counseling for MD?

[psychtorads]

I am a 1st year psychiatry resident, struggling with the demands of
residency. What I really want to do is be a counselor.

How might I become licensed in mental health counseling, without
completing the 4-year psychiatry residency? I have graduated from
medical school, so I am an MD. If I were to complete my first year of
residency, what requirements would I need to fulfill so that I
could begin counseling? If I were to stop residency now, after 4
months, would the requirements differ? I am wondering if I need a
master's degree in counseling, or if my MD degree would suffice. Would
I also need to fulfill additional hours of counseling internship at a
university, or other teaching institution?

Any information you have would be appreciated.

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[Therapist4Chnge]

*The best place to ask this is in the Psychiatry Forum, so I'm going to move it over there.*

I know there are institutes that provide training for psychiatrists who want a better understanding of theory, therapy, etc. I am sure there are a number of different orientations available, though I've only heard of more traditional psychodynamic ones. I'd think if you are serious about expanding your training, this would probably be the best route to pursue, though you should definitely finish your current training.

-t

 

[Ollie123]

I'm honestly not sure, but I'd hazard a guess that your options are either complete your psychiatry residency and find a way to specialize in counseling either at residency or fellowship (not sure what options are available).

I cannot imagine anyone being licensed with no additional training in something specific to counseling beyond an MD (which in nearly all cases, probably barely touches on counseling). I'd assume if you don't want to complete your residency you would need to go through a full master's program in any of the usual choices (LMHC, MSW, Clin/Counsel Psych).

I'm far from an authority on the matter, but I highly doubt you'd see it any other way since an MD, while obviously a FANTASTIC background to have as far as diagnosis, biology of disorders, would provide near-zero training in formal counseling. So you'd basically need to start over on a different track, or finish your psychiatry residency.

 

[yeti00]

What about psychoanalysis? Would you have to be licensed to start an analytic training program?

 

[deleted77919]

Most states require one year of residency training to get a state license. Beyond that you can offer whatever services you feel comfortable offering. There are a few caveats to this 1) getting malpractice insurance will be difficult to impossible 2) You aren't getting any additional training and can't say you are certified to do anything in particular. However, you could probably hang a shingle that says "Joe's mental health services ~ Joe, MD."

In reality the ability to practice as a generalist is a vestige of long ago, but if you were bent on not finishing residency I suppose you could go through with it.

 

[whopper]

I might be interpreting you incorrectly, but do you want to be a liscenced counselor?

There are masters in counseling available in several programs. I believe this will allow you to be a liscenced counselor in several states.

I do though suggest you strongly consider finishing your psychiatry training since you've already completed medschool and psychiatry has several similarities to counseling. Personally I find them too similar for me to want to get a masters and disregard my M.D., especially considering that psychiatry will offer you better job security & pay.

Psychiatry residencies in general ease up as time goes by. Hopefully you (edited-won't) want have to take a step back to get to where you want. However you do what you think is best. Hopefully your residency program will offer you psychotherapy oppurtunities in the future to the point where you don't feel you have to quit your program.

I have some knowledge of what is needed for a masters in counseling, but my wife would be a better person to ask because she is applying to counseling programs for next year. I believe all you need is 2 years of training but I could be wrong. You can PM me and she can answer you through the PM.

 

[psychtorads]

You can practice after one year of residency in very few states:

http://www.ama-assn.org/ama/pub/category/1555.html

As for counseling, seems you have to get a degree in that area.

Does not leave many options if you want to leave residency. Especially with the debt we have.

I wonder if it is realistic to try to find a better 2nd yr somewhere? My program actually gets worse in the 2nd yr. I can't imagine many pgy2 spots are available at reasonable programs.

thanks for the replies.

 

[Ollie123]

Practice is very different from "get malpractice insurance". Admittedly, if you're doing counseling you are probably less likely to get sued, but that's still a gamble. You likely wouldn't be able to bill insurances, and good luck getting referrals without formal training, so having a cash practice isn't likely an option.

I'd really really look for a better residency before dropping entirely. Most "counseling" jobs pay like crap. PhD psychologists usually start in 50k range, though there is obviously a range. I would not want to try and pay off med school debt while earning a social worker salary.

 

[Therapist4Chnge]

I've heard there are some very good psychiatry residencies that have a more applied therapy training/supervision (still obviously not going to be a major area, but better than places that don't have any), though I'm not sure how competitive or available a 2nd year spot would be at such a place.

Can anyone here recommend some programs that are known for having some therapy training/supervision?

-t

 

[deleted77919]

You can practice after one year of residency in very few states:

http://www.ama-assn.org/ama/pub/category/1555.html

Most states have different requirements for IMG's and AMG's, I suppose I shouldn't have assumed you were the latter. Best of luck.

 

[cleareyedguy]

I'd suggest trying to figure out why you want to become a counselor rather than a psychiatrist.

