Therapist Training
A newly graduated social worker on the gap between what MSW programs promise and what new therapists actually need to build a career.
Stewart is a recently graduated social worker from Columbia University's MSW program, now building a therapy practice across two private practices in New York City. Before counseling, he considered law — a background that shapes his blunt read on the structural problems in therapist education and career development.
“It's the age-old issue of specialization and segmentation … we've historically always associated the behavioral, environmental side — that's always been the job of social workers.”
"It became clear day one," Stewart said. "Every single class, if the professor asks who's here for the clinical track to be a practicing therapist, I'd say half of every class raises their hands." Yet the curriculum has stayed a "united front" of generalized social work training, drifting further from what most students in the room actually need.
Newer mental health counseling programs are more clinically focused, he noted — but choosing one means weighing a newer curriculum against an established program's name and network. "It's a cost-benefit analysis."
“You need a home econ of therapy master's programs … procedures for getting licensed, what different state boards require … these are things I'm still trying to figure out, and honestly there's no united front with any of this stuff.”
Stewart argues for a mandatory, full-year course on the licensure mechanics that no one teaches: hours requirements, what happens if you change jobs mid-process, what different state boards actually require. Right now, students piece it together themselves — while also trying to build the clinical confidence to actually sit with a client.
“The people who are doing pretty well in therapy — it's the people who already knew why they were there … you need to go in looking at state licensure websites, state board PDFs, and have all those conversations on your own.”
There's no practicum advisor who lays out the path for you, Stewart said — the career is entirely what you make of it, for better and worse. "It cuts both ways. You are responsible for the nuts and bolts, but it means the career is entirely what you make of it. The freedom comes with increased responsibility and self-ownership."
“I went into this profession because I'm not a big operational person … and I have found myself as the nexus of like 50 different time constraints and schedules. That does actually kind of keep me up at night.”
As a 1099 clinician, Stewart isn't salaried — he's paid based on who shows up. "If 10 people can't make their concrete session that week, that could have been rent." No one prepared him for becoming, in effect, his own office manager.
What gives Stewart confidence isn't certainty about whether he's helping — it's staying curious about the question. "The day that you stop being curious about whether you're providing quality care is the day you're probably not fit to be in the field," he said. He treats therapy as something built together with the client: "Let's try this. If this doesn't mesh with you, we try something else."
Building a sustainable therapy career, Stewart argues, shouldn't require being in the top one percent of self-directed learners. Right now, it does.
We're designing supervision and training around the realities in this article — structured feedback, outcome tracking, and a team invested in your growth as a clinician.
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