What does a successful career look like that features no therapy caseload work?

[therow]

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I’m a current clinical psychology PhD student in their 3rd year going through a bit (a lot) of an existential crisis regarding my career choice, and I was hoping for some guidance from more experienced professionals out in the field. I feel as though I hate being a therapist, no matter what orientation I try to lean into it has not gotten any better in the 1.5 years I’ve been one. Sitting with others in open ended psychotherapy for 50 minute sessions has proved to be incredibly anxiety provoking, far from personally compelling or meaningful, and I have so often felt lost on how to respond or empathetically listen to clients. I now believe it’s been a key catalyst in the depression I’ve been experiencing the last year, and I want to finally decide that I will not be a therapist after graduate school for my own sake and that of any potential patients. I’m trying to come to terms that it’s simply not a good fit for me. My worry is almost all successful LPs in the area seem to all have outpatient therapy caseloads



That being said, is it realistically feasible to be a full time clinical psychologist without doing much of any therapy without compromising much on stable income (hoping to make 120-150 or so, which I know is reasonable in my area). I love psychological assessment and am soon starting practicum at a neuropsychological assessment site, and I hope to lean more into that, but I have heard that a full time assessment gig is hard on financial security in comparison to a weekly caseload, but I wanted to ask the perspectives on others on that. It’s worth mentioning that I don’t care to go the academic route as well for several reasons I’ve been sure of since before graduate schools. I enjoy working with patients, just not as a therapist. Supervision and adjunct teaching are interesting too down the line as supplementary work though not as well paying. While I am considering looking into pursuing neuropsychological specialization, I don’t want to bank on that due to competitiveness, and assuming I don’t go down that route, how reasonable is it to hope I can achieve a well paying and secure career with this degree without doing therapy? What should I aim to do now for achieving such a route? For any who have achieved this or seen it, what does it look like (employed, private practice etc)? Thank you all

 

[futureapppsy2]

What assessment experience do you have currently? You can totally make a good—and often better—wage doing assessment over therapy, but there may be similar components to the history gathering or feedback processes that mirror what you don’t like in therapy.

 

[therow]

What assessment experience do you have currently? You can totally make a good—and often better—wage doing assessment over therapy, but there may be similar components to the history gathering or feedback processes that mirror what you don’t like in therapy.

Mainly ADHD/personality assessment/differential diagnosis at the university clinic. Your point is well taken but I don’t mind, honestly enjoy clinical interviews. There is a more stuctured and less ambiguous purpose to the meeting that guides what I’m to say next. In fact, assessment feedback sessions have been the most exciting and fulfilling clinical work I’ve done, while therapy sessions fill me with intense anxiety. Most of my cohort has had the opposite experience

I feel as though no matter the type of assessment, the inherent structure of an evaluative clinical encounter is what draws me as opposed to extended psychotherapy sessions where it feels so much more on the fly, if that makes sense. My worry is, how realistic are careers that are entirely assessment based. I’ve heard mixed things and worry about stability

 

[futureapppsy2]

Mainly ADHD/personality assessment/differential diagnosis at the university clinic. Your point is well taken but I don’t mind, honestly enjoy clinical interviews. There is a more stuctured and less ambiguous purpose to the meeting that guides what I’m to say next. In fact, assessment feedback sessions have been the most exciting and fulfilling clinical work I’ve done, while therapy sessions fill me with intense anxiety. Most of my cohort has had the opposite experience

I feel as though no matter the type of assessment, the inherent structure of an evaluative clinical encounter is what draws me as opposed to extended psychotherapy sessions where it feels so much more on the fly, if that makes sense. My worry is, how realistic are careers that are entirely assessment based. I’ve heard mixed things and worry about stability

There’s a definite market for ADHD assessment, especially if you gain some experience in ASD assessment as well.

 

[therow]

What assessment experience do you have currently? You can totally make a good—and often better—wage doing assessment over therapy, but there may be similar components to the history gathering or feedback processes that mirror what you don’t like in therapy.

There’s a definite market for ADHD assessment, especially if you gain some experience in ASD assessment as well.

To your knowledge, are most practitioners who make a primary living in this area doing so through their own private practices, or as apart of larger organizations?

 

[Therapist4Chnge]

Most are PP, especially if they also do legal work.

 

[therow]

Most are PP, especially if they also do legal work.

Any thoughts on the best way to break into the forensic sphere? I’ve already had my practicum oppertunies pass me up

 

[AcronymAllergy]

Any thoughts on the best way to break into the forensic sphere? I’ve already had my practicum oppertunies pass me up

Depends on what type of forensic work, but broadly speaking, you still have time to focus on it during internship and, possibly, fellowship. After that, mostly peer-to-peer consultation/supervision and lots of self-study.

 

[ForensicPsychFightClub]

Will add my two cents for forensics: I am currently in civil (which I would not recommend starting out in, as it is much more adversarial) but did my internship training in criminal forensic assessment - much more accessible as there are plenty of state hospital, correctional, and forensic consortium sites which offer training. That work - criminal forensic evaluations - is most typically done with no intervention requirement. Many places offer a starting salary comfortably within your quoted range, as well as (usually) having great benefits and potentially qualifying for public student loans forgiveness - whatever that counts for given the current administration. A common career path is individuals work doing competency evaluations, and after a few years when they feel experienced, can supplement their criminal caseload with private practice work, if not transitioning to private practice entirely.

