Hello, I’m probably one of the outspoken frequent flyer midlevel haters in this forum you’re referring to. Please note I’m a midlevel myself (LPC/LMHC). I did not enjoy my education and I put my money where I mouth is by going back to get a doctorate (albeit not a PhD).
Here are my general gripes:
1. Masters level education is not very standardized. Yes I know CACREP, COAMFTE, and CSWE exist, but the implementation of the (low) standards varies greatly. In my program you couldn’t do prac/internship in private practice settings to force you to get HLOC experience. My colleague who went to a well known MFT program in California did all of her clinical at a private practice with a not-so-legit LMFT supervisor who barely supervised her.
2. Licensing is not standardized across states. Heck, we can barely decide what to call ourselves, leading to this dumb alphabet soup of LPC/LPCC/LMHC/LCPC. In Massachusetts you needed 960 direct hours to get fully licensed. In Texas I needed 1500. It’s a mess.
3. In general (key word), masters level programs are easier to get in and thus the average caliber of individual that self selects for a masters program vs. a research-based doctoral program is significantly lower. Many of my classmates struggled through our already fluffy stats and research design courses. (I tested out and did the doctoral level courses in the psych department instead)
4. The aforementioned situations leads to masters therapists not wanting to conduct, consume, assess, or disseminate research. And definitely not to the level of our doctorally trained peers.
5. Most masters level therapists want to get in, get out, and (definitely generalizing here) start their private practice ASAP. (This makes sense; if they didn’t want to do this, they would have gone the doctoral route…) I’m not bashing private practice, but I am bashing clinicians who want to run before they can walk. As a newbie therapist with your measly 900 hours of experience, you want to start holding people’s lives in your hands with barely any oversight or guidance?! Heck, let’s just let med students practice independently without guidance after graduating too, because that’s the equivalent. Don’t talk to me about required pre-license “supervision”, which is largely a financial agreement and is also poorly implemented in most situations.
6. To be a competent masters clinician, you *need* to spend lots of time on extra training that was not wrapped up in your graduate program and isn’t even made explicit to you at any time. I’ve been working with OCD patients since 2015 and it wasn’t until 2022 that I felt comfortable saying it was one of my “specialties”. Obviously this is true of all clinicians, but given the lack of education and supervised training in our education, the masters trained ones have a much steeper hill to climb and - dangerously - they often don’t know and/or care the hill is there.
7. Don’t get me started on the pseudoscience. I have had many colleagues boast they specifically went the masters program route because they are angry that doctoral programs don’t provide training or allowance for “alternative therapies”. Cue the reiki, EMDR, crystals, tarot readings, neurofeedback, “collage your feelings”, you name it.
Before going to med school, I did UR for a very large national behavioral health company, which meant I was reading/auditing every single session note and intervention that my masters-trained colleagues were conducting. I’ve worked with a total of ~50 facilities, each staffing 2-5 therapists each, across at least 20 states (too lazy to count). And let me tell you… it was BAD. Very poor case conceptualization. Very poor treatment planning. Also very poor outcomes.
I’m not just spewing out vitriol because I think it’s fun. I’ve seen directly how poor education and poor training hurts patients on a very large scale. I had to take this poor treatment planning and somehow spin it into gold for the payors.
Yes there will be superstar masters clinicians, and I know some myself. But by and large 80% are mediocre. They do not provide adequate quality for the huge fees they think they are entitled to charge (one of my colleagues, still under associate license, lamented that she was “only” able to charge $150/hr cash rate). They cannot and do not want to delve into research. They have poor understanding of how to get further training or do not comprehend they need further training.
I do not blame the individuals one bit. They don’t know what they don’t know. I do blame the bargain bin low quality of 80% of these masters degree programs for not properly training clinicians.
Please note there are obviously good and bad eggs everywhere. But for masters programs it’s probably a 20/80 split whereas for PsyD’s we’re closer to 60/40 and PhDs we’re closer to 80/20.
Do I have research to back any of this up? No, but I don’t think my concerns should be swept under the rug just because of it. I’d love to pull data from my company to prove it (because trust me, the data will prove it) but they’d probably sue me to oblivion.
psycnet.apa.org
