The practice of Clinical Psychology looks deeply at people’s motives, feelings, thoughts and actions in hopes of providing them relief from distress. It is a profession that requires deep empathy for humanity’s struggles to help bring about change. The field is one that requires significant training, education as well as mental and emotional strength.

As clinical psychologists, we work with clients of all ages facing countless challenges. Our clients come from all walks of life and social groups, representing the larger American society.

In providing mental health treatment, we are addressing topics that impact humanity as a whole; including violence, trauma, loss, grief, politics – the list goes on.

The impact of psychotherapy is enormous and touches individuals, families, and society. Despite all of this, we are in a profession that is paid drastically less than other fields with the same level of education.

We are Underpaid from the Beginning

The first steps of our career demonstrate this severe lack of monetary compensation.

There are not enough paid internship, post doc or employment opportunities for every clinician working towards licensure. Many of us are forced to take an unpaid position or to extend our graduate experiences another year (or more) to accomplish the goal of receiving a doctoral degree. This results in more debt and more time before beginning our professions.

When we do obtain predoctoral internship, we are still paid modestly. Beyond graduation, it is again difficult to obtain paid postdoctoral training as we accrue hours for licensure. Some of us take on unpaid trainings; meaning we are either supported by our spouse or family or have to work multiple jobs in order to care for ourselves. Even positions that are paid are done so insufficiently and offer little financial support to fulfill the needs of the clinicians.

In addition to insufficient payment, we take jobs that push packed schedules and overwhelming caseloads. Often, lower level trainees are paired with some of the most intense populations, as these are the clients who cannot afford to work with more experienced clinicians. This means that in a time where clinicians are being inadequately compensated, they are also being given heavier and larger caseloads.

Clinical psychology is a deeply personal profession, and often involves every part of us. We bring our own growth, pain, struggles and experiences to the work. This is not a job we can “leave at the office”. We are in a therapeutic relationship to help our clients grow and change.

As a result, we are prone to compassion fatigue and vicarious trauma. We carry the trauma with us in our minds and our bodies. We care for and worry for our clients. If we are not able to be attuned to this and have the resources to care for ourselves, we will experience symptoms of burnout.

Keep an Eye Out for Burnout

This field is one that is at its most deep and beautiful when we are able to engage the work with our full selves. Clinicians possess empathy that allows us to be in tune with our clients and respond to their needs. When we are able to engage the work, it can be transformative and life changing.

However, in order to be able to engage the work, we must be sure that we are taking care of ourselves.

To avoid burnout and illness requires substantial self-care and careful monitoring of our internal experiences, especially early in our careers. We need to have insight into ourselves and be in tune with the indicators that we are facing dryness, bitterness and burnout.

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The professional demands paired with the lack of financial compensation are a perfect recipe for exhaustion. This can look like anxiety, depression, illness, fatigue, anger and emotional detachment. If these aspects become too powerful they may overtake us.

It is almost impossible to care for oneself if there is not proper compensation for our work. If clinicians do not have an adequate salary, medical benefits and the ability to care for our most basic needs, how can we provide care for those who need us?

Invisible Communication About Worth

What is added to this often significant financial burden is the psychological effect of not receiving sufficient compensation.

When we do not receive proper payment, we are being told we are not valued or worth monetary reimbursement. Without getting a salary we are being shown that the work we are doing isn’t valuable, that helping those who are impoverished, struggling and in pain is not a value in this society.

This can be highly demoralizing.

Not only are we engaging in difficult work and not receiving compensation (or very little), we are also not receiving support from our society. We run the risk of burning out before our careers have even begun.

How are we expected to care for our clients, who are often struggling with unimaginably difficult things, when we ourselves are not being valued or cared for?

It seems nonsensical that a field that works with the foundation of what makes us human – what helps us to be in relationships, to cope with trauma and to help answer large existential questions – should also be a field that is paid poorly.

Clinical psychology is an invaluable field, yet is one of the most underpaid in our society, especially considering its educational requirements.

Proper compensation would not only allow us to take care of our most basic needs, it would also acknowledge us as valued members of the American society. This in turn would allow us to better care for our clients, allowing them to feel valued and to have space to heal.

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Elise Joy Middleton, PsyD, MACL

Elise Joy Middleton, PsyD, MACL

Elise Middleton is a recent PsyD graduate from Fuller Graduate School in Pasadena, California. She currently resides in San Francisco and specializes in working with children, youth and families. She will be completing her Post Doctoral Fellowship at the Infant/Parent Program at UCSF and moving on to becoming a licensed psychologist.
Elise Joy Middleton, PsyD, MACL