If you would like to learn more about these types of evaluations, consider seeing if your school library has this book. It’s a very comprehensive overview of major forensic evaluations.

 

[PsyDr]

A. It sounds like you are getting exposed to the standard outpatient, worried well, etc caseload. There are tons of other options.

1) Neuropsychology/rehab psychology- it is easier to get into rehab psych. You could also work in nursing homes, with brief consults.
2) Forensic psychology- you could do assessment or time limited manualized treatment. I know a person that makes a killing in applying some manualized group therapy program to first time DWI people. I know another dude that makes a killing doing manualized treatment of sex offenders.
3) Psychiatric hospitals- If you live in some states, you can admit patients. I know a guy that makes a lot of money just doing that. I also know a guy who makes an average amount of money doing that. Alternatively, the median length of stay in a psychiatric hospital is like 3-5 days. Maybe you do assessments, maybe you do brief solution focused therapy with people you never see again. It is not like open ended psychotherapy.
4) RxP- you could do something related to prescribing.
5) Respecializing in IO

B. You mention stability a lot. I'm gonna be blunt here. There is no reason you can't make a very decent living as a psychologist. However, there is some significant skew in the reported numbers that are caused by part timers. The available stats seem to indicate that 17% of psychologists are working on a part time basis. The largest groups of part timers are:

1) The elderly who are working part time in retirement. 15% of psychologists are over 65+ years of age. 60% of the male part timers are "retired". You can't tell me that their part time work doesn't skew things. Maybe they just can't give it up, maybe they are working for insurance, maybe they're tenured and don't care about how their actions affect the youngsters. It also seems to indicate that men are pretty bad at creating a life outside of work.

2) The mommy/caretaker track. 72% of psychologists are female. 45% of the female part timers are doing so due to "family responsibilities". Maybe that's parenting, maybe it's taking care of elderly parents, who knows. But we are in a profession, the majority of which is comprised of the gender that gives birth, nurses, and commonly serves as the primary caregiver. Right or wrong, that affects income.

 

[therow]

Will add my two cents for forensics: I am currently in civil (which I would not recommend starting out in, as it is much more adversarial) but did my internship training in criminal forensic assessment - much more accessible as there are plenty of state hospital, correctional, and forensic consortium sites which offer training. That work - criminal forensic evaluations - is most typically done with no intervention requirement. Many places offer a starting salary comfortably within your quoted range, as well as (usually) having great benefits and potentially qualifying for public student loans forgiveness - whatever that counts for given the current administration. A common career path is individuals work doing competency evaluations, and after a few years when they feel experienced, can supplement their criminal caseload with private practice work, if not transitioning to private practice entirely.

If you would like to learn more about these types of evaluations, consider seeing if your school library has this book. It’s a very comprehensive overview of major forensic evaluations.

Thank you for the book recc, I’ll definitely check it out

 

[BuckeyeLove]

Find a state hospital job. Doing it 10 years now and you won’t find much chiller work with solid compensation and pretty amazing benefits (some better than others depending on the state). Youll likely have time to do other work as well.

 

[Sanman]

1. Define successful for us. Everyone has a different definition. For some people that is making bank in clinical practice, for others it may mean full tenure academia, for others it is being the next Dr. Phil.

2. Pretty much anyone working full-time hours and seeing patients in any capacity can make $120-150k even taking insurance. What you will realize in the future is that this is not much money. Most cops in higher income municipalities, states, or the federal government make this. Most plumbers working for themselves make more than this.

3. If you like assessment, it is time to figure out what kind of evals you want to do (ADHD, Autism, neuropsych, surgical clearance, transplant, sex offender, child custody, disability, educational, etc.)

4. As a psychologist in training, do you tell your patients to avoid everything that causes them anxiety?

 

[therow]

1. Define successful for us. Everyone has a different definition. For some people that is making bank in clinical practice, for others it may mean full tenure academia, for others it is being the next Dr. Phil.

2. Pretty much anyone working full-time hours and seeing patients in any capacity can make $120-150k even taking insurance. What you will realize in the future is that this is not much money. Most cops in higher income municipalities, states, or the federal government make this. Most plumbers working for themselves make more than this.

3. If you like assessment, it is time to figure out what kind of evals you want to do (ADHD, Autism, neuropsych, surgical clearance, transplant, sex offender, child custody, disability, educational, etc.)

4. As a psychologist in training, do you tell your patients to avoid everything that causes them anxiety?

I’ll start with 4. I’m trained psychodynamically(probably contributes ti feeling so frustrated with the ambiguity of therapy work) but I’ve personally made ACT principles a cornerstone of my approach. And exposure to anxiety is really only on the table IF it is in accordance with a valued aspect of life. It’s been over a year and I just honestly hate this work. Unguided open ended outpatient therapy is something I dread and it is incompatible with personal qualities of mine I have no desire to change from an ACT pov. This deep in I think it’s not wrong to be honest with myself about that.

