Surviving the Pre-Licensed Desert:
Thoughts for Postgraduate Psychotherapists on Supervision, Licensure, and finding your Tribe.
To be honest, I cannot remember a whole lot about the thoughts going through my head that day.
Graduation day, for me, represented the culmination of a lot of hard work I had done in a brief amount of time. I was graduating with my master’s in marriage and family therapy, and I had also completed coursework to qualify as a professional counselor and to pursue certification as a sex therapist. I had finished over 80 credit hours in less than 2 years. Of course, the labor was not only my own. Mine was a very privileged situation as a student. My family supported me financially, so I was able to work full-time at doing school. I was single and had no children, so beyond whatever time I chose to give to friends and hobbies, I could give my full energy to my program. I was close with my cohort members, many of us had worked at the same practicum and internship sites, and graduation felt very much like a collective celebration.
My hair was long then, and I remember a classmate giving me a hairpin so I could secure my cap and keep my hair out of my face. I can remember the face of the commencement speaker, but I cannot remember her name or what she spoke on. I also remember at the reception having my new business cards in my pocket, and I made sure I showed them to all my classmates and favorite professors. I had been hired by a local therapy practice. I was going to be generally responsible for generating my own caseload, but the disbursement rates from the practice were generous and I felt confident I could make it work.
Truth be told, the job was almost an afterthought. A friend and classmate had interned with the practice and told me that they were hiring. I had spent so much time and energy working on developing my clinical skills and finishing courses, thinking about work after school was not much of a priority. I remember having this general impression that employment would be an automatic process, I do not recall many of my professors giving much time to talk about getting a job. So I thought, “how hard could it be?”
And then came the reality, and it was not nearly as automatic of a process as I hoped it would be. As a clinician, I had entered what is, for many of us, a professional desert that I had to cross. I had finished school and I had my degree, but I had more years to go before I could be fully licensed. Also, I knew nothing of what to expect of the work environment for the most part. I had no clue what I could reasonably expect for an income. And I did not fully understand my options for supervision, and how to best move myself forward to licensure. And because of all that, I had a lot of growing pains in the years to come.
I am happy to say that I survived my desert. Today, I am a licensed clinician and supervise postgraduate therapists, I also do some adjunct teaching along with continuing education courses. My own desert experience has intensely formed me in my desire to help other new therapists avoid some of the pain points that I experienced. Many of the lessons that I try to impress on my students and supervisees I have put together in my free mini-course, 7 Things I Wish I Knew as a New Psychotherapist. And for those who want a full blueprint, I have done my course the Psychotherapist Start-Up Kit, which includes more of an in depth guide with templates and handouts. I have done these courses as I am truly passionate about helping new professionals earn a good livelihood and avoid some of the many common pitfalls. But in this article, I want to highlight 3 things that make a big difference in surviving in the desert. Supervision, Licensure, and what I call “Finding your Tribe.”
For those reading this who are not yet familiar with all our common psychotherapy terms, “supervision” is the process of working under the guidance and direction of a fully licensed therapist. We begin the supervision process while in school, completing practicums and/or internships. A typical set up involves weekly meetings with the supervisor. You talk through your client cases, review your documentation, listen or watch recordings of session you have done in the week, and receive direction from your supervisor. The process continues when we finish school. Once we have our degree, we enter the postgraduate season of supervision, which I often compare to a medical residency that a physician completes after earning their degree, but before being fully boarded in their specialty. While under supervision, a therapist works under the authority of their supervisor’s license, and the supervisor bears ultimate responsibility (and therefore can make ultimate decisions) regarding client care. For those pursuing licensure in professional/mental health counseling, clinical social work, and/or marriage and family therapy, postgraduate supervision is designed to last 2 to 3 years in most states for those pursuing clinical work full-time. For psychologists, time is often covered, partly or wholly, in a psychology internship, though this can also vary based on program accreditation and state licensure.
Most graduate programs match students up with supervisors while they are finishing their degrees to cover practicum and internship. Once a therapist graduates though, the process of connecting with the supervisor can be a lot more difficult. Some employers offer supervision as part of the employment agreement with postgraduate therapists, but this is not necessarily universal. There is also another caveat to pay attention to, supervision needs vary between states and what license (or licenses), a postgraduate therapist is pursuing. Who qualifies as a supervisor is not universal across all licenses, many employers do not necessarily know what a postgraduate therapist may need to become licensed. I have consulted with many professionals who have worked years in a clinical setting and were receiving supervision there, only to find out that the supervision hours they received did not meet the criteria for what they needed for licensure.
So, what can you do about it?
The first thing I would recommend is to try and familiarize yourself with the rules and statutes covering your profession in your state. This can feel daunting, and it may be hard to fully interpret, but you need to start there. State licensing boards publish rules that can be found on their website regarding requirements for licensure, which include supervision requirements. Knowing the rules for different states can be important as well, particularly if you might end up pursuing licensure in another state.
After reading the rules, explore what supervision options you may have locally. Many groups and associations, such as the American Association for Marriage and Family Therapy (AAMFT) maintain online directories for supervisors in your area. Even if you cannot find somebody who is taking on new supervisees, ask somebody who is licensed in the discipline you are pursuing whether you could buy a single hour supervision. This could be a way have somebody with experience in the licensure process walk you through the rules and regulations in your state, and they may also help you find someone who may be a good fit as a supervisor.
