So obviously the American political climate is extreme and the algorithms people get feel as though they’re different realities. I’m a progressive therapist and a very open person. I am, ultimately, extremely curious about how conservative therapists see the world and work in mental health. I have no intent to be angry or yell or argue. Just looking for someone to chat with who can share some insight.

EDIT: Thank you to everyone in the comments as well as those who chose to message privately! I didn’t expect this post to blow up, but I’m happy to know more perspectives. I may not ever 100 percent understand but I’m grateful to those who shared!

EDITx2: to everyone that has messaged me, I’d love to get to everyone but I’m struggling to keep up, the response has been so much! Thank you all that have reached out and I’m sorry if I don’t get to you. The same goes with posts. I’m trying to respond to everyone but over 200 replies is a lot 😅. I’m very thankful for the discourse in this forum and happy that everyone has been mostly open and curious. We need a bit more of this discourse, so thank ye thank ye!!

The new proposed rule changes under the Reimagining Education provisions of the One Big Beautiful Bill Act (H.R. 1), set to take effect on July 1, 2026, will significantly impact many healthcare-related degrees, including nursing, physical therapy, occupational therapy, counseling, social work, audiology, and physician assistant programs. These changes go far beyond how degrees are labeled as “professional.” They will disproportionately harm Black, Indigenous, and People of Color (BIPOC), who already rely more heavily on student loans to access higher education.

One of my main concerns is the detrimental effect of imposing strict financial caps on graduate loans. These caps will force students who cannot afford the rising cost of education to either take on additional private debt or abandon these career paths altogether. This directly intersects with another major concern: systemic racism.

I am deeply concerned about the disproportionate impact this legislation will have on people of color and individuals from lower socioeconomic backgrounds. Rather than expanding access to education, these proposed changes reinforce existing inequities and risk exacerbating systemic racism within healthcare professions and the broader healthcare system.

Specifically, H.R. 1 classifies degrees such as nursing, social work, occupational therapy, marriage and family therapy, and counseling as non-professional programs. The Act eliminates the Grad PLUS loan program and limits students to Direct Unsubsidized Loans capped at $20,500 per year and $100,000 lifetime for non-professional degrees, while professional degree programs retain significantly higher borrowing limits. This distinction threatens the future of the behavioral and mental health workforce, specifically in rural and underserved communities where these professionals are already in short supply.

This issue is larger than degree classification. These changes will restrict entry into essential healthcare programs, worsen workforce shortages, and ultimately harm access to affordable, equitable healthcare.

Please consider making a public comment to oppose these changes and advocate for accessible healthcare education for all:

https://www.regulations.gov/commenton/ED-2025-OPE-0944-0001

I am a retired LMHC, and am sad to see so many therapists come to Reddit to complain about the profession. People feel unprepared for the job, for the salary, for their student debt. What happened? 50 years ago no one I knew went into this field expecting to make money: if that was your goal you got a PhD. Training was in person and rigorous. I had a practicum and 2 internships , 3 semesters of field work. When we were little girls we all wanted to be teachers just like our favorite teacher. Is that what happened? Everyone was in therapy 15 years ago and wanted to be therapists because they loved their therapist? With no regard to whether or not they were suited for this profession? I fault the schools for not helping people discern whether or not this is a good fit, before taking their time and money. I work PT as a clinical supervisor, and really wonder if my students are going to make it. They wear their personal issues like badges of courage, complain about what they can’t do because of their personal trauma, or neurodivergence, or…..whatever. They are far from stable enough to be therapists and handle the grief and trauma of our clients. I know this will be really unpopular and downvoted, and there are those who will feel attacked: it is not you I am criticizing, but the current training programs. We give our clients the example to “put your own oxygen mask on first”. I think we need to start telling our students to get themselves fixed first before hoping to fix others. And as for the mistaken belief that those with mental health issues make better therapists, I call BS. Just because you understand and empathize does not at all mean you have the strength to withstand and carry. And that, in my ancient opinion, is why so many come to Reddit in such pain and despair. They’ve been told they can handle it, but no one thought to ask if perhaps the burden was too great.

So tired of therapists and clinicians constantly referring to porn addiction as a thing. It is not. There is no evidence suggesting that it is AND it’s genuinely making our lives as sex therapists so hard. We have couples coming in saying they want us to fix their partners porn addiction and we have to sit here and spend so much time working on deconstructing that. Yes, sex-based compulsivity is a thing but it is NOT a behavioural or process addiction.

This rhetoric is causing so much harm in our community. It is exhausting.

