I, Dr. Steele-Wren, of PsychologyWorks PLLC, straight out of Bentonville, AR am back after yet again a months-long hiatus from blogging. The end of 2021 was busy but very good to me! I often get emails from those interested in becoming a Psychologist seeking advice or just wanting to know how I got to where I am today. I figured writing a blog on what it takes to become a psychologist might help those considering the career who want a raw authentic recount from someone who went through it themselves. Or, if you are a current patient or thinking of reaching out for services, it may serve as validation that I am someone who has been highly trained and beat a lot of odds to be in a position where I could help others heal.
Here are the steps and my freely-written story to becoming a doctoral-level independently licensed Psychologist (what a mouthful and I did not even add ‘in private practice’) : **Some requirements, etc. may have been changed, and my opinions are not necessarily facts, so make sure you do your own research if you plan to apply to doctoral programs!**
1. Bachelor’s degree; I believe it is best to major in psychology with a focus on clinical psychology courses (it’s not the end of the world if you don’t major in psychology but it’s ideal when applying to grad programs after).
2. Master’s degree; Because of how competitive doctoral programs are and having been on selection committees myself, it’s almost a requirement now to have a Master’s in Psychology or Mental Health Counseling with real clinical experience actually meeting with and providing therapy to patients. After my bachelor’s, I pursued a Master’s in Clinical Mental Health counseling and went on to get my Licensed Mental Health Counselor designation in my original home state of Massachusetts. I ultimately knew I wanted to pursue the doctorate, but the Master’s was key to ensure I wanted to further get involved in this field and devote a lot more time and money to my intended career. I have certainly seen the case where someone enters a doctorate without a Master’s degree and spends lots of money and time to realize they don’t enjoy the work itself. That is not a fun time.
3. Related Work Experience; Any volunteer work in the mental health realm you can get involved with during your education really helps with being more competitive when applying to PhD or PsyD programs. In my former job, I created an undergrad ambassador team who engage in all kinds of outreach (CAPS Ambassadors at University of Arkansas). Something like this is a good way to “dip your toes in” to the field.
4. Apply to doctoral programs; The application process to doctorates can differ for each program and is certainly a lot of work where you then hope to get interview offers. You also must apply to APA-accredited programs nowadays or you will have trouble with later phases toward licensure. I chose to apply to a PsyD because the courses were more focused on providing therapy services versus research and teaching, which PhDs traditionally focus on. But even PsyDs require you to successfully complete an original research dissertation (which is so much work!). PhD programs will likely have more class requirements based on research to possibly become a professor or go on to fully work in a research lab (although those jobs are super slim right now and have been). In addition, PhDs, like PsyDs, also require many hours of direct clinical experience in order to apply for internship (akin to a medical doctor’s residency) year. PhDs are so incredibly competitive because they tend to pay for your tuition by having you teach undergrad courses or work in a research lab. My PsyD program offered me a really awesome fellowship that covered almost all my tuition for the 4 years of academic courses- but that’s not typical for those programs. If going the PhD route, make sure you get a psychology-based research lab position of some sort as an undergrad and/or summer positions. You also must identify PhD programs that have a professor who specializes in the research area you have been working in to have a true chance to get acceptance offers. As for PsyDs, I’d definitely apply to those regardless as a backup if wanting to go the PhD route.
5. Complete required coursework; You must successfully pass academic courses and clinical practica hours in your doctoral program (usually need a B or higher and around 450 direct client hours) which takes around 3-5 years total before you can then sit for your comprehensive exams (which highly differ by program). Once you pass the comps, you can then petition for the clinical director of your academic program to approve you to apply for internship.
6. Applying for internship; The Internship process is really identical to the residency match system medical doctor students have to apply to and successfully complete after their academic courses are finished. You usually have to have at least proposed your dissertation study and can finish it while on internship, although it was hard for me to balance all that. You won’t be a “doctor” until you successfully defend the dissertation even if you’ve completed internship year.
The application process for internship was honestly one of the least enjoyable experiences (I don’t sugar coat things and wish someone was honest with me about how arduous a doctorate in this field really is). Every application costs money to submit: $50.00 for the first application submitted, $32 for applications 2-15; $60 for each additional application above 15 (in which 13-15 sites was recommended to successfully match). It adds up, not to mention if a site requires you to travel there for interviews and paying those travel costs, but that may be less the case from now on with the pandemic. But it’s expensive and there’s no financial aid built into the process. Once you do all your exhausting interviews, if you are lucky to even be offered several of them, around the end of January, you rank order your choices. The places you interviewed at also rank their applicants (or don’t rank you but you won’t know that). Then in later February you anxiously await an email saying you have matched successfully or did not and now have to go to the second phase match and rapidly send out applications to sites that say they have openings. Then the same process of interviews, rank order, and hope to match again happens. I was so fortunate to match in the first phase. Internships give you a stipend but the highest I’ve ever seen is 30k for the year which is minimum wage or lower depending on the cost of living where your internship is located. You do have to move to that area for the entire year. Internship is a full time (40+ hours a week) position where you are engaging in direct client services, receiving weekly didactic trainings, where some sites offer you the chance to supervise a Master’s level trainee to get that experience, and others may have community outreach requirements or teaching and research components like mine had. It was HARD with later night hours and after-hours evening and weekend coverage. Every site differs but I haven’t heard anyone have the best time of their lives while on internship- I feel as though it’s that final gatekeeping system to weed anyone out who won’t be a good fit in the field.
