Psychiatric NP + counseling degree?

[MustIReallyThough]

Hello!

I have a bachelors in psychology and am currently weighing grad school paths and practice options. It's currently between counseling or venturing into the medicine world. I am strongly considering getting into an accelerated RN program, working awhile, and seeing if the NP or med school route is viable for me. I would not want to abandon my desire to be a competent psychotherapist though. So eventually I'd want to do whatever it takes to pursue that training. Even knowing a employer would not likely pay me for therapy as a NP.

Do you all think it's realistic to aim to be a good mid level prescriber AND psychotherapist?

Both nursing and psychiatry have always interested me and the pay, employability, benefits, etc of medicine are ridiculous compared to masters level therapists.

Though, what really has me worried about counseling is the lack of job freedom. I just feel like I'd burn out of therapy eventually if the best I could hope for career wise is to crank out therapy hours in private practice. I also currently have no interest in teaching, research, assessment, niche areas in psych, or anything psychologists or counselors seem to pursue in lieu of therapy.

So that's led me to consider the job flexibility in medicine + psychotherapy.

Hope that makes sense. Trying to think very long term here.

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[clozareal]

It's not realistic because the NP training contains very little training in psychotherapy but not impossible. There are NPs who do additional training in psychotherapy even psychoanalysis, but those are rare. It's tough because it depends on whether your state allows for independence practice or not which limits your flexibility in being a therapist/clinician.

You won't get out of learning teaching, research, assessment, niche areas if you do an NP degree and in fact, you'll have to learn public policy, health care delivery, leadership, health informations, and have a research project as well in NP school.

 

[MustIReallyThough]

Good points. Why do you think it's rare to pursue psychotherapy training besides the independent practice issue? I'm not in a independent practice state btw.

I haven't ruled out the doctor path. I'd just have to be very careful in making that decision. Same with the NP really. I've always wanted to primarily be a therapist.

Thanks for outlining the NP path. I'm not necessarily opposed to any of this in a curriculum besides research. Just don't see them being long term job options

 

[TexasPhysician]

Becoming a NP does not get you anywhere with counseling. Becoming a LPC in my state is roughly a 2-3 year masters plus 2-3 years of being an associate. Add that to nursing + Psych NP and you’d be better off becoming a psychiatrist for the time.

 

[MustIReallyThough]

Becoming a NP does not get you anywhere with counseling. Becoming a LPC in my state is roughly a 2-3 year masters plus 2-3 years of being an associate. Add that to nursing + Psych NP and you’d be better off becoming a psychiatrist for the time.

Yep, I think my choice is solely between psychiatry and a lpc now. I think my next step is a lot of shadowing and taking some pre med classes. Volunteer at a local hospital maybe. Go from there.

What do you think about a psychiatrist attempting to master both medicine and psychotherapy? Realistic?

 

[Psychresy]

Yep, I think my choice is solely between psychiatry and a lpc now. I think my next step is a lot of shadowing and taking some pre med classes. Volunteer at a local hospital maybe. Go from there.

What do you think about a psychiatrist attempting to master both medicine and psychotherapy? Realistic?

Yes, this is realistic. Many people do it.

 

[romanticscience]

Yep, I think my choice is solely between psychiatry and a lpc now. I think my next step is a lot of shadowing and taking some pre med classes. Volunteer at a local hospital maybe. Go from there.

What do you think about a psychiatrist attempting to master both medicine and psychotherapy? Realistic?

It's great to be interdisciplinary; I pride myself on being a psychiatrist--psychotherapist. However, like many things, you must develop a firm foundation in one thing (e.g., medicine/psychiatry) before mastering a secondary speciality (psychology/psychotherapy).

 

[FlowRate]

Yep, I think my choice is solely between psychiatry and a lpc now.

Why not become a psychologist?

 

[MustIReallyThough]

Why not become a psychologist?

That's always been the dream and still a consideration. I don't really have research interests though. As I understand it even funded PsyD programs have a good amount of research. And given my orientation towards practice, I'm not sure if the time and debt is worth it. Even the small, typical debt associated with funded programs.

