Careers in Mental Health (Omnibus) - work in progress (done up to Appendix B)

by u/MattersOfInterest

Hello, and welcome to the Careers in Mental Health omnibus! If you’re here, it’s probably because you have an interest in mental health and are wondering about different career options for working in mental health. In this form, I will: answer some FAQs regarding careers in mental health; provide guidance about the different routes one may take when pursuing a career in mental health; explain the difference between masters- and doctoral-level career paths; provide general advice regarding how to use your undergraduate years to prepare for graduate school applications; and answer common questions about doctoral study (e.g., “How are clinical psychology and counseling psychology different?” “What are the differences between a PhD and a PsyD, and which should I pursue?”).

Content Overview

Part 1 will deal with issues concerning doctoral training in psychology—Do I need it? Is it worth it? What is the purpose of a doctoral degree? Which type of doctoral degree should I pursue?...

Part 2 will give a brief overview of different career options, stratified by the minimal educational requirements needed to pursue them.

Part 3 will very briefly discuss some potential options which lie at the periphery of mental health work and may be considered by those who seek different ways of being involved in mental health which do not involve direct provision of behavioral health services.

Appendix A will provide a short overview of other careers which are commonly asked about in mental health circles.

Finally, Appendix B will seek to serve the broad, didactic role of informing interested readers about the importance of evidence-based practice and rigorous training in scientific research.

At the end of this document, there is also a collated list of external resources about various topics discussed herein. I strongly encourage you to check those out, especially links germane to the particular careers for which you harbor the most interest. I also recommend that all readers follow the link to the University of Kentucky Mental Health Professions Career Test ©.

I hope this answers your big questions and look forward to providing more targeted advice where needed. Note that not all of these options involve direct, independent provision of psychotherapy. Those which (commonly) do have been marked with an asterisk (*).

Please note that this document is specific to the United States. If you are not in the United States, please review the education standards and licensure criteria mandated by your country or local geographical region.

Part 1: The Long and Short of Doctoral Training in Psychology

One of the most pervasive misunderstandings regarding training for careers in mental health is that one needs to, or even should, seek doctoral training in psychology in order to pursue such a career. This is absolutely not the case for every individual interested in these careers. As made evident in Part 2, there are many options for working in mental health which do not include doctoral training in psychology, some of which include the ability to independently practice psychotherapy. In fact, most mental health workers in the United States are not psychologists.

If you are thinking of trying to pursue a doctoral degree in psychology, there are a number of very important questions and considerations to which you should subject yourself before choosing that path.

Q1: Do I need to be a psychologist in order to be a psychotherapist?

A1: Absolutely, unequivocally not. Most psychotherapists in the U.S. are not psychologists. You can practice psychotherapy by becoming a licensed counselor (LMHC/LCMHC/LPC/LPCC), a Licensed Clinical Social Worker (LCSW), or a Licensed Marriage & Family Therapist (LMFT). While these “mid-level” practitioners do not hold the rights to perform standardized assessments (cognitive batteries, educational & achievement batteries, IQ assessments, or standardized diagnostic assessments), their legal scope of practice for psychotherapy is equivalent to that of licensed psychologists. Each of these different professionals receives training at the master’s degree level, as well as practica, with each curriculum course (master’s in counseling, MSW, or MFT) focusing on slightly different populations and approaches to therapy. Check out Part 2 for a thorough overview of these careers. The take-home message is that doctoral training is not the most expedient, efficient means of pursuing a career in psychotherapy. If practicing psychotherapy is your chief goal as a mental health professional, it would be auspicious of you to consider one of these paths.

Q2: If doctoral training is not for everyone, then who is it for?

A2: Doctoral training in clinical, counseling, or school psychology is primarily meant for individuals who—in addition to having interest in clinical practice—are interested in psychology as a scientific endeavor. In other words, doctoral training is for individuals who wish to take part in the scientific enterprise, whether as active researchers, as professors, or as clinicians with highly specialized expertise in the published literature and evidence-based practices implicated in particular subareas of clinical science and practice. Doctoral training is not simply a continuation of your undergraduate studies with progressively harder courses. In fact, classes are arguably the least important component of doctoral training. Instead, the teaching duties, research endeavors, close didactic mentorship under a faculty sponsor, clinical practica (both internal and external), and mandatory internship which make up the other components of doctoral training are much more formative of one’s career as a graduate student. Yes, doctoral training from an APA-accredited program, when completed, can lead to licensure to practice psychotherapy and assessment. However, it is important to note that psychology was a basic science long before it was an applied, practicing science—as such, practice as a mental health professional is only one part of the “DNA” of what psychologists are ideally meant to represent.

Q3: I have considered all the different options for my career and determined that doctoral training is the most appropriate path for me. How important is APA-accreditation?