Rant over, but when I say success, what I really worry about with evals is consistent caseload. In all these assessment areas, if I decide, I will do no therapy, is there enough business to find in these areas? Is there truly enough demand a typical clinical psychologist with the right experience can tap into for a stable source of income?

 

[Sanman]

I’ll start with 4. I’m trained psychodynamically(probably contributes ti feeling so frustrated with the ambiguity of therapy work) but I’ve personally made ACT principles a cornerstone of my approach. And exposure to anxiety is really only on the table IF it is in accordance with a valued aspect of life. It’s been over a year and I just honestly hate this work. Unguided open ended outpatient therapy is something I dread and it is incompatible with personal qualities of mine I have no desire to change from an ACT pov. This deep in I think it’s not wrong to be honest with myself about that.

Rant over, but when I say success, what I really worry about with evals is consistent caseload. In all these assessment areas, if I decide, I will do no therapy, is there enough business to find in these areas? Is there truly enough demand a typical clinical psychologist with the right experience can tap into for a stable source of income?

Who says this is the only way to practice psychotherapy? Plenty of time limited individual, couple, and group therapy options. That is different from no therapy ever. ForVery few places allowing open ended anymore anyway.

As for the assessment question, there are plenty of folks making a living just on assessments on this board. However, this all requires some additional training opportunities. Hence point 3 in my previous post.

At this point, I am just going to assume you attend Adelphi because it would explain a lot.

 

[therow]

Who says this is the only way to practice psychotherapy? Plenty of time limited individual, couple, and group therapy options. That is different from no therapy ever. ForVery few places allowing open ended anymore anyway.

As for the assessment question, there are plenty of folks making a living just on assessments on this board. However, this all requires some additional training opportunities. Hence point 3 in my previous post.

At this point, I am just going to assume you attend Adelphi because it would explain a lot.

Incorrect assumption there lol, but my perception is probably influenced greatly by my local area and supervisors my cohort and I have had, which all seem to have PP caseloads on top of whatever else. I haven’t had the opportunity to do shorter term treatment within an institution much so I can’t speak on my feelings on it.

Would you care to share what your assumption “explains”? I sense some judgement there

 

[Sanman]

Incorrect assumption there lol, but my perception is probably influenced greatly by my local area and supervisors my cohort and I have had, which all seem to have PP caseloads on top of whatever else. I haven’t had the opportunity to do shorter term treatment within an institution much so I can’t speak on my feelings on it.

Would you care to share what your assumption “explains”? I sense some judgement there

Explains that. Adelphi/Derner is a very psychodynamic program where folks start out in their in house clinic. There are only a handful of other programs I can think of where you would be in your third year and have such limited exposure to both assessment and short term psychotherapy treatment. IMO, your program is doing you a disservice in preparing you poorly for the modern psychology job market.

 

[therow]

Explains that. Adelphi/Derner is a very psychodynamic program where folks start out in their in house clinic. There are only a handful of other programs I can think of where you would be in your third year and have such limited exposure to both assessment and short term psychotherapy treatment. IMO, your program is doing you a disservice in preparing you poorly for the modern psychology job market.

Thanks for the perspective. Can you describe at a glance what, in your view, that modern psychology job market is?

 

[Sanman]

Thanks for the perspective. Can you describe at a glance what, in your view, that modern psychology job market is?

Unless folks are paying cash, no one is doing open ended, non-directive therapy. In clinical work, things are more time limited and goal oriented for psychotherapy.

If doing assessments for insurers, briefer and more limited in scope is also the rule. Assessment rules vary more by referral needs and associated legal requirements (forensic, accommodations for educational purposes, etc).

If all you are getting is the therapy experience you mentioned above and some basic general assessment training, that is limited in application. Ask around here and how many folks routinely give a TAT or Roschach in practice.

 

[docloufan]

Unless folks are paying cash, no one is doing open ended, non-directive therapy. In clinical work, things are more time limited and goal oriented for psychotherapy.

If doing assessments for insurers, briefer and more limited in scope is also the rule. Assessment rules vary more by referral needs and associated legal requirements (forensic, accommodations for educational purposes, etc).

If all you are getting his therapy experience you mentioned above and some basic general assessment training, that is limited in application. Ask around here and how many folks routinely give a TAT or Roschach in practice.

Agree. Open ended, non-directive therapy is not sustainable other than at a private practice, and with those not on Medicaid. Agencies have to have access availability for new patients. In these systems, you have to be moving all but the most SPMI cases along in the treatment process. Which includes discharge goals and planning from almost day 1 of OP tx. Insurers are also, rightly, not going to pay for that. Targeted, goal-directed treatment is how it needs to be done outside ones own PP. There will be very few exceptions to this.

This is 2025. No one needs a Rorschach or TAT to help plan their treatment. The field has progressed.

 

[cara susanna]

Locally, the only job psychologists can get with large healthcare systems (outside of the VA) is by doing testing

 

[docloufan]

I have no desire to change from an ACT pov. This deep in I think it’s not wrong to be honest with myself about that.