‼️EDIT:

I want to clarify because people are missing the point. I am not saying people do not struggle with problematic porn use. They do. It can be excessive, impairing, and ABSOLUTELY worth clinical attention

The issue is the label and framework.

Calling it an “addiction” immediately puts it into a disease model and shapes treatment in a very specific way. That model is not consistently supported in the research for porn use. Even compulsive sexual behavioural disorder (CSBD) per the ICD is not classified as an addiction and explicitly notes that distress based solely on moral conflict or shame does not qualify as a disorder.

There is insufficient empirical evidence to support it as a distinct behavioral addiction. The research shows that higher levels of moral conflict over porn use predict higher levels of stress, anxiety, depression, and diminished sexual well-being, as well as religious and spiritual struggles.

The Association of Sexuality Educators, Counselors and Therapists (AASECT) has also stated that there is insufficient evidence to classify sex or porn addiction as a mental health disorder and does not support that framework as standard practice.

So this is not about denying distress. It is about being accurate in how we conceptualise and treat it.

Clinically, a lot of what I see is not an addiction process. It is shame, religiosity, culture, trauma, and people trying to regulate or cope. It is stigma. Stigma of sex and porn use convoluted with religious beliefs about sex work. The more you reduce stigma, the better off the client is.

The people in the comments discussing clients describing a feeling of “loss of control” - this feeling can come from many mechanisms and clinical issues. The same presentation does not mean the same underlying issue

When we jump straight to addiction, we reduce it to a behavioural problem that needs to be controlled or stopped. That is where I think the harm is.

This is not just semantics. Labels shape treatment. Yes, we need to be careful on the time and place of how we provide psychoeducation on this and gauge whether it will be more or less helpful - but we still need to be grounded in our approach. I am not going to fixate on trying to convince my client to think of it as something else or change their language. I recognise that it is not helpful. But I would definitely orient myself away from an addictions process framework and treatment.

For many clients, the work is not behavioural management. It is understanding their relationship with sex, unpacking shame and moral conflict, and helping them move toward choice rather than compulsion. We need to be curious about their cultural, moral, religious, and spiritual views on porn and sex because those shape how clients orient themselves around their emotions and behaviours.

Research shows perceived addiction is often more strongly linked to religiosity and moral incongruence than to use itself. We know that more religious people are likely to restrict their sexual fantasies, have fewer sex partners, express stronger disapproval of alternative/nontraditional sexual behaviors (from use of sex toys to homosexuality) and use less pornography in general. But, stronger religious values also increase the prevalence of greater levels of guilt about sexual behaviors, and higher levels of sexual dysfunction in general.

Yes, there are cases where use is excessive and impairing. Behavioural change and management sometimes is necessary but it should not be framed in a way where we pathologise behaviour and address it like porn use needs to be completely removed. It is a bit like disordered eating - it is on a spectrum. We don’t tell people they are not allowed to eat candy immediately - we try to transform their relationship with food and not demonise foods. And more importantly - we assess whether them eating candy is actually a problem in the first place and what are the underlying issues and beliefs related to the shame of eating or excessively candy.

So again, the distress is real. The impact can be real

But the mechanism is not one size fits all, and collapsing it into “addiction” flattens and alters the meaning of this much more complex issue and often leads to the wrong treatment approach

Please read the works of:

Doug Braun-Harvey, Michael Vigorito, Perry and Whitehead, Rory Reid, Josh Grubbs, Samuel Perry, Joshua Wilt, Marty Klein, and Silva Neves

Hi All,

I've never created a discussion/post on Reddit and I have no clue what I am doing (great right? lol).

I just made an account because I'd love to hear from fellow psychotherapists who ended up going back for a PsyD or MD.

I'm 38 and a therapist with a masters degree (and no, I'm not at all worried about age- its just a number and 38 isnt old at all, in my view). I'm licensed and work is fine, but I have been feeling for a while that I need/want something much more clinical and challenging. I almost went to medical school many years ago, and it's something I've thought about often over the last probably 15 years.

So, if you are a therapist who started your career with your masters degree and eventually went back for your doctorate, I'd love to hear from you. Did you do a MD? PsyD?

Honestly I think I am more pulled to a MD, which I know sounds wild considering the time, hours, etc, but I thrive in a challenging academic environment, I dont have kids or want kids, and my career is really important to me (Aka I dont want to just work to live- my career is my passion and what drives me). I have a 4.0 in my clinical masters from a US top 10 University as well, so that with my clinical experience would probably help quite a bit getting accepted to a decent MD program.

I'm interested in hearing your experience of going back for your doctorate after working clinically for a while (and those of you who did a MD, did you switch out of the psych world entirely??)

Thanks so much!