A3: APA-accreditation is an absolute necessity when searching for a program. Though many psychologists would argue that the APA accreditation standards are a low bar for determining the quality of a doctoral program, nearly every state in the U.S. requires that one attend an APA-accredited internship to be license-eligible, and those internships are essentially impossible to secure without attending an APA-accredited doctoral program.

Q4: If accreditation is a low bar for quality, what other things should I look for in a program?

A4: There are a number of things you should look for in a program. Briefly, you should consider programs with: small cohorts (<20 per class/”year”); full tuition remission; high entrance standards (competitive GPA, GRE scores [although this is changing], and research experience); high (near 100%) EPPP pass rates for those students who opt to take it; universal APA-accredited internship match rates; and strong internal and external practicum placements (at research hospitals/medical schools, or specialized centers which emphasize evidence-based practice).

Q5: Should I pursue clinical, counseling, or school psychology?

A5: This depends on your research and practice interests. Traditionally, clinical psychology programs focused more on severe mental illness (SMI) relative to counseling psychology programs, while the latter were more focused on substance use disorders (SUD), adjustment disorders, and milder disorders of mood and anxiety. This is still a little true in terms of the research experiences available in these programs, but the educational curricula and practicum experiences are becoming increasingly hard to differentiate. As for school psychology programs, these tend to be more focused on neurodevelopmental and learning disorders as well as intellectual disabilities, and may put a stronger focus on certain assessment types relative to the other two degrees. After licensure, however, the scope of practice is the same across all three degrees. In the end, you should attend a program which provides you the right fit for your research and clinical interests and worry less about which subfield you choose.

Q6: Should I pursue a PhD or PsyD? If I choose the former, which training model should I choose?

A6: The answer to this question is dependent upon a few factors. First, you should consider the extent to which research and academia are part of your future career goals. While this is not universal, the PhD tends to be a more flexible degree for those who would like to have research and/or academic careers alongside having clinical opportunities, as the PhD typically includes more stringent training in research and teaching. This has led many to believe that the PsyD degree is “more clinically-focused” than the PhD, and that the former degree is more suited to those who do not enjoy research or wish to pursue academic/research careers. Though this belief is widely held (and widely marketed), this is a myth. While it is true that the PhD tends to place more of an emphasis on research relative to the PsyD, it is not true that the PhD puts less of an emphasis on clinical work relative to the PsyD. Rather, students entering their APA internships from both program types, on average, have about the same number of clinical practicum hours. It is therefore not accurate to call the PsyD a “more clinical” degree, but it is somewhat accurate to call it a “less research” degree (with a couple of exceptions).^[1] The reason for this difference in the amount of research training provided is due to the PsyD degree employing the “practitioner-scholar” training framework, which operates according the principle that a practicing clinician need not demonstrate as much expertise in research output as someone whose main career is in producing such research (similarly to how, e.g., a neurologist may not produce as much basic research about the brain as, say, a neurobiologist, but is still the main clinical authority on matters of clinical treatment).^[2] Because of this myth, many students mistakenly believe that a PsyD is an appropriate choice for those who do not like research and/or do not have sufficient research experience to be a competitive PhD applicant. I cannot state this strongly enough: Any program with good training, good internship-match outcomes, and good EPPP-pass rates will have similar entrance criteria and training milestones, including research and clinical milestones. High quality doctoral training will require that you take a large role in conducting and producing rigorous scientific research, even if the expectations for quantity vary. You should not be entering a doctoral degree without research experience and without the expectation to be doing a lot of rigorous research work in your program. Therefore, even if you wish to have a mainly clinical career, your main criteria for a program should be goodness of “fit.” Should you decide that the PhD training goals better suit your overall career goals, you will then be faced with a second choice—whether to choose a scientist-practitioner (“Boulder Model”) program or a clinical science (“bench” scientist) program. This choice is really, again, a matter of minutiae in most cases. Either training model is going to place a strong emphasis on the role of psychologists as not just clinicians, but as scientists as well. However, most clinical science programs operate under the principle that the greatest value of psychological expertise is that of a scientist, even if that means “a clinician who operates like a scientist” (i.e., a clinician who applies evidence-based practices in a methodological, careful, and skeptical way). Given that both of these training models strongly emphasize science and evidence-based practice, it can be hard to really pin down any universal differences between these models. Some self-professed Boulder Model programs are more similar to clinical science programs than to other Boulder Model programs. Again, the real criteria for choosing a program should be how well that program seems suited to support and train you in pursuit of your career goals and interests.

Q7: What is PCSAS, and why does it provide program accreditation?

