Medical psychotherapy
Medical psychotherapists are trained psychiatrists who specialise in psychotherapy, the use of psychological or talking treatments.
You’ll assess complex psychiatric cases and decide the most appropriate treatment or advise on the management of a patient.
Life as a medical psychotherapist
Your goal is to give a patient a better understanding of their difficulties and worries, their abilities and motivations. You’ll help them explore difficult experiences and painful emotions and reflect upon harmful patterns of behaviour.
You’ll see patients with a wide range of mental health conditions including:
- anxiety and depression disorders
- health anxiety and eating disorders
- personality disorders
- post-traumatic stress disorder (PTSD)
- psychotic disorders
Patients may be experiencing more than one psychological disorder or other difficulties such as anger, low self-esteem and self-harm.
Medical psychotherapists use their expertise to give psychological and relationship-oriented elements to psychiatric care. This could be recognising the impact of mental illness on a patient’s life or the role a patient’s carers and relatives play in their treatment.
There are many different forms of psychotherapy and as a medical psychotherapist working in the NHS, you’re likely to specialise in one type while having a working knowledge of all main forms.
The main types of therapies are:
- psychoanalytic/psychodynamic psychotherapy – the relationship between the psychotherapist and the patient is used to explore past and present ways of relating to others and to enable change. Early family and other important relationships are often explored.
- cognitive behaviour therapy (CBT) – helps patients to identify unhelpful thought patterns and behaviours which may have contributed to symptoms such as depression and encourages more helpful ways of thinking and reacting to situations. The emphasis is on the present rather than the past, homework between sessions and developing new skills to get well and stay well.
- cognitive analytic therapy (CAT) – looks at the way a person thinks, feels and acts and also explores past and present in examining the events and relationships that underpin these experiences. The relationship between the client and therapist is also used to help achieve recognition and change.
- systemic therapy – looks at the relationships between individuals as part of a unit and how systems work together. Groups and family therapy are examples of this approach.
- trauma-focused therapy – such as eye movement desensitising and reprocessing therapy (EMDR), focuses on the bodily felt-sense and aims to help the patient digest or process traumatic experiences which may have caused a variety of symptoms including PTSD.
Medical psychotherapists have an extremely varied working life. You’ll work in general hospitals and outpatients, contribute to the community mental health team (CMHT) and could run units dealing with specific disorders such as eating disorders, personality disorders and trauma.
How much can I earn?
You’ll first earn a salary when you start your foundation training after medical school. The basic salary ranges from £29,384 to £34,012. Once you start your specialty training as a medical psychotherapist employed by the NHS, you can expect to earn a salary of at least £40,257, which can increase to between £84,559 and £114,003 as a consultant.
How about the benefits?
- make a difference
- flexible and part-time working
- high income early in your career
- work anywhere in the world
- excellent pension scheme
- good holiday entitlement
- NHS discounts in shops and restaurants
Must-have skills
- excellent communication skills to manage a wide range of relationships with colleagues, and patients and their families
- emotional resilience, a calm temperament and the ability to work well under pressure
- teamwork and the capacity to lead multidisciplinary teams
- problem-solving and diagnostic skills
- outstanding organisational ability and effective decision-making skills
- first-class time and resource management for the benefit of patients
In addition, medical psychotherapists need to demonstrate:
- empathy and compassion and the ability to treat others with understanding and respect
- patience – progress can sometimes be slow
- self-understanding and the willingness to learn by applying some of the principles of their therapeutic approach to their own lives
Entry requirements
Your first step is medical school. Typically, you’ll need excellent GCSEs and three A or A* passes at A level including chemistry for a five-year undergraduate degree in medicine. Many medical schools also ask for biology and others may require maths or physics.
If you already have a degree, you could study for a four-year postgraduate degree in medicine.
You’ll need to pass an interview and admissions test. You’ll be asked to show how you demonstrate the NHS values such as compassion and respect.
Some medical schools look to recruit a mix of students from different backgrounds and geographical areas, so your educational and economic background and family circumstances could be considered as part of your application.
How to become a medical psychotherapist
After medical school, you’ll join the paid two-year foundation programme where you’ll work in six placements in different settings.
After your foundation programme, you can apply for paid specialty training to become a medical psychotherapist, which will take a minimum of six years.
You may be able to train part time, for example for health reasons or if you have family or caring responsibilities.
What are my chances of starting a career in a medical psychotherapy?
In 2021, there were 32 consultants in medical psychotherapy working in the NHS in England. In 2020, there were 14 applications for four training places.
Where a career as a medical psychotherapist can take you
You could:
- specialise or conduct research
- teach medical students or postgraduate students in training
- get involved in research at universities, the NHS or private sector
Higher specialist training ST4-6 psychotherapy to become a Consultant Psychiatrist in psychotherapy
Posts in Medical Psychotherapy are either single Certificate of Completion of Training (CCT) or dual CCT.
