Psychotherapy Field

[cybertsiren]

Hi. So, I finally got my LCPC and am about to take my LMFT exam. I am a career changer so I didn't know a lot about members of the field. Schools are graduating hordes of counseling and social workers every year. Initially, no one wanted to take interns or LPC's until Obamacare and the Marketplace. Suddenly, fully licensed clinicians realized they could have large group practices and make money, big money by taking on interns to work for free seeing welfare and low reimbursing insurance plans. Then, when they became provisionally licensed they'd get paid $20-30 a client and pay $200 a month in supervision. Suddenly, all kinds of post graduate training programs have appeared, offering unpaid "tuition" for monthly seminars in exchange for seeing pro Bono clients and paying for supervision. Cathedral Counseling and Northshore Phychological Assocs. have similar schemes. Most LPC's are so desperate to get clinical hours, they go along. We are all caught in a Ponzi scheme!

That said, I am astonished at the number of practice owners and clinicians who are suffering from OBVIOUS personality disorders and exploit clinicians and patients alike.

So, now let's talk about fully licensed new clinicians. They often join large group practices Tinder for Therapists) where the receive half the insurance reimbursement. They are required to sign non-compete contracts so basically, they are indentured and can't start their own practices. In the meantime, these clinicians NEVER build a full time case load. It usually tops out at 10-12. So clinicians have to have a second job at a non profit, a hospital or have a rich uncle.
It's like wack a mole. Directories like PT have thousands of listings! Many psychotherapists list themselves as Dr.'s but upon closer examination they have an academic PhD or an EdD. They hope the prospective client doesn't know the difference. I am utterly diillusioned. Some non profits in Chicago are family businesses intended to provide jobs to family members! Like the Clinton Foundation.

I didn't want to work in business but psychotherapy is just that, and clients are commodity traded on the open market. I wonder if Medicare for all would make it any better.

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[DynamicDidactic]

Schools are graduating hordes of counseling and social workers every year.

Yup, it is a relatively easy way to make a buck.

Initially, no one wanted to take interns or LPC's until Obamacare and the Marketplace. Suddenly, fully licensed clinicians realized they could have large group practices and make money, big money by taking on interns to work for free seeing welfare and low reimbursing insurance plans.

I am pretty sure this was the case before the ACA.

Then, when they became provisionally licensed they'd get paid $20-30 a client and pay $200 a month in supervision.

Not sure about the client fees but I always found the idea of paid supervision to be greasy.

Suddenly, all kinds of post graduate training programs have appeared, offering unpaid "tuition" for monthly seminars in exchange for seeing pro Bono clients and paying for supervision. Cathedral Counseling and Northshore Phychological Assocs. have similar schemes. Most LPC's are so desperate to get clinical hours, they go along. We are all caught in a Ponzi scheme!

from my limited experience, the LPCs have it tough.

That said, I am astonished at the number of practice owners and clinicians who are suffering from OBVIOUS personality disorders and exploit clinicians and patients alike.

Selection bias most likely.

So, now let's talk about fully licensed new clinicians. They often join large group practices Tinder for Therapists) where the receive half the insurance reimbursement. They are required to sign non-compete contracts so basically, they are indentured and can't start their own practices.

For psychologists, I have always thought those non-competes are also greasy. Plus, I am not sure they would actually survive a court battle. But to be fair, all non-competes for this type of job should have a radius limit.

In the meantime, these clinicians NEVER build a full time case load. It usually tops out at 10-12.

This does not represent what I see in the world. Generally, there are too many clients and not enough providers.

Many psychotherapists list themselves as Dr.'s but upon closer examination they have an academic PhD or an EdD. They hope the prospective client doesn't know the difference.

Technically, this is unethical and can be addressed by the local board.

I didn't want to work in business but psychotherapy is just that, and clients are commodity traded on the open market.

Yes, it is a business but I hope people are treated somewhat better than inanimate objects.

I wonder if Medicare for all would make it any better.

I really don't see how. If anything, it would get worse.

