Careers in Therapy

The simple task of defining what constitutes therapy, or even who should properly be called a therapist, is more complicated that it might seem on the surface. In part, that’s because therapy can refer to any number of different treatments for all kinds of conditions, including physical therapy, massage therapy, aromatherapy, and dozens more.

Even in the somewhat narrower realm of mental health treatment, therapy has lost some of its meaning. It began as shorthand for psychotherapy, and then expended to include a variety of different formal and less formal approaches to treating emotional and behavioral dysfunction, all of which fell under a widening umbrella of treatment options. To add to the confusion, therapist doesn’t exist as a formal professional designation, at least not in the eyes of the states that regulate mental health professions through licensure and certification boards. Without state licensing, you can’t practice as a counselor and you can’t even call yourself a psychologist. You can, however, call yourself a therapist and even practice as one, provided you don’t cross the line into psychotherapy and/or counseling. As the American Counseling Association bluntly points out in its fact sheet, “Therapy and therapist are unregulated terms.”

That said, there are therapists, and there are professionals who administer psychological therapy in a formal setting, using well-established practices. The Bureau of Labor Statistics officially recognizes marriage and family therapists as a subset of mental health professionals who, “Diagnose and treat mental and emotional disorders, whether cognitive, affective, or behavioral, within the context of marriage and family systems.” And that remains the primary area in the realm psychology where therapy and therapist appear to be the preferred term for those recognized and licensed to provide mental health counseling to patients in need.

Marriage and family therapists are trained in the systems theory of psychology, which views the complex interpersonal dynamics of familial and intimate relationships rather than any one individual as the source of dysfunction. As the American Association for Marriage and Family Therapy (AAMFT) explains, “In marriage and family therapy, the unit of treatment isn’t just the person — even if only a single person is interviewed — it is the set of relationships in which the person is embedded.” The AAMFT literature goes on to point out that, “Marriage and family therapists treat a wide range of serious clinical problems including: depression, marital problems, anxiety, individual psychological problems, and child-parent problems.”

These therapists work in counseling clinics, mental health centers, outpatient care facilities, and very often in private practices. They meet with individual family members, couples, and entire families to talk through challenges and dysfunctions, to cultivate healthy coping strategies, and to loosen the psychological knots that so often impair familiar relations. They are by nature counselors, skilled in the art of listening, equipped to assess and advise, and trained in the practices of psychological therapy, or, fittingly enough, psychotherapy.

What Does a Therapist Do?

While there are no legal prohibitions related to the use of the word therapist, successful careers in therapy require a command of a body of knowledge about human behavior and emotional health, as well as a particular set of clinical skills that stem from the theories and practices of psychology. In this sense, therapists are essentially counselors, and thus must be licensed to practice legitimately. In most states, that means completing a master’s degree program in counseling, and passing a state licensing exam or, in some cases, the National Board for Certified Counselors’ National Counselor Examination for Licensure and Certification.

Therapists are also similar to clinical social workers (CSWs), both in terms of training, as we’ll see below, and in terms of the role they play within the mental health profession. Like clinical social workers, marriage and family therapists spend their work days meeting with couples, families, and individuals who want help, listening to their problems, and offering guidance in the form of healthy behavior modifications, emotional reassurance, and more finely tuned coping and communication strategies. The difference is that CSWs tend to take on clients who are dealing with day-to-day survival challenges, including homelessness, joblessness, hunger, substance abuse, and other community-wide problems. Therapists may also have clients who are struggling with those kinds of issues, but they tend to be sought out by people whose day-to-day welfare is less of a pressing concern.

With that in mind, it can be useful to think of therapists as occupying a niche somewhere between doctor of psychology and clinical social worker, or perhaps as CSWs whose primary domain is helping couples and families navigate through difficulties in their relationships. In a country where the divorce rate is hovering around 50 percent, and child neglect and abuse remains a pressing concern, therapists have an important role to play in helping to hold the social fabric together.

How Long Does it Take to Become a Therapist?

The route to a career in therapy runs on a timeline parallel to that of a licensed counselor or clinical social worker. The starting point is a four-year bachelor’s degree from an accredited college or university. Majoring in counseling, social work, or psychology can help lay a solid foundation for most therapy careers, but it’s not a requirement. Any major is potentially sufficient for the next step, which is usually a master’s degree in counseling with a focus on marriage and family therapy. There are also master’s programs in marriage and family counseling, as well as in counseling therapy. But, essentially, any properly accredited master’s program in counseling will offer coursework in the dynamics of the family, couples counseling, and counseling children and adolescents.

It is also possible to become a marriage and family therapist with a master’s in social work or psychology. All of these master’s programs are designed to be completed in two years, after which most states require between one and two full years of supervised clinical experience. Some of this in-the-field work can be completed as part of the master’s degree program, in a practicum or internship. All in all, it generally takes eight years from the start of a bachelor’s degree before candidates have fulfilled the requirements to take the state licensure exam.

What Do You Study to Become a Therapist?

Careers in therapy usually begin much in the same way that careers in social work and counseling do, with an undergraduate degree from an accredited college or university. Majoring in counseling or social work isn’t a bad idea, but it isn’t necessary, and not every four-year college or university offers those options. Majoring in psychology or sociology can be helpful, and it is a good idea to take introductory classes in both of those disciplines. Developmental and/or childhood psychology are also solid foundational areas of study, as are classes that address the history of the family, the sociology of family life, the anthropology of family, and the theology of marriage and family.

The core coursework in marriage and family counseling takes place at the master’s degree level. While some marriage and family therapists do come out of master’s programs in psychology and social work, it’s more common to earn a master’s in counseling. Either way, you’ll learn many of the same principles and practices, which draw on psychological research and the methodologies of behavioral science, but are tailored to the specific needs of counseling. Here are some of the key areas of study:

  • Psychological Assessment
  • Psychosocial Development
  • Legal and Ethical Concerns in Counseling
  • Group and Family Counseling Strategies
  • Human Sexuality and Development
  • Couples Counseling
  • Psychotherapy with Children and Adolescents
  • Systems Theory in Psychology
  • Childhood Development

How Much Do Therapists Earn?

Along with the skills, training, and competency that come with a master’s degree, earning potential is another substantial benefit. Marriage and family therapists often work in larger healthcare organizations or clinics that only hire licensed counselors and clinical social workers. It’s also common for therapists to set up in private practices. A state license and a master’s degree can be helpful in attracting clients, and while an increasing number of insurance plans do cover part of the cost of therapy, the companies that administer those plans often require the therapy to be with a licensed counselor.

The chart below illustrates the breakdown of marriage and family therapists work settings, as of the latest data from the Bureau of Labor Statistics Occupational Outlook Handbook.

Individual and family services25%
Outpatient care centers24%
Offices of health practitioners8%
Nursing and residential care facilities5%

According to the BLS, marriage and family therapists made a median annual salary of $51,340 in 2020. And demand for these professionals is on the rise, with employment expected to increase 22 percent between 2019 and 2029. This should result in the creation of 14,800 new jobs nationwide for marriage and family therapists over that time period, the BLS reports.

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