A7: The Psychological Clinical Science Accreditation System (PCSAS) is a system of accreditation which specifically accredits clinical science programs according to whether they meet their standards of research and scientific training. PCSAS accreditation essentially demonstrates a program’s commitment to placing science at the forefront of its training model. PCSAS was created to address what many saw as deficiencies in the APA accreditation standards. While all PCSAS programs will meet the criteria for APA-accreditation almost by default, some programs may not actually be accredited by the APA (for various reasons, including: a lack of desire to train students seeking licensure; a belief that APA standards are too minimal; or as part of a larger effort to have PCSAS-only programs be eligible for licensure in that state). Such programs are rare, but it is important that you check the APA-accreditation status of any PCSAS program you wish to attend if you hope to pursue clinical licensure, as most states do not accept programs which are solely accredited through PCSAS for licensure eligibility (though this is changing slowly).

Many readers will stop here and protest:

“Okay, maybe I don’t need a doctoral degree to be a therapist, and I don’t like research, but I really want to be a psychologist!”...

…and I get it. Many human beings, especially of the career-minded sort, are driven to reach what they consider to be the highest level of recognized academic achievement in their field. This is a natural and admirable desire. However, it must again be reiterated that doctoral training in psychology is first and foremost an endeavor in the scientific enterprise. What counts as the “highest level of recognized achievement” is not necessarily the same as what makes the most sense given your career interests, competitiveness for graduate school, and lifestyle realities or wishes. If you have read to this point, and based on an honest self-assessment feel as if you are the kind of person who would be unhappy with—or unable to take part in—the process of doctoral school as thus far described, then it would be auspicious of you to consider alternative options…

“…but then I won’t be able to do assessments! My scope of practice will be limited!”...

It's important to remember that no single career path will allow you total freedom to be everything to your clients. Psychiatrists can't typically do standardized testing; psychologists can't (usually) prescribe (and when they can, it's quite limited); master's degrees don't lead to assessment opportunities, unless they are in school psychology (and then the psychotherapy scope is limited); and all of these professionals are limited by their own expertise with certain populations and practice methods as well as their educational background. Do not let scope of practice alone dictate your chosen career path. You should weigh all the options available to you and determine which gives you the overall best package in terms of scope of practice and what you must put into achieving licensure (including work, time, effort, lifestyle compromises, monetary costs, and opportunity costs). To reiterate, achieving a license-eligible doctoral degree in psychology from a reputable program requires:

1. Several years of preparation to become a competitive applicant (a bachelor’s degree, including, or plus, at least 2 years of high quality research experience and competitive GRE scores);
2. A possible delay of years between applying to programs and being admitted (many very competitive applicants apply multiple times before being admitted, with only one cycle per year);
3. The cost of 10-12+ application fees and sending both transcripts and GRE score reports to admissions departments per cycle; 
4. Five to six years of in-program graduate school training which includes coursework; teaching duties; research work; writing grant applications and securing additional funding; writing manuscripts for publication; internal and external practica; a master’s thesis (usually); and a doctoral dissertation which must be defended before a committee;
5. And a 1-year APA-accredited internship, which must be competitively applied for similarly to the process to applying for doctoral programs.

This doesn’t even include the optional post-doctoral placement of an indeterminate length which many doctoral candidates then pursue so that they can meet qualifications for board-certified specialization. If an honest self-assessment of the information you’ve been provided up to this point leads you to believe that you would not be happy in this kind of environment (or would be unable to engage in it for whatever reason), then you should strongly consider non-doctoral options. Remember: no one can be everything for their clients. It is okay to be a fantastic counselor, social worker, or marriage & family therapist and work within the scope of practice afforded to you based on your training…

“...but I’m afraid that people won’t respect me if I don’t have a doctorate!”...

Everyone wants the respect that comes with the title of “Dr.” However, proper professional respect is a function of your competency, curiosity, and humility, as well as how you treat people—it is not a function of your title or degree. A competent, curious, empirically-minded, humble, and compassionate psychotherapist will be respected by his or her clients and colleagues  irrespective of his or her title.

The long and short of it is that doctoral training is not for everyone, and not everyone will be best suited by the pursuit of a doctoral degree. If you have thoroughly read this section and determined that you are indeed best suited by this pursuit, check out the section on doctoral programs in “The Long and Short of Graduate School: Gaining Admissions, What to Look for in a Program, and Funding Your Education.”

Part 2: A Brief Outline of Career Options in Mental Health

Non-Postgraduate School Paths

Not every student is a fit for postgraduate^[3] school, and that’s totally okay. Whether it’s due to time constraints, family/life obligations, or just a general desire never to go to school again (trust me, I get it!), some people with a passion for mental health work just simply do not plan to go to postgraduate school and would like to avoid doing so if possible. If you are one such person, you may be wondering if any paths exist which would allow you to work in a mental health setting without attending graduate school…

So, first, the bad news. I won’t sugarcoat it—deciding not to attend postgraduate school will limit your mental health career options substantially and will, in most cases, vastly limit the scope of professional responsibilities which you will be able to hold in your career. This is something you should consider carefully when deciding if postgraduate school is the right path for you.

