Amid a national mental health crisis and provider shortage, some experts are asking: Are we making it too hard to become a therapist?
Traditional state licensure is expensive and time-consuming, requiring a bachelor’s and a graduate degree, according to the American Psychological Association (APA). In 2016, the APA found early-career psychologists had an average $80,000 in student debt. There’s also a lack of diversity; in 2019, 88% of mental health counselors were white.
As a result, some are redefining who can provide counseling.
One example is the Lay Counselor Academy, co-founded in 2021 by psychologist Elizabeth Morrison and lay counselor Alli Moreno. It focuses on training people who are already connected to their communities—like social workers, legal aid staff, case managers, and community health workers—to provide mental health support. Morrison said about 850 people have been trained so far.
“Now, the community health worker who was helping someone with their diabetes and finding childcare can say, ‘Yeah, I’m glad you told me about the panic attacks. Tell me more,’” Morrison said.
Research backs up Morrison’s approach, suggesting that even when counseling is provided by someone who learned outside the licensure pathway—one version of this is called a lay counselor—clients see improvements similar to when they see a licensed mental health provider.
Zooming in. The academy is a 14-week program that provides 65 hours of training, including instruction on cognitive behavioral therapy, motivational interviewing, and counseling practice with other participants. The group also does specific trainings for conditions like substance use disorder, trauma, and suicidal ideation.
Navigate the healthcare industry
Healthcare Brew covers pharmaceutical developments, health startups, the latest tech, and how it impacts hospitals and providers to keep administrators and providers informed.
Organizations contract with Morrison to give this training to their staff at the cost of $5,500 per participant for groups of less than 10 and $4,800 per participant for groups of 10 or more, according to the program’s website.
Research suggests the key to successful therapy is the establishment of a therapeutic alliance: a trusting, honest, empathetic connection between therapist and clients. A master’s degree isn’t necessary for this, Morrison told us.
Many people in the academy instinctually know how to do this already, and the program just hones their skills, Morrison said. (Organizations are asked to enroll people who are emotionally mature, self-aware, have humility, and other qualities that make a good counselor, according to Morrison.)
The idea isn’t to replace licensed therapists, she added. Lay counselors from her trainings don’t work independently; they operate within organizations and under licensed providers’ supervision.
Providers on board. In a March report conducted by the independent nonprofit philanthropy California Health Care Foundation and consultant Prism Partners Group, participants largely said they were more confident in their counseling skills, and in a follow-up survey, said they were more likely to address clients’ mental health issues post-academy.
On top of that, 77% of the 319 surveyed participants were non-white and 63% spoke other languages in addition to English. The report noted this was more diverse than California’s licensed workforce, a development that “may eventually result in improving access to mental health care for diverse populations.”