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How to become a Psychotherapist

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Nearly 42 million Americans sought help in 2022 for mental health according to Statista. In times of crisis, loss and major life changes, people turn to psychotherapists to help them get through the dark and confusing times.

What is a psychotherapist?

Psychotherapy, sometimes called “talk therapy,” is often lumped into the broader category of counseling. There are many similarities between these two branches of psychology: they both involve communication between a patient and a therapist, for instance, and they are both intended to address mental illness or distressing emotions.

Generally however, counselors tend to see patients for shorter periods of time and address a specific problem or crisis—grief counseling for instance, or a family or marriage problem.

Psychotherapists, on the other hand, specialize in many therapies. They determine which types of counseling will be most beneficial in helping someone learn to think through an ongoing problem, change a behavior or cope with a major life change. As such interaction with a psychotherapist may last longer or be ongoing.

Some common reasons people seek help from a psychotherapist include:

  • Feeling overwhelmed by daily activities
  • Having explosive or unpredictable emotions
  • Persistently low self-esteem
  • Relationships have become problematic
  • Addiction or an inability to avoid risky behavior

One out of every five adults in the U.S. live with a mental illness, according to the National Institute of Mental Health. Some of these disorders are severe, and can seriously disrupt a patient’s ability to function. Other mental illnesses, while not immediately life-threatening or destructive, still take a toll on a person’s quality of life.

Psychotherapists are solution-focused therapists. They examine the root cause of a person’s symptoms and try to find the best therapy for each individual. A psychotherapist analyzes their patient and then selects a therapy that may help teach healthier habits, or unlearn habits that are causing harm.

If the idea of being a lifeline to someone in their time of need sounds like a mission that resonates with you, a career in psychotherapy might work well for you. It’s an investigative role as well as a therapeutic one. Therapists must ask thoughtful questions, be aware of body language and social cues and think creatively in order to make an authentic connection with their clients.

While this position can be rewarding, psychotherapists must have a strong sense of integrity, a high tolerance for stress and exercise self-control in order to remain composed when clients become emotional or share information that makes them feel vulnerable.

Steps to becoming a psychotherapist

Just as there may be different roles you might be interested in under the umbrella of psychology, there are also many different degrees to pursue. You can explore an MS/MA in counseling, behavior analysis or addiction counseling, to name just a few. It isn’t the specific degree you earn that will determine your outcome, but it is your electives and supervised experiences (called clinical hours) that will define what role you are best suited for.

Earn a master’s or doctoral degree in psychology.

woman sits on floor with books around her and studies

Whether you choose to earn your bachelors, master’s or PhD-level degree in person or online, it’s important to make sure your program is accredited by the American Psychological Association and the Higher Learning Commission.
Undergraduate work will introduce you to the foundations and history of psychology. You’ll have a chance to choose electives that will help you decide what specialties you’re interested in. Expect to spend three to four years after high school completing your undergraduate degree.
In your master’s degree program, you will focus on specific conditions, treatment philosophies and patient populations. You’ll choose your career objectives and career focus with the help of an advisor. Many programs require students to complete a comprehensive research project or thesis in order to graduate.
Some careers in psychotherapy only require an MA/MS, so be sure to ask if your area of interest requires a postgraduate master’s or if you’ll need to continue your education with a doctoral-level degree. Professors and fellow students may be a great resource during this time as you can make professional networking connections when you can ask about their experiences working in psychotherapy. Taken full-time, a master’s degree should take anywhere from one to two years.
For students interested in applying to medical school, a pre-professional program may be a more logical next step (as opposed to a traditional master’s degree program). While both programs focus on specialized studies about disorders and treatment plans, a pre-prof program places greater emphasis on real-world applications specific to a particular discipline such as psychiatry.
While all colleges demand certain requirements to apply, doctoral students will face a competitive application process. Research experience, letters of recommendation, grades and volunteer experience are among the things application committees review when they’re considering your application. If you begin your PhD with an MA/MS degree, your program will likely take three to four years to complete.

