Therapists Are Disappearing: It’s Becoming the Job That Nobody Wants

The truth about working in mental health

I like to scroll through Reddit at the end of the day because why not take a deep dive through the bizarre and insane before bed right? I don’t spend much time, at all, on any of the subs that are dedicated to being a therapist because well, why would I want to think about work-related things when I’m not at work? Regardless, it is my profession and it is my craft and it’s sometimes interesting to glance at some of the trends.

Case in point, I’m noticing, more and more, a troubling and yet comforting trend. A lot and I mean a lot of clinicians want the hell out of their chosen career. They are burned out. They are physically exhausted and they are considering other career options. They make posts about it so often that it often starts with some kind of pre-qualifier like “I know people talk about this a lot but…”

My momentary comfort turns into concern. I know my profession and my work is profoundly important. I’ve been passionate about my work and I’m just plain good at it. Personally, I believe that I have saved lives by preventing suicide. I’ve helped kids get out of abusive situations and I’ve been able to help people work through trauma and live freer. Therapy made a big difference in my life and I know that it makes a difference for countless people.

A better world

I believe that real progress in the world will come in the wake of a mental health revolution. The world has been adopting more healthy physical practices. We have a basic working knowledge about nutrition and physical exercise. I believe that similar things will be around the corner for mental health. I can see a day when people wake up, do some pushups before exercising some mindful techniques that improve their personal insight, awareness and help them set their intentions for the day. I would love to see a day when health classes in school don’t just teach good nutritional facts but also good ways to deal with depression and anxiety.

It’s a nice dream and one that is slipping through our fingers because the mental health fields are hemorrhaging professionals. My home state is experiencing a major shortage of mental health professionals and is one of many that is considered underserved. Licensing and governing boards are scrambling to make some adjustments. There’s a huge need for professionals and with each passing year, it’s becoming harder and harder for companies to meet the needs of their clients because they just can’t hire good therapists and keep them.

Therapists bounce from job to job, snatching up signing bonus after signing bonus. Companies are desperate to keep them and therapists are desperate to find a good place to land permanently. Many people seeking mental health will be assigned and re-assigned to multiple therapists in a short amount of time because of how high the turnover rates are. The unintended consequence is that people become treatment-resistant as their faith and trust for the profession breaks down.

Shoulda done something in tech

Being a therapist is sucky job. I’ve been doing it long enough that I know that even though there are a lot of things that I have loved about it, it’s not enough to make up for the ocean of BS that we have to swim through. Here’s a basic breakdown of why being a therapist is a crappy job and why I’ve been thinking about a career change.

1. You have to jump through endless hoops to get a therapy license and to keep it — Aside from getting an advanced degree, we have to take expensive exams, fill out lengthy applications and pay expensive application fees. And even after all of that, we’re not fully licensed and we have to work up to two years as a professional equivalent to a medical resident in which our job options are limited and our pay is poor. During that probationary period we have to track all of our clinical hours and work under the tutelage of capricious clinical supervisors. Seriously, some of them are psychos and you have to basically crawl around for them if you want them to sign off on your hours. Once we’re fully licensed we have to keep on continuing education units by going to expensive seminars with so many credits being specific to ethics and certain units being specific to suicide prevention. We have to pay expensive license renewal fees. There are also national provider identifiers that we have to keep up with, credentialing paperwork to be able to get paid by insurance companies, expensive malpractice insurance and on and on. Everytime I turn around there’s somebody else wanting to put additional requirements on us to be able to practice. We should have to get more education on trauma, more education on medical issues that affect mental health. On and on and on. Local legislators keep trying to pile more onto us because of social problems; they are slowly legislating us to death. The hoop-jumping never ends.
2. Overworked and underpaid — Therapist pay sucks. It’s high middle class, sometimes we get paid less than a teacher when our professional requirements are way steeper. Most of us get paid through insurance plans and the pay sucks. We end up having to work caseloads that overburden us just to get paid enough. Insurance companies will raise the rates for doctors but they don’t raise the rates for us. I don’t know the last time that insurance companies raised the rates for therapy. Agencies and clinics that hire us need to make a profit and so they give us these massive caseloads that are unmanageable so that they can make a profit.
3. Government insurance is the absolute worst — When I hire therapists they are relieved when I tell them that we don’t take Medicaid. Medicaid is a morale destroyer. Give me a therapist that loves their job and after a year of dealing with Medicaid, I will show you a therapist that hates their job. They bury us in paperwork and red tape and if you don’t live up to their standards because of your own burnout and exhaustion, their strict auditing processes will put you in the hole financially because these jerks will take their money back. And not a little bit. Sometimes tens of thousands of dollars for minor infractions. It’s also not uncommon for them to file criminal charges against those of us found with major infractions; professionals get strung up for “breaches in the contract” and then your career is toast. Time to go to truck driving school. Medicaid treats us like we are criminals on probation. They hate us and they will look for any and every reason not to pay us or take their money back. They grill us because the people they are paying for aren’t making enough. progress. What they don’t take into account or even care about is that we spend our hours filling out all of their reports when we could be spending our time improving the quality of care for their patients. They have zero-tolerance policies for mistakes. If we don’t cross every “T” and dot every “I” they will make us pay. They are a nightmare and they are chasing therapists away from this career, we are dropping like flies. If you saw the Joker movie in 2019 then you’ll remember the government therapist that he sees. She’s apathetic and she’s burned out. This isn’t fiction, it’s based on actual events.
4. We aren’t allowed to make mistakes — We are expected to always make good decisions, always keep our emotions in check and always make exactly the right decisions all the time. We walk on eggshells because people, including insurance companies, are waiting for us to step out of line so they can hang us from the nearest tree. People like making an example of us. Back in the old days, government officials would put the corpses of convicted pirates into cages as a warning to other pirates. They kind of do the same thing to us. One major mistake and we are toast. We could spend the next several years in malpractice lawsuits. One major mistake and we are permanently screwed. Every single one of us is an accusation away from a career-ending situation.
5. We get compassionate fatigue — Yes, it is hard working with people through extremely difficult life issues. People are imprisoned by their trauma. They come in with complex problems. They are overburned with grief and despair and it can take a lot out of us mentally and emotionally when we try to help them climb out of hell. We can’t see thirty people a week without going home and just wanting to drink alone.

Now combine all these together and it makes for a lot of ingredients on a shit pizza that we have to eat every day. Therapist burnout is high, the average is about five years before they start thinking about changing careers.

I’m actually one of the lucky ones. I have built my reputation and I am able to pick and choose who I want to work with. I’m lucky that because I am in higher demand I can raise my rates and ask for cash pay only. I’m lucky because I get paid to supervise other therapists and do administrative tasks. I’m also lucky that I have managed to built a personal life worth going home to. I can’t imagine what it’s like to go home to soul-crushing marriage or have to deal with a messy custody battle.

And yet, despite all the positives and the rewarding outcomes that I see, I still want out. I know an amazing therapist that is thinking about going back to teaching. She’s so burned out from doing therapy that even teaching seems like a better option but these stories are repeated over and over again across the country.

I shudder to think about a future where seasoned mental health professionals have gone the way of the dodo. We need fewer government mandates, better protection, less work and better pay or our future might not be a mentally healthy one.