 

[foreverbull]

So I'd like to note that what you've said partially reflects regional differences.
Chicago metro area is NOTORIOUS for being flooded with provisional LPC's desperate for supervision (there are several master's level programs in that general area). Several folks in here have complained about this and were seeking resources to figure out how to get licensure hours or whether it was worth it to pay for supervision (multiple older threads about this in here).
Meanwhile, in some other areas with fewer master's level programs, the outlook isn't nearly as bleak (i.e. Kansas City, etc.). Basically, if folks choose to practice in an area not completely flooded with MA level graduates, their chances of finding decent employment are much higher, even if it's a big city (some big cities don't have several grad programs with large cohorts).

Some issues I see here that speak to your concerns are:
1. Flooded market - supply of MA graduates too high
2. It's a license (LPC) that has zero transferability across states, so folks in Illinois can't expect to be able to pick up and move to another state to get supervision. The best bet is to get licensed FIRST, then move states, although that has its own bumps, but then you go back to problem #1.

It's a bummer, but I wish folks in Chicago would check these threads first before entering grad programs and getting a rosy view from grad programs about job outlook post-graduation. Perhaps students would be better off moving to another city in the midwest and getting licensed there, then returning to Chicago and seeking licensure. Folks would have to check the state boards to see what the requirements are, though.

 

[Sanman]

I didn't want to work in business but psychotherapy is just that, and clients are commodity traded on the open market. I wonder if Medicare for all would make it any better.

Everything is a business, for the most part, especially in the U.S./ Medicare for all won't make it any better. Medicare is not a high payor currently compared to private insurance, so fees will take a dip. Also, audit requirements are high and the push for things like requiring EHR when taking insurance means you will lead to join a large practice to amortize the costs. More of the same unless the regulatory environment changes drastically.

 

[R. Matey]

So I'd like to note that what you've said partially reflects regional differences.

This is true. I've lived in a few places and can speak to this. In cities with numerous M.A. in counseling programs, I've seen similar to what you're describing. A flooding of LPCs with no work for LPCs. In other places (e.g.: smaller cities and towns), I've seen people desperate for ANY mental health providers and have seen LPCs do quite well. I've mentioned elsewhere that I was an LPC before becoming a psychologist. When I was living in a less populated state and was licensed as an LPC in said state, I used to receive recruitment flyers in the mail! That never happened when I was living the trendy coastal life.

 

[R. Matey]

I always found the idea of paid supervision to be greasy.

Alas, many LPCs don't have a choice. I've yet to encounter a structured training experience for M.A. graduates seeking licensure. I'm not sure they exist.

 

[Danagirl]

Non compete clauses for social work interns and new licensees! Wow. So basically they want you to do all the work like at a hospital but they know you are the relationship if you leave clients will want to leave too if they like you. There has to be a loophole if they come of there own volition. Why would I stay as a client with someone I probably never speak to? But then again I am not a lawyer.

 

[WisNeuro]

Not sure about the client fees but I always found the idea of paid supervision to be greasy.

I've only ever given supervision as a part of my job. But, I can see what paid supervision is a thing. Ideally, one gets supervision as part of a structured training experience (internship, postdoc). But, if I were private practice, I probably wouldn't touch supervision, added liability for minimal monetary benefit. And that's just for doctoral students. The training system should have things set in place, like PhD/PsyD internships. Leave it to the "free" market, and this is the inevitable endgame.

 

[R. Matey]

I've only ever given supervision as a part of my job. But, I can see what paid supervision is a thing. Ideally, one gets supervision as part of a structured training experience (internship, postdoc). But, if I were private practice, I probably wouldn't touch supervision, added liability for minimal monetary benefit. And that's just for doctoral students. The training system should have things set in place, like PhD/PsyD internships. Leave it to the "free" market, and this is the inevitable endgame.

My experience is that it's more common at the master's level as there aren't many structured training experiences for people who are post-master's but have not completed their licensing hours.

 

[Therapist4Chnge]

My experience is that it's more common at the master's level as there aren't many structured training experiences for people who are post-master's but have not completed their licensing hours.

Also, collecting hours toward licensure often occurs over multiple years and sometimes to finish hours (job change, supervisor retires, agency cuts supervisor, etc) paying for supervision is needed. I wouldn't do it in private practice (for liability reasons) especially for a new clinical, though it seems much more common at the masters level.

