The 7 Pros of Working as a Therapist for an Agency (and the 10 Cons)

The process of becoming a skilled therapist is a rewarding but long and challenging road. You have completed at least 6 years of post-secondary education and at least 2 years of post-graduate supervised work. And, it’s not just the time. It’s the constant growth, learning, and personal development. We give so much of ourselves to become therapists and to maintain that profession.

I graduated from my MSW program in 2001 and have been growing and building my clinical skills ever since. It’s truly a never-ending process, and I wouldn’t have it any other way. This is a really exciting time in the field of mental health. We are seeing the emergence of celebrity therapists like Brené Brown, Bessel Van Der Kolk, and more, and we’re learning ever more about how the brain, mind, body, and spirit interact.

Over the years, I have been able to continue my education by learning directly from supervisors, mentors, and coworkers, from continuing education teachers, from experience, and from books, podcasts, and any other avenue for learning that I’ve been able to find.

And, I’m sure that you have done the same. You’ve taken the time to learn evidenced-based treatments. You are trauma informed. You understand the complexities of family systems and how societal pressures and government policy can have an influence over a person’s mental health. You are committed to excellence in the care to provide to your clients.

So, what to do with your big, beautiful brain?

As I see it, we have four main options when it comes to practicing as a psychotherapist:

1. work for an agency/hospital/corporation;
2. work for someone else’s group practice;
3. work as a solo private practice owner;
4. or work in and for your own group practice.

I’m going to be detailing the pros and cons for each.

Today, we’re going to focus on what it is like to work for an agency, nonprofit, hospital, or other such corporation.

What’s my experience?

Working for a larger agency or hospital is often the new therapist’s first stop out of grad school and for good reason. Personally, I have worked for hospitals, child welfare agencies in their mental health divisions, substance abuse treatment facility, a community mental health agency, and a couple of hospices. I’ve always worked with at least some direct care and have had multiple supervisory roles.

With all of these experiences, I can say with some authority what the pros and cons are for this type of work.

Here are the “Pros” of working for an Agency or Corporation

1. You are usually able to be employed without a full license. Applying for a job at an agency or corporation is most often the first step out of grad school. You don’t have your license yet, and you need to get your career underway.
2. Supervision is often provided for you free of charge. This is a huge perk, as you are required to get around 2 years’ worth of supervision on a weekly basis, which can be costly. Each state has their own regulations, but in most cases, you will need weekly supervision either as a group or individual model, and that can cost up to $500/month if you had to pay out of pocket.
3. You will have a large number of coworkers, and you can often find a mentor. It can also really be lovely to have a group of people with shared expertise and experiences.
4. You have a predictable paycheck. You are paid biweekly or semimonthly, and you know exactly what that paycheck is going to be each pay period. As a planner, knowing exactly how much and exactly when my paycheck was going to arrive was very helpful. I would pay my personal bills the day after my paycheck would arrive, and it was nice to know exactly how much money I could expect.
5. You have paid time off and holidays. This is honestly one of the things I have loved most about working for larger corporations. I was a massive PTO hoarder, and I would make the most of the days off I was given. Working for agencies, I had to be judicious in how I used my time off, but I was generally able to make it work to have vacations, long weekends, and whatever I absolutely needed.
6. Benefits such as health insurance and retirement savings are usually available.
7. There may be opportunity for advancement into leadership roles. I have worked in direct client care and in leadership positions. I’ve loved both but have never excelled beyond middle management, so I can’t speak to the C-level positions in larger agencies. If you believe that leadership is part of your mission/calling, this is one of the two work situations where that is possible.

Here are the “Cons” of working for an Agency or Corporation

1. Limited flexibility. You are expected to work your assigned schedule without much opportunity for change in schedule. Even with this, though, large entities are beholden to OSHA and FMLA guidelines/laws. If you need FMLA, you will have a much easier time getting it when working for a larger entity, as some regulations do not apply to employers with less than 50 employees.
2. Supervision is not guaranteed. You’ll need to confirm this before accepting employment through an agency. If supervision is free, you may not mesh well with your assigned Supervisor, and you may not have any choice in the matter. This happened with me. I worked for two different entities, a hospital and a hospice, straight out of school, and I had one supervisor that I loved and felt that I was learning from and another who just was not a great fit.
3. Accepting “free” supervision may obligate you to a contract to stay within the agency for a period of years after you have earned your license. This is something that your agency will have to be explicit about at the outset, so you will know if this is the case or if it is not an issue.
4. While they can be lovely, and there can be camaraderie, impromptu “watercooler debriefing”, and more, it’s just as likely that there will be personality differences that make life hard. Also, they may microwave fish for their lunches. Gross.
5. Paperwork is often quite extensive. This varies by agency/company. If you have a difficult time with paperwork at all, you need to learn as much about the expectations around paperwork as possible before accepting an agency position. I have worked for some places where the paperwork was very manageable and seemed to make sense for the work being done, and I’ve worked for some places where the regulations were so tight that no one even seemed to know why we had as much paperwork as we did, but it sure was important that we did it!
6. Your work and therapeutic style may be stifled, and you may be expected to conform to your company’s methods. This obviously varies widely by the type of agency, but this is definitely something to check out in your interview process. You will want to know what types of treatment you will be expected to deliver and to make sure that this is something you are both knowledgeable about and aligned with.
7. There are limits to your paycheck. Though it is predictable, it is finite. Because you have all of the lovely perks of front office staff, benefits, and so forth, overhead can be high, which means that your pay may be much lower than the services that you provide.
8. You may be offered benefits, but you will not have much choice about it.
9. Accepting time off may result in you having to plan and arrange for your own coverage, and there are some entities that will encourage you to practice self-care while at the same time guilting/shaming you for taking time away.
10. You have little to no autonomy when it comes to the clients that you serve. Unless the client has broken an agency guideline, they will be served by your agency, and if you are assigned that case, it’s yours!

Bottom line, working for a large agency/government entity/corporation/hospital can be exactly the right fit for you, but you do need to consider all of the pros and cons.

What other pros and cons have you found from working at a larger agency?

Stay tuned for next week when I will discuss the pros and cons of working for another clinician’s group practice!