Now for some good news! While options for bachelors-degree-only holders (or those holding less than a bachelor’s degree) are harder to find and more limiting than those requiring further education, they do exist, and they are valuable and respectable careers. Again, I would like to reiterate that not every student with a passion for mental health work is going to be a good fit for postgraduate school. Deciding not to further your education does not make you lesser than, or less valuable than, anyone else. In fact, some of the options listed below are highly sought-after and provide invaluable services to the mental health infrastructure. Now, with words of affirmation out of the way, what are the options for someone looking to avoid postgraduate school?

Requires, at minimum, a high school diploma (or equivalent) and additional training:

1. Mental Health/Therapy Aide: A paraprofessional who assists patients in inpatient or other long-stay units with basic hygiene, dressing, eating, attending appointments, and other activities of daily living, and who assists with documenting patient behaviors under the direction of a licensed clinician.

2. Certified Nursing Assistant (CNA): Similar to mental health aides, CNAs assist patients with completion of activities of daily living. Furthermore, the CNA scope practice also includes duties such as cleaning bedpans and taking blood pressure. The content of specialized courses for CNA certification are generalist and can be applied to any kind of long-stay health setting, not just psychiatric settings.

3. Registered Behavior Technician (RBT): A paraprofessional who is trained to follow the treatment plan of a BCaBA or BCBA and provide direct behavior therapy to client, typically (but not always) children and adolescents with autism spectrum disorder, ADHD, DMDD, IED, or other overtly behavioral conditions.

4. Substance Use Paraprofessional: Some states allow individuals with at least a high school diploma (or equivalent) to complete a certification course, plus a minimal number of practicum hours and examination, to be certified to work with individuals with SUDs. These opportunities vary widely from state to state and may or may not be available in your area. If you are interested in pursuing a career as a substance-use treatment paraprofessional, it is important that you seek training opportunities which place an emphasis on evidence-based methods of treatment, as SUD treatment is rife with pseudoscience. 

Requires, at minimum, an undergraduate degree (and additional training):

1. Psychiatric Nurse: Psychiatric nurses can work in both inpatient (or otherwise long-stay) and outpatient mental health settings, and typically help participants engage in activities of daily living, as well as supervising CNAs and performing certain medical tasks under the direction of an independent, licensed healthcare provider (usually a physician, but less commonly an NP or PA). A psychiatric nurse can be a licensed practical/vocational nurse (LPN/LVN) or a registered nurse (RN), but it should be noted that the RN has a larger scope of practice which includes placing IVs, administering medications, and supervising LPNs/LVNs.  

2. Board Certified Assistant Behavior Analyst (BCaBA): A professional who is trained to conduct all the duties of an RBT, along with the additional ability to create and oversee client treatment plans under the supervision of a BCBA.

3. Social Worker (entry): Settings in which social workers may be employed include, but are not limited to: protective services (including child and senior protective services, etc.); rehabilitation programs; community health organizations; inpatient and outpatient psychiatric centers (as case managers); nonprofit agencies; policy agencies; and other systems-based organizations. Tasks which social workers might typically perform as part of their job include: basic psychosocial assessment; case management; connecting clients to relevant services/organizations such as group homes, service providers, welfare agencies, and vocational training organizations; community engagement and public health/outreach initiatives; child or adult safety investigation; compliance monitoring; and other tasks related to basic safety, psychosocial functioning, and client-system interactions.

4. Recreational Therapist: A professional who focuses on the use of recreational or leisure activity to support and promote psychosocial and physical well-being for those with mental or physical disabilities. Recreational therapists very often (though not always) work in inpatient units and other long-stay programs, such as substance use rehabilitation programs.

Postgraduate School Paths

If you have made it to this point and have decided that some form of postgraduate training is the route most suited for you to set about achieving your career goals, there are a number of further options you may wish to consider. Please be sure to note that not all of these options involve direct, independent provision of psychotherapy. Those which (commonly) do have been marked with an asterisk (*). Also note that some of those careers which do not involve the provision of psychotherapy do involve the provision of other forms of therapy, whether occupational, recreational, or otherwise. Individuals interested in pursuing postgraduate training are encouraged to read “The Long and Short of Graduate School: Gaining Admissions, What to Look for in a Program, and Funding Your Education.”

