The Hidden Benefits of Working with Pre-Licensed Therapists

by Liz Pignatelli, MS,  Co-Author: Amy Vigliotti, Ph.D

These days, the process of finding a therapist is like speed dating: you’re usually interviewing several different people at a time, and even when you do click with someone, you’re never 100% sure they’re going to be a good match.

Much like speed dating, having a good listening ear and relationship insights can go a long way. As a former therapist turned intake coordinator, I have listened to hundreds of people express their worries, needs, wants, and everything in between. While these will always vary to some degree, there are several common threads – the need to be heard and understood, the need to be helped, and the need for security and emotional safety in the therapy space.

In choosing a therapist, new patients often ask about a therapist’s credentials and sometimes show hesitations when I offer a pre-licensed therapist. I sometimes hear: “I would really prefer a licensed clinician,” or “I would prefer someone who has more experience.” These sentiments are understandable concerns, and are sentiments that I validate each time I hear them.

People who come to therapy have often been let down, given terrible, or at best irrelevant advice, and are searching for more stability and wellness. It makes sense, then, that they want to make sure their mental health professional has what it takes to meet their needs.

In talking with discerning patients, I try to strike a balance between validation, while also gently pointing out that pre-licensed clinicians generally can provide what they need even if their preconceived notions tell them otherwise.

Some research even suggests that having a pre-licensed therapist can be beneficial in unexpected ways. According to Harrichand et al. (2021), pre-licensed counselors are benefitting from the current zeitgeist that places a refreshed emphasis on three facets of counselor education: multicultural competence, education about the signs of counselor burnout, and self care. Even though this push came mainly as a response to adapt to the COVID-19 pandemic, those who have recently become pre-licensed have graduated from a program that encourages its students to remain cognizant of both their client’s wellbeing, as well as their own. So, it makes sense that a prospective client would want someone who is able to balance the challenges of the work, while also knowing they can work on themselves at the same time.

To help bring some of these ideas to light, I interviewed three of our pre-licensed clinicians to get their perspective on the uncertainty that their titles can sometimes bring.

Q: Have you ever been directly asked by a current or potential client how your status as an intern might impact your ability to deliver effective treatment?

TN: There was one time where I had a consult call, and it was the one that everyone kind of dreads where they said something like “you’re too young,” and they even asked about my supervisor. So, I told them about my supervisor and gave them some information on new trainees, such as how they tend to have more enthusiasm right off the bat, and also tend to have a better adherence to sticking to certain treatments before trying a new one too soon.

I have also had the opposite response to my status. An example would be another one of my clients. We had developed a pretty good working alliance, and they actually ended up recommending me to a friend who had some concerns about my status. Thankfully, their concerns were able to be alleviated. So, all this to say that no matter where you start out, it doesn’t necessarily impact your ability to develop a relationship with your client.

Q: Can you provide an example of skepticism about your status as an intern, and describe how this treatment evolved?

MP: There was one instance when I recommended to parents that their daughter (my patient) seek out a pediatric psychiatric consult to perhaps start her on some anxiety medication. I told them that in the 9 months I worked with their daughter, we kind of exhausted all therapeutic options, and they responded with “I don’t think you exhausted all avenues.” So, I’m not sure if this was more directed towards my experience, my therapeutic approach in general, or other contributing factors to medication resistance.

Q: In addition to having the right treatment models, what are the other aspects of treatment that you might find important for healing?

TA: At the heart of it, having a trusting relationship with your therapist is the most important thing. If you don’t have that, you don’t really have treatment because you can’t be honest and learn and grow together. I can give insights, but we have to be able to learn about each other.

At times, people also think they need to come in and dump their problems, and then have to do this one specific thing to get better. There shouldn’t be this anticipation of failure if the client didn’t tell me something right away. People tend to feel a pressure to dump and it doesn’t work, and they beat themselves up for not improving. As a result, I’ve seen clients pull away when too much came out too soon. So, it’s okay to know that it takes time.