Complete supervised clinical experience hours.

group session with male therapist calling on man with raised hand

Sometimes called an internship or practicum, there are a certain number of hours that psychotherapists need to log in order to apply for a license. Students apply to internships like jobs, and the application process is as competitive as graduate program admissions.
The hours you work in your internship or practicum are a requirement to receive a psychotherapy license. During your practicum, you’ll work closely with a licensed therapist to observe how they provide care to patients as well as gain experience delivering care yourself.

Requirements for your practicum will vary by your career specialty and by your state. Psychiatrists, for example, are required to complete medical school, as well as meet residency requirements (which usually take approximately four years to complete). Psychologists, on the other hand, may be required to complete a minimum of 36 months of full-time counseling experience or 3,000 hours of postgraduate mental health counseling.

Complete the appropriate exam and apply for licensure.

woman professional at laptop writing up notes

In order to obtain licensure, you’ll need to complete an exam. Your degree program or state licensing agency can tell you which one, specifically, you’ll take.
The National Counselor Examination for Licensure and Certification (NCE), for instance, is a 200-question, multiple-choice exam administered by the National Board for Certified Counselors. It assesses knowledge, skills and abilities in effective counseling services.
Another exam, the National Clinical Mental Health Counseling Exam (NCMHCE), is made up of 10 clinical mental health counseling cases. It assesses a graduate’s clinical problem-solving ability by testing identification, analysis and treatment. It is also administered by the National Board for Certified Counselors.
The Examination for Professional Practice in Psychology (EPPP) is required for candidates seeking a psychology license after they complete their PsyD or PhD. This 200-question test is industry-standard and covers topics such as assessment, intervention and diagnosis.
You’ll register and sit for whichever exam is right for your career path. Once you complete your exam and submit proof that you’ve completed a degree at an accredited college as well as the practicum hours required, you’re ready to apply for licensure.
It can take time for exams to be processed and sent to licensing agencies. It can also take time for universities to submit proof of completion. Expect a wait time of at least two weeks and up to two months to receive your counseling license after graduation.

Begin your career.

woman therapist listens to client

The journey to becoming a psychotherapist is one that requires pulse checks every few years. You choose degree programs for your bachelors, master’s and doctoral program, so you likely know what you want to do once you graduate. You may even have a good idea about where you want to do it.
Just as your psychotherapy education may have taken place remotely, so can your professional experience.  Following the pandemic, more therapists are embracing the value of remote relationships with their patients. Don’t discount the value of telehealth opportunities as you consider your employment options.
You may also consider joining an established clinic or starting your own counseling service. Different private practices, nonprofits or government organizations have different licensure requirements, so pay close attention to these as you target positions to apply to. Similarly, it’s important to remember that your qualifications are powerful but you still need to apply with thought and care. A degree does not guarantee you a job—employers are hiring a person, not just a license and a degree.

Complete continuing education credits.

woman therapist sits on couch and listens intently

Psychotherapists must complete continuing education credits in order to maintain their licensure. Many states ask that those continuing education credits explore specific topics. For instance, Washington state psychotherapists must complete 36 hours of CE every three years, and six of those must cover ethics and professional law topics.
The number of hours and timeframe can vary. Check the Department of Licensing or Department of Health in your state for details.

What psychotherapists do

Psychotherapist is a broad term that encompasses all kinds of mental health professionals. A psychotherapist’s education places emphasis on the specific therapies that attempt to root out the core of a problem. Most patients spend an extended period of time working with their psychotherapist to identify their specific problem, work through the how and why of it, and then focus on creating habits and behaviors that solve their problems.

Who is this career best suited for

Psychotherapists who can respect their patient boundaries thrive in this role. The process can be slow and requires trust and patience from both the therapist and their client. Because no two patients or their problems are the same, psychotherapists must have a curious mind that enjoys investigating and creative approaches to problem-solving. Stellar listening skills are a must for talk therapists, and an ability to inspire others doesn’t hurt.