Requires, at minimum, at master’s or specialist degree, plus additional training:

1. *Licensed Counselor (LMHC/LCMHC/LPC/LPCC): Licensed counselors—not to be confused with counseling psychologists—are licensed to work as independent psychotherapists, and tend to work with individuals with less severe conditions, such as adjustment problems, interpersonal problems, depression, and anxiety disorders, but this is not universally true. Vocational/career counselors and substance abuse counselors are often, but not always, licensed counselors.

2. *Licensed Marriage and Family Therapist (LMFT): As practicing therapists, LMFTs tend to focus on helping solve interpersonal conflicts, but also work to help individuals with mental illness operate within their family units and promote healthy interpersonal relationships within these units.

3. *Licensed Clinical Social Worker (LCSW): At the master’s level, social work retains its significant breadth and flexibility. While many LCSWs simply practice individual and group psychotherapy, a large portion of them will focus their attention on individuals who experience significant problems operating within societal systems. LCSWs also commonly work in systems-based advocacy, working to use, amend, and implement societal systems and systems-based programs to help their clients.

4. Board Certified Behavior Analyst (BCBA): BCBAs supervise and train BCaBAs and RBTs, directly provide behavior therapy, and perform functional assessments to create treatment plans. BCBAs typically work with individuals diagnosed with an autism spectrum disorder, but can also be found working with individuals with other overtly behavioral disorders or symptoms (e.g., ADHD/executive functioning problems, IED, DMDD, etc.). The typical work setting for a BCBA is in the client’s home or an outpatient clinic, though some may also work in long-stay settings.

5. School Counselor: School counselors—not to be confused with School Psychologists—enjoy a relatively broad scope of practice. School counselors help advise students on meeting graduation requirements, prepare for standardized testing, prepare for college admissions, and find areas of interest for future career pursuits. Though school counselors are not licensed as psychotherapists, they do work with students, parents, and teachers to help promote academic success, emotional wellbeing, and the solving of interpersonal problems. School counselors also often act as administrators in charge of students’ academic records, coordinating certain school events/activities, and working to develop curricula and academic schedules.

6. Licensed School Psychologist: School psychologists—not to be confused with Licensed Psychologists—do a lot of assessment work, particularly to help identify school-aged children with special learning needs, behavioral disorders, or those meeting requirements for gifted education. School psychologists also generally spend a lot of time with parents, teachers, and administrators to assist with implementing specialized education and behavioral plans for students requiring such support. They may also work with children in therapeutic settings with the goal of promoting students’ mental-emotional wellbeing. Note: School psychology is not not to be confused with educational psychology.

7. Psychiatric Nurse Practitioner (PNP/PMHNP): Nurse practitioners have the same scope of practice as RNs, with the added ability to act as prescribing medical practitioners either autonomously or semi-autonomously (i.e., with physician oversight), depending upon the state.

8. Psychiatric Physician’s Assistant (PA): A physician’s assistant is a mid-level medical practitioner who administers and prescribes medications, as well as other healthcare interventions, under direct or indirect physician oversight (depending on the state). Many of them may work in psychiatric settings.

9. Occupational Therapist (OT): An occupational therapist’s (OT) helps individuals learn skills which allow them to successfully engage in their activities of daily living. An OT is concerned with helping people with physical and mental disabilities develop the motor and cognitive skills needed to bathe, get dressed, tie shoes, feed oneself, etc. In the context of mental health, OTs are often part of the treatment plan of children with motor dysfunction related to autism spectrum disorder or other neurodevelopmental disorders, or individuals with neurological disorders such as Parkinson’s disease (which is often accompanied by significant psychiatric conditions such as psychosis and dementia).

Requires, at minimum, a doctoral degree, plus additional training:

1. *Licensed Psychologist: A licensed psychologist is a doctorate-level practitioner with competency in psychotherapy, standardized psychological assessment, and scientific research. With very few exceptions, becoming a licensed psychologist requires successful completion of all the following: an APA-accredited doctoral degree (PhD or PsyD) in clinical, counseling, or school psychology (with accompanying practica and dissertation requirements); an APA-accredited clinical internship (usually lasting one year); a minimal number of supervised practicum hours (numbering in the thousands); a post-doctorate (this requirement may vary); and licensure examination (EPPP). This route takes 6-8 years after undergraduate school. Psychologists can work in all mental health settings and have a large scope of practice (though many choose to specialize in certain populations) within the umbrella of psychosocial interventions. Psychologists also commonly work as academic instructors and/or professors, researchers, consultants, policy advisors or advocates, and health system administrators.

Common Subtypes:

Neuropsychologists: Licensed psychologists who focus on the assessment and treatment of cognitive, emotional, and behavioral disorders related to neurological conditions.

Forensic Psychologists: Licensed psychologists who specialize in the assessment of legal competency, the treatment of conditions related to criminal behavior, and legal consultations. Note: Non-clinical degrees in forensic psychology will NOT lead to license-eligibility.