I also don't have any particular interest in the kind of things that set psychologists apart. Like assessment or niche specialities.

So...just not sure about that. If anyone would be willing to speak about psychology though I'd love to listen.

 

[MustIReallyThough]

It's great to be interdisciplinary; I pride myself on being a psychiatrist--psychotherapist. However, like many things, you must develop a firm foundation in one thing (e.g., medicine/psychiatry) before mastering a secondary speciality (psychology/psychotherapy).

Absolutely. That makes a lot of sense. Have to have a solid foundation to build on.

Do you have enough opportunity to practice therapy as you would like?

 

[mistafab]

Do you absolutely need to prescribe medications? If the answer is no, then LPC/MSW or PsyD or PHD is a great option as well.

 

[MustIReallyThough]

Do you absolutely need to prescribe medications? If the answer is no, then LPC/MSW or PsyD or PHD is a great option as well.

In short, no. But there are things about medicine that draw me in.

And there are things about clinical practice with the above degrees that give me pause. The best I could hope for financially and clinically with a LPC/MSW seems to be private practice. But that's not all it cracks up to be, and I'm afraid I'd burnout eventually and not have many other job options.

I'm also not interested in research and hate the thought of writing up my own. As I understand it, good, funded PsyD programs have a good bit of research as well. I also don't have much interest in admin work or anything else psychologists usually do besides therapy. I'm not sure it'd be worth it for me.

Are these fair assessments? I've thought long and hard about a LPC only. But I just can't imagine doing therapy the rest of my life and never retiring because I just don't make enough as a LPC even in private practice. That doesn't seem realistic

 

[WisNeuro]

In short, no. But there are things about medicine that draw me in.

And there are things about clinical practice with the above degrees that give me pause. The best I could hope for financially and clinically with a LPC/MSW seems to be private practice. But that's not all it cracks up to be, and I'm afraid I'd burnout eventually and not have many other job options.

I'm also not interested in research and hate the thought of writing up my own. As I understand it, good, funded PsyD programs have a good bit of research as well. I also don't have much interest in admin work or anything else psychologists usually do besides therapy. I'm not sure it'd be worth it for me.

Are these fair assessments? I've thought long and hard about a LPC only. But I just can't imagine doing therapy the rest of my life and never retiring because I just don't make enough as a LPC even in private practice. That doesn't seem realistic

What admin work am I usually doing besides clinical work that isn't part of any other healthcare provider's general experience again?

 

[MustIReallyThough]

What admin work am I usually doing besides clinical work that isn't part of any other healthcare provider's general experience again?

Don't get me wrong, I think psychology is a great career. But the feedback I've gotten (mostly) suggests that if you're just interested in generalist practice a masters is the way to go.

Not that I wouldn't be interested in very fascinating specialties like yours. But... seems like a gamble.

What do you think?

 

[WisNeuro]

Don't get me wrong, I think psychology is a great career. But the feedback I've gotten (mostly) suggests that if you're just interested in generalist practice a masters is the way to go.

Not that I wouldn't be interested in very fascinating specialties like yours. But... seems like a gamble.

What do you think?

It's a great and lucrative career if you're interested in it. I was just curious as to what admin tasks you think we do as I think it may be a misconception. Also, what's the gamble?

 

[romanticscience]

Absolutely. That makes a lot of sense. Have to have a solid foundation to build on.

Do you have enough opportunity to practice therapy as you would like?

I'm in private practice. I'm "therapeutic" with every encounter (which therapy training helps) and offer traditional therapy (CBT or TFP) as the clinical situation demands it.

 

[whopper]

A weakness of psychiatric academic training is that there is not a strong emphasis on psychology. E.g. how many psychiatry programs do you see that makes residents take courses on psychometrics, child development, abnormal psychology, and yet these classes are very potent in their clinical importance.

A problem with prescribing psychotropics, however, is unless you do a psychiatry residency you're really only going to be able to handle less severe cases unless you intentionally go out of your way to do something on the order of a psychiatry residency such as be an NP on a consultation service, or inpatient and have a great physician mentor.

