job description

As a counseling psychologist, my primary responsibilities are psychotherapy and counseling for adults.

I like working with adults because they're capable of talking about their problems and thinking through some of the concerns. They're usually motivated, and they're in counseling because they want to be. They usually are compliant, meaning they do the assignments that are given to them, and they're just generally very motivated to feel better.

Adults are more likely to be set in their ways and to have difficulty changing.

The biggest challenges are trying to come up with new approaches that will help people deal with very complicated problems. I have to be sure to identify the problems correctly, so I can help the client find a good solution.

With each case, I try to do a very careful and thorough assessment so that I can identify the problem as accurately as possible. I'll try to take a complete history perform a thorough analysis of the presenting problem, then gather relevant information so that I can define or diagnose the problem accurately.

A new client would be different than a continuing one, but if it was a continuing case, we would spent the first few minutes of meeting setting the agenda for the session. I would ask the client what it is he or she would like to talk about that day. Usually, I have some ideas because I've been keeping track, and if I had given them an assignment at the last appointment, then reviewing that assignment would be on the agenda. Sometimes the clients themselves have something more pressing they want to approach, so we'll focus on that whatever it is that's most important to them. We'll spend the bulk of the time talking about whatever it is they want to talk about, and exploring that in depth. Usually the session ends with my recommendation for something they could do before the next session. Sometimes it means reading something in a book or practicing a new behavior, having a difficult conversation with someone. The goal is to have something that will form a bridge between each session so they're doing something outside of our time that ties into what we're working on in each session.

The most satisfying thing is that when I see progress and realize I am really helping someone. Psychologists help someone meet a need that they have, and sometimes you're one of the few people in someone's life who gets to share a very private, personal time with them, so it's really an honor to be allowed into someone's inner world to such a great extent. That's a privilege, really. Someone finds you safe enough, someone trusts you enough to tell you something they wouldn't tell anybody else.

I like the financial parts the least. I'm not the most comfortable with billing, following up with collections, and making sure that insurance is paying. The financial part and the business ends of it are the parts that I like the least. In terms of the work, sometimes I have difficult sessions with couples who are fighting. They come in and they want me to be the judge of who's right, and that's not how I see my role. It can be a challenge when someone wants me to fix their partner.

I think it's typical of other people who are in self-employed private practice, but probably not exactly typical of someone who's in an institutional setting or an organizational setting that deals with a specific population.

education & career path

I went to graduate school, and when I got my Ph.D., my intention was to do academic work or research. I took my first job out of graduate school with a research group that hired approximately 150 Ph.D.s in psychology, all of whom were doing government-funded or corporate-funded research in education or psychology. My work at that time was to examine the effectiveness of treatments for families undergoing divorce or remarriage. I discovered that the full-time research meant a lot of grant writing and trying to secure funds and that was often difficult, because researchers are dependent on government sources and political administrations. When I first started working, Carter was in office, and there was a lot of funding available for psychological and social science research. In the middle of my time there, Reagan came into office and things shifted a little bit. There was less funding available for psychological and social science research, and the work became much harder. About that time, I decided to have children, and I wanted more flexibility in my job. I didn't want to work full-time anymore, because I wanted to be home to raise my kids. So I went and did some additional training and took the licensing exam to enable me to practice counseling psychology in California.

No. I wasn't really sure what I wanted to do, but I knew that I wanted to work with people, and I had the right skills to do so.

I think I clarified in undergraduate school that I wanted to work with people, that I really liked the idea of having that as a profession. I was really interested in research, so that's why I decided to get a Ph.D. instead of a Master's in Social Work.

I had an undergraduate adviser who encouraged me to go to graduate school, and she helped direct me to different kinds of programs that I might find helpful. It helped to have a mentor. Many people that I know in the field had a mentor, and that was very useful to them, as well.

Flexibility was highly important for me. To have independence, to not be too locked in, to set my own hours and to set my own pace were all extremely important to me.

my day

A typical day for me starts in the morning, probably between 9:00 and 10:00 a.m. I do a little bit of paper work, get the office ready, and have someone come in every hour. I usually have a break in the middle of the day for about an hour and a half for lunch, and I work into the evening until about 6:30 p.m. My appointments are usually back-to-back, but not always. I stop each appointment at 10 minutes to the hour, so I can write my notes, put them away, clear my head, and move on to the next client.

