Who Gets to Be a Therapist?

Weston Allen knew he wasn’t going to be popular with his professors before he even started his master’s in counseling at the University of Virginia. Weeks before the program began, Weston, who has bowel disease and dyslexia, had filed a civil rights complaint against the school about the lack of adequate disability accommodation in student housing. Two years later, he is now about to graduate from Liberty University in Lynchburg, Virginia, having left UVA, he says, because of the leadership at its counseling program. Weston, and other students like him across the United States, claim that such programs are using an official process of “gatekeeping” to weed out anyone who doesn’t match preconceived ideas about how a therapist should be.

Many future therapists are carefully molded inside highly competitive, expensive college programs recognized by the Council for Accreditation of Counseling and Related Educational Programs (CA-CREP). Upon graduating from a CA-CREP-affiliated program, they can get a license to practice within a specific state. Once a therapist is licensed, it is difficult to hold them accountable for bad practices, except for something egregious like sexual abuse or neglecting a suicidal patient. And by then, the harm is done. For this reason, colleges take it upon themselves to vet students before they go out into the world.

Gatekeeping is the process of making sure that those entering the field are emotionally and ethically suited to the work, or as the American Counseling Association’s 2014 Code of Ethics describes it, “the initial and ongoing academic, skill, and dispositional assessment of students’ competency for professional practice.” Lynn Linde, ACA’s Chief of Professional Practice, helped to draft the 2014 Code of Ethics and says it is being updated next year. “We spent a lot of time talking about gatekeeping,” she says, “I still stand by what we wrote, but I think it was very prescriptive.” The problem is that it’s hard to figure out what will make someone a good counselor. The ACA landed on the concept of “disposition.” This encompasses empathy, the ability to relate to others, self-reflectiveness, and being open to different ideas.

It’s hard to find clear data on ethics violations across the therapeutic profession, but one study from 2013 analyzed 453 ethics violation cases in the United States. The most frequent violations related to competency, including practicing outside of the scope of a therapist’s training, or practicing while impaired due to substance use or mental health problems. Crossing professional boundaries accounted for around 22 percent of violations, and 10 percent were attributed to breaking confidentiality. 

Gatekeeping is seen as a noble way to keep vulnerable people safe from these kinds of behaviors. It relies on predicting who would be an unethical therapist  based not just on their grades or the quality of the coursework, but how they act while they are learning. And it often occurs after students have spent significant time and money on their graduate programs (or accrued large amounts of debt). More worryingly, some feel that gatekeeping is not just a matter of professional due diligence but a way to systematically discriminate against students with disabilities or non-conforming personalities.

“I can say without a doubt that it is harder for non-standard students to get into therapy educational and training programs,” says a therapist in Virginia who asked to go by his first name, Dave, so as not to deter future clients. Dave is now a licensed clinical psychologist but previously worked in a different field; by the time he went to graduate school, he was older than his peers. “The standard student is, or was, white, female, in their twenties, healthy, with no visible or non-visible disabilities,” he says. “They are bright, hard-working, ambitious, and unlikely to strongly question faculty or clinical supervisors’ opinions.” The stereotype is also referred to in small therapy blogging communities as “nice lady therapists.” But what happens to those who deviate from this standard?

One effect might be the underrepresentation of people with disabilities in psychology. While around 25 percent of adults in America have a disability, only about 2 percent of students at CA-CREP accredited programs disclosed having a disability in a 2023 survey. Similarly, only around 2 percent of psychology faculty at American Psychological Association-accredited programs disclosed having a disability.

In a small study on counselor educators’ experiences with gatekeeping, one faculty member recalled a student who had to be reprimanded for not arriving on time to class:

This student was chronically late, and when the student arrived, instead of just sliding in quietly, the student would make an entrance. . . . After this became a chronic problem, there seemed to be resistance. The next semester was similar, except by now, I could see that the student was being avoided by many of his classmates.

Ironically, this assessment deviates from some of the pillars of good therapy, which doesn’t just look at someone’s symptoms (say, chronic lateness) but asks why they might be popping up (whether the underlying cause is a disability, undiagnosed mental illness, or even financial difficulties requiring a student to work alongside their studies). In this way, gatekeeping can wind up shepherding people out of the profession who understand on a deeply personal level the very reason it exists.

Take William “Billy” Moncure, who from 2019 to 2021 was pursuing a master’s in clinical mental health and addiction counseling at the College of William & Mary. Billy had been diagnosed with major depressive disorder and was granted accommodations by the university—including leniency for any lateness to class due to sleep issues that occur alongside depression—before he started his course. He later filed a lawsuit against William & Mary in 2023 for discrimination and constructive discharge.

In the legal complaint, Billy’s lawyer alleged that Billy had never actually used any of the accommodations he was granted, yet an associate professor in his program appeared to take issue with the accommodations even existing, telling Billy to drop out after hearing about them. Billy’s lawyer also noted that the same professor told other staff that Billy was “playing the disability card” and making excuses to avoid participation when he asked for an accommodation on a group project that was not granted. 