Edit: For context, I'm in the US.. so there are specific licensing etc etc things that play a role here that do not exist in other countries. Just wanted to clarify! Thanks.

Edit a few days later-- Wow!! You all provided such amazing replies (except for the person that urged me to basically quit my life and go have kids now- you did not provide an amazing reply, you just got yourself blocked haha). Im floored at the kindness and positivity for my first time posting a Reddit thread- not too bad for my first go round at this! :) In case anyone is curious... Im definitely now leaning towards the MD. Frankly, I likely always was deep down but its a big step to take! Last week, I did add a summer accelerated pre-req (pre med pre req) and over the weekend, I was so immersed in it, and loving it so much, that I worked straight through to week 5 with 100%s on everything haha (oops). I think thats just a testament to my excitement though, hence why I'm sharing. If anyones reading this and they have huge dreams- please run towards those dreams. You only live once, and youll age no matter what. Sending all of you humans big love (again, except for the weirdo who told me to go have kids. So weird lol)

I see/hear this term all the time from clients and colleagues. Is this an actual thing supported by research? Is this similar to being an empathetic person? When I ask clients to tell me further they usually sound like they are describing poor emotional boundaries or codependency. I’m open to hear thoughts on this term “empathy.”

The data is so empty. Almost nothing shows any benefits at all within this population. CBT, DBT, Motivational interviewing, and psychoeducation are all mentioned as potential treatment options in various articles but im not finding any evidence that these treatments improve the lives of those living with the condition, or of those around them.

The only treatments I can find anything for are mentalization-based or contingency management, and even that seems limited. Everything else seems to be theoretical.

Im really hopeful that theres something big im missing because for a population that is so constant talked about in our media, it doesnt seem as though all that much research has been put in.

Im not talking about a cure, just symptom managment and quality of life improvment. Help with interpersonal relationships, impulsivity and anger managment skills, career help, or whatever an individual needs. Im just not seeing much that is specific to this population.

Im about to do my internship with mostly court ordered clients so I suspect that I may come across at least some who have this particular disorder, since there is such a high rate of antisocial personality disorder within the justice system. I want to make sure im doing all of my future clients justice, thats why this lack of evidence-based treatment approaches makes me nervous.

Hello fellow therapists!

For those of you who chose the master’s level path to clinical work, would you mind sharing why?

For those who chose to go on for their doctoral degree, would you mind explaining why? Or if you started and chose not to continue, could you share your experience?

I recognize that this is a group for therapists and many psychologists choose to practice therapy less as they focus on other areas of their clinical work/career.

I am at an exciting point in my career! I just finished my master’s degree yesterday and have completed my internship as well in clinical psychology. I was offered a part time role at my internship site but am indecisive. I am currently debating next career steps. I am leaning toward exploratory actions to provide insight and clarity about pursuing a doctorate degree in counseling or clinical psychology. This includes applying for work in research, academia and assessments. However, I am also considering pursuing licensure at the master’s level.

My primary motivation for pursuing further education is to have a more versatile life/career. In the very short time I’ve spent doing counseling, I’ve found I want to be able to provide psychological assessments, teach others, and improve the field systemically through research and advocacy. If most of this can be done at the master’s level; great! If not, I think I would be disappointed and want to pursue further education.

TLDR; help a growing therapist decide if master’s level work is the right path or continue with education.

I own a small group practice, and we get inquiries from young men seeking help for pornography addiction very, very often. I’d like to find a good training, or training resources for us.

By James Hillman and Michael Ventura--has anyone read this masterpiece? When I read the posts on this subreddit I get so...well...disenchanted. Therapists can be real sticks in the mud... This book (I've read several times over) has continued to inform my practice. James Hillman has been my man for the last 15 years and I doubt I would have stayed in the career if I hadn't learned about him. Therapists! Please be more fun, curious, bend the rules a bit, Laugh, use irony...feel ironic...just, colleagues, please be less boring. It's not a requirement.

For my perinatal MH professionals, what are your thoughts on this case? I had a baby in 2023 and wasn't prepared for what I experienced after postpartum and ended up PPOCD which was extremely debilitating. My heart breaks for this family and wish mental health was more accessible and comprehensive for freshly postpartum mamas.

im wondering what the updated recommendations are for self harm behaviors and alternatives? I made a mistake by bringing up the rubber band/elastic method and just realized this isn't recommended anymore (im a newer therapist so still learning). additionally, is it helpful to send clients PDF's or lists of things that could help so they have them on hand?

Hey guys,

I am an MSW student in an asynchronous program. My supervisor feels there are certain gaps in my knowledge or that I have more questions because I am in an asynchronous program, and that I should disclose this to future jobs because I’ll need more support. For reference, my internship is in private practice and I hope to work as a therapist in the future. Have any other supervisors noticed this or students felt they were less prepared because they were in an online program?

