Working as a Counseling Psychologist

Therapist comforting her crying patientThere are different career options available depending on whether you attain a Master's degree or a Doctorate. A Master's degree in counseling psychology will allow you to practice as a LCMHC (Licensed Clinical Mental Health Counselor), or similar master's level counselor. The title of the credential will vary from state to state. Twenty five states will also license holders of Master's degrees as Master level psychologists, or other titles which vary from one state to another (NAMP, n.d. ,...). With a Master's degree, you can also teach at a community college, and with more experience in practice or teaching along with licensure, you may be able to teach at a four year college or university. Consulting and research opportunities are also available with a Master's degree. A doctorate can open more doors for you in your career. If you graduate from an APA accredited counseling psychology program, you will be able to take the exams needed to be licensed as a counseling psychologist,  and practice.

Counseling Psychologist Work Settings

Inpatient Facility

An inpatient facility is a hospital or institutional setting. It may specialize in treatment of severe mental illness, substance abuse, children and teens with behavioral problems, or any combination of the above. Patients stay on site until they are stable enough to be discharged. There will typically be medical staff present, including psychiatrists and psychiatric nurses, and a variety of clinical mental health providers. The inpatient facility may be a freestanding psychiatric or substance abuse treatment center, or it may be a floor or wing on a general hospital. Staff are both salaried and contracted, full time or part time, and receive either salary or an hourly rate, and may receive benefits if they qualify. There are numerous administrative supports and amenities in  inpatient settings, such as reception, billing, security, grounds keeping, and  janitorial/custodial services.

Outpatient Clinic

outpatientAn outpatient clinic is a health care facility in which patients visit typically one to three times a week, for 50 minutes to several hours each visit. Services provided can include: Crisis management, intake, evaluation and diagnosis, individual or group psychotherapy,  IOP  (Intensive Outpatient Program) in which the patient visits the clinic three or four times a week, for one to four hours each visit, for a period of three to four weeks. Case management may also be provided, as well as in-services for other professionals. There may be a mix of clinical staff on site, such as psychiatrists, doctoral level psychologists, Master's level psychologists (depending on the state) Master's level counselors and social workers, Bachelor level case managers, and interns.  Staff will typically meet as a group at least once a week for supervision, case reviews and disposition, and to receive and discuss administrative matters. Typically, administrative offices are contained within the same building, there is a reception desk,  and amenities such as public and staff bathrooms, and a staff kitchen or lounge may be  provided.

Group / Private Practice

A group practice is similar in structure to an outpatient clinic, but there are several differences. In an outpatient clinic, the staff are typically salaried or contracted employees, who may receive a benefit package, and are usually covered by an umbrella liability insurance policy. After hours crisis services are provided, as well as support staff. In a group practice, the clinicians are basically tenants of the building who rent offices or suites. They do not receive a salary, they are fee for service, they only get paid when providing a clinical service billable to a patients insurance company, or billed directly to the patient. They must pay their own liability insurance, their own benefit package such as medical and dental insurance, and an IRA. There is no paid vacation time, and they must arrange emergency coverage in their absence with other clinicians. Some administrative services may be provided, but they are minimal:  receptionist, intake person, biller, and building maintenance. In some group practices, there will not be any support staff, and clinicians will be responsible for every phase of operations, from intake to billing. In private practice, which is in some cases synonymous with group practice, a clinician may rent an office in a building in which they are the only tenant, or the only clinical tenants among other professionals e.g., attorneys, accountants, and realtors. They operate with complete independence. It is advisable to work in an outpatient clinic setting or inpatient facility for a period of time before venturing into private practice. This is important for gaining clinical experience and refining your expertise, finding your clinical specialties and preferences, and networking with other clinicians and providers (DeAngelis, 2014).

Teaching

Counseling psychologists may teach undergraduate or graduate courses in psychology, either as their primary employment, or as adjunct faculty, combining teaching with any combination of practice, research, or consulting.

Research

Counseling Psychologists may do research instead of or in addition to clinical work.