After Weston Allen filed, and eventually won, his student accommodation complaint with the Office for Civil Rights, he says that faculty at the University of Virginia retaliated against him under the guise of gatekeeping. Weston was instructed to sign a “student success plan” which stated that he needed to “take responsibility for [his] own role in mistakes and miscommunications” but never explicitly spelled out what the issues were. Weston says he was mystified by the plan, wondering if his dyslexia, or the one instance when he had been late to class, contributed to it. He recalled another day when he and his fellow students were uploading client videos from their practice therapy sessions in the computer lab. Weston had difficulty uploading his video—“We were in a basement, you can’t pick up Wi-Fi in a basement”—but, he says, so did the rest of the class, and the professor sent an email saying it was a frustrating day for everyone with technology. “But then she reported back to my academic advisor that I was the only one who had those issues,” Weston says. “It was like I had some kind of deficit in using technology.”

Weston filed a claim of retaliation against the university with the Office for Civil Rights in the spring of 2023, and the investigation is still ongoing. But he eventually left the school because the stress was making him sick. “I think it was that I was different. I had accommodations, and that was abnormal for them.” (UVA did not respond to multiple requests for comment.) At Liberty University, where he is set to graduate in May, Weston says he’s received straight As. “If we don’t discriminate, I can thrive, and I’ve had no problems.”

According to publicly available documents, Billy appears to have settled with William & Mary; he says he is “satisfied with the way the legal situation was resolved.” A representative from the college says that while they don’t comment on litigation, “the action was withdrawn by the complainant and never served.” Since then, Billy has successfully completed a master’s degree in mental health counseling at a different university and is now in his third year of a doctorate in clinical psychology. Since transferring schools, he has worked with more than a thousand clients, he says, including patients in a psychiatric hospital and an addiction rehab center. “I think I have proven that I am able to do the work, and I belong in this field, as a person with a disability,” he says. “I believe there are many students who would make great counselors who find themselves in positions similar to my own.”

Simcha, who asked to go by their first name, came close to not graduating from their counseling program at a small college in 2019. Simcha is autistic and describes their personality as being like “Marmite”: the salty brown spread that people tend to love or hate. Despite maintaining a 3.9 grade point average and initially doing incredibly well in therapy field work, Simcha faced multiple issues. Some students found their contributions in class to be “intense” or “intimidating.” Simcha believes this had something to do with the content of the classes themselves. “I was on the sub track called social justice and community counseling. We were supposed to be talking about issues that have to do with sexism, racism, ableism, all these kinds of biases that people bring into the counseling room. We were supposed to be pulling all of that apart.”

Another “problematic behavior,” as one of Simcha’s gatekeeping evaluations dubbed it, occurred when a professor played a tabloid-style video clip about transgender people in class. “I just was like, ‘you couldn’t have come up with a better clip to introduce this topic to us?’ I think I said something a bit bolder, kind of off the cuff, and the discussion from that class led a bunch of people to complain about me.” This culminated in an hour-long roundtable discussion with eighteen students who were encouraged to air their grievances with Simcha. “People assumed that because I came across a particular way in one context, that was how I was going to come across in counseling settings,” Simcha says.

The program that Simcha was enrolled in had a policy that if two faculty members checked the “problematic behavior” box on the regular evaluations that students received, it would trigger a meeting. Despite feeling like they’d smoothed things over with the professor who played the news clip, Simcha’s academic advisor ticked the box on that professor’s behalf. Later, Simcha also butted heads with an addiction professor. “He was very oriented to an approach to addiction that I don’t see scientific validation for,” Simcha says. “And he seemed like he was not open to other ways of discussing recovery from addiction.” While Simcha admits they may have been a bit of a pain in that class, professors were meant to take students aside and talk about any issues, giving them a chance to remediate their behavior. This never happened, Simcha says; one day, the professor simply placed an evaluation onto Simcha’s desk with the ominous “problematic behavior” box checked. At the subsequent meeting, faculty closed ranks. “People were not addressing their issues with me in the way that I’d been led to believe they would. It was not giving me a chance to course-correct or have these difficult discussions before it got to, ‘okay, this is on your record now.’”  

Simcha was put on academic probation but was allowed to continue their therapy placement. While Simcha had had a good relationship with their previous supervisor, they did not gel with the supervisor for this second placement. This mismatch became apparent during a discussion where the supervisor spoke about a client likely being autistic because they displayed narcissistic tendencies. Simcha was compelled to speak about how harmful that way of thinking was, divulging that they were autistic. “As soon as the label autistic entered the mix, I noticed that the kinds of feedback that I was getting changed. It changed into just stereotypes. Suddenly, I was too rigid.”