Health Psychologists: Licensed psychologists who specialize in the interplay between psychology and physical health, often with an emphasis on using psychological interventions to prevent or reduce behaviors which prevent or minimize the risk of disease (such as practicing safe sex, avoiding tobacco, eating healthy and exercising, or attending regular health check-ups).

2. Psychiatrist: A physician (MD or DO) who completed residency in psychiatry. Though some psychiatrists provide complex psychotherapy, more and more of them are moving toward implementing basic techniques and focusing on pharmacotherapy (and other modalities germane to general and specialized medical practice). Standardized psychological assessments such as cognitive batteries as well as IQ and achievement tests are not typically administered and interpreted by psychiatrists, but a number of medical assessments are. Like other physicians, psychiatrists are also able to work in research settings and as instructors or professors in academic departments, and as consultants and policy advocates.

As should now be clear, there are a ton of career paths one may choose if interested in a career in mental health work. You should carefully consider all of these options and pick the route which offers you the best overall balance between fit for your career interests and the costs or work involved in following that path.

Part 3: Careers on the Periphery

It’s a common assumption that the only, or best, way to have a career in which one gets to “help people” is through one of the so-called “helping professions” of nursing, medicine, public health, or mental health. This is an understandable assumption to make, but it is far from correct. In fact, “helping people” is such a broad goal that one could argue that nearly every socially-accepted form of employment provides some sort of “help” to people. Carpenters help people live and work in safe shelters. Electricians and plumbers are essential to the quality of life we currently enjoy. Suffice it to say that there are many ways one can go about “helping people” without providing mental or behavioral health services. Not everyone who wants to help people who are struggling with mental health concerns are personally suited for, or even interested in, the provision of direct services. Career tasks which can help individuals without the direct provision of services often include: participating in, or conducting, clinically-relevant research; legal services; and political/social advocacy. Individuals with expertise in the following subjects/fields are often involved in services which could be of benefit to individuals with mental health disorders:

1. Neuroscience
2. Social & personality psychology
3. Educational psychology
4. Cognitive psychology and other cognitive sciences
5. Behavioral psychology
6. Developmental psychology
7. Behavioral biology
8. Industrial/organizational psychology (for workplace mental health)
9. Sociology
10. Psychological anthropology
11. Political advocacy/political science/public administration
12. Public health, epidemiology, and/or biostatistics
13. Law, legal studies, or criminal justice
14. Data sciences (for managing research data)
15. Computer science (programming mental health applications, mobile health software, etc.)
16. Special education
17. Counselor education

In addition, there are numerous non-profit, non-governmental organizations which engage in mental health-related advocacy and/or funding for  research, services, policy, criminal justice reform, and legal representation. Helping people is not limited to directly providing services to people in need of help. Working in research, advocacy, policy development, education, criminal justice, or law could provide you with myriad opportunities to take part in activities which directly benefit individuals with mental health disorders without ever performing direct provision of any health services.

Appendix A: Other Careers of Common Interest

Aside from the careers mentioned in Parts 2 and 3, there are some careers which are often asked about in the context of questions about mental health careers. Some of the most common ones are mentioned below, along with brief explanations of why they have not been mentioned elsewhere in this document.

Life coaching often appeals to individuals who wish to focus less on individuals with mental health disorders and more on the provision of encouragement for helping people meet regular life goals (such as losing weight, self-improvement, or going sober). Life coaching has been thus far omitted from this text because it is a largely unregulated field which straddles the borderline between being simple affirmative coaching and downright unethical attempts to practice therapy without “practicing therapy.” If you want a career in providing psychosocial support, this document will have provided you plenty of routes to consider without the need to think about life coaching, and I highly recommend pursuing one of those routes instead.

Creative arts (expressive) therapies, such as art therapy, dance therapy, and music therapy are also of common interest to students who enjoy both the creative arts and the idea of providing psychosocial support to people. Though the different fields of creative arts therapy are more tightly regulated than life coaching, there are still many who argue that the training standards for such fields are quite minimal. Furthermore, while there is evidence that creative arts therapies likely help provide reductions in mood disturbances and anxiety, especially in tandem with other forms of evidence-based treatment, there is little evidence that they are efficacious for long-term treatment of severe pathology, such as psychosis or thought disorder. As such, these therapies are limited in their application, at least as primary forms of treatment for severe pathology. In tandem with recreational therapists working in long-stay settings, creative arts therapists likely provide a valuable day-to-day service, but interested parties should be aware of the limitations of the practice and pay associated with these jobs. Caveat: This paragraph is in reference to creative arts therapy outside the context of being otherwise licensed to practice psychotherapy. Licensed psychotherapists who employ creative arts therapy are less limited in scope than individuals whose competency is only creative arts therapy, and are more likely to be able to use creative arts therapy in direct combination with traditional psychotherapy—which evidence demonstrates is the most effective means of using these therapies. There is some evidence that creative arts therapy implemented in tandem with evidence-based therapies can increase the efficacy of the latter. Therefore, individuals interested in creative arts therapies would be best served by also pursuing a path which allows for fuller practice of psychotherapy alongside the implementation of creative arts therapy, such as being a licensed counselor or social worker alongside being competent in the expressive therapies.

