As a therapist, I have largely been shielded from the more grievous aspects of being a therapist, including agency work, and productivity demands. Of course, I, too, paid my dues providing in-home therapy, and choosing contract work when I no longer wanted to complete over 30 clinical hours per week.

Eventually,  I chose private practice, where I continued to specialize in couple therapy, and made the decision to not accept insurance as an in-network provider. Both of these decisions offered me improved freedom and flexibility, with increased pay.

Today, I am not considering leaving the mental health field. In addition to writing here, on  Family Therapy Basics, I own a private practice. And, until 2022, I was also a full-time marriage and family therapy professor (MFT). I love, love, love the field of marriage and family therapy, and I deeply identify with my systemic training.

Despite these facts about my professional path, I recognize that the system that supports our profession as psychotherapists is broken. This is true from the level of government; at times, the advocacy of national organizations; health insurance and reimbursement; to the more micro level of specific employer policies and work positions. The system, as it exists, requires that we as therapists make impossible choices between, for example: Making a living wage and resting; having health insurance and doing work that aligns with our values; overworking to meet productivity and being available for our families, and so forth. I also had to make a few of these trade-offs, until I decided it wasn’t worth it. How about you?

In this post, I continue listing reasons why therapists are considering leaving the mental health field, because there are many. And, if you are one of the therapists considering leaving the field, please know: You are not alone. If you missed the first post on this topic, head here, and read that first.

The following comments are from therapists responding to that original post on LinkedIn. The thread for the post is found here. (I have taken some comments, without providing quotations; but, I have mostly summarized. I am including the link to the post, so that you are also able to see the discussion and the original commenter.)

6 | Lack of Advocacy from Professional Organizations Regarding Pay

I haven’t done the research to understand how our respective national organizations could help with standardized practices in pay. However, in the mental health field, we do have a consensus that pay is a problem. This is a complex issue that encompasses whether therapists are employed or contracted, as well as the setting in which they work. Low pay also points to the perceived value of our profession by consumers and employers.

7 | No Accountability Measures for Insurance Companies

Health insurance can be both a barrier to care to care for clients, as well as a barrier to fair pay for providers.

There seem to be different reimbursement rates from insurance companies for private practices versus therapy insurance brokers / large online therapy providers, with private practices receiving lower amounts. This practice adds to the burden of private practice owners willing to accept insurance and creates a reimbursement advantage for large companies.

Disclaimer: I am not an expert on insurance reimbursement in mental health, or the current trends in reimbursement.

8 | Lack of Freedom Choosing Modalities When Working with Insurance Companies

Of course, one of the challenges of using insurance for the reimbursement of sessions is navigating the therapeutic limitations dictated by some insurance providers. The frustration of having to stick to a few theoretical orientations, or a pre-approved number of sessions, is a factor for some therapists considering a change in profession.

9 | Systems That Perpetuate Overwork and Exhaustion

This point was briefly mentioned in the introduction to this article. Depending on their work setting, therapists must at times face tension between taking care of themselves and continuing, perhaps, in a job position they enjoy. Overall wellbeing, as we know, includes rest, financial wellness, relational support, and more. With the absence of several wellness factors in the workplace, many therapists wonder—Is it worth it?

10 | Moral Injury

An additional conflict therapists may face is the feeling that they must provide “less” than the therapeutic ideal when their workloads are high, their work environments are high stress, or when dictated by insurance. Over time, this may lead to shame, guilt, or less enjoyment of their work.

Summary

In this post, and the previous, I’ve covered ten reasons that therapists are considering leaving the mental health field. If you are also contemplating this change, or you have already left the field, please share your story, in the comments below.