization" you're speaking of is encouraging! I haven't read as much on people addressing that here either so I appreciate the input.

 

[foreverbull]

Admittedly I asked my question without looking into specialized certs or CE/CEU so the degree of "customization" you're speaking of is encouraging! I haven't read as much on people addressing that here either so I appreciate the input.

@chicandtoughness is correct; people with a master’s degree can choose to pay for further training and/or certification in a specialty niche. The tricky part is paying for it out of pocket (can run up into a few thousand dollars for training depending on the subject) and the time commitment, depending on how in depth the certification/training is (ie a one-time 2-day workshop vs. several months of group consultation and trainings once every few weeks).

DBT is very involved (ongoing consultation on a regular basis after the training, for example), as is certification in Gestalt therapy. Meanwhile, ACT trainings typically go 2-days and I think offer certification afterward. EFT for couples requires ongoing consultation as well, if I recall correctly. EMDR trainings run up into the thousands but are relatively brief trainings.

So it just depends on your interest area. I will say, many early career practitioners can’t usually afford to cough up a few thousand for the pricey trainings after spending thousands to get licensed in your state (between licensure exam costs, practice materials, and licensure fees), but it depends on each individual’s financial situation.