Pretty much. People cancel and no show, so sometimes you'll get breaks in the middle of the day that you hadn't planned on having, or someone will call and want to see you right away, so you can get them in if you have an opening in your schedule. Unlike some jobs where you know exactly what your day is going to be like, this requires a little bit of flexibility.

Sometimes at the end of the day I start to feel tired. If it's been a really difficult session where someone became really upset or angry, it can be hard to leave that behind and then move on to the next person. It requires that you're able to take a deep breath, set any stress aside, clear your head, and move on to the next case.

I try not to see more than eight people in a day - four in the morning and four in the afternoon. Anything more than that or without a break in the day is too stressful. For me, an ideal day would be seeing six people, three in the morning and three in the afternoon. It requires a great deal of concentration and focus.

Two to three.

No, that's part-time. I think someone who works full time is probably working four days a week or the equivalent of four days a week. A full-time psychologist in private practice probably has twenty to thirty client hours a week, and I have about twelve to fifteen.

salary & lifestyle

I work by the hour, and most psychologists like myself charge somewhere between $100 and $120 an hour. I charge $110. Now, insurance companies don't pay that much if you're on a preferred provider panel. Medicare or Medicaid will often reimburse the fee at a lower rate. If you were salaried, you would not be paid by the hour; the salary for a full-time psychologist is probably somewhere between $60,000 and $80,000 per year.

Salaried psychologists can work in hospitals, schools, prisons, industries like the CIA and the FBI, medical clinics, social service agents I even saw an ad in the psychology newspaper for an online dating service that was looking for a psychologist to do profile matching.

I have enough income, but not as the primary breadwinner. If I had to support a family on my income alone, that probably wouldn't be enough to support the lifestyle that we currently have. I would either have to work more hours or change my lifestyle. As a secondary wage earner in our family, it's fine.

It's come and gone over the years. When you're starting out, it's not very steady and that's when newer psychologists sign up for insurance panels or get a contract with an insurance agency to have more guaranteed referrals. My referral bases and word-of-mouth testimonials are pretty well-established, so I feel that even if I have a couple weeks or a month or so where I'm a little short with the hours, I'll make it up at some other point in the year and, surprisingly, that's been really steady over the course of the last ten years.

No, I don't advertise, but I have a line in the yellow pages under "psychologist," so I have my name, my phone number, and my license number (which is required). I don't do any advertising beyond that.

Yeah, some of them have big ads in the yellow pages. Some of them will occasionally advertise on radio. Many have websites now and will buy space on websites like Psychology Today. Online advertising is a new frontier I haven't really explored, but that's what a lot of younger psychologists are doing now.

I would consider it; I just don't know how to do it! I haven't really felt like I've needed to do it. My practice is very stable.

I think the job is excellent for somebody who wants a part-time job with flexible hours. I think this work really allowed me to be available to my children when they were growing up, when they needed me. It doesn't require any travel. I was able to create an office close to home, and some psychologists even work in their homes. The flexibility of part-time psychology is really one of the strongest benefits of it, and there are very few psychological emergencies. I haven't had to deal with weekend calls. I'm really able to keep my work confined to my normal business hours.

Very rarely. I have to think about my cases, I read about them, I do some research on some of the problems coming up. I'm constantly doing continuing education, which is required by my license. I do continuing education beyond my license requirements because I like to stay up-to-date. I bring work home by reading at night, thinking about my cases and taking case notes or consulting colleagues, but that's something I can do on my own time.

Usually once or twice a year.

One to two weeks. It's hard to be gone for more than three weeks because people depend on you, and many times you can get someone else to cover your clients for while you're gone, but that's a little tricky because they've already established a relationship with you, and they've come to trust you. You're not really interchangeable with another psychologist.