The shortfall of qualified supervisors in certain geographic areas has become an acute problem for many people seeking licensure. In this need, certain creative individuals are working to fill the gaps. Motivo is a service that provides connections for postgraduates to tele-supervision with supervisors qualified in their state. This form of distance supervision is a way to eliminate many of the barriers keeping professionals from accruing their supervision hours. There are caveats to tele-supervision. As this is a new platform, different states and different licensure boards allow for it in different ways. As of this writing (May 2019), in Tennessee the licensure board for professional counselors and marriage and family therapists will approve tele-supervision, but the supervisee must still formally petition the Board for approval. In Florida, the board for mental health counselors, social workers, and marriage and family therapists’ states that a postgraduate therapist may only receive 50% of their supervision through a tele-supervision format. But as a rule, many states and licensing boards have become more open to allowing for tele-supervision. Click here for our special discount with Motivo.
Very much related to the process of supervision is the goal getting licensed. Many newly graduated therapists take on a very dangerous mindset, typically, when it comes to thinking about licensure. They think about licensure as something in the “future” and as something that will work itself out if they are employed in the field. The danger in this comes, not only from the reasons I covered in the previous section on supervision, but also because it minimizes a lot of the professional vulnerabilities that new therapists have until they get licensed. I want to be clear; I believe the supervision process is important in the creation of competent therapists. But I equally believe that new therapists need to work with singular focus and progressing themselves towards licensure. One does not need to spend a lot of time on job boards to realize that employment opportunities for pre-licensed therapists are far fewer.
One thing that often contributes positively to the licensure process, and which I fear many therapists may have a poor understanding of, is associate/intern licensure. My experience may be an outlying one, but I did not hear a single discussion about associate licensure when I was in graduate school, even though the state of Georgia has associate licensure status for both professional counselors and marriage and family therapists. Most states have licenses that are designated as either associate, intern, provisional, or temporary, depending on your state. These licenses are designed for people still in the supervisory process, but it allows you to have your own designation under your state licensure board. For social workers, this is most often called a licensed master social worker (LMSW). Depending on your state and employment setting, this first level licensure is not always required. I never pursued this in my first years as a postgraduate therapist in Georgia, but now I wish I did.
Most associate/intern licenses are designed to move you through the required national exams, so that applying for your final license is simply a question of verified supervision hours and clinical hours. Otherwise you can end up taking your national exams years after you finish grad school. To the person, without exception, every therapist I have spoken to that has done this expresses regret. National exams require you to be tested on information that is the freshest in your mind when you are finishing graduate school. Also, difficulty in successfully passing exams, can further delay your licensure process.
I personally left one of my required exams for LPC licensure until I was ready to apply for full licensure. I failed the test on my first try by a few points, and had to wait 3 months before I could sit for it again. I passed on the 2nd try, but this delay, along with the application process, meant that I was over 10 months late in receiving my LPC. This was time that I had to pay for supervision, and if I had finished sooner, that would have been quite a bit of money and time I could have saved.
Finding your “Tribe”
In a recent conversation with a professional mentor, we discussed different factors that affect burnout for people in this pre-licensure desert. This particular mentor is the chair of a graduate program in marriage and family therapy, and he was noting to me feedback he is getting regarding burnout from people after they finish the program. The common factor was that individuals that had a hard time making it were ones that were working in the most isolation. Something that I look on in my own story with gratitude is that I had the benefit of having a good tribe around me.
What I mean by “tribe” is something specific. It is not just a peer group, though it does include peers. When I was a new graduate therapist, I stay connected with many people in my cohort. My roommate was a fellow therapist who graduated with me. I worked and socialized with other therapists who were in the same phase of career as I was. But I also had people ahead of me, some of these were supervisors and were more informal relationships, professors with whom I stayed connected. Others were professionals that were simply a few steps ahead of me. I tribe is made up of peers, but also chiefs and elders, as well as newer members below you. This sustains us, helps us process the difficulty and triumphs of the desert. For even when you cross the desert, for the fully licensed and experienced psychotherapist, the greatest dangers seem to lie in isolation. We need both the encouragement, and push-back, that having people around us means. And this is not simply mean just co-workers in our profession; many of us have worked in settings with people in the mental health profession where we feel no connection. I am talking about people we feel genuine camaraderie, individuals that are driven by similar impulses to ourselves, and who can offer us understanding and questioning as we need it. The relationships I formed in the desert have sustained me years on end. I married a fellow therapist I met in this season. But beyond this, I have relationships that help me think through things as a professional.
Finding your tribe can simply mean staying connected with the people which you completed your training. Sometimes it means seeking out relationships in your workplace. I would strongly encourage getting connected with your professional associations early, particularly on the state and local level.
There are many more things I want to share with new therapists. Considering job options, finding paths for student loan repayment, creating alternate sources of income, and finding niches as a therapist. If you want to know more about these things, check out our free course 7 Things I Wish I Knew as a New Psychotherapist. And to get even more in depth, check out Psychotherapist Start-Up Kit
S. David Hall, PsyD serves as the Chief Maven of PsychMaven. He is a psychotherapist and supervisor, and is the founder of Haven Family Psychiatry in Knoxville, TN. He has served as the President for the Tennessee Association for Marriage and Family Therapy (TNAMFT) and as an adjunct professor with Richmont Graduate University.
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