Have childhood trauma and be socialized female (developing under patriarchy’s assigned burden of emotional-relational over-functioning).

I jest.

For those of you who are therapy curious, here is the actual pathway to becoming a psychotherapist.

I’ll be outlining the requirements for a Marital and Family Therapist (MFT) in Washington state, since that is the degree and license I hold and that is my state of licensure (though I attended graduate school in California), but most states have similar or comparable requirements, with a few outliers here and there (for example, California has their own licensing exam).

1. Bachelor’s Degree

Time: 4 years

Cost: $25,000-$460,000

Earn a bachelor’s degree in social science (psychology, sociology, etc.).

The price range for this step varies widely. I’ve shared about how my children have attended the Running Start program in our state, which includes 2 years of community college tuition-free for 11th and 12th grade, followed by guaranteed admission and full credit transfer to several in-state universities. My eldest lived at home through her bachelor’s degree and we ended up paying about $25K in tuition. Living on campus at Harvard will currently run you about $460K for 4 years.

2004

2. Master’s Degree

Time: 2-3 years

Cost: $50,000-$100,000

Earn a master’s degree in Marriage and Family Therapy.

Again we have a wide range of cost depending on the school you choose. 20 years ago I attended a high level, private graduate school of psychology (Alliant International University) that cost me $50K. If I could do it again, I might have gone to a more accessible school for $25K (like National University). (Keep in mind, these are early 2000s dollars.) No one asks or cares where I went to school.

You can also become a therapist with a master’s degree in Mental Health Counseling (LMHC) or Social Work (LCSW). These degrees have separate but similar pathways to licensure. I actually love the systemic framework that my MFT education provided me. But the Mental Health Counseling pathway is easier and will get you to the same place (plus, they have a freshly launching national compact that will allow them to practice across state lines, which is huge).

I was actually in a doctorate program for graduate school (PsyD in Marital and Family Therapy), but therapy is a master’s level license, meaning there is no tangible benefit or return on investment for getting a doctorate. It is only an advantage if you want to teach in higher education, but the pay is not enough to justify the expense. If graduate school was free would I get a doctorate for my own enlightenment and fulfillment? Maybe. But that’s not the reality I live in. So I chose not to continue on after the master’s degree. If you are hoping for a license in clinical psychology, then you would need either a PsyD (clinical practice) or PhD (academia or research), as that is a doctoral level license.

3. Supervised Clinical Experience: Practicum Hours

Time: 1 year

Cost: Supervision included in graduate school tuition/Unpaid work (lost wages)

Alongside the full-time coursework in the master’s program, we are required to complete a year-long, 20 hours per week, unpaid internship in which we provide therapy to clients and receive supervision. This is a graduation requirement.

I attended a COAMFTE accredited MFT program, which meant I had to accrue 500 hours that included at least 300 client contact hours (hours doing therapy), at least 100 of those being relational (with couples or families), and at least 100 hours of supervision, at least 50 of those being one-on-one supervision (the remaining 50 could be group supervision).

This internship precludes working for money during the second year of graduate school and is why it often takes 3 years to complete. I gave birth to my first child a couple of weeks into the start of graduate school, so it did take me 3 years to complete my practicum and coursework and graduate from my master’s program. I was also pregnant during my third year, giving birth days after walking across that stage (very puffy).

2008

4. Supervised Clinical Experience: Associate Hours

Time: 2 years

Cost: $10,000-$40,000

Once we complete the master’s degree (coursework and practicum), we can move into practicing as an associate therapist (LMFTA). During this period, MFTs must accrue 3000 hours that include 1000 client contact hours (500 can carry over from practicum if we attended a COAMFTE graduate program), 500 of those hours must be relational, 200 hours of supervision (100 can carry over from a COAMFTE practicum), 100 of those hours must be individual supervision, and the remaining 1800 hours are indirect, meaning time spent outside of session in service of doing the work of therapy.

Note: I have some beautifully designed and effortlessly functional Google Sheet templates that track, calculate, organize, and educate the WA therapy licensing and private practice requirements (they gather all the numbers and do all the mathing for you).

Functionally, we are working as therapists during this associate period (we can have our own private practice), but we are paying for supervision while doing it. If we attended a COAMFTE accredited master’s program and are efficient with maximizing things like group supervision (which costs less than individual supervision), we can expect to spend about $12,500 on supervision over this two year period (($200 individual supervision rate x 50 individual supervision hours = $10,000) + ($50 group supervision rate x 50 group supervision hours = $2,500) = $12,500), but it can cost as low as $10K (you could find individual supervision for $150 an hour) and as high as $40K ($200 supervision rate x 200 individual supervision hours) without that COAMFTE credit and group supervision. (Note: LMHCAs cannot do group supervision—a significant downside to the counseling path.)