Appendix B: A Short Treatise on the Importance of Science & Evidence-Based Practice

Thus far, I have mostly focused on the practical aspects of pursuing a career in mental health, though I did offer some didactic information in my discussions of doctoral training in Part 1. The goal of this appendix will be to provide readers a deeper, more fundamental understanding of certain very important aspects of engaging in a mental health career. Topics will include the paramount importance of science and practicing evidence-based psychotherapy; the relative meaning and importance of accreditation by different organizations; and a broad discussion on graduate school admissions, funding, and quality indicators. Many readers will have already been provided a thorough education in the importance of evidence-based practice and the scientific nature of psychology, but others may have not yet reached that level in their education or may have been educated in unrelated fields and are considering a career change. Some may have even (unfortunately) forgotten this information. Therefore, it always bears repeating that psychology^[4] is first and foremost a scientific endeavor.

When I say that psychology is scientific, what exactly do I mean? If you are like most people, when you hear the word science, you think back to your science classes from middle and high school and consider the subjects you learned in those courses. However, if someone asked you to define science, you may have a bit harder of a time, as defining science based on its subject matter would prove to be a daunting task indeed. The subject matter of English is a central characteristic when defining it. Similarly, historians agree that the subject matter of past events defines what history is (however broad that is). But science…is about cells, and stars, and rocks, and insects, and DNA...it’s about “the natural world.” But that isn’t exactly a helpful definition because English and History also look at things in “the natural world.” Why is it, then, that English and History can both pin down exactly which subject it is with which they concern themselves while “science” is so hard to sum up in terms of subject matter?

The answer, as many of you will already know, is because science is not a subject but rather a system of inquiry by which truth claims can be investigated. Such claims can then be clustered into fields (such as biology, chemistry, and psychology) which can then be defined according to subject matter. Biology is the scientific study of life; chemistry is the scientific study of matter; and psychology is the scientific study of behavior and mental processes.^[5] What makes these disciplines sciences is that they employ the scientific method in their evaluation of truth claims.

I will trust that my readers broadly remember the basic tenets of scientific epistemology. Readers will remember that science is defined by the consistent, systematic use of rigorous, empirical (“based in observation via the physical senses; measurable”) evaluative methods (often called “experimentation,” though this word technically refers to a particular sort of scientific testing) to test the veracity of claims. While the exact demarcation between what is science and what is not science has long been the topic of debate among philosophers of science, this broad definition will for all intents and purposes satisfy the criteria for which I am primarily concerned in this appendix.

Therefore, when I say that psychology is first and foremost a scientific endeavor, what I mean is that it seeks, through utilization of the scientific method, to test claims germane to its topic of interest and arrive at ever-closer approximations of truth. Psychology is, when properly defined and applied, an empirical pursuit. Psychology may study feelings, but it is not based upon feelings. What this means is that everything that psychologists do, including the provision of mental health services, should, without question, be based upon the best available scientific information.

Doing “What Works”—Why Science Education for Psychotherapists is Essential

One common refrain voiced by people interested in a career in psychotherapy is that individuals focused on pursuing a career in clinical care need not concern themselves with learning research methods and statistics, or participating actively in research during their studies. The logic behind this thought process is usually something akin to “Clinical practice and research are different skill sets, and learning to apply evidence-based practices will suffice to make me a good clinician.” While it is true that being a good clinician involves a number of skills which are not necessarily implicated in research work, it is also true that being a good clinician requires doing what works. 

Indeed, nearly everyone will agree that psychotherapists can only provide a useful service to the world if they engage in practices which work, by which I mean practices which are effective at improving the mental-emotional wellbeing of their clients. This is a completely non-controversial position, and few if any would push back against it. The issue, however, is determining which practices do, in fact, work. The only objective and demonstrable means of doing so is, of course, through the systematic evaluative techniques which make up the scientific method. Properly utilizing and relying upon the methods of science is the only way psychologists and other mental health scientists can objectively demonstrate which psycho-social-behavioral interventions are effective at alleviating problematic symptoms or behaviors. Licensed psychologists who seek to apply therapeutic techniques and achieve truly therapeutic outcomes are therefore ethically obligated to rely upon findings which are achieved via the scientific process.