BTW. You can be "true to yourself" or whatever as much as you want, but inflexibility at such a junior stage is not going to serve you well in this (or any) career. Especially being married to ACT??? Its just not going to really fit with a broad population. There are times where it fits...and many times where it just, wont. Depends on the problems, AND the patient too. You have to be more flexible than that to be deemed a decent (or desired) psychotherapist. One trick pony stuff isn't going to cut it out there on the job market.

Ambiguity with therapy work is always going to be there. Always. Even with the most structured of therapy protocols (e.g., PE, PST). So, I can agree that maybe psychotherapy isn't for you? But it also doesn't sound like you have real breadth and depth of exposure to psychotherpay...as it actually has to be practiced in most all employed settings.

 

[cara susanna]

I’ll start with 4. I’m trained psychodynamically(probably contributes ti feeling so frustrated with the ambiguity of therapy work) but I’ve personally made ACT principles a cornerstone of my approach. And exposure to anxiety is really only on the table IF it is in accordance with a valued aspect of life. It’s been over a year and I just honestly hate this work. Unguided open ended outpatient therapy is something I dread and it is incompatible with personal qualities of mine I have no desire to change from an ACT pov. This deep in I think it’s not wrong to be honest with myself about that.

Rant over, but when I say success, what I really worry about with evals is consistent caseload. In all these assessment areas, if I decide, I will do no therapy, is there enough business to find in these areas? Is there truly enough demand a typical clinical psychologist with the right experience can tap into for a stable source of income?

I also hate doing unguided open therapy, but the good news is you don't have to! If you get the right job, you can just do EBPs with structured protocols all day long. And even if you aren't doing a protocol-based therapy, you can still structure sessions (in fact, it's recommended to do that regardless). If the person doesn't have anything they want to work on or do, then you end the session (and possibly the episode of care).

Isn't exposure in therapy always going to be in accordance with a valued aspect of life? They're in your office because they have goals. And why else would anyone do exposure? It's not a fun time.

 

[Therapist4Chnge]

As someone who literally counted down the days I had left before I could stop all therapy interventions….it’s 13+ yrs later and I actually still do some therapy-adjacent work. A lot of injury-related education and time-limited goal-based intervention work found me bc I like do the initial assessments and refer out. Neuro psych, Rehab psych, and Primary Care are all areas where there are intervention options that are not trad therapy.

Manualized treatments were helpful to learn during training, especially for therapy adjacent work: smoking cessation, medication compliance, and related behaviorally-based interventions with strong empirical support.

EAPs (employee assistance programs) are an interesting niche too, as they usually span 3-6 sessions and by design are short-term interventions.

You still have plenty of time, so definitely explore your options and be open to multiple approaches bc you might stumble across a mix that works for you.

 

[PsyDr]

I’ll start with 4. I’m trained psychodynamically(probably contributes ti feeling so frustrated with the ambiguity of therapy work) but I’ve personally made ACT principles a cornerstone of my approach. And exposure to anxiety is really only on the table IF it is in accordance with a valued aspect of life. It’s been over a year and I just honestly hate this work. Unguided open ended outpatient therapy is something I dread and it is incompatible with personal qualities of mine I have no desire to change from an ACT pov. This deep in I think it’s not wrong to be honest with myself about that.

Rant over, but when I say success, what I really worry about with evals is consistent caseload. In all these assessment areas, if I decide, I will do no therapy, is there enough business to find in these areas? Is there truly enough demand a typical clinical psychologist with the right experience can tap into for a stable source of income?

1) you understand that REBT, CBT, and arguably Reality therapy, logo therapy, and humanistic therapy started because people were frustrated with psychodynamic, process oriented results… right? Ellis, Glasner, Beck were all piiiiiiiiiised at psychodynamic approaches. Rogers just approached it with the “you don’t know where I’ve been Lou”/Ghandi “I’ll let you beat me into you feel bad about it” tack. Long story short: there’s a lot of people that started out with your dissatisfaction. Even if you don't like those therapy modalities, I'd encourage you to read some news articles about the personalities of those individuals.

2) Go look up psychology jobs on indeed or psychcareer or wherever. Look at the preferences for “trained in”. Near zero jobs say psychodynamic.

 

[AcronymAllergy]

I've said it before in other threads, but I could keep myself booked indefinitely just by accepting adult ADHD and ASD evaluation referrals. Couple that with CBT-I or any kind of psychotherapy for depression/anxiety and I'd need two of me to keep up.

 

[clausewitz2]

BTW. You can be "true to yourself" or whatever as much as you want, but inflexibility at such a junior stage is not going to serve you well in this (or any) career. Especially being married to ACT???

It's interesting that allegiance to a therapeutic modality that is about psychological flexibility above all can turn into "everything must be this way forever".

 

[futureapppsy2]

It's interesting that allegiance to a therapeutic modality that is about psychological flexibility above all can turn into "everything must be this way forever".

One of my ABA friends described ACT as “a cult” once, and, while I wouldn’t go that far, some people definitely do approach at with an almost religious fervor. (Also, Steve Hayes did not independently discover mindfulness in the 1970s, ffs 🤦‍♀️).