If an associate therapist joins a group practice, supervision is usually included, but the pay is also significantly less than the per session fee the therapist is bringing in. I opted to earn and keep my own income and pay for my own supervision in private practice, which was far more financially (and otherwise) advantageous, in my assessment.

5. Exam

Time: 6 months

Cost: $500-$1200

After completing at least 6 years of higher education and 3000 hours of experience and supervision, we must pass a 4-hour national licensing exam.

Actually, LMFTAs can apply to take the exam as soon as they get their associate license, so I went all in on studying for the exam right away, while I was establishing and building up my private practice (less clients at the start meant more time for studying). I highly recommend this strategy; it felt so good to get this beast out of the way.

The fee to take the exam was $370, but I experienced the practice tests and prep programs as highly beneficial. The exam is testing obscure details from ancient theories with nonsensical vignettes. As is true for most standardized tests, it’s more about memorizing test strategy than learning quality material that is meaningfully applicable to your practice. I passed with a wide margin on my first attempt, thanks entirely to the prep materials I worked hard.

6. Continuing Education

Time: 32 hours

Cost: $1500

Therapists need 32 hours of continuing education every 2 years forever, including specific categories like law and ethics, suicidality, roles and boundaries, or health equity. So in the 2-year associate period before full licensure, let’s account for this time and expense. The cost of trainings varies widely, from free to $5000, but $1500 for 32 credits is a conservative average.

I actually have included in my template bundle a lovely and detailed CE tracker that makes navigating this requirement a cinch.

While this is generally considered to be a box-checking burden, I actually really enjoy and feel nourished by the ongoing learning—the expansion of my perspective and skillset around topics of interest. Some of my favorites have been minimalist documentation, nature therapy, Acceptance and Commitment Therapy (ACT), and body justice.

7. Licensure

Time: 3 months

Cost: $453

Therapists must hold an active license from the state in which they are practicing.

To become a therapist, that includes applying for an associate license ($81), renewing that license ($66), and then applying for full licensure ($306) once our experience and supervision hours are complete and we have passed our exam (and we then renew that license annually forever).

While this should only require a minimal processing time, the WA Department of Health is currently taking an average of six months to process an application for full licensure (can be shorter but can also be longer). This is creating significant negative impact for therapy associates who are stuck paying for extra supervision and continuing to receive lower pay in the gap between satisfying all of the requirements and having their license approved. My full license was approved 3 months after applying.

If you’re interested in learning more about the regular, ongoing expenses of being a therapist, stroll on over to this post here.

Once we have that LMFT credential number in hand, we have officially reached the promised land. (Feel free to explore my therapy offering here, where I specialize in motherhood and anxiety, using a feminist, postmodern, and holistic alchemy of ACT and Parts, with a liberation orientation).

2025

Total

Time: 8-10 years

Altogether, we’re looking at a minimum of eight years.

My timeline is an outlier, but worth covering if we’re taking an honest look at the feasibility and costs of this career path (especially for women, who are often balancing caregiving responsibilities). After completing my bachelor’s degree, it took me 3 years to complete the master’s degree and internship. But 18 years ago when I graduated, therapy could only be in person, which functionally left the only option for the next step on this career path as a full-time, in-person, associate position at an agency. This was not in alignment with my 3 children’s needs or my parenting values. So I pivoted and built a private practice as a parenting and life coach, where I could live, parent, and work in the overlap of the Venn diagram (honoring my children’s needs harmoniously with my own fulfillment and service). Then covid shifted the therapy industry’s landscape and my children grew into greater independence. So I was able to step back onto the mainstream therapy path and the fullness of my potential as a clinical psychotherapist in (virtual) private practice. It’s been a 25 year journey for me to get to full licensure.

Cost: $63,153-$598,153

Altogether, we’re looking at a minimum cost of about $65K.

Excluding lost income from the many years of not being able to earn money while in school and training, I directly paid about $125K to satisfy the requirements of becoming a therapist.

Cons

One of the major problems with this path is that it requires an immense amount of privilege to access. In addition to paying the enormous direct costs of higher education in this country (read my thoughts on this issue here), one would need a financial benefactor (parent, spouse, etc.) to survive the years of education and training in which we have no income. There is no student loan for a single mother to feed her children during a required unpaid internship (and even if there was, the post-license income wouldn’t be high enough to repay it).

Therapist income does not reflect the investment (of both time and money). The average salary for a marriage and family therapist (LMFT) in the US is $63,780—for a career that takes a decade and over six figures of direct costs to get to. (The average salary for a mental health counselor (LMHC) and clinical social worker (LCSW) is $80K—why it would be higher I could not say.) The cost of living for an individual in my state is $110K ($277K for a family of four). And let’s not forget that the average monthly student loan payment for a master’s degree in the US is $842. A therapist should at least be able to support themselves (ideally we could also feed our children). For comparison, an average salary for a master’s level nurse in the US is $120K (about double) and hospitals usually pay for their education.

