8 ms·

A PhD in psychology takes 6 years to complete plus another year for licensing. A PsyD is a little bit less, but typically you pay high tuition during that time,

A PhD in psychology takes 6 years to complete plus another year for licensing. A PsyD is a little bit less, but typically you pay high tuition during that time, whereas most PhD programs are free (with a small stipend). So, you make little to no money (or pay money) for a long period of time and then you are presented with a choice to take or not take insurance. If you choose the former, you: - Get paid half as much - Have to deal with filing claims, which ultimately becomes an additional expense, since chances are you have to pay someone to do this for you. - Get your money later instead of now. - Have to keep meticulous notes in case you ever get audited by the insurance companies, who can refuse to issue payments if your notes don't meet their standards. - Have to lose patients when their coverage runs out Meanwhile, there's overwhelming demand for therapists in many cities and plenty of people who will pay cash. I truly believe that many therapists are not in it for the money... but if they are going to make less money, let's at least figure out a way to handle the bureaucracy so that their jobs are more enjoyable.

BeetleB 2y ago
You don't need a PhD to get a license...
- nothercastle 2y ago
  But very few non phd therapists practice evidence based medicine
  - r00fus 2y ago
    Most therapists I’ve spoken to aren’t PhDs and the one we do work with isn’t noticeably better for outcomes.
  - hiddencost 2y ago
    lol you have that backwards. The LCSWs tend to be evidence based, the PhDs are busy working on their book promulgating their theories.
    - nothercastle 2y ago
      Lcsw are more like someone you go talk to when you are having a bad day not so much when you need to manage chronic pain, anxiety or ptsd. Insurance understandably does not want to reimburse much for that.
  - meroes 2y ago
    And yet you produced zero evidence. The irony is off the charts.
  - Suppafly 2y ago
    >But very few non phd therapists practice evidence based medicine That's a good point, although people don't seem happy to acknowledge it. In my metro area, the biggest providers of mental health services are aligned with religious organizations or outright promote themselves as offering religious based therapy. It's frustratingly hard to get evidence based treatment free from religious influence.
notepad0x90 2y ago
if the government directly subsidized healthcare instead of relying on the insurance middlemen to perform its duties, this wouldn't be an issue.
- JumpCrisscross 2y ago
  > if the government directly subsidized healthcare instead of relying on the insurance middlemen to perform its duties, this wouldn't be an issue Most psychiatrists I know refuse to take Medicare because it has the same paperwork and pricing issues.
  - CPLX 2y ago
    Medicare is not direct. Direct would be if the therapist worked, on salary, as a therapist, and received a paycheck from the government.
    - lolinder 2y ago
      That isn't what "directly subsidized" means, though, that's "directly run". A subsidy is a strictly monetary arrangement, not one where the government actually becomes the employer.
    - jerkstate 2y ago
      Tricare is perhaps the closest thing we have to direct government healthcare, it handles healthcare for active duty military, it is part of the DoD and contracts out to providers directly (including therapists) and compared to other private insurers they are among the most difficult to work with. My partner is an independent psychotherapist and contracts with various healthcare providers and Tricare has by far the highest rate of spurious rejections, short paychecks, heavy audit requirements, etc and their resolution department is the hardest to work with. So we already have evidence of how it goes when the government manages it directly and it’s worse than private industry.
- nradov 2y ago