 

[Sanman]

My experience is that it's more common at the master's level as there aren't many structured training experiences for people who are post-master's but have not completed their licensing hours.

There is a reason for that. It is not profitable. This has more to do with payor limitations on reimbursement for trainees than it does anything else.

 

[R. Matey]

There is a reason for that. It is not profitable. This has more to do with payor limitations on reimbursement for trainees than it does anything else.

CMHCs will do it because you can pay an unlicensed master's level clinician nothing to bill Medicaid and then stack them with clients. I've actually been seeing some post-master's fellowships popping up at some UCCs and hospital systems. So, that's cool.

 

[Sanman]

CMHCs will do it because you can pay an unlicensed master's level clinician nothing to bill Medicaid and then stack them with clients. I've actually been seeing some post-master's fellowships popping up at some UCCs and hospital systems. So, that's cool.

CMHCs are non-profit and about the only way to make money with medicaid in many instances is to pay the provider little to nothing after covering overhead and some business profit. There are some niches were medicaid pays alright, but not everywhere. Point being demand means little if you cannot turn a profit based on what they pay you.

 

[R. Matey]

CMHCs are non-profit and about the only way to make money with medicaid in many instances is to pay the provider little to nothing after covering overhead and some business profit

This is literally what happens. I made 10% of my per service fee when I worked in a CMHC. It sucked to learn that. Once I got licensed, I left.

 

[Sanman]

This is literally what happens. I made 10% of my per service fee when I worked in a CMHC. It sucked to learn that. Once I got licensed, I left.

This is why I am not a fan of LCPC degrees. They might have better training in counseling than an MSW, but their lobby sucks and thus they are barred being providers in major insurance markets.

 

[R. Matey]

This is why I am not a fan of LCPC degrees. They might have better training in counseling than an MSW, but their lobby sucks and thus they are barred being providers in major insurance markets.

So agree. It gets a little better for people past licensure, but the opportunities are very limited especially if you live in a desirable area. Most of my friends were still making more with their bachelor's degrees than I was with a master's degree plus two years supervised experience to licensure. As an LPC, most hospitals and VAs wouldn't even look at my application while my social worker counterparts at the CMHC were snatched up by those places. I made a little more when I took a triage position in a walk-in clinic and managed a PP, but it was a lot of hours for such little pay.

People who want to get into this field really need to understand how easily you can be screwed over if you "just want to do therapy" especially at the master's level. At least with MSWs and Ph.Ds, you have the option to do something else.

 

[Sanman]

So agree. It gets a little better for people past licensure, but the opportunities are very limited especially if you live in a desirable area. Most of my friends were still making more with their bachelor's degrees than I was with a master's degree plus two years supervised experience to licensure. As an LPC, most hospitals and VAs wouldn't even look at my application while my social worker counterparts at the CMHC were snatched up by those places. I made a little more when I took a triage position in a walk-in clinic and managed a PP, but it was a lot of hours for such little pay.

People who want to get into this field really need to understand how easily you can be screwed over if you "just want to do therapy" especially at the master's level. At least with MSWs and Ph.Ds, you have the option to do something else.

As someone in psychology that managed teams of people, I can say it doesn't get that much better with a doctorate. I had friends in tech and business doing the same type of jobs as me (mid level manager of a team for a large company) getting paid significantly more because that is the baseline for their fields and I was paid based on the baseline for mine. The numbers are bigger, but it is all relative.

 

[R. Matey]

As someone in psychology that managed teams of people, I can say it doesn't get that much better with a doctorate. I had friends in tech and business doing the same type of jobs as me (mid level manager of a team for a large company) getting paid significantly more because that is the baseline for their fields and I was paid based on the baseline for mine. The numbers are bigger, but it is all relative.

Right, but you can afford food and housing. I've known LPCs to make ~90k, but they're typically rural. In my city there's a bear market on LPCs so that number dwindles to about the average pay without adjusting for the high COL. I'd wager it's the same in other cities. Putting it this way, five years out, more than 50% of the graduating class from my master's program had left the field completely for another industry (including me if you count psychology as a different "industry").

Psychology has problems, but at least there's room for innovation. In terms of ROI, LPCs are just as bad as Psy.Ds.