 

[cara susanna]

1) you understand that REBT, CBT, and arguably Reality therapy, logo therapy, and humanistic therapy started because people were frustrated with psychodynamic, process oriented results… right? Ellis, Glasner, Beck were all piiiiiiiiiised at psychodynamic approaches. Rogers just approached it with the “you don’t know where I’ve been Lou”/Ghandi “I’ll let you beat me into you feel bad about it” tack. Long story short: there’s a lot of people that started out with your dissatisfaction. Even if you don't like those therapy modalities, I'd encourage you to read some news articles about the personalities of those individuals.

2) Go look up psychology jobs on indeed or psychcareer or wherever. Look at the preferences for “trained in”. Near zero jobs say psychodynamic.

I'm curious, do we know why Ellis and Beck were pissed off at psychodynamic therapy? I hadn't heard this before (although it makes sense!)

 

[R. Matey]

I'm curious, do we know why Ellis and Beck were pissed off at psychodynamic therapy? I hadn't heard this before (although it makes sense!)

Beck was a numbers guy and to him the numbers didn't add up. Ellis found his own methods more effective (i.e., that central park story you've probably heard a thousand times).

 

[Sanman]

One of my ABA friends described ACT as “a cult” once, and, while I wouldn’t go that far, some people definitely do approach at with an almost religious fervor. (Also, Steve Hayes did not independently discover mindfulness in the 1970s, ffs 🤦‍♀️).

Some people would consider that the pot calling the kettle black,lol. I personally have no problems with either ABA or ACT.

 

[ClinicalABA]

I’m a current clinical psychology PhD student in their 3rd year going through a bit (a lot) of an existential crisis regarding my career choice, and I was hoping for some guidance from more experienced professionals out in the field. I feel as though I hate being a therapist, no matter what orientation I try to lean into it has not gotten any better in the 1.5 years I’ve been one. Sitting with others in open ended psychotherapy for 50 minute sessions has proved to be incredibly anxiety provoking, far from personally compelling or meaningful, and I have so often felt lost on how to respond or empathetically listen to clients. I now believe it’s been a key catalyst in the depression I’ve been experiencing the last year, and I want to finally decide that I will not be a therapist after graduate school for my own sake and that of any potential patients. I’m trying to come to terms that it’s simply not a good fit for me. My worry is almost all successful LPs in the area seem to all have outpatient therapy caseloads



That being said, is it realistically feasible to be a full time clinical psychologist without doing much of any therapy without compromising much on stable income (hoping to make 120-150 or so, which I know is reasonable in my area). I love psychological assessment and am soon starting practicum at a neuropsychological assessment site, and I hope to lean more into that, but I have heard that a full time assessment gig is hard on financial security in comparison to a weekly caseload, but I wanted to ask the perspectives on others on that. It’s worth mentioning that I don’t care to go the academic route as well for several reasons I’ve been sure of since before graduate schools. I enjoy working with patients, just not as a therapist. Supervision and adjunct teaching are interesting too down the line as supplementary work though not as well paying. While I am considering looking into pursuing neuropsychological specialization, I don’t want to bank on that due to competitiveness, and assuming I don’t go down that route, how reasonable is it to hope I can achieve a well paying and secure career with this degree without doing therapy? What should I aim to do now for achieving such a route? For any who have achieved this or seen it, what does it look like (employed, private practice etc)? Thank you all

Current gig (past 11 years)-
Monday- Intake appointments
Tuesday-Thursday- Autism Diagnostic Assessments
Friday- Report writing, more assessments, or take day (or part of it) off.
Scattered throughout week- staff supervision (ABA stuff). I can do some direct ABA treatment for extra $$$ (beyond salary) if I want, but my choice
Scattered throughout the month- adjunct teach in a hybrid masters/Ph.D. probram (ABA)

Salary (contingent upon minimum billables in the low 20 hours per week) easily in the range you gave before doing any ABA treatment or supervision. Bonuses for higher productivity. Bonused for publication. Partial student loan reimbursement from company adds more $$$. Company pays for all licenses and certifications (3 licenses, one certification), and all CEUS. Some of that latter stuff is negotiable and, honestly, because I'm reliable, have been doing this for awhile, have good professional and clinical skills, and- gosh darnit- people like me (which comes from being reliable, good clinically and professionally, consistently offer to solve problems rather than make them, etc.). It may take awhile to get to the point in your career where such things are available to you, but they are definitely possible (and at least worth asking for).

In the past, I have had pure administrative jobs (e.g. program director of a private school for children with acquired brain injury; Director of Operations for an ABA agency; Clinical Director of an adult residential program for clients with ID) that did not involve any mandatory therapy provision.

 

[ClinicalABA]

One of my ABA friends described ACT as “a cult” once, and, while I wouldn’t go that far, some people definitely do approach at with an almost religious fervor. (Also, Steve Hayes did not independently discover mindfulness in the 1970s, ffs 🤦‍♀️).

I'm sort of an ABA guy, and I would describe ACT as being primarily based on principles of ABA. If you want to be jerk, ask said ABA friend for a description relational frame theory, stimulus equivalence and derived verbal behavior, etc.

I can see the cult stuff though. Even with approaches that are empirically derived and "proven," there seems to be a human need to "appeal to authority" and assign guru-like status to the big names, whether that's intended that (Hayes?) or not (Linehan; Skinner).