Providing Supervision

group supervisionAs counseling psychologists gain more experience, they may offer supervision and training to interns, or new clinicians working toward licensure.  Supervision is conducted in a group setting or on a one to one basis, typically once a week, although this can vary depending on state licensure requirements. Supervision consists of reviewing cases, examining supervisees'   feelings and reactions to patients, exploring any counter-transference, and how it could interfere with the therapeutic process, and giving feedback and direction. Supervisors will also sign off on their supervisees' paperwork, such as  diagnostic evaluations and treatment plans.

Consulting

Counseling psychologists may consult with individuals or organizations (DeAngelis, 2014). Consulting can include a variety of activities outside of clinical practice, teaching or research,  in which you offer your expertise. This can include writing, presentations/training workshops, developing and evaluating human services programs, human resource training and development, conflict resolution, grant writing, or improving organizational communication or processes (Entrepreneur Media Inc. , 2014).

Finding Right Place to Work

Considerations include if you want to reside in the city or town you intend to practice in, or if you prefer some professional distance, residing remotely from your workplace so you don't regularly encounter patients in public. This can lead to confidentiality issues. Pay is a consideration, as well as whether clinicians are actually paid a salary or will be fee-for service. If you are planning on getting licensed it is important for you to make certain that there is a staff member available who is qualified to supervise you, so you can work toward licensure. The rates of staff turnover, financial stability of the potential workplace, and the professional reputation of the facility are also important considerations.

Completing Job Applications & Resume (CV): Employer Expectations

This will vary, depending on the preferences of your potential employer. The basics are you must have the appropriate advanced degree, whether a Master's or a Doctorate, from an accredited program. Accreditation must be from a regional educational credentialing organization, and in some states, in order to undergo the licensure process,  the program must also be accredited by the APA (American Psychological Association) (Dittman ,2014). Items on your CV which can strengthen your competitiveness include a high GPA, an adjunct faculty position, membership in a professional organization, and pertinent volunteer experience. You should have at least rudimentary computer skills, and be comfortable using at least word processing, spreadsheet, internet browsing, and email software. Red Cross, AHA (American Heart Association, or OSHA (Occupational Safety and Health Administration) Certification in First Aid, CPR, and AED (Automated External Defibrillator) operation may also make you more attractive to a potential employer.

What to Expect During Interview Process

counselor interviewYou may have multiple interviews with different individuals, or a group interview. You may be asked clinical questions, for example "what to do in the event of a suicidal patient?". You will want to study and review crisis management, and the diagnostic criteria for common mental disorders.  You may need to submit a writing sample. You may also be asked what you do when you are not working. (See Developing diverse interests and broad/wide scope of view).  You may undergo what is referred to as  a stress interview, in which you will be asked very direct questions, and efforts may be made to provoke you to see how you respond to personal challenges and pressure (Interview Skills Consulting Ltd. , n.d.). You will need references, typically three to five, ideally at least one from your internship supervisor. You will have to pass a background check, which may include:

  • DMV records
  • Federal criminal background check
  • Child Abuse Registry
  • Elder/vulnerable Adult Abuse Registry
  • Sex Offender Registry
  • Credit history
  • History of being a plaintiff in civil litigation, including malpractice suits
  • Investigation, restriction, or disciplinary action by a state licensure board

You may also be required to submit to a pre-employment urine toxicology screen, especially if you are applying to a substance abuse treatment facility. A pre-employment physical, or proof of vaccination may be needed, particularly  if you are applying at an inpatient facility.

Independent Practice: Pros & Cons

Private practice is an option to consider, either full time or as a part time venture outside of clinic work. As a private  practitioner,  you are self employed.  You will have a very high degree of freedom and autonomy in terms of days/hours worked, and clinical decision making. However, you will have to provide your own benefits, and you may not earn steady income. As a private practitioner, you have to be able to tolerate anxiety about not having income when you want it. You will have days where everyone on your schedule cancels, no shows, or people show but don't bring their fee or co-pay. If you want the same hours, and the same steady paycheck every week, you may feel more comfortable in a clinic. However, clinic work is not for everyone. There may be a frustrating bureaucratic maze to wade through, reams of redundant paperwork, or bytes of redundant electronic records, multiple supervisors for one individual, who may give contradictory direction, questionable priorities, petty office politics, meetings to attend which you are not reimbursed for at a clinic rate, and a lack of focus. There are advantages and disadvantages to both clinic and private practice, which the clinician must weight and determine which will match their personality and preferences.

