Therapist Training is Broken

Is there a better way to train wisdom workers?

I recently penned a note lamenting the harsh realities of graduate school for therapists:

Since then, the note has picked up a surprising amount of momentum, including a number of personal responses from both therapists and those who would like to become therapists, but don’t want to spend $100K only to graduate with sub-par clinical skills.

Given the recent discourse about the “wisdom economy,” AI, and the need to upskill knowledge workers, it seems high time to re-evaluate how we’re educating and training therapists.

Grad School Leaves Therapists in Massive Debt

According to some quick Google research, the average therapist with an MA or MS degree will graduate with $78,000 in student debt, with the average Psy.D. coming in at $120,000 or $160,000. That means new therapists are doing their clinical work under the financial and psychological burden of all that debt.

I can tell you from personal experience that this is a huge bummer; such a bummer, in fact, that I used to fantasize about faking my own death and moving to Thailand in order to escape my student loans.

A lot of smart people, who otherwise would have made good therapists, will look at these numbers and decide that it’s not worth it. Some of those individuals will become coaches; others will stick with more lucrative career paths in tech or finance. (Other truly prescient souls, anticipating AI’s immanent gobbling of the knowledge economy, will no doubt become plumbers.)

Grad School Doesn’t Prepare Students to Become Good Therapists

Even more damning than the cost of graduate school, though, is its lack of effectiveness.

As an experienced therapist and clinical supervisor, I routinely hear from newer therapists that they don’t feel graduate school taught them the skills they need to work effectively with clients.

This is not simply a case of impostor syndrome—although therapists are vulnerable to that, as well—it’s a failure of pedagogy.

Therapeutic skills are not terribly difficult to learn. They do not require a “+3SD” IQ or 10,000 hours of deliberate practice to develop. Therapy skills are an extension of basic human skills, like expressing accurate empathy, asking good questions, building rapport, and compassionately challenging a person who is stuck.

That being said, they do require effective pedagogy. In my experience, the most effective training focuses not on psychological theories (most of which have only a tenuous relationship with reality) but on the actual, conversational skills employed in “in the room.”

The graduate program I attended did a relatively good job teaching these skills. In our “Process of Psychotherapy” classes, we practiced basic therapy techniques: active listening, empathic statements, open-ended questions, and so on—by role-playing in dyads and “fishbowls” where we were observed by professors and our fellow students, and got direct feedback on our performance. At other times, we audio or video-taped sessions, typed up transcripts, and analyzed them.

While undoubtedly harrowing at times (for whatever reason, therapist types seem especially prone to fear of judgement and not being good enough), these practices were in line with Ericsson’s famous studies on “deliberate practice” and the development of expert-level skills. Direct feedback on in-the-moment performance is key.

In fact, these classes were so important that I frankly believe all our other classes could have been canceled, and we would still have become competent therapists.

On the other hand, technique isn’t everything. The qualities that truly make someone a good therapist are hard to teach, because they fall into the somewhat nebulous category of “character.” Qualities like presence, emotional warmth, and the knack for building rapport with a wide variety of individuals with different personalities and backgrounds sometimes feel more like inborn traits than skills that can be learned.

Not Everyone Should Be a Therapist

Part of the problem is that not everyone is suited to become a therapist. This is an inconvenient truth for the private, for-profit graduate schools who are flooding the market with new therapists every year. These programs tend to admit nearly everyone who applies, because it’s in their financial interest to do so. I have seen several cases in which students who should have been kicked out of these programs (either for academic failures, psychological red flags, or ethical concerns) were allowed to continue and graduate.

But these red flag cases are the exception, not the rule. Much more pervasive is the problem that some people are just not suited to become therapists. Therapy, like the priesthood, is not just a job or career path, but a vocation—a calling. It takes individuals who are exceptionally perceptive, empathetic, and incisive, not to mention ethical, and willing to question themselves, including their own ideas and motivations.

Therapists Need Therapy

When I reflect on where I really learned to be a therapist, I’m faced with the fact that my own personal psychotherapy was far more valuable than all the years of education and training I’ve accumulated. In reality, I learned to be a therapist from the experienced clinicians I worked with from age 20 to 40. The hundreds of hours I spent in therapy also gave me the opportunity to work through a significant portion of my personal psychological bullshit—bullshit that might otherwise have gotten in the way of my being a good therapist—and perhaps to make a beginning at developing real wisdom.

Before states began to regulate therapist education and licensure, the way to become a therapist was by training at a psychoanalytic institute. These institutes, as a rule, required a lengthy “training analysis” on the part of the candidate. Irvin Yalom, the noted psychiatrist and author, has written about the value of the 750 hour analysis he went through as part of his training.

My graduate school required us to have a minimum of 50 hours of personal psychotherapy (that’s 1 year of once per week sessions), which I grossly exceeded. But many other grad schools had no personal therapy requirement whatsoever. Additionally, the California Board of Behavioral Science used to incentivize personal therapy by allowing a couple hundred hours to count toward the 3000 required for licensure. They removed this incentive in 2021 (a decision for which I can imagine no good reason).

All of this means that there are therapists out there in the field today who have never been to therapy themselves. As a potential therapy client, that should scare you.