  It would still be an issue. Even countries with socialized or heavily subsidized healthcare systems tend to have long waiting lists for therapists and strict limits on the number of sessions. Services are rationed everywhere.
jdgoesmarching 2y ago
LPCs, MSWs, LCPCs, LMHCs make up a much larger portion of therapists over PhDs and PsyDs. All take much less schooling.
- timr 2y ago
  I know someone who is in training to be a therapist. It still takes an absurdly long time and a lot of money to get any of those degrees. In New York, for example, there's a mandatory multi-thousand-hour internship that essentially treats you as indentured labor for several years -- and this is after getting a masters, which you usually pay for. The average case ends up substantially in debt, for a field where private practice pays mediocre salaries. (Hot take: the masters was the truly offensive part of the equation -- most of the content was total bullshit / pseudo-intellectual woo. At least you're getting supervised practical training in the internship, even if your salary is low.)
  - leoqa 2y ago
    Yeah my wife is a MFT and it’s wild how long the process has drawn out before she made money. School, internship, practicum (actually just another internship), license exam, associates licensure requires a supervisor- either you pay them to supervise you or you have to work somewhere that will hire associates.
    - spicyusername 2y ago
      Anecdotally, as someone who is considering a career change out of tech, I am constantly shocked at just how long and how expensive it is to change careers to do anything else. I shouldn't be surprised, given how much training it took me to get into this field, but being paid nothing and spending years in training was much easier to tolerate at 20 than at 40.
  - marcuskane2 2y ago
    > most of the content was total bullshit / pseudo-intellectual woo. At least you're getting supervised practical training in the internship If you're lucky enough to get an unusually good internship. Won't most of the interns be shadowing someone who is just practicing the same bullshit/pseudo-intellectual woo the elder therapist was taught by the same programs a few years earlier?
miki123211 2y ago
Okay, here's one thing I really don't get. There are plenty of native English speakers in third-world countries. Presumably, some of them could become qualified (from a practical point of view, not a legal point of view) therapists. Therapy can be offered via telemedicine, over the internet. At least some of these people are far enough from US jurisdiction that they could probably offer this service to anybody who wants it over the internet, and just not care what foreign governments have to say about it. This feels like an easy way for people there to make relatively large (by their standards) amounts of money. Why isn't this happening yet?
- rafram 2y ago
  Because people want therapists who’ll connect with them and understand their life experiences. I’m sure there are fitness/“life” coaches working online from who-knows-where, though. That’s more or less a form of counseling.
- PretzelJudge 2y ago
  Sure, if you just want someone to talk to. But most clinical psychologists are dealing with more severe cases. Would you want your suicidal teenager talking to a licensed therapist trained to deal with their case, or to someone overseas whose qualification is that they speak English?
- Suppafly 2y ago
  The problem with this, and we see this in the US already with medical providers, is that even if they are 'native' speakers in their own country, they miss a lot of important nuance and conversational skills to work with US native patients. And that's before you even consider the cultural stuff that they just don't have a frame of reference to understand. Someone from a country where women don't have rights, or where normal things like divorce or abortion are illegal, isn't going to be able to offer useful therapy to someone from the US.
timbo1642 2y ago
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BeetleB 2y ago