Eventually, Simcha graduated, because they had the support of several other faculty members and stayed quiet for the rest of their last semester, what is known in autistic communities as “masking.” The experience, though, was instructive, especially now that Simcha sees neurodivergent clients in their private practice. “The structures as they exist right now are really, really good at churning out therapists that conform to white, middle-class, neurotypical standards,” Simcha says. “They are not very good at allowing people through who don’t fit that mold because there’s so much of this subjective gatekeeping.”

Weston, Billy, and Simcha all managed to succeed in their studies and careers, but not every student affected by gatekeeping has been as fortunate. “A lot of the people in these situations have no real recourse,” Billy says. “It becomes very easy for professors to dress up their personal biases as concerns about things like professionalism, and that’s so subjective that you can’t really prove it’s wrong.”

In the spring of 2021, Alice (not her real name) was placed on a candidate improvement plan while pursuing a counseling degree at Johns Hopkins University, following a B- grade and feedback from professors that she was too quiet in group projects. Alice’s remediation plan included separate biweekly meetings with her advisor and her professors to improve her communication skills and to make sure she was on track with grades. If Alice got a B- again, she was told, she’d be kicked out of the program. Alice, who has PTSD, also says she was encouraged by her academic advisor to disclose past traumatic experiences, which she was reluctant to do. “My personal life was between me and my own counselor,” she explained. “I felt like I was getting remediated for not trusting them.”

After her improvement plan was created, Alice says, she got a 4.0 average that semester. But things went downhill again when she began a new therapy placement. Alice was uncomfortable with her supervisor, who constantly critiqued her notes, at one point stating she should work at the mental health app Better Help, since the app doesn’t require practitioners to submit notes. “When I made mistakes, she did not give me written feedback or instructions but instead told me I was not fit for the site or even the profession,” Alice says. She emailed her professor asking to change sites due to the personality clash but was told to wait for a meeting between her professor and supervisor to occur. The situation came to a head when Alice had to record two client sessions as part of a class requirement. The supervisor did not think Alice was ready to hold a session alone with clients and said she would discuss the situation with her professor. After this meeting, the supervisor let Alice go from the therapy practice, in her last semester before graduating. Her professor subsequently gave her an F, and Alice was dismissed from her studies. A 2022 article for the student newspaper at Johns Hopkins covered Alice’s story as well as four other students who alleged they had been unfairly dismissed from the program, which temporarily lost its CA-CREP accreditation in 2019.

A Johns Hopkins spokesperson said that while they are bound by student privacy laws, they take all reports and claims of discrimination seriously, investigating them fully and taking appropriate action: “The safety, success and well-being of our students have always been of the utmost importance to all faculty and staff at Johns Hopkins. We are committed to providing academic programs, support services and facilities that are accessible and welcoming to all.”  

Alice’s and Simcha’s experiences illuminate the gatekeeping role played by supervisors who work with students during field training, in addition to professors and other faculty members. South Carolina therapist William Mulkey tries to provide reassurance and guidance to his trainees, saying he aims to be nonjudgmental and appreciates the challenges that people face. At the same time, he says, “even senior clinicians or supervisors may sometimes have unresolved personal issues, which could inadvertently affect students or newly licensed counselors.” In exceptional cases, Mulkey has refrained from endorsing students for full licensure as a counselor. “This includes individuals who may not have addressed their own issues or who display behaviors or interactions showing that they could potentially provide harmful services to others,” he says. But decisions like these shouldn’t be delayed. “A Gatekeeper should inform them of deficiencies early so they can seek further training or consider a career change,” Mulkey says. “It is unethical to supervise someone for years only to deny their licensure at the end.”

Simcha believes that “as a field, we are doing people a disservice by having such a narrow definition of what is acceptable to be as a therapist.” People often connect more to those who have gone through similar setbacks to them, even if those setbacks aren’t explicitly disclosed on the therapist’s end. Simcha sees this with their autistic clients. More than half of autistic people are estimated to have a co-occurring mental health diagnosis, such as anxiety, OCD, or depression. Yet there are numerous articles and studies pointing to the lack of effective talk therapy for such clients. It’s not necessarily that talk therapy itself is inadequate for autistic people; they are most likely being talked to by therapists who do not understand how their brains work. In Simcha’s practice, they take note of non-verbal cues to steer the conversation, and clients have expressed relief at not having to explain their “weird” behaviors, giving them time to focus on the real issues at hand. A similar logic applies to people with other kinds of disability or chronic illness, who might also stand to benefit from practitioners who can relate to their circumstances—and understand how they can trigger or exacerbate mental health struggles.

Dismissing students who deviate from a limiting ideal, who perhaps even require more work on the part of paid university staff, is not something to do lightly. As experiences like Simcha’s show, the way someone interacts with professors or other students is not necessarily a predictor of how they’ll approach clinical work. And discouraging certain kinds of people from pursuing careers in counseling could have effects on the profession that are more significant than dashed ambitions. How many people drop out of therapy because they don’t feel heard? In losing out on therapists with more diverse points of view, we may be driving people away from the very help they seek.