A New, Common-Sense Therapy Licensure System: It's Time for Change
If you’ve followed our journey to help students become licensed therapists, you're already familiar with our stance: The current therapy licensure system in the United States desperately needs an overhaul. We are not just frustrated—we’re actively lobbying for meaningful reform. Today, we are officially launching our advocacy campaign to redesign therapy licensure nationwide.
Why Change Is Essential
According to the Kaiser Family Foundation, nearly half (47%) of the U.S. population lived in areas experiencing a shortage of mental health professionals in 2022. This shortage is expected to worsen in the coming years—not due to a lack of interest from potential therapists, but because of a poorly designed licensure system.
Mental health care is also undergoing a significant shift, increasingly recognizing trauma as the underlying cause of many mental health challenges. Our current academic system, however, isn’t designed for trauma-informed care, which relies less on traditional academic methods and more on compassion and somatic approaches. By shifting towards trauma-informed and body-based care, we can better equip therapists to thrive in a future where AI-driven therapy is inevitable.
The problems plaguing the current licensure system are apparent, and yet persistently ignored:
1. Excessive Complexity and Inconsistency
There are over 200 different therapy licenses across the United States, each varying by state and discipline, often with only minor, somewhat arbitrary differences. These discrepancies create unnecessary confusion and complexity, making it nearly impossible for educational institutions and students to prepare efficiently for licensure. Aspiring therapists find themselves navigating a complex web of regulations, which can significantly detract from their primary goal: helping others.
2. Excessive Time and Cost
Becoming a licensed therapist today typically requires at least nine years of education and supervised practice, comparable to the time required to become a medical doctor. However, entry-level medical doctors (MDs) earn approximately 4.6 times what entry-level therapists make, despite similar educational investments. For licensed psychologists (Ph.D.), this jumps to twelve years.
This imbalance doesn’t just affect therapists; it discourages talented and passionate individuals from entering the mental health field altogether, exacerbating an already critical shortage.
3. Limited Access to Modern, Effective Therapies
Contemporary approaches, particularly somatic and body-based therapies, have demonstrated significant effectiveness in clinical practice. Yet, due to outdated licensure and insurance reimbursement rules, therapists frequently cannot bill insurance for these modalities. Consequently, many clients lose access to therapies that could dramatically enhance their well-being.
4. The Rise of an Unregulated Coaching Industry
In response to these burdensome licensure barriers, a rapidly growing market of unregulated mental health coaches has emerged. Unregulated coaches often provide services that are indistinguishable from therapy but operate without oversight, accountability, or regulation, posing significant risks to their clients. While blame is usually cast on coaches themselves for entering unregulated practices, we believe this is a symptom of the poorly designed licensure system.
The Utah State legislature recently introduced legislation to curb the practice of mental health coaching. We strongly disagree with this legislation, as we believe the coaching industry has grown in response to a lack of access to a therapy license.
Our Solution: A Common-Sense Therapy Licensure System
To address these systemic issues, we propose a new, common-sense, federally organized licensure framework, implemented by state boards. Here’s the vision:
A Single License: Licensed Therapist (LT)
We advocate for creating a unified "Licensed Therapist (LT)" credential with simplified requirements. It also includes additional recognition and higher insurance reimbursement rates for more experienced practitioners (see below, LST).
- Associate’s Degree: Eliminate the outdated requirement for a bachelor's degree. Instead, candidates would only need an associate's degree in any subject prior to entering a master's program. This change acknowledges that most bachelor's degree curricula offer little direct value to the practice of therapy. It will make licensure far more accessible for hundreds of thousands of students who cannot afford, and will not benefit from a bachelors’s degree.
- Master’s Degree Simplification: Almost all state licensing boards require the Master’s degree to be 60 credit hours, which is twice as much as the typical 30 credit hour master’s degree. Most of this coursework is academic and increasingly irrelevant in modern trauma-focused therapy practice. This would significantly lower educational costs and time barriers without sacrificing the quality of training.
- Recognition of Equivalencies: Allow "Master’s Degree Equivalents" from unaccredited yet highly effective training programs, such as Somatic Experiencing and Internal Family Systems (IFS), which mirror successful practices in Ontario, Canada. This flexibility recognizes that high-quality therapeutic training can occur outside traditional academic institutions.
- Reduction in Supervised Hours: Decrease required supervised clinical hours for initial licensure to 1,000 hours. This adjustment maintains professional readiness while eliminating unnecessary delays in entering professional practice.
- Broader Clinical Focus: Accept any master's degree with a clinical psychology focus, removing rigid state-specific curriculum mandates. This shift enables institutions to innovate and better address diverse therapeutic needs rather than adhere strictly to conventional diagnostic approaches.
- Pay Parity and Simplified Insurance Billing: Establish standardized reimbursement rates for 50-minute therapy sessions across zip codes, simplifying billing processes. Additionally, supervised LTs can directly bill insurance at reduced rates during their supervision, ensuring sustainable compensation early in their careers.
Implementing these reforms means individuals could become fully licensed therapists within five years, making this vital career accessible to a broader, more diverse population.
Licensed Senior Therapist (LST)
The current system does not honor or incentivize continued excellence and mastery in practice. Therapists who have gained significant work experience should be recognized and be able to bill insurance at a higher rate than new practitioners. For therapists who advance their practice:
- Enhanced Recognition: After five years and 3,000 client hours under license, therapists would qualify as a Licensed Senior Therapist (LST). This distinction allows for higher insurance billing rates, acknowledging their advanced expertise and sustained commitment to the field.
Anticipated Benefits of the New System
Our proposed common-sense licensure reform offers clear, tangible benefits:
Increased Accessibility: Reduced barriers to entry will encourage more qualified individuals to pursue therapy as a career, directly addressing the critical shortage of mental health providers nationwide.
Improved Affordability: Lowering educational costs and shortening training periods drastically reduces the financial burden on aspiring therapists, making this career path economically feasible for a wider audience.
Enhanced Clarity and Consistency: A uniform licensure framework will eliminate confusion for students, institutions, and clients, simplifying education, supervision, licensing, and insurance billing.
Better Regulation and Safety: Bringing mental health coaching under a regulated framework ensures clients receive safe, effective, and accountable care.
Expanded Access to Effective Therapies: Modern therapeutic modalities, such as somatic and integrative practices, will finally receive the recognition and insurance reimbursement they deserve, significantly improving client outcomes.
Join Our Movement
We cannot accomplish this transformative change alone. Achieving this vision requires coordinated advocacy, strategic partnerships, and robust public support. In the coming months, we'll be engaging policymakers, licensing boards, universities, professional associations, and the public to build a coalition that demands and achieves meaningful reform.
We invite you—students, therapists, educators, advocates, clients, and anyone passionate about mental health—to join us. Together, we can create a therapy licensure system that truly makes common sense.
Stay tuned for updates and learn how you can participate in our advocacy efforts.
It’s time for change. Let’s make therapy accessible, affordable, and effective for everyone.