Working with patients

The first visit with a patient usually involves an introduction. Clients express the problem they’re having and their goals for therapy. Psychotherapists create goals based on the client’s stated needs.

Appointments typically consist of appointments that last anywhere from 30 to 60 minutes. During sessions, psychotherapists prompt clients with questions, discuss the topics at hand and take notes of insights that are revealed during sessions. When therapists aren’t seeing patients, they may have administrative tasks to complete. They may answer phone calls or emails, bill insurance, type up and organize patient notes or review notes for their next scheduled client.

What does this job look like from a client’s perspective?

A great majority of people who seek out the services of a therapist are bright and highly functional. However, they recognize that they have a problem, or that they’re struggling to overcome one. They may approach therapy from a guarded place (“I don’t really know why I’m here”) or an emotional one (“I just feel so lost”), but they’ve come to therapy to resolve their issues.

Clients want to know how long therapy can expect to take and may ask questions like, “So what’s wrong with me?” Your clinical training will prepare you to give constructive answers and to emphasize that therapy is an unknown, just like any relationship. But it is okay to give them statistics about common therapies and their outcomes. This may reassure them that their problem is solvable and they don’t necessarily need therapy interminably.

Psychotherapists need to know, too, that it isn’t just therapy clients are looking for. They’re looking for a pleasant experience, a painless billing process, knowledgeable and professional front desk staff and a robust website that’s easy to use. If you’re considering working at an established practice, read the client reviews. Most come from an honest place and can help you determine if you’re a good fit for the clientele that that practice serves.

Where you’ll work

Psychotherapists are needed in many settings, and there is a place for qualified, caring therapists in places such as:

  • Schools
  • Hospitals
  • Prisons
  • Community health centers
  • Nursing homes
  • Group and private therapy clinics
  • Rehabilitation centers

Generally speaking, most therapists work as a private practitioner in a private office. This provides a familiar setting where their clients can speak to them without interruption.

Skills you’ll need for psychotherapy

So, what makes a good psychotherapist? You might think that psychotherapists rely almost entirely on the skills they gain in higher education and their practicum experience. These skills are important, but there are others that you’ll need to use in your career as a psychotherapist.

Tools and technology you’ll use

Some therapists will use statistical software or test interpretation software, and many use client information database systems of electronic medical record software. There are therapists who use dictation software or recording devices in sessions, but this is not common as many patients see this as a breach of trust.

Email, calendars and scheduling software are an important tool that psychotherapists need a working knowledge of. Scheduling patients and keeping track of their contact details is crucial.

Depending on the type of therapy you specialized in, you may also administer tests. There are depression tests, disorder screening questionnaires, personality tests and other tools that you may use to help patients understand themselves and their unique situation better.

Keep in mind that the tools and equipment you’ll actually use may vary depending on the specific setting you find yourself in and the types of patients you serve.

Psychotherapist salary

Median annual earnings of a psychotherapist depend on several factors, and it’s a good idea to consider each of these factors before you commit to a degree program as they may impact your earning potential.

Factors that impact salary

There are four major factors that have a major impact on what you can earn as a psychotherapist. These include where you’re interested in working, your educational experience, your geographic location and the kind of employer you’re applying to.

A higher level of education and experience are the most obvious predictors of income in psychotherapy. The amount of education you received as well as the amount of industry-specific experience will increase your chances of negotiating a higher starting salary. Speciality certifications may also make you more attractive to some employers. The more hands-on experience you have, the more you may expect to make.

Where you want to work—in both the broad and specific sense—are also important factors in predicting your salary range. For instance, psychotherapists who operate their own practice regulate their own fees and determine how many hours they work. This means you may find more work than you would if you were employed at a group practice. You will, however, have to pay operating costs (such as office space, appointment setters and insurance/billing specialists, if you don’t plan to do that yourself).

Also, psychotherapists earn more in certain states and cities. Location can play a large factor in how much you earn.

Median annual psychotherapy salaries

The U.S. Bureau of Labor Statistics (BLS) does not track psychotherapist salaries specifically, but it does include several types of psychotherapy specialties under “Therapists, All Others.”