Therapists Probably Need Meditation, Too

As much as I’ve benefited from therapy over the years, I may have benefited even more from meditation. In therapy, we tend to get caught up in the narrative self, the self that we construct out of language and memory, the story of ‘I,’ ‘me,’ and ‘mine’ that we spend most of our lives obsessing over. Meditation and self-inquiry, on the other hand, have given me glimpses of what lies beyond rumination. And this has probably done even more to relieve my personal psychological suffering than years of therapy.

As we move from the knowledge economy to the wisdom economy, I believe our training needs to expand from the personal realm to the transpersonal, with therapists and coaches being trained in authentic, rigorous forms of contemplative practice. Then we can work with clients from a perspective based not only in conceptual knowledge and technique, but nonconceptual wisdom.

Imagining Alternatives

Some readers asked what my imagined, alternative training program would look like. A few even said they were interested in signing up. To be clear, I’m not advertising a program. But—as a thought experiment—if I had 1 year to train someone to be a good therapist, I’d skip classes entirely and use an apprenticeship model:

First, I would choose apprentices who are naturally suited to become therapists. I’m talking about emotionally mature individuals who are already smart, empathetic, and kind. People who have already been through at least a year or two of therapy and personal growth work. I’d grant preference to students who have done some serious meditation practice and perhaps some (responsible) psychedelic experience—enough to give them a glimpse of what lies beyond the incessant chatter of the narrative self and familiarize them with the deep territory of the psyche.

I’d start students out with the dyad exercises I talked about above, focusing on the basic listening and conversation skills that make up 90% of actual therapy. As soon as possible, I would get my students working first with volunteer clients, and then with “real” clients (perhaps for a low, sliding-scale fee). Supervision would include going over audio and video of sessions, analyzing transcripts, and case conceptualization. I would supplement this with a handful of textbooks focusing on fundamental theory and technique.

I’m convinced that 1 year of this apprenticeship would train students just as effectively, or more effectively, than 2 years of grad school, even with zero actual classes.

Barriers to Change

One potential problem with this apprenticeship model is that it woudn’t scale—I could only handle a max of 3-4 students per year. On the other hand, if other therapists also took on apprentices, we could have a legitimate alternative to grad school. In that case, the real barrier to change would be the state laws that regulate the education and licensure of therapists.

One reader noted that since professionals theoretically have the ability to regulate their own fields, it might be possible—with enough lobbying—to change the laws that prevent this kind of innovation. Doing that, however, would require building enough consensus among therapists (already herding cats, on a good day) to introduce legislation at the state level, and then get it passed. I believe this would be extraordinarily difficult, not only because of the consensus-building part, but because a number of vested interests (from therapists afraid of competition to grad schools afraid of bankruptcy) are incentivized to block any changes that would disrupt their current business models.

The Coaching Question

At this point, many readers will wonder if coaching provides a ready-made solution for the problems of the therapy field. Because it’s not regulated by the government, there are no laws mandating what kind of training is or is not required for coaches. This is both a good thing and a bad thing: anyone, even you, could declare themself to be a coach and start taking clients immediately.

There are private organizations like the ICF which have established certification programs: ICF’s Professional Certified Coach (PCC) credential mandates 120 hours of training—a tiny fraction of what is required for therapists. On the other hand, coach training is also a fraction of the cost—with top tier programs coming in at around $10K instead of $50-100K.

But aren’t we comparing apples and oranges? After all, coaches are trained to help people perform better and achieve their goals, not diagnose or treat mental disorders like depression or PTSD. Right? But it needs to be said that while some coaches make clear, ethical distinctions between coaching and therapy, many are simply practicing therapy without a license. And even the best, most ethical coaches will occasionally find themselves in a gray area.

A therapist-turned-coach I know once said, “coaches have a training problem and therapists have a marketing problem.” It’s true that coaches typically have less training than therapists and charge more money, with more freedom in how they are allowed to advertise themselves and package their services. But the point of this essay is that I think therapists have a training problem, too. And I have no doubt that the best coach training programs are better than the worst therapist schools.

All in all, I believe that coaching will be part of the solution, but not the whole solution. Right now, because of its lack of regulation, the coaching field has more room to innovate in training models than the therapy field, and that’s a good thing. But coaching is also limited because coaches aren’t licensed or trained to treat mental illness.

Moving Forward

I don’t know what the future of therapist training will look like, but I suspect the current machine won’t last long before grinding to a halt. It’s too expensive. It’s not very effective. And AI will rock the world of therapy in unpredictable ways. But there will always be a need for human beings with real wisdom and empathy. How we train them is an open question: perhaps there will be profusion of private institutes, apprenticeship programs, coach trainings, wisdom schools, and modern monasteries—let a thousand flowers bloom.

If there’s one thing I’ve learned from my 12 years as a therapist, it’s that resilience in the face of change (in this case, massive, unpredictable, civilization-level change) requires psychological flexibility. Instead of sticking stubbornly to outdated, rigid structures, we must remain open to new ideas, make bold experiments, and find out what works.

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That’s all for this week! As always, I appreciate your feedback on Mind, Meaning, and Magic. What do you think about the future of therapist training? What experiences have you had with therapists or coaches? How will AI impact our fields? Let me know in the comments.

As always, thanks for reading,

Chris Cordry, LMFT