You don't need a PhD to get a license...

nothercastle 2y ago
But very few non phd therapists practice evidence based medicine
- r00fus 2y ago
  Most therapists I’ve spoken to aren’t PhDs and the one we do work with isn’t noticeably better for outcomes.
- hiddencost 2y ago
  lol you have that backwards. The LCSWs tend to be evidence based, the PhDs are busy working on their book promulgating their theories.
  - nothercastle 2y ago
    Lcsw are more like someone you go talk to when you are having a bad day not so much when you need to manage chronic pain, anxiety or ptsd. Insurance understandably does not want to reimburse much for that.
- meroes 2y ago
  And yet you produced zero evidence. The irony is off the charts.
- Suppafly 2y ago
  >But very few non phd therapists practice evidence based medicine That's a good point, although people don't seem happy to acknowledge it. In my metro area, the biggest providers of mental health services are aligned with religious organizations or outright promote themselves as offering religious based therapy. It's frustratingly hard to get evidence based treatment free from religious influence.

notepad0x90 2y ago

if the government directly subsidized healthcare instead of relying on the insurance middlemen to perform its duties, this wouldn't be an issue.

JumpCrisscross 2y ago
> if the government directly subsidized healthcare instead of relying on the insurance middlemen to perform its duties, this wouldn't be an issue Most psychiatrists I know refuse to take Medicare because it has the same paperwork and pricing issues.
- CPLX 2y ago
  Medicare is not direct. Direct would be if the therapist worked, on salary, as a therapist, and received a paycheck from the government.
  - lolinder 2y ago
    That isn't what "directly subsidized" means, though, that's "directly run". A subsidy is a strictly monetary arrangement, not one where the government actually becomes the employer.
  - jerkstate 2y ago
    Tricare is perhaps the closest thing we have to direct government healthcare, it handles healthcare for active duty military, it is part of the DoD and contracts out to providers directly (including therapists) and compared to other private insurers they are among the most difficult to work with. My partner is an independent psychotherapist and contracts with various healthcare providers and Tricare has by far the highest rate of spurious rejections, short paychecks, heavy audit requirements, etc and their resolution department is the hardest to work with. So we already have evidence of how it goes when the government manages it directly and it’s worse than private industry.
nradov 2y ago
It would still be an issue. Even countries with socialized or heavily subsidized healthcare systems tend to have long waiting lists for therapists and strict limits on the number of sessions. Services are rationed everywhere.

jdgoesmarching 2y ago

LPCs, MSWs, LCPCs, LMHCs make up a much larger portion of therapists over PhDs and PsyDs. All take much less schooling.

timr 2y ago
I know someone who is in training to be a therapist. It still takes an absurdly long time and a lot of money to get any of those degrees. In New York, for example, there's a mandatory multi-thousand-hour internship that essentially treats you as indentured labor for several years -- and this is after getting a masters, which you usually pay for. The average case ends up substantially in debt, for a field where private practice pays mediocre salaries. (Hot take: the masters was the truly offensive part of the equation -- most of the content was total bullshit / pseudo-intellectual woo. At least you're getting supervised practical training in the internship, even if your salary is low.)
- leoqa 2y ago
  Yeah my wife is a MFT and it’s wild how long the process has drawn out before she made money. School, internship, practicum (actually just another internship), license exam, associates licensure requires a supervisor- either you pay them to supervise you or you have to work somewhere that will hire associates.
  - spicyusername 2y ago
    Anecdotally, as someone who is considering a career change out of tech, I am constantly shocked at just how long and how expensive it is to change careers to do anything else. I shouldn't be surprised, given how much training it took me to get into this field, but being paid nothing and spending years in training was much easier to tolerate at 20 than at 40.
- marcuskane2 2y ago
  > most of the content was total bullshit / pseudo-intellectual woo. At least you're getting supervised practical training in the internship If you're lucky enough to get an unusually good internship. Won't most of the interns be shadowing someone who is just practicing the same bullshit/pseudo-intellectual woo the elder therapist was taught by the same programs a few years earlier?

miki123211 2y ago

Okay, here's one thing I really don't get. There are plenty of native English speakers in third-world countries. Presumably, some of them could become qualified (from a practical point of view, not a legal point of view) therapists. Therapy can be offered via telemedicine, over the internet. At least some of these people are far enough from US jurisdiction that they could probably offer this service to anybody who wants it over the internet, and just not care what foreign governments have to say about it. This feels like an easy way for people there to make relatively large (by their standards) amounts of money. Why isn't this happening yet?

rafram 2y ago
Because people want therapists who’ll connect with them and understand their life experiences. I’m sure there are fitness/“life” coaches working online from who-knows-where, though. That’s more or less a form of counseling.
PretzelJudge 2y ago
Sure, if you just want someone to talk to. But most clinical psychologists are dealing with more severe cases. Would you want your suicidal teenager talking to a licensed therapist trained to deal with their case, or to someone overseas whose qualification is that they speak English?
Suppafly 2y ago
The problem with this, and we see this in the US already with medical providers, is that even if they are 'native' speakers in their own country, they miss a lot of important nuance and conversational skills to work with US native patients. And that's before you even consider the cultural stuff that they just don't have a frame of reference to understand. Someone from a country where women don't have rights, or where normal things like divorce or abortion are illegal, isn't going to be able to offer useful therapy to someone from the US.

timbo1642 2y ago

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