Gary Bloom

March 29, 2021

So You Want to Be a Counselor or Psychotherapist

(This is an excerpt from a book I wrote on how to have career in the mental health field. I unpublished it because it would need to be revised to stay current.)

In the 60s and 70s, my father had the largest counseling practice in the San Fernando Valley. Note that, when he started out, the largest practice in the Valley might have been three clients. At the time, the good news was, as the 17th licensed psychologist in California he had little competition. The bad news was there were few customers seeking help for emotional, marital, or family issues. As a pioneer, he had to help invent a little known professional service that would capture the attention of those in need.

During World War II, psychiatrists were pressed into service as physicians; clinical psychologists took over the responsibility to treat soldiers’ emotional problems, primarily PTSD (then known as shell-shock). But their role in the armed forces aside, hardly anyone knew what a clinical psychologist did. 

Following the war, and a move from Chicago to Los Angeles, my father spent years marketing his practice, educating people on how his work could make their lives better. Eventually, it paid off, as he developed a full-time practice. 

As my father’s practice expanded, my life didn’t change much. Though we moved from living with relatives to moderately large homes (by that era’s standards), there wasn’t any upgrade in family cars, let alone cars for teenage boys that would elevate my status with high school girls. What I gleaned from my father’s success were some false premises about a career in the counseling business. This is what my father’s practice looked like to a kid: step 1, you train to be a therapist; step 2, you go to your office daily to serve your large clientele; step 3, you send invoices at the end of each month; step 4, deposit checks, paid by grateful clients; step 5, enjoy the steady income and professional respect. 

Though I grew up in the household of a pioneering psychotherapist, what I missed was the part about building a practice. And what I couldn’t expect is that only the first step would remain relatively fixed. My intended profession would evolve into something entirely different from my father’s experience: marketing a counseling practice became less like giving an educational talk in a library and more like trying to be heard above the din in a football stadium. While I didn’t have to invent the profession, I had to compete vigorously in the bizarre bazaar1 of pioneering counseling practices, and many of those practices were wrapped in packaging that was better than the product.

The most unprepared change for me was that, while in my father’s time, clients came armed with problems and insecurities, in my era, clients came armed with problems, insecurities, and insurance forms. I was prepared and confident dealing with the first two, not so with the third. While as an MFT, I initially cheered the professional recognition that insurance coverage meant, with its accompanying boon to private practice, I wasn’t a proponent of the medical model that insurance coverage brought to marriage and family therapy. 

Don’t chase a mirage

When you’re young, you don’t understand how quickly change comes, or that what you saw was a mirage. Part of my attraction to becoming a counselor was the rarity of practitioners, but when I was in college, budding clinicians had become as rare as Beatles fans (if you’re a millennial, read that as rare as Taylor Swift fans). By far, the most popular major at my undergraduate school was psychology. The territory I considered my birthright turned out to be public property. 

While much has changed since I became a counselor, what hasn’t is that I see budding counselors going into a field that’s very different from what they envision. Your motivation for joining the profession may stem from a counselor helping you through a difficult transition; or because you’re regarded as a good listener; or you’ve been lauded for your parenting advice; or you have contended successfully with a serious emotional or substance abuse problem of your own. Unfortunately, one or more of those gratifying personal experiences does not mean you know what you’re in for as a future clinician. If the counselor you saw was in private practice and had a nice fancy office, you may have gotten the wrong idea. The mental health profession is much like professional baseball, where you have a minority of players who do really well, and many who never get past the minor league system. To make good in either, combine talent, hard work, and a bit of luck.

How to Have a Career

The counseling field is often both a difficult professional environment and a competitive business environment. That doesn’t even take into consideration the challenge of becoming a competent clinician. If you work in an agency, you will find that your bosses aren’t the compassionate bunch you’d expect with trained counselors. As in most professions, your superiors may have gotten to their positions by being good at office politics, rather than being good at clinical work, or good at leadership. 

Occasionally, people land in great organizations. If that happens early in your career, you might expect that will be the norm. While I encourage people to be adventurous, if you find a decent-paying job in a comfortable organization, don’t assume you’ll find another situation that matches it, let alone exceeds it. 

Money

Before you commit to a counseling career, look at the statistics on the average and mean incomes for the mental health professions. You need either a carefully crafted business plan or a willingness to sacrifice riches (that is, being able to pay your bills) for the love of the work. Even if the former is true, that you think you can make big money, I hope that anyone who doesn’t have a passion for counseling goes into something else. Working 40 hours a week at something you don’t find interesting and enjoyable (not every moment, to be sure) is miserable. And anyone who can make lots of money from counseling will make even more in the marketing field. 

A satisfying and possibly lucrative career

Pick some counselors’ web sites at random. They list 20 to 30 problems they treat. They will provide a safe space to take you on a journey to find your authentic self. By implication, their primary approach is insight-oriented talk therapy, with no theory that would explain how it will help you. But in case you are too anxious or depressed for that insight-oriented journey, they keep cognitive-behavioral therapy in their back pocket, right next to their iPhone. 

Luckily for both counselors and clients, many people just need someone to listen. They don’t need meds, dramatic breakthroughs, or a U-Haul load of insight. They just need someone to stop texting and listen. You could be that person. Unfortunately, so can dozens of other counselors in your area. It might be a good idea to find a way to stand above the crowd of counselors. 

Be the proctologist of counselors:
The easiest way to stand out is to specialize in something, preferably something that most counselors prefer to stay away from. Most counselors don’t like to deal with boys in their teens (especially if they get in trouble with the law), personality disorders, significant sexual problems, life-threatening eating disorders, or domestic violence. If you want to carve out a career in private practice, invest in advanced training to deal with one of the icky categories. Get great at it, and once you do, it will be far more satisfying than icky. You’ll get plenty of referrals, and eventually have opportunities to mentor, teach, and consult. 

Complement a group practice:
If you have a specialty, become the go-to person in a group practice. If you are the expert in what no one else wants to do, or what no one else does well, you will be sought. 

There are counselors who make money. If you don’t follow the crowd, or take the easy path, you can be one of them.

Conclusion

Institutions usually start with the interest of the customers, but over time segue to serve the providers, or worse, the monied interests. If you work in the mental health system, find a way to make it work for you and your clients. 

When my daughter started her master’s program in education, I suggested that she would not learn much in class, that her learning opportunities would come from doing research and writing a thesis. I was advising her that the program would be what she’d make of it. I also have a young friend who recently became a public school teacher. And another friend who just started a second career, as an MFT. What these roles have in common is that they will all take place in institutions that have survived well past their pull dates. And in all these cases, when their institution doesn’t support it, they will have to make it work for themselves and for their clients or students. They’re all confident, emotionally strong people. I have faith, a belief they’ll do well and make their little part of a deficient system, better. 

I hope anyone who’s choosing the counseling profession goes into it with their eyes wide open, with the confidence to make the system work for them and for their clients.