 

[borne_before]

B. You mention stability a lot. I'm gonna be blunt here. There is no reason you can't make a very decent living as a psychologist. However, there is some significant skew in the reported numbers that are caused by part timers. The available stats seem to indicate that 17% of psychologists are working on a part time basis. The largest groups of part timers are:

1) The elderly who are working part time in retirement. 15% of psychologists are over 65+ years of age. 60% of the male part timers are "retired". You can't tell me that their part time work doesn't skew things. Maybe they just can't give it up, maybe they are working for insurance, maybe they're tenured and don't care about how their actions affect the youngsters. It also seems to indicate that men are pretty bad at creating a life outside of work.

2) The mommy/caretaker track. 72% of psychologists are female. 45% of the female part timers are doing so due to "family responsibilities". Maybe that's parenting, maybe it's taking care of elderly parents, who knows. But we are in a profession, the majority of which is comprised of the gender that gives birth, nurses, and commonly serves as the primary caregiver. Right or wrong, that affects income.

What PsyDr is saying is that a lot of people in the psychology hustle are not serious people (for whatever reason) who do not hustle (for some good reasons likely) or who do not feel the need to take the game seriously and full time. In my niche, I've observed a certain type of psychologist who seems to stop working much after they practiced for a few years. It almost seemed like they wanted the clout instead of the ability to contribute.

 

[futureapppsy2]

I'm sort of an ABA guy, and I would describe ACT as being primarily based on principles of ABA. If you want to be jerk, ask said ABA friend for a description relational frame theory, stimulus equivalence and derived verbal behavior, etc.

I can see the cult stuff though. Even with approaches that are empirical derived and "proven," there seems to be a human need to "appeal to authority" and assign guru-like status to the big names, whether than intended that (Hayes?) or not (Linehan; Skinner).

I have nothing against ACT personally and use it a decent bit clinically as a behaviorist/ABA trained person), but I do think the cult of personality around Hayes (and others, Hayes is just the one I have the most exposure to) can get a bit much.

 

[borne_before]

Some of that latter stuff is negotiable and, honestly, because I'm reliable, have been doing this for awhile, have good professional and clinical skills, and- gosh darnit- people like me (which comes from being reliable, good clinically and professionally, consistently offer to solve problems rather than make them, etc.). It may take awhile to get to the point in your career where such things are available to you, but they are definitely possible (and at least worth asking for).

My god, @ClinicalABA basically dropped the Unified Field Equation of Career Success for psychs.

Here's the equation:

Career Success = (core skills) × (human factor)

Note: It’s multiplicative, not additive. That means if one side tanks, the whole thing tanks. Good news is weak aspects can be made up with strengths, but some weights are much higher.

The first factor are the core skills = (experience + clinical ability + professionalism)

• experience = been around the block a bit, not your first intake, don't get scared easily, 30,000 foot view of the field
• clinical ability = you know what you’re doing with actual humans, effectiveness, etc.
• professionalism = dress right, don't create drama, documentation on point, cover your ass, etc.

These can kinda balance each other out. You can be weak in some parts, but as long as you're strong in the others... and no one has a flat profile.

The second factor is the human factor = (reliable + likable + actually helps)

• reliable = you show up, follow through, don’t flake
• likable = people aren’t secretly relieved when you take PTO
• actually helps = you solve problems, you don’t forward them

This is the multiplier. If this part is strong, it boosts the whole thing. If it’s weak? Doesn’t matter how good you are clinically, nobody wants to be in a team meeting with you. Also: being chill under pressure/not blowing up over small stuff? Offering to help? Saying “no” in a way that doesn't make others feelbad? All fo that is high-level likability unlock. Likeability is disproportionally weighted in the human factor.

I'd be interested in other's thoughts on the formula.

 

[ClinicalABA]

My god, @ClinicalABA basically dropped the Unified Field Equation of Career Success for psychs.

Here's the equation:

Career Success = (core skills) × (human factor)

Note: It’s multiplicative, not additive. That means if one side tanks, the whole thing tanks. Good news is weak aspects can be made up with strengths, but some weights are much higher.

The first factor are the core skills = (experience + clinical ability + professionalism)

• experience = been around the block a bit, not your first intake, don't get scared easily, 30,000 foot view of the field
• clinical ability = you know what you’re doing with actual humans, effectiveness, etc.
• professionalism = dress right, don't create drama, documentation on point, cover your ass, etc.

These can kinda balance each other out. You can be weak in some parts, but as long as you're strong in the others... and no one has a flat profile.

The second factor is the human factor = (reliable + likable + actually helps)

• reliable = you show up, follow through, don’t flake
• likable = people aren’t secretly relieved when you take PTO
• actually helps = you solve problems, you don’t forward them

This is the multiplier. If this part is strong, it boosts the whole thing. If it’s weak? Doesn’t matter how good you are clinically, nobody wants to be in a team meeting with you. Also: being chill under pressure/not blowing up over small stuff? Offering to help? Saying “no” in a way that doesn't make others feelbad? All fo that is high-level likability unlock. Likeability is disproportionally weighted in the human factor.

I'd be interested in other's thoughts on the formula.