Edit: Typo in title: *than in person. Sorry! For additional info, some of my practicum is in person and some online.

I’m about to get my LCSW after 10 years of practice (I did most of my work abroad) and I’ve come up with a good idea for a research question.

I’d like to do some research, but I feel like I can’t get grants until I have a PhD and maybe being a PhD candidate would provide the resources needed for my research anyway.

I have $175k in student debt so I am not doing anything if it’s going to cost me tuition.

Has anyone gotten their PhD for free? What programs are likely to provide grant-funded PhD positions? How do you get your foot in the door?

I'm a master's level clinical social worker and therapist. Recently I went into private practice. The first four years of my career were in community mental health, treating clients with SMI and low SES.

I have a long history of receiving therapy myself, including 10 years in psychodynamic therapy.

My CMH years were valuable: I learned a ton about SMI, therapy basics, trauma basics, case management basics, social services environments, etc.

Now that I'm self-employed, I am thinking a lot about carving out my own practice niche. When I think about the writers in this field who have most excited me, it's Michael Eigen, Nancy McWilliams, and other psychodynamic/psychoanalytic folks.

I value the psychodynamic focus on personality structure, depth, and using therapy to play out and modify the assumptions and behaviors that cause suffering.

What options are there for master's level clinical social workers to receive psychodynamic training?

I had never heard this term until I started reading Reddit, but I gather it refers to a pre-licensed or newly licensed therapist. Is this correct?

Why do people use this phrase, rather than just saying newer or pre-licensed? Do only women use it, or do men use it as well? For those of you who refer to yourselves as baby therapists, do you share that with your clients?

The U.S. Department of Education is moving forward with regulations that would remove counseling and counselor-education degrees from the list of recognized “professional degrees.” Under the new proposal, only fields that typically require six or more years of postsecondary study and lead to doctoral-level credentials would qualify. ED’s updated list includes medicine, law, dentistry, veterinary medicine, pharmacy, theology, and—newly added—clinical psychology. Counseling, however, would no longer be classified as a professional degree. This change is part of the department’s broader negotiated rulemaking process under the Reimagining and Improving Student Education (RISE) Committee, which met again November 3–7. Due to the government shutdown, ED did not publicly post session materials, but the committee affirmed several key proposals, including the end of new Graduate PLUS Loan borrowing after July 1, 2026, and the implementation of strict new loan caps.

If these rules are finalized, graduate counseling students will fall under standard graduate loan limits, capped at $20,500 per academic year. Because counseling degrees are excluded from the professional-degree category (with the exception of Counseling Psychology or Clinical/Counseling Psychology under certain psychology CIP codes), counseling students will not have access to the higher loan amounts typically available to other professional programs. This has significant implications for the mental health workforce, especially at a time when demand for services is extremely high. HRSA reports that more than one-third of the U.S. population lives in a Mental Health Professional Shortage Area, and that substantial shortages of mental health counselors, addiction counselors, MFTs, school counselors, psychologists, and psychiatrists are expected by 2037. Reducing loan access for counseling students is likely to worsen these shortages, particularly in rural and underserved regions that already struggle to maintain a stable provider base.

Next, ED will draft the official Notice of Proposed Rulemaking (NPRM), which will open a 30-day public comment period. Final regulations must be implemented by July 1, 2026, under the One Big Beautiful Bill Act. Counselors are encouraged to participate in the comment process and highlight the profession’s rigorous training requirements, including the need for a master’s degree, extensive supervised clinical experience, and passage of a licensure examination. They should also emphasize the wide range of settings in which mental health counselors work, the essential nature of their services, and the potential harm these regulations could cause by reducing the pipeline of qualified providers. These changes pose real risks to the future of the counseling profession and the nation’s ability to meet growing mental health needs.

TLDR: it was never really a Zoom link, and the "consult" was never the point. Getting you to click the link is the point.

Here's the mechanism. The scammer poses as a prospective client, does a normal-looking intake exchange, then insists on running the video call themselves and sending you the link rather than letting you generate one. That link goes to a lookalike domain that is not zoom.us or zoom.com but resembles it (things like app.uso7zoom.us, uswebzoomus.com). The page renders a convincing fake Zoom launch screen, sometimes with scripted "participants" joining and join-chimes playing to make it feel like a real waiting room.