 

[comp1]

There are NPs who do great psychotherapy. It's just not an easy path or one that will have any clearly laid out plan for you. You'll have to cobble together experiences and mentorship. I second whopper's comment about the path to becoming a really great psychopharmacologist likely lies in spending a lot of time on inpatient units as an NP post graduation and that doesn't really align a great deal with becoming a great psychotherapist, although there certainly CAN be good psychotherapy done on inpatient units. This whole thread is about generalities and you have some conflicting ones.

 

[MustIReallyThough]

It's a great and lucrative career if you're interested in it. I was just curious as to what admin tasks you think we do as I think it may be a misconception. Also, what's the gamble?

Ah I see. A couple folks have mentioned that hospital psychologists typically manage the therapists on staff in addition to clinical work. Or are in charge of certain programs.

The gamble to me is going through the rigorous training in psychology and hoping I want to do more than private practice one day. Or that I could even get into these very niche specialities if I wanted to.

Another part of that is being 28 and feeling like I can't go much longer without a stable income. It's a different consideration with psychiatry you know. The income there seems safer and more predictable

 

[WisNeuro]

Ah I see. A couple folks have mentioned that hospital psychologists typically manage the therapists on staff in addition to clinical work. Or are in charge of certain programs.

The gamble to me is going through the rigorous training in psychology and hoping I want to do more than private practice one day. Or that I could even get into these very niche specialities if I wanted to.

Another part of that is being 28 and feeling like I can't go much longer without a stable income. It's a different consideration with psychiatry you know. The income there seems safer and more predictable

As to the first point, only a small number do, and that's only the ones that want to. Very small percentage. As to the second point, which niche specialties? The degree is fairly broad. For example, I do primarily legal work these days. As for the income piece, depending on what you want to do, salaries can be much higher on an hourly basis than most clinical psychologists or psychiatrists make in general clinical work.

 

[MustIReallyThough]

As to the first point, only a small number do, and that's only the ones that want to. Very small percentage. As to the second point, which niche specialties? The degree is fairly broad. For example, I do primarily legal work these days. As for the income piece, depending on what you want to do, salaries can be much higher on an hourly basis than most clinical psychologists or psychiatrists make in general clinical work.

Ah I see. I thought it was more that they were forced into these roles since a lot of generalist practice has gone over to the masters level as I understand it.

That's the thing. I have no particular interest in any niche specialty, though I could gamble on that changing eventually if I did a PhD. My real interest is having an in-depth understanding of mental illness and working with the full gamut, including SMI. If I had to choose something to research right now it'd be about innovations in treating this population.

But I definitely could be interested in niche areas. I don't really know enough to say. Gero, addiction, and neuro seem fascinating. As long as I wouldn't have to give up being a therapist completely.

 

[Alemo]

My real interest is having an in-depth understanding of mental illness and working with the full gamut, including SMI.

This is psychiatry. Not nurse practitioner, not PA, not psychology (assuming you want to treat with medication and understand more neurology/other organ systems). If you want to seriously learn about pathophysiology and treatment of mental illness, there’s no shortcut aside from medical school.

 

[MustIReallyThough]

This is psychiatry. Not nurse practitioner, not PA, not psychology (assuming you want to treat with medication and understand more neurology/other organ systems). If you want to seriously learn about pathophysiology and treatment of mental illness, there’s no shortcut aside from medical school.

I see what you mean! Good, narrows the choices a good bit.

So what if I didn't want to treat with medication? How exactly do you think a psychology PhD would align with that stated goal?

To be honest, I'm not terribly interested in anatomy or the like. I don't really crave an understanding of the body.

The best plan I've come up with so far is do an accelerated BSN and work as a RN for awhile. Try and volunteer at the local medical school and see if I can get involved with any research. See how I manage with pre med classes and if I could hack research...

 

[MustIReallyThough]

I'm in private practice. I'm "therapeutic" with every encounter (which therapy training helps) and offer traditional therapy (CBT or TFP) as the clinical situation demands it.