Therapists in this country exist between a rock and a hard place where clients struggle to access services at rates that still leave therapists in poverty. When lay folks do the back-of-the-napkin math on a therapist charging $200 a session x 40 hours a week, the numbers look gluttonous. But most insurance companies pay therapists a fraction of their full session rate and therapists cannot hold 40 sessions a week—it’s not possible. 16 sessions a week would be my maximum capacity before which my personal health and quality of services would steeply decline (you can read more about that here). Graduate schools for therapy recommend 15-20 as the upper limit for sustainable, high-quality care. That limitation is a reality of the nature of this work (there is a toll for metabolizing the world’s pain). Not to mention the documentation, billing, and business admin that is required outside of sessions.

My current caseload is 12, as I can only hold 3 sessions a day between school drop off and pick up (3 sessions x 4 days a week, as I hold the 5th day for all of the necessary creative and administrative work of running a private practice). That limitation is a reality for most mothers, who typically bear the responsibility of picking up their children from school and starting their second shift of parenting and domestic labor (sports practice, homework, dinner, bedtime routines, etc.). (This responsibility often falls to women because they make less money, while causing them to make less money.)

So, what’s the solution to making therapy feasible, both for clients and therapists? A community care model of social governance, in which higher education and health care are provided by the community collective (the government—nordic countries do this well). Insurance companies increasing their rate of pay for therapists significantly and the government abolishing clawbacks (where insurance companies force therapists to pay back the money they’ve been paid for potentially years of services rendered). It’s important for those of us on the inside to call out the problems and advocate for change, both for our benefit and for the benefit of all those we serve. It’s also important for those entering this field to do so with their eyes wide open.

Pros

The question I come to now on the other side of this journey is this: If I could do it over again, would I choose to walk this path? Knowing all I know now, would I choose to become a therapist?

Yes.

I love being a therapist. I love doing the work of therapy. It feels like the magical intersection of my natural gifts, my chosen passions, and my community’s needs. It is hard and important work, and I wish it was monetarily valued appropriately (as I do all predominantly female professions that are undervalued by patriarchy benefitting from care-taking work being the invisible and free labor of women), but I still choose it.

The work is meaningful and fulfilling. Therapy is essential for healthy individuals and communities. We have so much intergenerational trauma to heal and therapy is a primary asset on the path to peace. The work itself engages all of me deeply, in a challenging and rewarding way. It is both technical and creative, intellectual and intuitive. At the end of each day, I know I made a difference in someone’s life and a positive contribution to the world. I get to help people heal, learn, and grow while deconstructing broader toxic systems. I can feel the shift of humanity as a whole evolving through each individual session. Existentially, I am richly compensated. (Though I feel the need to add that that doesn’t mean we should work for free. A medical doctor can find their work rewarding and still expects to be financially compensated enough to meet their needs.)

“Therapist” is a respected profession. There is some prestige encoded into the cultural role of therapist. People generally understand and acknowledge (give credit for) the high level of requirements for this career path. When asked the common question of, “What do you do?,” I received starkly contrasting responses reflected back to me between answering with, “I’m a homeschooling mother to 3 children,” and “I’m a family therapist,” even though I was actually the same person in both responses. Part of me wants to dismiss this arbitrary external validation as socially constructed irrelevance, but having presented as such a devalued class of citizen under capistlism’s metrics for so long, I feel it’s very real benefits acutely.

Therapy lends itself well to entrepreneurship in the form of private practice. While I do sometimes see the appeal of the consistent paycheck of employment, the benefits of entrepreneurship far outweigh the drawbacks for me. I relish the freedom to live and work fully in alignment with my needs and values. I set my own hours, choose my own clients, make my own decisions. I even genuinely enjoy the business of owning and running a business. It’s such a nice balance to the clinical work itself. Sometimes I’m holding someone’s trauma and sometimes I’m holding numbers in a spreadsheet. It feels holistic and integrated to have my arms around the full circle. Owning my own business feels like freedom (the flexibility and control of entrepreneurship is especially valuable for primary parents).

8. Supervision

Time: 2 years

Cost: $395

The final step on my therapy career path is into the role of clinical supervisor, offering supervision to other therapists during the associate period. This was actually my primary motivator for pivoting back into working under the formal therapy license. I have much to offer within the mentorship dynamic and this fresh dimension of therapy work feels enlivening and expansive. I sincerely look forward to guiding aspiring therapists in nourishing the parts within that need tending, growing a holistic practice of skills, and blooming into the kind of clinicians our world needs.

To become a supervisor, we must hold full licensure for 2 years, complete 15 hours of supervision training (a multi-day course that cost me $395), and 25 hours of supervision experience.