Continuing Education and Licensing Maintenance/Renewal

Supervision Requirements: Maintain License and Best Practices

The number of hours of supervision you require each week, or if you even require supervision after licensure, is determined by the licensure board in the state in which you practice. You may not be required to have supervision, but it may still be advisable for best practice, especially during the first several years of practice, where one is still very much a novice. For experienced clinicians, you can still benefit from peer consult- require  meetings with peers, to review cases, and seek input and guidance.

Professional Ethics Awareness & Adherence

ethics 2Clinicians have a code of ethics which they must adhere to in order to maintain your license in good standing, and to maintain a sound reputation with your peers and the public. A clinician must be familiar with the code of ethics associated with their licensure, as well as federal laws regarding patient confidentiality, such as HIPPA  (U.S. Department of Health and Human Services, n.d.) and limitations to confidentiality, such as the Tarasoff ruling (Case Briefs, LLC ,2014). If you are working at a federally certified substance abuse facility, you must also be familiar with 42 CFR, which is a federal confidentiality regulation for substance abuse providers (U.S. Government Printing Office, 2014).

Continuing Education Requirements

Depending on what type of license you hold, you will have a minimum number of continuing education credits to complete during each license renewal period. This can be done through attendance at professional conferences, webinars, or independent reading with an accompanying test. Teaching preparation and hours may be applied for continuing education as well.

Independent Reading, Skills & Knowledge Upkeep

The clinical professional, including the counseling psychologist, should be a perpetual student. Reading professional peer reviewed literature, as well as other scholarly sources, and popular literature is essential. Reading related to or remote from the field will also keep the practitioner well informed, and can prevent over focus, or a myopic point of view. History, classic literature, theology, philosophy, biological sciences, and political science are all important topics which can enrich one professionally.

Burnout Prevention & Self-Care

Keeping Perspective

Counselors are prone to burnout, vicarious traumatization, and compassion fatigue. As a counselor, and depending on the patient population you choose to work with, you may be exposed to some of the worst aspects of human nature and society. Addiction, alcoholism, molestation, incest, domestic violence, child abuse, combat trauma, poverty, serious or life threatening illness, and grief and loss are all topics which you may deal with on a regular basis. You must take good care of yourself, physically, mentally, and spiritually in order to be fully available to your patients when you are working.  A supervisor and peers you can trust will also be very important. Read more about counselor self care from our resident expert, Amy McNamara.

Developing Diverse Interests & Broad Scope of View

It is important to have outside of work activities and sources of restoration and fulfillment. When you leave your office, strive to leave your work behind. Hobbies and interests remote from the job, time with family, partner, and friends,  and travel are essential to your maintenance and development as a clinician.  Get exposure to different cultures, lifestyles, and points of view.

Practice Development and Management

managementWeigh the benefits of different business structures, such as a sole proprietorship  vs.  incorporating yourself as an LLC (Limited Liability Corporation). A professionally designed web page, business cards, envelopes, and letterhead will present a polished and professional image which will lend credibility to your name. You will need to get empanelled with health insurance companies to collect third party reimbursement from your patients, and you will need professional liability insurance. You will also need a TIN (Tax Identification Number) on file with the IRS, and a business checking account. Membership in a local chamber of commerce also adds to credibility, can help you with advertising, and networking.

Contact and Collaborate with PCP's

Get to know the PCP's in your area, as a mutual referral source. PCP's will have patients that need psychological services, and you will have patients that need medication consults and management, either through a PCP, or referral to psychiatry.

Crisis Management and Difficult Situations

In your career, you will have to deal with patients in crisis, ethical dilemmas, professional crossroads where you will have career changing decisions to make, and the possibility of lawsuits, and media interviews. This will require the sound judgment that comes from experience, and often the support and input of trusted peers, which you have cultivated relationships with. A maxim in dealing with professional challenges is: document everything, and seek supervision or peer consult.

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References