Thirty Years in the Mental Health Field

As this year is drawing to a close, I realize that 2024 is an anniversary year for me. I started working in the mental health field in 1994. My first position was working in a group home serving adults impacted by traumatic brain injury. I think like most professionals, I learned a lot about healthcare from my first job. I learned how important nurses are to the system of healthcare. I learned about multidisciplinary teams. I learned what it was like to provide direct care to individuals with significant impairments. Most of all, I learned how fulfilling it is to help people.

My next job was at a long-term-care facility. At this job, I developed a love for working with older adults and also working in organized healthcare settings. I met my wife at this job, so I have a lot of good memories of working at Branch Villa in Seattle, WA. My wife, Julie, worked in the recreation therapy department and I worked in the social work department.

I went to graduate school from 1996-2001, but continued working in the mental health field throughout this time. When I started, all documentation was paper-based. During my 2000 internship at the Department of Veterans Affairs, some files were still paper-based, but new records were electronic, and the facility was transitioning to digital files. I had wonderful mentors during my internship. All my supervisors have retired over the years, and the last one left in November 2024.

I worked at a church-based counseling center from 2001-2007. Two primary areas of my work were couples counseling and Christian Counseling. I returned to the Salisbury VA in 2007, and I am finishing up my 18th year in the Salisbury system. My experiences earlier in my career with couples counseling and Christian Counseling have remained relevant at the VA. I am grateful for work that is fulfilling and also for the relationships with coworkers.

There have been many changes in the field of psychology since I completed my doctorate in 2001. One change that has both positives and negatives is the emphasis on standardized and short-term treatment. Research has identified techniques that are effective in treating emotional problems. Standardized treatments enable far more patients to receive quality care. Brief therapy can be a cost saving for many patients and provides more capacity for treatment. There is a tremendous shortage of therapists and more capacity is critically important.

Unfortunately, some patients want psychotherapy that is not brief. They need time to build trust with their therapist and time to recover. Many patients benefit from 8–12 therapy sessions, but some may prefer to receive support for 6 months or more in the unique and confidential environment of professional psychotherapy. Personal and professional relationships, like those with friends, family, physicians, and clergy, can provide valuable support. For people without mental illness, these relationships can be more beneficial to their well-being than therapy. However, some individuals (even those without a mental illness) may need psychotherapy in addition to other types of support.

Quality psychotherapy can be very difficult for some people to access. I have not seen signs of improvement. There is often a long wait to find a therapist. Many people struggle to determine if a therapist is a good fit, often relying on several sessions to gauge their comfort level. If there is a 6-month wait for the first meeting, trial and error is not a good option.

By the time they have obtained licensure, most therapists are well-trained in effective psychotherapy methods. They have also had several years of supervised work in which a supervisor could evaluate their clinical judgement and character. This is good news.

There is a tremendous need for more therapists. I hope more people will choose to become therapists. Training is at least a master’s degree, and following that, one or two years of supervised experience. That is a long time to delay earning a salary and graduate training is very expensive. Many therapists can earn a decent income, but it’s not proportional to the 5 to 10 years they spend in education and the high costs they incur compared to their peers. Educational debt is considerable, and not earning a professional salary for five or more years can lead to a much smaller retirement fund, even if future earnings are higher.

I don’t know the answer to this problem, but I know what won’t help. Lowering standards for therapists won’t lead to better outcomes. Therapists need quality education and maturity that only comes with years of supervised work. Cutting jobs or reducing therapists’ pay will worsen the existing shortage of available therapists.