Here’s a glance into the national median annual salary for therapists. Compare the national average to average earnings in a specific state below.

Therapists, All Other

National data

Median Salary: $60,800

Projected job growth: 12.2%

10th Percentile: $37,990

25th Percentile: $47,340

75th Percentile: $82,760

90th Percentile: $111,800

Projected job growth: 12.2%

State data

State Median Salary Bottom 10% Top 10%
Alabama $59,070 $40,270 $63,440
Alaska $52,220 $32,130 $98,140
Arizona $65,130 $51,920 $126,370
Arkansas $58,860 $39,450 $83,860
Colorado $81,140 $56,840 $92,990
Connecticut $60,630 $39,140 $104,110
Delaware $74,810 $64,180 $78,670
District of Columbia $81,400 $40,420 $131,250
Florida $49,530 $35,450 $124,800
Georgia $55,120 $33,940 $100,670
Hawaii N/A N/A N/A
Idaho $23,500 $22,680 $38,810
Illinois $49,560 $38,480 $83,770
Indiana $57,590 $39,280 $80,230
Iowa $48,080 $39,360 $70,050
Kansas $47,690 $38,250 $65,790
Louisiana N/A N/A N/A
Maryland $49,690 $33,340 $106,100
Massachusetts $53,690 $41,940 $104,670
Michigan $55,150 $33,280 $81,520
Minnesota $49,010 $36,200 $82,030
Missouri $51,570 $36,750 $90,120
Nebraska $61,040 $40,760 $114,520
Nevada $93,600 $47,930 $101,030
New Mexico $59,640 $50,510 $75,330
New York $59,490 $33,700 $121,040
North Dakota $83,550 $57,300 $120,730
Ohio $67,570 $40,850 $136,870
Oklahoma $56,830 $52,530 $60,800
Oregon $150,800 $65,860 $154,810
Pennsylvania $44,250 $38,970 $64,050
Rhode Island $64,420 $34,840 $110,350
South Carolina $75,030 $30,640 $81,570
South Dakota $83,640 $50,260 $130,190
Tennessee $47,950 $35,800 $84,070
Texas $67,910 $46,040 $87,110
Utah $59,500 $49,630 $79,120
Virginia $63,380 $44,500 $120,640
Washington $84,030 $62,220 $106,140
West Virginia $50,800 $38,620 $91,780
Wisconsin $59,230 $48,130 $102,010

Source: U.S. Bureau of Labor Statistics (BLS) 2022 median salary; projected job growth through 2032. Actual salaries vary depending on location, level of education, years of experience, work environment, and other factors. Salaries may differ even more for those who are self-employed or work part time.

How does a psychotherapist salary compare to similar occupations?

If you’re interested in how other therapist salaries compare to other therapy or psychology fields, here are median wages for some common psychology practices:

Career Median Annual Salary
Therapists, All Other $60,800
Counselors, All Other $43,390
Psychologists, All Other $106,420
Clinical and Counseling Psychologists $90,130
Marriage and Family Therapists $56,570

Where is the highest pay and demand?

Here are projected salaries for therapists for the top ten highest paying metro areas in the U.S.

Metro Area Median Annual Salary
Raleigh, NC $99,460
Las Vegas-Henderson-Paradise, NV $93,600
Denver-Aurora-Lakewood, CO $92,990
Washington-Arlington-Alexandria, DC-VA-MD-WV $92,300
Cincinnati, OH-KY-IN $84,670
Seattle-Tacoma-Bellevue, WA $84,030
Los Angeles-Long Beach-Anaheim, CA $81,190
Louisville/Jefferson County, KY-IN $79,060
New York-Newark-Jersey City, NY-NJ-PA $79,010
Salt Lake City, UT $74,440

If you’re planning a move to a city that has a larger psychotherapist population, the BLS reports the following metro areas with the highest number of therapists:

