I was recently asked to speak to a group of psychology students at a university about careers in psychology. I have done so the past few years and greatly enjoy speaking to aspiring students. I have worked as a clinical psychologist for over 20 years, long enough (!) to experience one paradigm shift and enter another with which new therapists are now experiencing with the ongoing contortions of health care reform. How did psychotherapy get here? That’s a story another piece. I want to share some words of advice to the aspiring psychotherapist entering our “field.”
In 1993, before I started grad school, I saw a psychologist for personal issues. I paid his fee with health insurance. I paid 20% of his hourly fee and
However, in 1994, after tremendous academic struggle to “get in” to my Psy.D. program and learning all I needed to learn, the health care “system” was changing. I was confronted with questions: “How” am I going to “practice?” “Who” will pay for my services? “What” are my services? and (of course) “How” I will I support myself (and my wife and small child — I was a nontraditional student at 33!) What was then called an HMO (Health Maintenance Organization) would soon become a PPO (a Preferred Provider Organization). In three letters, the mental health “field” shifted from maintaining health to one in which I (with all my student loans) may or may not be “preferred” by an organization to participate. Over time things got more restrictive. Esteemed psychologists pushed single session “therapy.”
The questions have not gone away for aspiring psychotherapists. Now, however, the field is more populated with different types of psychotherapists. There are social workers, marriage and family therapists, professional counselors. Advances in positive psychology in the last 20 years have led to the tremendous growth in coaching and the human potential “movement” (which I wrote about in a prior blog post). I think the answers may be just as they were with me, don’t be content to just be a therapist. Develop a niche specialty. Work as a behavior analyst. Work as an addictions counselor. Work with families struggling with limited social resources and need parenting support. Grow this niche and present yourself as the expert in this particular field. It may not feel like “doing therapy”, but it may allow you to broaden your skill set and work productively while growing a practice. Try to stay away from taking health insurance which seems less likely to be able to sustain a new practice. You’ll be working far harder and for less than you’re worth. Burnout is likely.
As a clinical and (now) forensic psychologist, I conduct psychological evaluations and consult to the courts, attorneys and public service agencies. I don’t do much “therapy.” In fact, while I worked hard over the past 15 years to get on insurance “panels” as an “in network” provider, I have now begun to shed my alliances with many health care insurers. I am no longer accepting insurance reimbursement for “therapy” in many cases. It’s my own professional paradigm shift but one I charted back in grad school 20 years ago when I realized that psychologists alone perform psychological testing. It’s my niche and having this has allowed me to deepen and broaden my therapy practice. I want the same for you and for you as an aspiring psychotherapist to be able to love your career and, in turn, pass this along to persons with whom you work.
Dr. Geysen is a clinical and forensic psychologist in Glastonbury, Connecticut. Learn more about him at www.drgeysen.com