This is the dream. I can see how flexibility = job satisfaction. Also a great, holistic model for your patients.

If I could ask, I assume you started your career with an interest in being a doctor in general rather than a psychiatrist specifically? What do you think of someone with an interest in psychology primarily trying to hack medical school?

 

[MustIReallyThough]

A weakness of psychiatric academic training is that there is not a strong emphasis on psychology. E.g. how many psychiatry programs do you see that makes residents take courses on psychometrics, child development, abnormal psychology, and yet these classes are very potent in their clinical importance.

A problem with prescribing psychotropics, however, is unless you do a psychiatry residency you're really only going to be able to handle less severe cases unless you intentionally go out of your way to do something on the order of a psychiatry residency such as be an NP on a consultation service, or inpatient and have a great physician mentor.

I don't think the NP route really aligns with my goals. I definitely want a deeper understanding no matter which degree I go.

What do you think of the psychologist path? Specifically if I was interested in generalist practice treating as much SMI that's possible with psychotherapy?

 

[MustIReallyThough]

There are NPs who do great psychotherapy. It's just not an easy path or one that will have any clearly laid out plan for you. You'll have to cobble together experiences and mentorship. I second whopper's comment about the path to becoming a really great psychopharmacologist likely lies in spending a lot of time on inpatient units as an NP post graduation and that doesn't really align a great deal with becoming a great psychotherapist, although there certainly CAN be good psychotherapy done on inpatient units. This whole thread is about generalities and you have some conflicting ones.

That makes a lot of sense. Really seems like it's between psychiatry and psychology at this point. What are the conflicting generalities?

 

[WisNeuro]

This is psychiatry. Not nurse practitioner, not PA, not psychology (assuming you want to treat with medication and understand more neurology/other organ systems). If you want to seriously learn about pathophysiology and treatment of mental illness, there’s no shortcut aside from medical school.

I'd beg to differ here. We do a pretty good job of that on our end, especially in the neuro side of things. Though, it's no shortcut.

 

[FlowRate]

I don't think the NP route really aligns with my goals. I definitely want a deeper understanding no matter which degree I go.

What do you think of the psychologist path? Specifically if I was interested in generalist practice treating as much SMI that's possible with psychotherapy?

I worked with psychologists when rotating through the CMHC/PHP primarily as DBT supervisors (for severe BPD/CPTSD). You could also do CBT (and offshoots) for bad OCD, eating disorders, and the like.

 

[clausewitz2]

I worked with psychologists when rotating through the CMHC/PHP primarily as DBT supervisors (for severe BPD/CPTSD). You could also do CBT (and offshoots) for bad OCD, eating disorders, and the like.

Work in an OCD residential treatment program and you are a) definitely going to see some severe mental illness and b) probably best served by being a psychologist.

 

[splik]

keep an open mind. your posts betray very little understanding of any of the fields you purport to be interested in pursuing. At the same time you say you want to do therapy, but couldn't imagine doing that for the rest of your life, aren't interested in the body or anatomy, aren't interested in research, teaching, assessment, administration, or "niche specialties" (whatever that means) etc. Fact is, you have no idea what you are actually interested in. You can't expect to know all that. You will figure it out when you actually have exposure to different things if you keep an open mind. I thought I was going to be a researcher. Turns out I don't have it in me (too much ADHD and not enough autism), and was way better at clinical work than I thought I would be. I thought I wanted an educational leadership position, but turns out I found that quite tedious and much prefer mentoring. I never thought I would be interested in forensics but I ended up training in that and it's quite a lot of what I do now, and I was totally disinterested in neuropsych until I wasn't. If you told me 10 yrs ago I was going to specialize in neuropsychiatry, I would have told you that you were crazy.

Also remember, you are going to have to suck it up and do things that might not interest you. Whether you are interested or like something is quite irrelevant if it is a prerequisite to achieving a particular goal. Think in big buckets about what it is you want. Right now you are getting too focused on small details.