7. Apply for jobs/post-docs and work toward licensure; While on internship you (yay) once again have to then apply for job openings for unlicensed psychologists (which won’t pay as well as you may have hoped, maybe 50k/60k in some places). Once you hopefully secure a position, and one that provides supervision by a licensed psychologist (of 3 years preferably as some states won’t count your supervised hours by someone licensed under 3 years), you can start working on licensure requirements, which differ among every state. Hopefully by now you have successfully finished and defended your dissertation, but some workplaces will consider you a “post-doc” and pay you less, but allow you to be ABD (all but dissertation) for the year. If you want a specialized area post-doc, there is an application system for that but it is not a match system like internship.
8. More steps to licensure; Depending on the state you plan to get licensed in, you may be able to take the licensing exam, EPPP, as soon as you graduate or within a few months. Many states require you to apply for this which is time-consuming and comes with many hefty fees associated just to be approved to schedule the EPPP at a Pearson testing center. The EPPP costs $600. In addition, you will face a testing center appointment fee of $87.50. and if you don’t pass you have to keep paying to take it until you do. Some employers will pay for you to take it that first time and you can try to negotiate that in your contract if they don’t offer it as a perk. Studying for the EPPP after internship year and also working full time as an unlicensed psychologist was exhausting. It seemed like getting to the final point was just never going to get here after so many steps and constantly having to prove myself I was worthy. It’s the nature of a doctorate in psychology although I would like to see the culture improve over time. I paid for online courses to help me study for the EPPP and somehow stuck to a good enough study plan during the height of the pandemic. Those courses cost well over 2k in addition to all of the fees to apply for licensure in my state. But they were worth it because I passed the EPPP during the pandemic. Right now, some states are starting to adopt the requirement of also passing a second part of the EPPP, which as far as I know is where you respond to simulations of clinical scenarios. I was relieved I was not required to do the second part! Phew.
After you pass, your state board gets word of it from the testing company, and next, you either have to sit for an oral exam at some point before licensure or if lucky enough, your state will grant you full licensure if you’ve passed the exam and also got all of your signed supervised hours (see each state for specific requirements) sent in and approved.
9. Fully licensed, then what?; Once you are licensed it’s a big relief. Often your workplace will provide a tiny raise for being licensed. Or, like me and many other psychologists, you can go into private practice now with full licensure to practice independently. There are options of joining a group practice already established or going out fully on your own if you feel comfortable learning the business side of running a solo private practice. There is no paid time off, no health or retirement benefits, and you only get paid if clients show up to appointments, not to mention dealing with insurance panels is not always easy; but applying and being approved to be in-network with major health insurers helps get your caseload built. Contract work with group practices tends to not offer any traditional employer benefits either and the industry standard is the practice owners take 40% of your pay and you receive 60%. For many who want more freedom from agency work, joining a group practice makes sense to not have to do all the marketing, accounting/taxes, and all the associated expenses like office rent and office supplies. Once I got really busy in my practice, I decided to outsource my billing to a professional company, as well as hire virtual receptionists to answer my phone while I am usually in sessions back-to-back during weekdays. I also utilize a professional accounting/bookkeeping company that keeps my business model in check and helps me stay on top of self-employed tax structures and deadlines. I want to spend as much time as possible providing treatment, not agonizing over the business side of things I didn’t go to school for.
10. What’s the job outlook like?; As for the job outlook, I get emails daily from recruiters for all kinds of jobs in the counseling field. There will always be work, it just may not be ideal financially or what you really enjoy doing. I’d say the one area that will continue to be difficult to earn a position in is that of university professors. But with a doctoral degree, more doors are open than that of Master’s level therapists. There are plenty of Master’s level therapists who make plenty of money in private practice, however, what they can do in terms of services is more limited. I do a fair amount of psychological assessment for things like ADHD and autism which you now must have a doctoral degree to offer those services. You may see some Licensed Psychological Examiners (Master’s level) still in some states, but in Arkansas, that credential has been phased out.
It also diversifies my days where I’m not always just seeing ongoing individual counseling clients every hour. Last I knew, there were maybe 500 licensed psychologists in the entire state of Arkansas, and that’s compared to states like New York or California with thousands upon thousands. So, this state is in dire need of psychologists especially those of us who provide specialty areas like testing or neuropsychological services. Neuropsychologists have even more steps to become licensed in their specialty. They’re in extreme demand all around the country.
It’s all a major learning curve if you eventually choose to go out on your own but at the end of the day, I love being a Psychologist and although sometimes the work is emotionally and mentally taxing, it’s the most rewarding career I could have chosen. I get to run my own ship, choose my hours and how many clients I want to see and can manage, be my silly awkward authentic self with my clients, and only work with clients who are a good fit, since therapy fit definitely goes both ways. And it feels good to reach my final goal, see the practice grow so fast, and experience the freedom to be able to do my best work.
I hope that provides you with an authentic overview of the steps to becoming a psychologist! It is really possible for the right individuals, just not a walk in the park.
Yours Truly,
Dr. Steele-Wren