I think that good clinical skills are the foundation for everything else. The other stuff can only get you so far if you don't know what you are doing with the psychology stuff (or don't have a good enough foundation to figure quickly learn how to address new clinical issues when they come up). Prepare yourself for things you haven't encountered yet. For example, I have a personal goal of reviewing at least 5 peer reviewed journal articles per week. These are often related to clinical issues that I'm dealing with (recent examples have been coprophagia and weaning preschoolers from breastfeeding). Sometimes it's stuff that comes up here. For example, ACT came up on this thread and I haven't read anything current on that in 5+ years so time to fill that knowledge gap. All that said, play well with others is a close second. simply not being a jerk de facto will get you pretty far.

I think it's also important to not conflate "don't cause problems" with "just put your head down and deal with nonsense." Rather, when faced with nonsense, you need to determine if there is something constructive that you have the ability, power, and authority to do to lessen the nonsense (it will never disappear completely). If you don't, then you got to figure out if something unique to your current situation and something you can live with. If not, find another job (which, if you are competent, have good work skills, and aren't a jerk, you should be able to do- there's not enough of us to do the work that needs to be done and a lot of the competition really sucks at at least one of those things). If you find that you need to leave multiple jobs because of nonsense stuff, then carefully evaluate whether or not the problem lies in you.

 

[BuckeyeLove]

Do they still do those cry group sessions? Like in the actual training? No lie it always weirded me out. Like tell me all the ways I’m effing up my life like Fritz Perls and you’re gonna see some longitudinal changes in me. Not so much with ACT.

 

[Sanman]

My god, @ClinicalABA basically dropped the Unified Field Equation of Career Success for psychs.

Here's the equation:

Career Success = (core skills) × (human factor)

Note: It’s multiplicative, not additive. That means if one side tanks, the whole thing tanks. Good news is weak aspects can be made up with strengths, but some weights are much higher.

The first factor are the core skills = (experience + clinical ability + professionalism)

• experience = been around the block a bit, not your first intake, don't get scared easily, 30,000 foot view of the field
• clinical ability = you know what you’re doing with actual humans, effectiveness, etc.
• professionalism = dress right, don't create drama, documentation on point, cover your ass, etc.

These can kinda balance each other out. You can be weak in some parts, but as long as you're strong in the others... and no one has a flat profile.

The second factor is the human factor = (reliable + likable + actually helps)

• reliable = you show up, follow through, don’t flake
• likable = people aren’t secretly relieved when you take PTO
• actually helps = you solve problems, you don’t forward them

This is the multiplier. If this part is strong, it boosts the whole thing. If it’s weak? Doesn’t matter how good you are clinically, nobody wants to be in a team meeting with you. Also: being chill under pressure/not blowing up over small stuff? Offering to help? Saying “no” in a way that doesn't make others feelbad? All fo that is high-level likability unlock. Likeability is disproportionally weighted in the human factor.

I'd be interested in other's thoughts on the formula.

I mostly attribute his success to the facial hair.

 

[ClinicalABA]

I mostly attribute his success to the facial hair.

Yes, but it only works in combination with the lack of hair on top. Also, I can juggle.

 

[Sanman]

Yes, but it only works in combination with the lack of hair on top. Also, I can juggle.

I am intimately familiar with the combination. My juggling skills are only novice level though.

 

[therow]

Agree. Open ended, non-directive therapy is not sustainable other than at a private practice, and with those not on Medicaid. Agencies have to have access availability for new patients. In these systems, you have to be moving all but the most SPMI cases along in the treatment process. Which includes discharge goals and planning from almost day 1 of OP tx. Insurers are also, rightly, not going to pay for that. Targeted, goal-directed treatment is how it needs to be done outside ones own PP. There will be very few exceptions to this.

This is 2025. No one needs a Rorschach or TAT to help plan their treatment. The field has progressed.

I’ll be honest I’ve been disillusioned in grad school because I’ve had the same feelings towards things like the TAT and RPAS. So even if I come out a little behind I’m getting the sense I’m not so different from the field at large, moreso the culture I’m surrounded by. Don’t get me wrong, I’m no defender of where I’ve found myself. Ultimately this all gives me some hope to do more applied and directive work with my psychology knowledge

 

[therow]

As someone who literally counted down the days I had left before I could stop all therapy interventions….it’s 13+ yrs later and I actually still do some therapy-adjacent work. A lot of injury-related education and time-limited goal-based intervention work found me bc I like do the initial assessments and refer out. Neuro psych, Rehab psych, and Primary Care are all areas where there are intervention options that are not trad therapy.

Manualized treatments were helpful to learn during training, especially for therapy adjacent work: smoking cessation, medication compliance, and related behaviorally-based interventions with strong empirical support.

EAPs (employee assistance programs) are an interesting niche too, as they usually span 3-6 sessions and by design are short-term interventions.

You still have plenty of time, so definitely explore your options and be open to multiple approaches bc you might stumble across a mix that works for you.

Thank you, your story ideas and attitude are all reassuring. I do love psychology just not the way I’ve been forced to engage with it so far

 

[therow]

I've said it before in other threads, but I could keep myself booked indefinitely just by accepting adult ADHD and ASD evaluation referrals. Couple that with CBT-I or any kind of psychotherapy for depression/anxiety and I'd need two of me to keep up.