 

[MustIReallyThough]

keep an open mind. your posts betray very little understanding of any of the fields you purport to be interested in pursuing. At the same time you say you want to do therapy, but couldn't imagine doing that for the rest of your life, aren't interested in the body or anatomy, aren't interested in research, teaching, assessment, administration, or "niche specialties" (whatever that means) etc. Fact is, you have no idea what you are actually interested in. You can't expect to know all that. You will figure it out when you actually have exposure to different things if you keep an open mind. I thought I was going to be a researcher. Turns out I don't have it in me (too much ADHD and not enough autism), and was way better at clinical work than I thought I would be. I thought I wanted an educational leadership position, but turns out I found that quite tedious and much prefer mentoring. I never thought I would be interested in forensics but I ended up training in that and it's quite a lot of what I do now, and I was totally disinterested in neuropsych until I wasn't. If you told me 10 yrs ago I was going to specialize in neuropsychiatry, I would have told you that you were crazy.

Also remember, you are going to have to suck it up and do things that might not interest you. Whether you are interested or like something is quite irrelevant if it is a prerequisite to achieving a particular goal. Think in big buckets about what it is you want. Right now you are getting too focused on small details.

Lol you're not wrong. It does feel like I have to make decisions now though as it'll effect how I move forward. But you're right, I don't really know. There's too many things I can't predict without experience. My thing with therapy is that I fully intend to make a career out of it, but not many of the people I've spoken to have been able to hang with it thier entire careers. Makes ya think.

With the price of education right now though, I really want to have solid information (as much as possible) about all available avenues and realistic practice expectations.

So...what would you do in my shoes? Do you think doing an accelerated RN and working awhile while I learn more about options would be a good idea? There's a medical school close that I could hopefully volunteer at at least. Maybe get involved in some research. Find some good mentors on both the psychology and psychiatry side.

Also, great points in your last paragraph. I agree

 

[MustIReallyThough]

I'd beg to differ here. We do a pretty good job of that on our end, especially in the neuro side of things. Though, it's no shortcut.

Could you speak a bit on your PhD experience before you specialized in neuro? How did you feel about your clinical training in relation to "pathophysiology and treatment of mental illness"?

I'm also very interested in how you ended up pursuing neuropsychology

 

[WisNeuro]

Could you speak a bit on your PhD experience before you specialized in neuro? How did you feel about your clinical training in relation to "pathophysiology and treatment of mental illness"?

I'm also very interested in how you ended up pursuing neuropsychology

Regarding the pathophysiology and treatment of mental illness piece, this is essentially what half of your time in grad school for clinical psych is spent doing. RE: the grad school experience and neuropsychology, feel free to message me back channel and I can explain a bit more in detail.

 

[clausewitz2]

(too much ADHD and not enough autism)

Can I get this on a t-shirt?

Joking aside, I also had the exact same experience of thinking I was going to be a researcher (with the vestigial PhD to show for it), finding out I was definitely not cut out of it temperamentally, and being shocked by a) loving and b) being pretty good at clinical work. Life is strange, OP, and got to leave yourself open to surprising new directions to some extent.

 

[michaelrack]

If you want to prescribe psychotropics, you will need to either become an NP or MD/DO.
that's the first decision. Assuming you choose the NP route and get the psych NP certification, that leaves the question of psychotherapy training, should you wish to provide this. There may be some limited psychotherapy training available through your NP school.
You can also get additional training on your own through various insitutes (ie Beck Institute for CBT).
There are also MSW and LPC programs- if you go this route there is no need to actually complete the whole program- you don't need the certification, just the training and experience. You could stay in it as long as it was helpful and then drop out.
My whole point in all this is that the only certification you would actually need is Psych NP or MD/psych boards.

Of course, if you aren't interested in prescribing, there are other career pathways in treating mental illness as discussed in other posts. And you would need to complete that degree program.