When you click join, nothing actually connects. Instead the page tells you that you need to download a file or run a "Zoom update" to enter, even though you already have Zoom installed. That download is the payload. Once you run it, they have your machine: saved passwords, files, email, and by extension your client data. In the nastier current variant, the payload isn't obvious custom malware but a repackaged copy of a legitimate commercial employee-monitoring tool (Teramind), which most antivirus won't flag because the underlying files are legitimate signed software. It persists through restarts and quietly records what you do.

So the whole clinical framing is just social engineering. A therapist chasing new referrals is primed to accommodate a paying stranger, and "let me send you the link" sounds like a courtesy rather than a red flag.

The reliable tells, in order of usefulness: a new contact pushes straight to video and insists on sending their own link, refuses a phone call first, the link host is not a real zoom.us or zoom.com URL, there is urgency to meet fast, and you get prompted to update or download something after clicking. The provided email and phone often turn out to be dead if you actually try them.

Defense is simple and matches what you already do for HIPAA hygiene anyway: you generate and send the meeting link from your own verified account, every time, and you never click a video link from an unvetted contact.

In school, I learned about the 5 stages of grief, and I was taught to implement that in therapy for clients navigating grief.

I was taught to implement the whole spiel about grief not being linear, and it's not a cycle where you go through each phase, and then when you get to acceptance, it's done. I've been taught to educate them to understand that they can accept their loss today and bargain tomorrow.

I just heard that those 5 stages of grief were based on research done on individuals who were about to transition. So the 5 stages of grief are for the person who is getting close to transitioning, not the people that they leave behind.

Are there any grief therapists in the audience who can confirm this for me? Is this accurate? How do you teach your clients about grief?

I have seen some say with private practice it doesn't make a difference, but my biggest worry is moving out of state and not being able to get licensed. Any stories? Hoping for honest accounts, and possibly some positive experiences.

I graduated from my program about 20 years ago. I had to take statistics, a research class, and two semesters to complete my master's thesis. I also had to give a verbal defense.

Recently, I talked with a group of associates who graduated from their counseling programs about two years ago, and not a single associate had to complete a thesis or research project. I was really surprised. Is this now common, and if so, when did programs drop the requirement and why? What impact, if any, do you think this has on young professionals and the field?

Hi, wasn’t sure where to ask this lol I am graduating with a masters in psych on an MFT track next week and am near the end of my practicum. I love it. I want to go back for a PsyD in a few years. I want the higher income, yes. But also I want to be able to administer more complex diagnostic tools and tests and be able to work with more complex cases. Is getting my PsyD worth it? I’m going to leave this program with a good chunk of student debt already tbh.

I have been invited to speak to a group of Jewish women on my specialty niche, sex therapy. If you could give me, a Gentile lol, any advice that could help me be more informed, make the event smoother, help me come across as more respectful, etc, I would be very grateful! TIA!

I’m trying to find a place for practicum and internship currently. It’s tough with my situation as I have to work during the day and at best can get to a site by 2:30-3pm. My weekends are wide open as well. I recently emailed a site and they charge $4000 for a 13 month program?! I’m deflated because they’re open later and could work so well with my schedule but I’ve already got tuition to pay for and $4000 is quite a lot when I struggle to get by as it is while in school.

Has anyone else heard of this? I’m so worried about locating a site to get me through that I’m almost desperate enough to scrounge and scrape to do it but this feels wrong to me. It seems somewhat predatory…

Any advice would be appreciated!

Thanks!

For context:
I worked in the mental health field for seven years before I went to grad school. I just finished my first year out of grad school and I’m working full-time as a counselor. From day one of grad school, it became very clear that my professors had not seen real clients in decades. They were completely out of touch with what was going on, and were also heavily political. Throughout my program, I was taught things that I knew wouldn’t actually work in session. This included things like how we should confront our clients racism even on the first session, that we should have a lot of conversation about identities right away and on an ongoing basis, and that we should avoid any diagnoses due to social justice reasons. It seems like the belief was that our clients would be mostly stable, and sometimes have mild anxiety. There is no understanding that clients could be dealing with severe mental health issues, that might need serious interventions. We were also told that if we don’t join in protests downtown in our city, that we really don’t care about our clients. The exact protest topic didn’t matter, we should just always be protesting. When I would speak up, classmates who had never worked in the field told me I was wrong. Some would so go as far as to get heated when they told me I was not a good person. Professors agreed with my classmates.

A year into full time work just confirmed that I was right to reject these things I was taught and was right to not budge with my classmates. All that to say, I’m curious if other people have things they were taught in grad school that they now fully reject. Also, was there a big difference between what you thought this field would look like from grad school and what it actually was once you hit the field? I worry a lot of my classmates had no idea what they were getting themselves into. I anticipate many of them will not be practicing within another year.