Grad school & training in mental health

Strong nerves before and during early sessions are named as one of the main stresses of beginning practice. They tend to ease as you build experience and see clients return.

What helps

• Arrive early and ground yourself for two minutes
• Plan your opening, not the whole session
• Remember the relationship matters more than perfect words
• Tell your supervisor which part makes you most nervous

Supervisors and faculty have a duty to judge whether trainees are ready to practice. Being under that spotlight is a stress of its own, even when you are doing well.

New helpers often swing between carrying clients home and holding them at a cold distance. Both are common steps on the way to steadier boundaries.

Your sense of yourself as a helper is fragile and incomplete in training. One hard session can feel like proof you don’t belong, and one good one can feel like luck.

Textbook models often seem not to match the person in front of you. Building working maps from theory, supervision and experience takes years.

Many people enter the field with glamorized hopes about how much change they will see. Real progress is often slow and uneven, and that can feel like failure when it isn’t.

Novices have an acute need for positive mentors. A supportive supervisor can make training feel possible. A poor fit can make it much harder.

Recordings and live observation are some of the best ways to learn, and some of the most exposing. Most trainees cringe at first.

Try

• Notice one thing you did well before looking for mistakes
• Pick one short clip and one question for supervision
• Watch with curiosity: “What was happening for me here?”

Many trainees split time between sites, classes and a paid job. Each place has its own forms, expectations and culture.

Ideas

• Ask each site for a written list of expectations in week one
• Keep one calendar for everything, including travel time
• Protect at least one evening a week with nothing training-related

Trainees meet clients in crisis, hear trauma stories and sometimes face a client’s death. You are not expected to handle this alone. Tell your supervisor the same day.

Being newer and less experienced, and lacking preparation or supervision, are listed among the risk factors for vicarious trauma.

In a classic study, 97% of mostly doctoral psychology trainees had withheld something from a supervisor. In a later study of counseling interns, 60% described holding back something significant, most often negative feelings about the supervisor, observations about clients, or mistakes.

Costs to plan for

• Exam fees (for example, ASWB lists US$230–260 per exam)
• Liability insurance (often cheaper at student rates)
• Paid supervision toward licensure, if your job doesn’t provide it
• Professional association membership
• State license application and renewal fees
• Travel between sites

Public Service Loan Forgiveness can forgive the remaining balance on federal Direct Loans after 120 qualifying monthly payments while working full time for a government or qualifying nonprofit employer. Rules and eligible repayment plans have changed in recent years, so check studentaid.gov for the current details.

The NHSC Loan Repayment Program helps licensed behavioral health clinicians, including psychologists, clinical social workers, professional counselors and marriage and family therapists, repay loans in exchange for at least two years of service at an approved site in a shortage area. Application cycles open and close, so check the HRSA site for dates.

Ask about

• Emergency grants or hardship funds
• Low-cost supervision through alumni networks
• Paid placements, stipends or assistantships
• Student rates for associations and insurance

The Examination for Professional Practice in Psychology is run by the Association of State and Provincial Psychology Boards. ASPPB says all of its member jurisdictions require a passing score on the knowledge part, and some also require a skills part.

The National Board for Certified Counselors offers the National Counselor Examination and the National Clinical Mental Health Counseling Examination. They are used for licensure across the U.S. Some states require one, some both, and some let you choose.

The Association of Social Work Boards offers four main exams. Each has 122 questions and a 4-hour time limit. The Clinical and Advanced Generalist exams come after supervised practice following the MSW.

In 2025, first-time pass rates were 73.9% for the Masters exam and 75.7% for the Clinical exam.

About a quarter of first-time ASWB Masters and Clinical takers did not pass in 2025. Many go on to pass on a later try.

Next steps

1. Give yourself a few days to feel it before planning
2. Look at your score report for the weakest areas
3. Ask peers or mentors how they prepared for a retake
4. Check your board’s rules on waiting periods and deadlines

What helps

• Do timed practice tests so the format feels familiar
• Plan the day before: route, ID, food, sleep
• Study in short blocks with real breaks
• Use slow breathing if you freeze, then skip and come back

Classmates often share their best sessions and hide their struggles, just like you. In a large survey of psychology faculty and trainees, more than 80% had had mental health difficulties at some point, which most people never mention.

Try

• Ask a classmate, “What’s been hardest for you this term?”
• Compare yourself to where you were last year, not to others
• Notice when you dismiss your own progress

Many trainees brush off positive feedback as kindness or luck. Write it down word for word. Read it before your next evaluation.

Imposter feelings were especially common in some ethnic minority groups in the systematic review. Being the only one like you in a cohort, or the first in your family in graduate school, can add pressure.

Programs differ widely on personal therapy. Some see it as a key part of learning and self-care.

If a psychology program requires therapy, the APA code says students must be able to choose a practitioner who is not part of the program, and faculty who grade them do not provide it.

Where to look

• Clinicians outside your training network
• Sliding-scale or low-cost clinics
• Telehealth with someone in another part of your state
• Your campus counseling center (ask about privacy from your program)

The APA code limits when psychology programs can require students to share personal information, such as their own therapy or history. It is allowed only if the program says so clearly in its materials, or if the information is needed to help a student whose personal problems are affecting their training or work.

The ACA code asks students and supervisees to watch for signs that their own health is affecting their work, to tell faculty or supervisors and seek help, and, if needed, to pause duties until it is safe to return.

The APA supervision guidelines ask supervisors to spell out expected competencies and help trainees set personal learning goals.

Ask at the start

• How often will I get feedback?
• What would worry you, and how would I hear about it?
• Which form will be used to evaluate me?

An estimated 4% to 10% of supervisees show problems with professional competence at some point. Remediation plans exist so programs can give extra support and a clear path forward.

What helps

• Ask for the goals, support and timeline in writing
• Ask how progress will be measured
• Bring a trusted faculty member or advisor into the loop
• Get emotional support outside the program, too
• Learn your program’s appeal or grievance steps

Steps

1. Listen and take notes, without defending yet.
2. Ask for one concrete example.
3. Give yourself a day before responding.
4. Sort what fits from what doesn’t.
5. Pick one thing to practice and tell your supervisor.

Ideas

• Explain confidentiality once, so silence isn’t taken personally
• Let people help with practical things
• Plan time together that is protected from studying
• Share how a day felt, without client details

Many trainees are parents, carers or full-time workers. Ask early about part-time options, placement hours that fit school pick-ups, and leave policies.

Sleep, movement, time outdoors and people outside the field all help you stay present with clients. The ACA code names self-care as part of counselors’ responsibilities.

Ideas

• A group chat for “that was a hard day” messages, with no client details
• A monthly meal with no talk of grades
• Peer study groups for licensure exams
• Sharing tips on sites, supervisors and costs

Helpful steps

• Clear, written evaluation standards
• Faculty who talk openly about their own struggles and help-seeking
• Lists of low-cost therapists outside the program
• Paid placements where possible
• Training supervisors to support, not just assess

Novices have an acute need for positive mentors. Alumni, early-career clinicians and student groups in professional associations can all offer guidance.