"Two roads diverged in a yellow wood,
and sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth;"
- from Robert Frost's "The Road Not Taken"
Now that October is here I'm beginning to believe that the Fall is upon us. The leaves are turning colors and the air has become finer and colder. This is the time of year for School. What better time of year than this to discuss schooling for the mental health professions? While I can't do justice to this huge, complex and important topic, I can at least share some knowledge and opinions I've formed over the years in the hope that they might be worth something to someone.
Here are some general things to know about a career in the mental health professions. They may seem obvious but I think they are not.
- Being a mental health professional is a job (it is not like being a friend or a causal Samaritan). It has all the ups and downs of any job.
- Being a mental health professional is a very hard job as it is emotionally demanding in a way that few other jobs are. This is one job you cannot fake your way through.
- You will generally be able to wake up in the morning and want to go to work.
- You will not get your needs met by your patients. Most of the time they will not be grateful.
- You will not be well paid compared to your peers.
- There are many therapists in the world right now. You may have some difficulty finding your way to a steady income.
- You will probably work within a group or organization that will both guide and limit what you do.
- Strangers will begin to attribute the ability to read minds to you and in general may treat you as having magic powers. This can be alienating.
- You won't be able to cure anyone (You won't actually have any magic powers) but you will see improvements in the lives of the people you help.
In sum - The rewards will be mostly intrinsic and not extrinsic. You get to feel like you've done something valuable rather than getting paid a lot of money.
There are three main paths that I will outline. These paths are:
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- Psychiatry (MD)
- Clinical Psychology (Ph.D/Psy.D./Ed.D.)
- Social Worker/Master's Level Counselor (MA/MS).
Doctoral Level Clinicians
A psychiatrist is a doctor of medicine(MD), while a psychologist is a doctor of philosophy (Ph.D.) or of psychology (Psy.D.), or of education (Ed.D). All of these degrees generally require between 4-8 years of schooling beyond graduation from college. These days a psychiatrist is sort of like a specialized internal medicine doctor who has focused on those medicines and procedures useful in treating mental disorders. Most psychiatrists get only minimal psychotherapy training if at all. A clinical psychologist (Ph.D. or Psy.D., sometimes Ed.D) is a doctor who has specialized in psychotherapy and assessment of psychological problems. Most of the time a psychologist with the Ph.D. behind his or her name has also had scientific research training (where the Psy.D. has not). Because of the way that things are set up in the western world, the MD is almost always placed in charge of things. If you are a psychologist working with a psychiatrist you will almost always be working under the psychiatrist (at least within an organization of any size). This is a deeply entrenched cultural practice reflecting our underlying cultural belief that medical solutions are more primary (better?) than behavioral solutions. Lest you think that the psychiatrists have it easy here, consider that psychiatry is generally thought of as the lowest in status of all medical specialties (I am told). Give me human beings and I'll show you a pecking order.
To become a mental health doctor - a psychiatrist or a psychologist - you will want to do the following:
- Start early. If you haven't started by your sophomore year of college you are already late. Best to start in high school.
- Have a college grade point average as close to 4.0 as possible.
- Do well on the GRE and/or MCAT tests.
- Join honor and professional societies.
- Do extracurricular activities that document your interest in the field.
- Do research whenever possible (become a research assistant by going to your university department of biology, chemistry or psychology and asking if any of the professors need assistants. I can't emphasize this one enough. The name of the game is "letters of recommendation". If you don't know at least three people in the field who aren't related to you who are willing to say you are wonderful you are out of luck. Being a research assistant is a good way to develop the relationships you will need to get these letters (and to pick up some excellent science skills along the way!). Also - when you get into the lab - become the most valuable assistant there by doing more than they ask you to do.
- Apply widely to as many programs as possible. Be willing to move to attend the program where you get in.
- Be willing to sacrifice your personal life during the schooling process which will require the lion's share of your energy.
Master's Level Clinicians
If you aren't willing or able to meet the criteria above (and many people are legitimately not willing) but you want to work in mental health, consider a masters' level program such as one in Clinical Social Work. This is actually the degree of choice for many people as it affords a solid education and quite good employment prospects with much more reasonable up front requirements. Generally, this type of degree requires between 1 and 2 years of schooling beyond college with training focused on performing psychotherapy as well as other aspects of social work. You don't have to be a straight "A" student (although you do have to be a good one). If you want to be doing legitimate psychotherapy, aren't hung up about status or salary, and don't want to devote half a decade or more of your life to school this is the degree for you. Other good masters' level or comparable programs exist too (such as in Psychiatric Nursing, and some Licensed Professional Counselor programs).
To Be Avoided...
What I do caution people to stay away from are the ample opportunities to cheat - to practice psychotherapy with false or misleading credentials. Anyone can (and many do) call themselves psychotherapists (as no law protects this term). Others can (and do) get legal but questionable credentials - sometimes even from mail order programs. Several popular and prominent "psychologists" of our day (who shall be nameless here) have taken this path. Let the buyer beware.
If you do decide to take the plunge - consider the following tip. In my experience many people want to become mental health professionals because of difficulties that they or their family members have faced. This a perfectly valid reason for wanting to do this work. However, the bias against mental illness embedded in our culture is also at work in our interviewing scenarios. Don't tell your interviewer about your drinking problem or your severe depression (in remission) or your personal rape experience. Interviewers generally want you to have the judgment to not spill your personal motivations all over the floor in a public interview setting. In general, stick with your less intimate reasons for wanting to enter the field or acknowledge them only in passing.
Summary and Recommendation:
Our culture has embraced the idea that medicines are the best way to cure our ills. Despite evidence that psychotherapies often produce equal (and often superior) results for mental health problems compared to medicines, medicines rule. Managed care and the pharmacy companies are deeply invested in this way of thinking. The ideal employment pattern in this environment is a few expensive psychiatrists (who can dispense meds) and a whole lot of cheap social workers (or equivalents) who can do therapy. This is an environment hostile to psychologists who are simply not cost effective as treatment providers compared to masters' level clinicians.
If you are going into the mental health field today my recommendation is that you aim for becoming either a psychiatrist (MD) or a clinical social worker or equivalent. If you are concerned about salary, prestige, and/or you just love biology then aim for becoming a psychiatrist. You won't get trained to be a competent therapist in medical school - but you can learn that later on if you are so inclined. If prestige and salary aren't that important to you and you want to do therapy but you don't want to sacrifice a big chunk of your life to school then aim for social work school. I don't recommend psychology school for anyone except people who simply must have the best training available (at any cost) for how to do and think critically about psychotherapy.
Mark Dombeck, Ph.D.
Dombeck, M.J. (Oct 1999). So You Want To Be A Mental Health Professional. [Online].