Metropolitan Areas Employment
New York-Newark-Jersey City, NY-NJ-PA 1,460
Chicago-Naperville-Elgin, IL-IN-WI 870
Atlanta-Sandy Springs-Roswell, GA 810
Baltimore-Columbia-Towson, MD 640
Minneapolis-St. Paul-Bloomington, MN-WI 500
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 360
Boston-Cambridge-Nashua, MA-NH 350
Providence-Warwick, RI-MA 330
Dallas-Fort Worth-Arlington, TX 320
St. Louis, MO-IL 300

Job growth for psychotherapy

Despite the stress that comes with working in healthcare, mental health professionals in general have a history of reporting high job satisfaction. There’s also a strong indication that careers in psychotherapy may be plentiful in the coming years. Through 2032, the U.S. Bureau of Labor Statistics, predicts that the demand for psychotherapists will grow by 12.2%.

Frequently asked questions

What is the difference between a psychologist and psychotherapist?

Psychologists study people: how they think, how they act, react and interact. They may conduct research, implement tests or specialize in a particular kind of treatment. Psychologists can deliver talk therapy treatments, but do not prescribe medication. Their focus is applying a scientific approach to helping people understand and change their behavior.

Psychotherapists can have many different job titles, including psychologist and psychoanalyst. Their focus is on assessing a person’s concerns and applying the best-fit therapy for their patient’s unique situation. This can include art therapy, cognitive therapy or hypnotherapy, among many other treatments.

Can psychotherapists work remotely?

Psychotherapists can absolutely work remotely, although it’s important to consider the needs of your patients when deciding how best to serve them. Some patients value the experience of visiting a therapist in their office.

Offering telehealth meetings via phone or video conferencing software may not be attractive to every patient, so keep that in mind. However, for busy adults who may have a long commute, a hectic schedule or live far from a metro area, this can be a major selling point in choosing what therapist to work with.

Can a counselor call themselves a psychotherapist?

The term “psychotherapist” is an umbrella term. That means that all clinical psychologists fit this description. Counselors and therapists often use those terms interchangeably, and there is no strong distinction between the two. As a general rule of thumb, a counselor will most likely specialize in one particular form of treatment that they are qualified to counsel patients on; a therapist is adept at providing therapeutic solutions for those same problems and working with patients to learn how they can solve their problem.

Can a psychotherapist give medication and diagnose?

There are some psychotherapists who go into the field of psychiatry, but it requires more education, medical school and a residency because a psychiatrist is a medical doctor. They are knowledgeable about the human body and its processes. They are trained to understand how chemical imbalances may be treated with medication. Without medical training about the human body (as opposed to the mind, which is a psychologist’s area of focus), a psychotherapist cannot be a psychiatrist and cannot prescribe medication. Most are qualified, however, to give patients a diagnosis and refer them to a psychiatrist.

What is the success rate of psychotherapy?

Study after study has proven the effectiveness of psychotherapy. Research demonstrates that psychotherapy is often more impactful than medication. This is because medication helps patients manage the symptoms of their mental health problems, but talk therapy helps them discover the root causes that they can control and develop behaviors that can cut those problems out or change how we deal with them.

Professional resources

Having a support system and a network can help greatly in a career that is based on helping others. Here are just a few resources for psychotherapists to join and utilize, depending on the area of specialty:

Getting started in psychotherapy

Psychotherapy is a rewarding career for those who truly care about helping others. You’ll research drug treatments that can improve a patient’s quality of life as a psychiatrist. You’ll identify ways that patients can develop better habits and help them learn behaviors that produce better outcomes in their lives. You’ll research disorders of the mind and the efficacy of different treatments as a clinical psychologist. Whatever piques your interest, there is a place for you to make a difference as a psychotherapist.

Becoming a psychotherapist requires a significant investment of time. An important first step when you’re considering this career path is to research what specific therapists do and make sure those roles line up with your career goals.

With the help of our school search on this page, you can find and compare a list of relevant psychology programs in your area or online. So start your journey today and take the first step toward becoming a psychotherapist.

Published: March 23, 2023

mariah beckman

Written and reported by:

Mariah Beckman

Contributing Writer