I probably won't retire for another ten years. This is one of those jobs that you can continue do quite well with age. If anything, maybe people think you're a little older, wiser with age. Youth is not really a benefit in this career. Age, maturity, wisdom are probably more helpful. You want to be able to relate to the people you're working with.

pros, cons & trends

Being self-employed, I'm not around a lot of other people, so it can be kind of a lonely job. I'm in my office with my clients, and the psychologist relationship is a one-way relationship. I can answer questions about myself if they ask and if they're relevant and helpful, but I won't get to talk to them about your life and what I'm doing, so mostly they're paying me to listen to them and help them solve their problems. It isn't like sitting down and chatting with a friend or colleague. It's an unreciprocated, one-way relationship, and that can feel lonely. If you're working in an institution, there are usually staff meetings and trainings, but in private practice, I share an office with two other people, but I only see one of them on a regular basis, and we'll only say "hi" in those ten-minute windows between sessions.

The isolation is a pretty big disadvantage, and I think sometimes the work that we do is very slow, but not always. Sometimes we'll see really great progress and that's very satisfying, but it doesn't happen overnight. There are no quick or immediate results; it's a slow process. It takes a fair amount of patience. You really can make a difference in someone's life. Sometimes the difference is just that they're not so isolated and they have someone they can share with what's going on in their life. Sometimes you see people really start to live their lives differently, but sometimes you have to accept that there's nothing you can do.

You get to work with people and you also have a job that you can feel good about, where you're actually doing something that is of value to people. You're making someone's life a little more pleasant or making her pain a little more bearable. Knowing that you have a job that does a service is gratifying. It's a job that's respected and it's interesting.

There's always something different. No two people are alike. No two problems are alike. Even though you may have seen a certain type of problem before, it's always a little different in each person.

I think I would probably spend more time with colleagues, consulting and reviewing cases together and just being with more people in the field, which I haven't developed as much as I'd like to.

There has been a push for shorter-term treatment. Insurance companies don't want to pay for years of therapy. Many insurance companies would allocate only ten or twenty sessions, so over the course of my career, I've had to learn how to do therapy in a brief format, to be more problem-focused than person-focused, and try to address the specific problem in a focused way, so it could be done in less time and in less sessions and be more cost-effective.

I think we've kind of hit the end of that. It got to the point where the allocation was for so few sessions that the counseling almost became a joke. The field as a whole has been required to prove its effectiveness, so that's led to more packaged kinds of therapeutic protocols. I think the days where you could just see someone for years and explore all kinds of issues are gone. Today, the treatments are much more targeted.

Psychologists have been lobbying to get special training to prescribe certain classes of medications, in the same way dentists, podiatrists, or ophthalmologists can prescribe certain types of medication. Psychologists want the privilege of prescribing medications for conditions like depression or anxiety, and that's been pretty strongly opposed by the psychiatrists' association and the American Medical Association because it's an infringement on the unique things they do. Things will probably move in that direction, though, and it'll require special training.

advice

It would have been helpful to know how to run the business part of a psychology practice. It would have been helpful to know about billing and insurance and to know about how to create referral sources.

On a personal level, you have to really enjoy being with people. You have to be good at analytical thinking, to be able to think about not just the person, but also the problem. You have to be empathic, and you have to be able to be sensitive and compassionate, because everyone that all of the clients you see are experiencing trouble in their lives. You need to be nonjudgmental about their problems, to join them and understand their worlds as they inhabit them. You have to have some good people skills, but you also have to have some good analytical skills to conceptualize the problem and identify possible solutions for the problem.

Graduate school in psychology has a competitive admissions process, so a good undergraduate GPA is important. Graduate programs in universities are more competitive in admissions, and their training focuses on both research and clinical practice. There are also freestanding private graduate schools of professional psychology that are less competitive in admissions and primarily train clinicians.

I learned how to conceptualize a case, how to conduct a history and assessment of each client, studied interviewing techniques, and learned how and where to get information about treatment.

You have to have an advanced degree, so that's the first step. Beginning psychologists would most likely find work in an organization or an institution like a community mental health center, family service agency, hospital, or prison. Private practice is difficult when you're first starting, because you generally don't have established referral sources. So I would get a job that would allow me to network and meet other healthcare professionals that might build referral sources in the future.

I would tell someone how important education and training is. Learning how to enter another person's emotional experience and how to leave the work, the emotional experience, behind requires time and training. Education, consultation, supervision are critical for developing competency.