Single CCT training is full-time for three years . Dual CCT training is full-time for five years. As a dual CCT trainee you will spend part of your training time in general adult psychiatry and part in medical psychotherapy.
Higher trainees in medical psychotherapy major in one psychotherapy modality and minor in two others. Posts tend to be set up with the major modality in mind.
You can obtain a Certificate of Completion of Training (CCT) in Psychotherapy by specialising in:
- Cognitive Behaviour Therapy (CBT)
- Psychodynamic Psychotherapy
- Systemic therapy.
Training comprises three years at ST4-6 level in a GMC approved psychotherapy scheme, quality assured by local deaneries through the schools of psychiatry.
Trainees acquire an in-depth knowledge of theory and practice of their major approach, and also receive training in CBT, psychodynamic, or systemic approaches.
At the end of this training you will gain a CCT as a specialist in psychotherapy and will be eligible to apply to be on the Specialist Register of the GMC. This will allow you to train specialty registrars in psychotherapy and to take the role of leading multi-modal psychological therapy teams. It is also possible to spend a year in psychotherapy which will lead to an endorsement in psychotherapy
Psychotherapy training for ST4-6 in specialties other than psychotherapy
The curriculum indicates that trainees continue to develop their psychotherapeutic expertise as they become higher trainees according to their interest and specialty, for example:
- A rehabilitation or general adult trainee might seek to gain experience of cognitive therapy of psychosis
- A trainee interested in eating disorders may gain further experience of family therapy
- Psychodynamic psychotherapy, or training on group therapy may interest a learning disability trainee.
The combinations are many and tailored programmes of experience can be devised in conjunction with tutors and training programme directors.
Also see our Best Practice Guide: Psychotherapy training in higher specialist psychiatry
If you want to become a therapist, you should first consider what type of therapy you wish to provide. A master’s degree is typically the minimum education required, but some specialty areas call for more schooling. You’ll also need to consider what license you’ll need to practice and meet the prerequisites needed to sit for state licensure exams.
The word “therapist” is a broad term that can encompass many mental health professionals. Counselors, social workers, marriage and family therapists, and psychologists are all considered therapists.
Depending on the individual, the geographic area in which they practice and their respective state licensure or regulatory practices, many mental health professionals use the term “therapist” to speak broadly about themselves. Regardless of what term is used, providing mental health services to clients is a meaningful way to offer help and support to others at the individual and community levels.
While the term “therapist” is often used as a general term to encompass the mental health field as a whole, “it is important to note that there are very real and significant differences between and among the mental health professions,” said Kristi B. Cannon, PhD, LPC, NCC, director of counseling programs, assessment and evaluation at Southern New Hampshire University (SNHU).
These differences include:
- The client population being served
- The types of intervention being offered
- The depth of the issue being addressed
While the term “therapist” can be used across professions, state licensure boards restrict the use of particular terms such as “licensed professional counselor” or “licensed psychologist” to “those who have received specific educational, exam and practice requirements for licensure in that area,” Cannon said.
And, because educational training, ethical guidelines and licensure are critical to each of these fields, “it is important for potential clients to understand that the term ‘therapist’ is not regulated,” Cannon said. Therefore, the term “therapist” can be used by anyone across the profession.
What’s the Difference Between a Therapist and a Counselor?
These terms are often used interchangeably. “Both a therapist and a counselor engage in a helping relationship,” said Metoka L. Welch, PhD, LCMHC (NC), director of counseling programs for the learning environment at SNHU. The difference between the two lies within the goal of the professional.
A therapist “provides mental health therapy to clients,” Cannon said, while a counselor is a specific type of mental health professional whose offerings “align with a wellness model of healing” and who “believes in the empowerment of clients to accomplish their goals in mental health, career and education.” According to Cannon, there are many different counselor roles to consider.
Just like with the term “therapist,” there can be distinct educational, training and licensure requirements for each of these professions.
The type of professional counselor most often associated with “therapist” is a clinical mental health counselor. This person “is someone who provides direct client counseling in a private practice, hospital or community-based setting,” Cannon said.
Learn more about how to become a mental health counselor.
What Does it Take to Become a Therapist?
The first step toward becoming a therapist is to decide which type of therapy you wish to provide.
These are some common pairings of interests and career pathways, according to Welch:
- Counseling or individual therapy is suitable for people who want to work with clients one-on-one
- Clinical mental health counseling can be good for people who want a broad scope of knowledge to help people with a variety of mental health needs
- Marriage and family therapy might be a good fit if you know you want to provide services to couples and families in a group setting
- Social work is a good fit if you are interested in connecting people to resources
After you determine which area of counseling you would like to pursue, go to your state’s licensing board website to determine what educational credentials you need. “Then, look into programs that offer the qualifying curriculum,” said Welch.