It sounds like the demands of internship are weighing heavy and that you believe that being a counselor would allow you to do therapy without as much pressure. Rather than give up on psychiatry, perhaps you could talk to your PD, get into therapy, talk to some peers, figure out what is specifically difficult about internship, develop more of a support network, etc. I am a big believer in the necessity of internship, but the goal is for it be hard enough, not too hard, and you shouldn't be going through it alone.

Good luck.

 

[Anasazi23]

I've heard there are some very good psychiatry residencies that have a more applied therapy training/supervision (still obviously not going to be a major area, but better than places that don't have any), though I'm not sure how competitive or available a 2nd year spot would be at such a place.

Can anyone here recommend some programs that are known for having some therapy training/supervision?

-t

It's not really a choice. All programs have a psychotherapy requirement with supervision. The ACGME has guidelines for psychiatry residency training. Though some may weigh therapy or a specific orientation more heavily than another, no program can just not have it altogether. It's a core competency requirement.

 

[Chimed]

So what's the difference between the general category of counseling versus psychotherapy training? I thought being a counselor just involved psychotherapy training at a masters levels with more focus on supportive therapies and such....

 

[Therapist4Chnge]

It's not really a choice. All programs have a psychotherapy requirement with supervision. The ACGME has guidelines for psychiatry residency training. Though some may weigh therapy or a specific orientation more heavily than another, no program can just not have it altogether. It's a core competency requirement.

Whoops.

So what's the difference between the general category of counseling versus psychotherapy training? I thought being a counselor just involved psychotherapy training at a masters levels with more focus on supportive therapies and such....

Counseling is based on counseling studies and theory, and doesn't look at pathology in quite the same way. Often counseling people think clinical people over-pathologize, while clinical people think counseling doesn't pay enough attention to the psychopathology. Theories and interventions can cross over, but general counseling tends to be more supportive in nature. The training is different in breadth, depth, and how research is tied in. Both are based in research, but I think it is more closely utilized on the clinical side (but that is my bias).

-t

 

[whopper]

As mentioned above, if you want to pursue a counseling degree despite your medical & psychiatric training--it may signal that perhaps your residency program is not giving you enough psychotherapy training. It may also be possible that it may offer you more training but you are not aware of it. My own program started its psychotherapy classes in the 2nd year. Until then I could only go off of what I learned in college & what my attending supervision.

I don't know where you are located, but there are several places where you may consider to do some extracurricular training.

If you decide not to leave your program and want more training, you can wait till electives, and then set one up at a location that can give very extensive psychotherapy training.

Another option is to see if you can hook up with a nearby counseling or psychology program and see if they can offer you any oppurtunities on the side (yeah I know--on top of your residency hours? Geesh!).

 

[positivepsych]

Finish your residency.

As bad as it might be right now, you'll be glad when you're done. It would be a huge waste to have gone through medical school and become a master's level counselor. It wouldn't be any less of a "shortcut" either, since it would take starting your academic life over again. The three years to complete your residency is the same amount of time to get a master's degree and accrue enough hours to get licensed.

But I hear you regarding the difficulties of residency. Considering seeing a psychologist trained in cognitive-behavioral therapy in order to learn better coping mechanisms and stress management. Stick out the residency, just try to deal with it better. Its hard, but you don't have to suffer through it.

BTW, what happened to switching over to radiology?

 

[PsyKardinal]

To OP, I am an LPC (licensed professional counselor) and I agree with many of the folks that have posted on here so far. You worked your butt off to make through medical school and the 1st year of residency. To start over and seek out a masters and then all of the work to complete your licensure hours would be more then the time you have remaining to complete residency. Think 2 to 3 years for the master’s degree and then 2 and more likely 3 years to complete 3000 to 4000 hours of direct client contact time.

I am not writing this to disparage my choice in going this route, I love what I do. If you want to get more therapy exposure ask for it in your program, or find a masters program and see if they will let you sit in on a class or two each semester. T4C was right that generally we look at things from a less pathological/symptoms based method and more psycho/social/environmental perspective. Whichever you choose good luck in your decision. PM if you any questions.

Jeff

 

[PsychMD2100]

Whoops.



-t

What qualifications and credentials does one need to become an SDN Senior Moderator?

 

[whopper]

Psykardinal,

Just trying to make sure you didn't get a wrong impression (which I don't think you did). I suggested continuing the psychiatry residency because I believe it'll pan out in time for the questioner. I meant no disrespect to your profession, and I have a lot of respect for people in your field and the level of training.

 

[Therapist4Chnge]

As for the OP's inquiry......PsyKardinal summed it up nicely.

-t

 

[PsyKardinal]

Whopper

No offense taking whatsoever, I thought that was your intent and was somewhat mine also. I can understand how much it sucks to be in-training and still looking at a another few years of training before you get to the pay off. I just wanted to put it out there that changing over to a counseling was going to be a tough change also, and that the OP should have as much information as possible for thier decision. Thanks for the good comments I appreciate it.

Jeff