This is exactly the kind of personal accounts I was hoping ti hear. While obviously still premature I did a grad school presentation on CBT I and was fascinated. May I ask what your referral networks consist of and how you cultivated them to get to this position? Genuinely you describe a dream job to me

 

[therow]

It's interesting that allegiance to a therapeutic modality that is about psychological flexibility above all can turn into "everything must be this way forever".

ACT hits home to me for a reason, lol. Lifelong rigidity can be a mountain to chip at. I made this to look for counter evidence for that belief

 

[PsyDr]

What PsyDr is saying is that a lot of people in the psychology hustle are not serious people (for whatever reason) who do not hustle (for some good reasons likely) or who do not feel the need to take the game seriously and full time. In my niche, I've observed a certain type of psychologist who seems to stop working much after they practiced for a few years. It almost seemed like they wanted the clout instead of the ability to contribute.

I think you've identified another subset. I don't disagree, but it's not what I was referring to. I don’t think they’re not serious people, but I agree there is another subset of people who went to grad school for silly reasons (e.g., trying to covertly treat their own mental illness, trying to avoid adulthood, wanting the perceived clout of the title, etc).

I think that some women wisely identify careers that they believe will allow them to be around their children when they are young. If you're gonna breed, it's not a bad move. But that move also requires you to select a mate that can mostly cover your living expenses for however long, which opens the door for prolonged work absence. IMO, that divides into mothers who love the job of being a mom, and mothers who hate the job of being a mother. IMO, the former don't return to work and the latter return ASAP.

I also think our profession is horrible at retirement. Our profession has a low physical demand, a long delay to begin working, and the human mind is bad at thinking exponetially.

I'm curious, do we know why Ellis and Beck were pissed off at psychodynamic therapy? I hadn't heard this before (although it makes sense!)

It was a product of the time. Psychologists weren't licensed at that time, and only MDs were allowed in the psychoanalytic institutions. He somehow conned the Karen Horney Institute into letting him in. So, he was surrounded by a bunch of analysts that were not a big fan of him being there. Additionally, Ellis said that he was pretty active in frotterism in the subways as a teen, so I'm guessing his training analsyis was ....weird. Ellis said that the NYC analysts were too rigid in their approach. No surprise, he said he was a big fan of Marcus Aureulous and Epictitus. It's also possible he just ripped off DuBois, and that his aggression was attempt to make sure that the analysts didn't notice.

 

[AcronymAllergy]

This is exactly the kind of personal accounts I was hoping ti hear. While obviously still premature I did a grad school presentation on CBT I and was fascinated. May I ask what your referral networks consist of and how you cultivated them to get to this position? Genuinely you describe a dream job to me

I should preface by saying I don't actually usually accept the adult ADHD and ASD evaluation referrals; I already have too many "standard" adult neuropsych referrals to even be able to consider them, unfortunately.

My referral sources are a mix of neurology, primary care, psychiatry, and other psychologists. The ADHD and ASD referrals, and the requests to provide therapy, are predominantly from neurology and primary care. At least based on my area, I think it would behoove non-neuropsych psychologists to reach out to neurology (and probably other non-primary care/non-psychiatry) practices to let them know they're accepting patients for psychotherapy. Neurologists are often already used to referring to MH in the form of neuropsych; they see a decent amount of MH-related stuff in their daily practice (e.g., functional neurological conditions, anxiety/poor sleep/depression causing memory concerns, dementia- and stroke-related behavior changes); and they seem to be one of the first points of contact, outside of primary care, to whom patients express MH-related concerns, which includes things like, "I think I have Autism/ADHD."

 

[cara susanna]

I have nothing against ACT personally and use it a decent bit clinically as a behaviorist/ABA trained person), but I do think the cult of personality around Hayes (and others, Hayes is just the one I have the most exposure to) can get a bit much.

coughLinehancough

 

[R. Matey]

I am intimately familiar with the combination. My juggling skills are only novice level though.

This is a winning combination on its own. Juggling skills not required 🙂

 

[therow]

I should preface by saying I don't actually usually accept the adult ADHD and ASD evaluation referrals; I already have too many "standard" adult neuropsych referrals to even be able to consider them, unfortunately.

My referral sources are a mix of neurology, primary care, psychiatry, and other psychologists. The ADHD and ASD referrals, and the requests to provide therapy, are predominantly from neurology and primary care. At least based on my area, I think it would behoove non-neuropsych psychologists to reach out to neurology (and probably other non-primary care/non-psychiatry) practices to let them know they're accepting patients for psychotherapy. Neurologists are often already used to referring to MH in the form of neuropsych; they see a decent amount of MH-related stuff in their daily practice (e.g., functional neurological conditions, anxiety/poor sleep/depression causing memory concerns, dementia- and stroke-related behavior changes); and they seem to be one of the first points of contact, outside of primary care, to whom patients express MH-related concerns, which includes things like, "I think I have Autism/ADHD."

Wonderful perspective, thank you. Lastly, can I ask if the majority of the evaluations you do or the evaluations you would do for ADHD/autism would be private pay or bill under insurance, I’ve heard mixed things on the field about what is most common in assessment private practice