What Degree Do You Need to Become a Therapist?
Most therapist positions require at least a master’s degree, meaning you must first earn a bachelor’s degree. Welch suggests choosing a major in the social sciences, such as:
- Bachelor’s degree in psychology: Study how the mind works and develop research skills through courses such as lifespan development, abnormal psychology and statistics. You can choose to add concentrations relevant to therapist specializations such as addictions, child and adolescent development and mental health.
- Bachelor’s degree in sociology: Explore human behavior as it relates to social interactions and dynamics with an undergraduate degree in sociology. This degree program can help you gain new and broad perspectives and develop skills in research, analysis and problem-solving.
If you already have a bachelor’s degree in another field, do not worry. “It has been my experience that counseling programs are understanding that people are often enrolling in counseling programs as a second career, so their undergraduate degree could be in political science or, in my case, English,” Welch said. Most bachelor’s degrees will provide the foundational concepts and information you will need to pursue graduate degrees.
For most therapist specialties, such as clinical mental health counseling or clinical social work, the minimum education needed is a master’s degree. You might consider one of these master’s degrees:
- Master’s degree in counseling: Learn how to provide mental health counseling to a range of clients. Through studying theories, strategies and techniques, you can grow skills relating to all aspects of counseling practice, including consultation, treatment, intervention and prevention. This degree is designed to help you become a counselor.
- Master’s degree in psychology: Dive deeper into the world of cognitive and social psychology with a degree that can help you become a psychologist. If you know you want to work with a particular audience, you might also consider specializing your psychology degree. For example, you might pursue a master’s in child psychology and development.
Karen Raquel Quezada ’21G became an in-home therapist shortly after earning her master’s degree in psychology at SNHU. She first became interested in this field of work while obtaining a criminal justice degree – another discipline within the social sciences.
While working on her master’s degree, Quezada felt each of her instructors and their varying backgrounds brought a lot of value to her. “The instructors were of great help (to) me,” she said. “Their feedback allowed me to have a sense of knowledge of my strengths and things that I needed to work on.”
Completing her capstone project was especially eye-opening for Quezada. It allowed her to reflect on all that she learned in her program and emerge important takeaways involving ethics, boundaries and more that she uses in her role as an in-home therapist.
“I do feel that my degree was worth it,” she said. “It opened doors for me. It allowed me to grow in my personal and professional life.”
You may find that a doctorate is required for certain specialty areas, such as a clinical psychologist or counselor educator. And to become a psychiatrist, “you need (to) be a medical doctor,” Welch said. If you’re wondering how these professions vary, discover the difference between a psychologist and a psychiatrist.
What Kind of License is Needed?
“Requirements for licensure include a set number of clinical hours completed under the supervision of an approved supervisor as well as passing required state licensure exams,” Cannon said.
Different types of licenses include:
- Licensed clinical mental health counselor (LCMHC)
- Licensed clinical professional counselor (LCPC)
- Licensed clinical psychologist (LCP)
- Licensed marriage and family therapist (LMFT)
- Licensed professional counselor (LPC)
Licensure requirements are top of mind at some counseling schools. For example, SNHU’s online CACREP-accredited clinical mental health counseling degree is designed to help you meet the educational requirements in most U.S. states. It’s important to see if there are any additional qualifications in your state to achieve licensure.
How Long Does it Take to Become a Therapist?
Quezada’s master’s degree took her two years to complete as a mom working full-time. “This program had the opportunity for online classes, which was something I really needed as a single working parent,” she said.
If you’re wondering how online classes work, exactly, the format is similar to that of a face-to-face class; you can expect to participate in class discussions and complete assignments such as academic papers. The difference is you have the flexibility to decide when and where you complete your work each week.
Some types of therapy practice, such as a counseling psychologist, “will need a PhD in Counseling Psychology as the minimum requirement for licensure,” said Cannon. Other types of therapy practice require a master’s degree.
Licensed professional counselors must have a master’s degree in counseling, “which includes the educational requirements established by the state counseling licensure board” to practice, said Cannon.
While in school, you will likely complete a practicum and gain internship experience. Depending on your state and area of specialty, “you will need to complete 2-4 years of post-graduate experience in order to be licensed,” Welch said. “I often tell students that (becoming a therapist) is a 2–5-year investment.”
Some master’s-level graduates land therapist positions right away. As Quezada wrapped her final term at SNHU, she said her supervisor was already considering her growth within the organization. This led to her promotion to a master’s-level clinician.
Are Therapists in Demand?
The COVID-19 pandemic has increased the need for services, and, right now, “many licensed therapists have waitlists,” said Welch.
