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How to become a mental health counselor, clinician or therapist


Making a positive impact on others as a mental health clinician, counselor, or therapist can be a rewarding experience. Let’s explore what it takes to follow these career paths.

What Do These Mental Health Professionals Do?

Counselors, clinicians, and therapists evaluate a person’s mental health and offer therapy based on specific training programs. They can specialize in fields such as school-based or substance abuse counseling. Their exact job titles may vary based on the treatment setting1; they’re often used interchangeably. The term “clinician” can refer to any mental health professional who works one-on-one with patients diagnosing or treating illnesses. Often, there’s no distinction among the terms unless required by state law, licensing regulations, or other agencies2.

These roles differ from that of psychiatrists and psychologists. As a social scientist, a psychologist studies human behavior and can do research or therapy; they often must attain a master’s or doctoral degree. A psychiatrist follows a similar career path and has a medical degree. Simply put, psychiatrists are licensed medical doctors who can and often do prescribe and manage medications3, while psychologists focus on treating individuals using psychotherapy and behavioral intervention.

Education and Licensing Requirements for Counselors, Clinicians, and Therapists

State laws determine the education, licensing, certifications, and experience needed for these careers. The standards can also vary by specialty or field.

Degree requirements: The minimum educational level is usually a master’s or doctoral degree in mental health counseling or a related field from an accredited college or university5. Other postgraduate programs are possible but have specific requirements that will require some focus on mental health, school counseling or other similar areas. Master’s degree programs are typically offered as either two or four year programs and often allow students to work under a licensed professional counselor and complete internships. After graduation, they might need to continue their education to meet licensing or certification standards. Despite their educational levels, they may still call themselves counselors, therapists, or clinicians.

Licensure and certification: Every state requires licensing and/or certifications to work with clients. These credentials prove the professional has met applicable state mandates. Some states and/or counseling programs require passing a recognized exam such as the National Counselor Examination (NCE) and/or the National Clinical Mental Health Counseling Examination (NCMHCE). Specializations in grief, pastoral, school-based counseling or other fields may require more certification. Certain states can have more licensing requirements, such as a certain amount of hours of internship and supervised clinical fieldwork under a licensed professional counselor. Applicants in some states, like California and Texas, must also pass a jurisprudence exam pertaining to licensing board rules, operating procedures and state counseling laws.

Examples of mental health counselor credentials, which can vary by state, include:

  • LPC, Licensed Professional Counselor
  • LMHC, Licensed Mental Health Counselor
  • LMFT, Licensed Marriage and Family Therapist
  • LCADAC, Licensed Clinical Alcohol and Drug Abuse Counselor

In New York State, the LMHC designation is standard6. To become licensed, LMHCs in New York must complete a master’s or doctoral degree educational program in counseling accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP) or another recognized agency. The New York Board of Mental Health Practitioners oversees licensing. Degree programs require 60 semester hours of graduate-level coursework, with instruction in areas such as human growth and development and counseling theory and practice.

Students must also meet a supervised experience requirement of at least 3,000 clock hours providing mental health counseling in a work setting, with 1,500 of those clock hours being direct contact with clients7. To become licensed, applicants in New York must pass the NCMHCE. They must also pay for the license application, exam, and renewal. LMHCs also need to re-up their licenses every three years with 36 hours of continuing education. Counselors from other states can get a “licensure by endorsement” in New York with proof of an active license for five years in the state of licensure in the ten years before they apply.

The Occupational Outlook Handbook by the U.S. Bureau of Labor Statistics (BLS) projects mental health counseling positions will grow 25 percent from 2019 to 2029. According to the BLS, California, Pennsylvania, Florida, Massachusetts, and New York have the highest employment levels.

Once you graduate and get your credentials, you’re on your way to an exciting career. And when you’re ready to apply for a position, consider Citizen Advocates. We’re known as an Employer of Choice in the region and offer the opportunity to provide quality care to the people we serve. See what one of our counselors has to say about her on-the-job experience.

For more information about our mental health counseling services, contact us today.