Those first job openings are usually in one of four main settings: agencies, hospitals, government entities, and other settings like churches; occasionally in private practices. Agencies, hospitals, and government entities are the most likely to hire therapists right out of graduate school. Why? Because they have other ways to collect fees for the treatment you are providing. They are not dependent on your license to secure funding. 

Insurance companies have made the higher-level master’s license the minimum credential for reimbursement for anyone in independent practice. Yet some private practices, especially larger ones, have found ways to make it work without the license.

Agencies, hospitals, and government entities tend to pay less than some other settings. On the positive side, they have better benefits and pay a salary right from the start. Those are quite unlikely in the private practice market. Whereas in a private practice one may make more money eventually, the minimal benefits and the time it takes to ramp up to a full caseload weigh on the negative side. (To read more about where therapists work read: “Types of organizations employing therapists“.

You need to be looking for the downsides in the first job and then consider which of your many objectives can be met in the particular position you are considering. Going in open-eyed regarding the positives and the negatives gives you the best chance to do the job with a minimum of disillusionment and discouragement.

First priority: Meet the licensing requirements

On your first job you need to think in terms of accomplishing some key goals. One of your highest priorities should be to meet all the experience and supervision requirements for the license you are attempting to secure. Nothing could be more important in today’s marketplace then getting that license. The lack of a license is the single largest limitation you will face upon graduation. The sooner you get it done, the better.

In most states, master’s-level licenses require a minimum of two years of supervised experience prior to qualifying to sit for the exam. Some states allow candidates to take the exam earlier in the process. All require at least two years of supervised experience after completing a graduate school degree. Check your state websites early and often, as standards can change without warning.

What the licensing does for you

While there are regional variations as to which license is most marketable, most master’s-level licenses will open most doors. This has changed over the years but in today’s market the variations between licenses is just not what it once was. The reason is because more and more companies using large national behavioral health companies to manage benefits, The biggest issue to overcome is not having a license at all. Even in those cases there are some insurance companies that will cover a therapist who is under supervision.

Some areas have an oversupply of mental health providers, i.e., most suburban and some urban areas. In those areas, some insurance companies are now insisting that clinicians have three to five years of post-licensure experience. Accepting you means being on their insurance panel.  Being on an insurance company’s “panel” means that they will refer clients to you. Your fees are covered at the “in-network” rates that they determine to be “reasonable and customary.” In areas with an oversupply, these “contracted rates” are not negotiable. Insurance companies dictate the terms. The clinician is left with the choice of taking it or leaving it. (For more on the decisions about joining insurance panels or not see: “Why join insurance panels“.

Go deep first and then wide

The next goal should be to build an expertise with a particular client population. A specialty becomes the vehicle for your next round of job interviews. And it gives you the first place to build your clinical confidence. Therapy requires such a complex set of skills that it helps to tackle the challenges one specialty at a time. Building that first expertise first.  Then widening one’s clinical experience. 

Becoming a generalist

When a clinician demonstrates skill in one specialty, clients will introduce you into other parts of their lives. It’s as if your clients start saying, “You helped me with this one impossible problem, now help me with all my problems.” They sense your confidence. They generalize that confidence to all of their issues. You will inevitably become a generalist with exposure to a breadth of clients.

Of course there are some unique aspects of treatment when moving from one disorder to another. And yet the similarities far outweigh the differences. As you work with people with one type of problem, you’ll become familiar with other disorders within the same person or system. Getting good supervision will help you with your clinical insecurity. Supervisors will provide you with the resources you need to build on what you already know.

This is the usual path therapists use to grow into a seasoned clinician comfortable with most clients, regardless of what may come up in the therapy session. The principle of going “deep first and then wide” is exactly the method that most use to develop skills and confidence. 

Make connections

The third objective for that first job is some connections. That first job will give you exposure to to referrers and potential employers. Some will aid you in getting and maintaining a more ideal job. If your starter position does not bring you into contact with the people you want, then find a way to make those connections on your own. It may take your initiative.

If you do not come into contact with other therapists outside your organization, try this. I have often had newly graduated therapists who would call me every six months or so to “do lunch.” We both knew that the purpose of these lunches was to build a relationship that might develop into an employment situation. Some did.

Doing lunches is a great approach when beginning. In addition, stay connected to your former classmates, your former professors, your former internship or practicum supervisors, and other therapists you just happen upon. Join the local chapter of your state professional organization. Volunteer to work at the annual conferences. You will meet other professionals and build your network. One never knows which relationships are going to be instrumental in finding the next job.

Start where you want to end

In order for this stepwise career management approach to work, you should strive to have that first job be located geographically near where you ultimately want to live. It is very hard to get most of your experience in one state and then jump into the ideal job in another state. It can be done, but it is more likely that a geographic leap will require you to take a step backwards in order to move forward. Again, this is merely a function of networking. Employers are most comfortable hiring people they know. The better an employer knows you or someone else who knows you, the better your odds of landing the job you want. And it’s easier to be known if you work in the area where you ultimately want to remain.

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