In addition to the pandemic, an increase in awareness of concepts like self-care, work-life balance and even mental health days, have helped “normalize mental health issues as part of a collective sense of overall health,” Cannon said.
There are many possibilities to build a robust and meaningful career as a therapist. Often, when people think of being a therapist, “they think of working in private practice,” Welch said.
Welch also noted that therapists could work in areas such as:
- Agency settings, where you could help connect clients with community resources
- Community settings, where you could provide mental health support in a prison, rehabilitation facility or mental health center.
- Hospitals, where you could help connect patients to services after they are discharged, as well as provide substance abuse counseling to patients, geriatric mental health and more
- Schools, where you could provide services as the school psychologist
The combined awareness, acceptance and prominence of mental health issues and the need for care “is only growing the field, and I fully anticipate this will continue,” said Cannon.
In fact, the U.S. Bureau of Labor Statistics (BLS) projects that employment of substance abuse, behavioral disorder, and mental health counselors will grow 23% from 2020 to 2030, which is much faster than the average for all other occupations.
Do Therapists Make Good Money?
Depending on the educational background, license, area of client focus and geographic location, salaries can vary considerably. For example, BLS notes the median pay for mental health counselors was $48,520 in 2021. Psychologists made a median of $81,040, BLS reported.
Within psychology, there are many paths you can consider. For example, you could become a child psychologist. Marriage and family therapists made a median of $49,880 last year, BLS reported, similar to the median salary for social workers, which was $50,390.
What Makes a Good Therapist?
All of these skills together enable therapists to help their clients strengthen their internal resources. “We want clients to use their own coping skills for the issues that come up in their lives,” Welch said. This skill can take years to build, so the ability to continuously grow and learn is key as well.
The ability to embrace and weather change is also crucial. “I cannot stress enough how important it is to be able to deal with ambiguity,” Welch said. “Often graduate programs in counseling are difficult for type-A perfectionists. You have to have a willingness to let go of what you think and become a student of the client’s work.”
What is the Job of a Therapist Like?
In clinical terms, a therapist “works directly with clients and provides some form of psychotherapy,” Cannon said. In more personal terms, the role of the therapist is to “hold space for the broken places of their clients and allow space for people to grow and change,” said Welch.
Therapy can occur in:
- Community mental health agencies
- Hospitals
- Outpatient programs
- Private practice settings, such as in an office or via telehealth
- Schools
The job itself can look very different setting by setting, therapist by therapist, because “the needs of clients and the services provided to those clients can vary” so widely, Cannon said. Regardless of the setting, the overall focus of a clinical mental health counselor is to “utilize a specific set of counseling skills, driven by an empirically valid theoretical orientation and interventions, to empower client growth and well-being,” said Cannon.
Is Counseling a Good Career?
For Cannon, being a clinical mental health counselor is a highly rewarding career. “In my work, I have the capacity to empower and support people in meaningful ways every day of my life,” she said.
Whether she’s helping a client work through a difficult decision or significant life trauma, she feels she’s making a difference in their lives. “I am hard-pressed to think of many other careers that center on such meaningful change and offer opportunities for such significant long-term impact,” Cannon said.
What Are Some of the Biggest Challenges of This Profession?
As you might imagine, while the rewards of being a therapist are great, there are some significant challenges as well. “As much as this career can be rewarding,” said Cannon, “it can also be emotionally and mentally taxing.”
The biggest challenge, according to both Cannon and Welch, is the risk of burnout. “Therapists need to know their limits and ensure they are seeking good self-care” as part of their practice, said Cannon. The importance of self-care and personal therapy is often a part of therapist training, according to Welch.
What Advice Would You Give Someone Who is Considering This Profession?
Becoming a therapist is a big investment of time and energy. Because it can take years to achieve licensure and become qualified to establish a practice or work full-time in your chosen area, this is not a career field to enter into lightly.
This is also a field that can be very rewarding for some but is not the right fit for everyone. For that reason, it’s worth taking the time upfront to research the different options within the field of therapy to decide if this is the right career for you. “This is not a profession you can just try out to see if you like it,” Cannon said. Becoming a therapist takes some “front-end research, identity alignment and a commitment to the profession” before deciding if it’s right for you, she said.
Welch advocates the importance of becoming a client yourself because “it takes a great deal of vulnerability to sit in the client’s seat and reveal deep, often painful parts of your life to a stranger,” she said. “Once you respect that position, you realize how sacred this work is.” For that reason, she recommends having your own therapist because if the idea of that is off-putting to you, “reconsider why you want to do this.”
Welch believes that the key difference between a good therapist and a great one is as simple as having the willingness to seek therapy yourself.
A degree can change your life. Find the SNHU psychology or counseling program that can best help you meet your goals.
Marie Morganelli, PhD, is a freelance content writer and editor.