Non-psychologist psychotherapists, in turn, ought to be informed by science and invested in the consistent application of scientifically-validated therapy practices. Though most non-psychologist psychotherapists do not receive in-depth training in scientific research, and though some argue that simply being educated in the practice of validated therapies is sufficient to create empirically-based clinicians, there are several problems with this line of thought.

First, one must consider that non-psychologist psychotherapists (and  psychologists trained in programs which do not place a proper emphasis on research), though ostensibly trained in the provision of evidence-based practices, are often inundated with information regarding new practices (or new applications of old practices). From widespread marketing efforts by healthcare companies to proliferation of books, lectures, and training seminars, opportunities to hear about new types of mental healthcare services are ubiquitous. Compared to doctoral clinicians with a strong research background, licensed professionals without a rigorous background in scientific methods are inherently at a disadvantage when it comes to being able to critically evaluate new information and determine the strength of the evidence for particular claims. In order to do what works, one must have the skills and training necessary to determine what works outside of their guided education. It is therefore imperative that mental health professionals receive, at minimum, a rigorous education in the critical appraisal of research evidence and methodology.

Second, it must also be noted that progress in healthcare interventions nearly always occurs in situations where clinical work and research work are deeply interwoven. Non-clinically educated researchers are often ignorant of common challenges clinicians face when attempting to: scale evidence-based interventions up or down; implement interventions with non-controlled populations outside of a lab environment; or successfully get clients to buy into new forms of intervention. Indeed, since research efforts are often conducted in controlled laboratories with samples motivated to participate either by personal ambition or by monetary incentive, they can often fail to accurately and exhaustively capture the potential barriers clinicians may face when trying to implement the intervention being tested. On the other hand, non-research educated clinicians are often ignorant of the nuance of research findings. They often do not deeply understand particular research methods/designs (and their relative strengths and/or weaknesses) and certain forms of inferential statistical methods (and their relative strengths and/or weaknesses). As such, some clinicians may be easily misled into believing that a particular form of treatment is evidence-based when the evidence is, in reality, weak or highly biased. The intermarriage of research with clinical work, either with one person working in both roles or individuals from both roles acting collaboratively, allows clinicians and researchers to communicate with each other bidirectionally, such that barriers faced by either party can be easily remedied. This is not to say that private, unaffiliated practice by non-scientist psychotherapists should be discouraged. Rather, the reality that research and clinical practice are intricately intertwined should at the very least encourage clinicians and researchers alike to communicate openly and often with members of the other camp while emphasizing to clinicians in particular the deep importance of research work to the continual provision of evidence-based services.

Finally,  it is extremely important to consider how “thinking like a scientist” is an asset to clinicians irrespective of their actual participation in research-based work.

that doing what works does not guarantee that any single individual will experience improvement in his or her symptoms and/or functioning. All psychosocial interventions are, unfortunately, limited insofar as they are unable to treat everyone, all the time.  Being able to think like a scientist

Additional Resources (Alphabetical)

American Association for Marriage and Family Therapy

https://aamft.org/

American Counseling Association:

https://www.counseling.org/

American Occupational Therapy Association:

https://www.aota.org

American Psychiatric Association:

https://www.psychiatry.org

American Psychiatric Nursing Association:  

https://www.apna.org/about-psychiatric-nursing/

American Psychological Association Career Guide:

https://www.apa.org/education-career/guide/careers

Behavior Analyst Certification Board:

https://www.bacb.com

Comparisons of Social Worker Scope of Practice based on Education (Michigan)

https://www.svsu.edu/media/socialwork/docs/Scope%20of%20Practice.pdf

Council for the Accreditation of Counseling and Related Educational Program (CACREP):

https://www.cacrep.org

Insider’s Guide to Graduate Programs in Clinical and Counseling Psychology:

https://www.amazon.com/Insiders-Graduate-Programs-Counseling-Psychology/dp/1462548474/ref=sr_1_1?crid=15Q2YXSQA7S2O&keywords=insiders+guide+to+graduate+programs+in+clinical+psychology&qid=1652847578&sprefix=insiders+%2Caps%2C87&sr=8-1

Mitch’s Uncensored Advice for Applying to Graduate School in Clinical Psychology: 

https://mitch.web.unc.edu/wp-content/uploads/sites/4922/2017/02/MitchGradSchoolAdvice.pdf

National Association of School Psychologists:

https://www.nasponline.org/

National Association of Social Workers:

https://www.socialworkers.org/

Substance Abuse and Mental Health Services Administration:

https://www.samhsa.gov

University of Kentucky Mental Health Professions Career Test ©:

https://uky.az1.qualtrics.com/jfe/form/SV_1BrTgfOY6qblpQx?Q_JFE=qdg