 

[clausewitz2]

If you want to prescribe psychotropics, you will need to either become an NP or MD/DO.
that's the first decision. Assuming you choose the NP route and get the psych NP certification, that leaves the question of psychotherapy training, should you wish to provide this. There may be some limited psychotherapy training available through your NP school.
You can also get additional training on your own through various insitutes (ie Beck Institute for CBT).
There are also MSW and LPC programs- if you go this route there is no need to actually complete the whole program- you don't need the certification, just the training and experience. You could stay in it as long as it was helpful and then drop out.
My whole point in all this is that the only certification you would actually need is Psych NP or MD/psych boards.

Of course, if you aren't interested in prescribing, there are other career pathways in treating mental illness as discussed in other posts. And you would need to complete that degree program.

Uh, please do not enter an MSW program and drop out, OP. Not being eligible for clinical licensure in most states will mean insurance won't reimburse you for services rendered and getting hired becomes dramatically harder.

 

[michaelrack]

Uh, please do not enter an MSW program and drop out, OP. Not being eligible for clinical licensure in most states will mean insurance won't reimburse you for services rendered and getting hired becomes dramatically harder.

My experience with np collaboration is that insurance company will reimburse psych np's for e and m codes with psychotherapy add on just like they do for psychiatrists. My comment about dropping out was aimed at those with a psych np degree/certification - who thus already have clinical licensure

 

[clausewitz2]

My experience with np collaboration is that insurance company will reimburse psych np's for e and m codes with psychotherapy add on just like they do for psychiatrists. My comment about dropping out was aimed at those with a psych np degree/certification - who thus already have clinical licensure

I am talking about MSWs, not NPs.

 

[michaelrack]

I am talking about MSWs, not NPs.

I was answering the title of this thread, which is "Psychiatric NP + Counseling degree" and I stand by my answer that a psych np can enroll in a msw program and drop out after she learns what she needs to learn. She needs the knowledge rather than another degree (although there is probably better ways to get that knowledge/experience)

 

[WisNeuro]

What experience would they get early in the msw program? The therapy training is pretty cursory, the ones that actually know how to do therapy get it in after programs with additional training and supervision.

 

[MustIReallyThough]

Can I get this on a t-shirt?

Joking aside, I also had the exact same experience of thinking I was going to be a researcher (with the vestigial PhD to show for it), finding out I was definitely not cut out of it temperamentally, and being shocked by a) loving and b) being pretty good at clinical work. Life is strange, OP, and got to leave yourself open to surprising new directions to some extent.

Also want that shirt!

Thank you for your input! Could you expand on why you didn't enjoy research?

As far as I know, I don't think and have never thought I'd enjoy research. I'm more of a people person and enjoy working with them. The only reason I'm considering a psych PhD really is the clinical expertise and job flexibility relative to a masters. Which is a big part of why I'm now considering medicine instead.

 

[MustIReallyThough]

If you want to prescribe psychotropics, you will need to either become an NP or MD/DO.
that's the first decision. Assuming you choose the NP route and get the psych NP certification, that leaves the question of psychotherapy training, should you wish to provide this. There may be some limited psychotherapy training available through your NP school.
You can also get additional training on your own through various insitutes (ie Beck Institute for CBT).
There are also MSW and LPC programs- if you go this route there is no need to actually complete the whole program- you don't need the certification, just the training and experience. You could stay in it as long as it was helpful and then drop out.
My whole point in all this is that the only certification you would actually need is Psych NP or MD/psych boards.

Of course, if you aren't interested in prescribing, there are other career pathways in treating mental illness as discussed in other posts. And you would need to complete that degree program.

Thank you for your input! That was more what I was originally thinking. But the above point is a great one. Might as well gun for psychiatry if I'm going to try to do all that eh?

Still, it'd be a good backup plan. That is, a NP with some sort of psychotherapy training. I think I should also still consider the PhD in psych.

The only option I might scratch entirely is stopping at a psychotherapy masters. I think the biggest thing I've learned from this is that job flexibility is very important as we can't predict how a career will go. And a LPC or MSW doesn't afford the clinical practice options I'm really looking for (or might want to look for).

I think I've read about enough therapists that are stuck in low paying/high stress jobs at this point...