Possible skepticism aside, another important piece of the pre-licensure puzzle is supervision by a fully licensed professional. According to a think piece by Stephanie Hairston (2021), “This means you’re benefiting from the fresh energy of an intern or trainee at the same time that you’re benefiting from the wisdom and experience of their clinical supervisor—and possibly also their manager” (How Supervision Can Be Like a Secret Weapon section, para. 3). Additionally, Gray et al.’s (2009) study found that regular observation of clinical skills by a supervisor led to higher self-efficacy in pre-licensed clinicians. So, not only is supervision a version of “two heads are better than one”, but it is also increasing a pre-licensed clinician’s confidence in their ability to be the best clinician they can be.

Q: What does it mean to be in supervision?

TN: I think it’s a good mix of bringing in treatment questions and discussing content from the sessions. When I think about treatments and how to approach different things as they come up, it’s nice to talk about your own reactions and what’s coming up for you personally, and how to navigate that in real time. There’s information in your own reactions and your transferences that become more apparent as you talk about them out loud in supervision.

TA: I think supervision should be in every profession. It means that you’re getting guidance to be a better therapist. For example, a study by Ebersole et al. (1969) that Yalom references in his group therapy book found that the therapists who were not in supervision actually got worse over time without that guidance. The therapists who had both the education and supervision, however, continued to improve.

Q: What might a typical supervision session consist of?

MP: It was a weekly check in just to see if anything pressing had come up that I wanted to discuss. Once I started seeing clients for an extended period too, it was a space to allow me to find common patterns and find common threads.

Q: How is supervision helpful when you are working with clients?

TN: It can be a lot to work with clients with extensive trauma histories, and it can feel like there is a lot to hold on to in between sessions. It’s nice to talk about that with someone else, to not feel alone in that space, and to be around someone who knows some history about your client too so you can help them and better understand some of the unconscious processes at work.

There is so much more to a pre-licensed clinician’s development than just meeting certain requirements. Just like how you wouldn’t expect to learn an instrument by just reading “how to” books, you wouldn’t expect a pre-licensed therapist to hone their skills by just attending classes and taking exams (How Supervision Can Be Like a Secret Weapon section, para. 3). With this mindset, it’s easier to understand that the learning never really stops.

Q: In addition to having the right treatment models, what are the other aspects of treatment that you might find important for healing?

TN: It’s a healthy amount of balancing two modes: both challenging clients while also empathizing with them. There’s a need for validation and reflection of feelings while also not pushing them too far too fast. There should be a healthy amount of discomfort and anxiety here, and being able to acknowledge moments where things are kind of slow and becoming a bit more static where it’s possible there might be some avoidance. You want to name that and be mindful of that, and push them so it doesn’t become static or problematic.

Q: How do you see yourself evolving as a clinician once you get your LP, and even your license?

TA: I got into this field because I’m a nerd. I hope I’m 70 years old and I’m still reading and learning stuff all the time. I love learning from all my patients; I hold them in the highest regard and I truly think they are all amazing. I even do continuing education things all the time because it is fun for me.

Q: What advice would you give to someone starting out in therapy?

TA: If you’re having questions or doubts, and you’re in a therapeutic relationship with someone and you don’t understand their credentials and you want to know more, it’s not off limits to ask. Nothing is off limits, and it’s not unimportant to the treatment because, if we really look at the heart of therapy, the relationship is going to mimic your relationships outside of the therapeutic space; it’s all part of it and fair game. I know it’s scary, but the importance of bringing these things up can unlock all different types of conversations you didn’t think were possible.

TN: Give it time.

MP: Being treated like an actual team member goes a long way.

You never know what can happen until you take that first step.

References:

Gray, N. D., Erickson, P., & Kehkashan, Z. (2014). The effects of observation on self-efficacy and satisfaction of pre-licensed counselors. Ideas and Research You Can Use: VISTAS 2014, 32, 1-14.

Harrichand, J. J. S., Arañez Litam, S. D., Ausloos, C. D. (2021). Infusing self-care and wellness into CACREP curricula: Pedagogical recommendations for counselor educators and counselors during COVID-19. International Journal for the Advancement of Counselling, 43(3): 372–385. doi:10.1007/s10447-021-09423-3

Hairston, S. (2021). The surprising benefits of seeing a less experienced therapist. Open counseling. https://blog.opencounseling.com/trainee-therapists/