How to Become a Mental Health Counselor


By Lee Kehoe, MS, LMHC, NCC

A career as a mental health counselor is richly rewarding for compassionate, empathetic people who want to make a significant difference in the lives of others. A skillful counselor leads a client on a journey of growth and self-discovery that allows him or her to overcome obstacles, reach personal goals, and lead a productive life. These counselors assess, diagnose, and treat psychological disorders; support clients through difficult life experiences; and teach the skills and attitudes needed to bring about behavior change. By assisting clients with clinical conditions such as depression, substance abuse and anxiety, they help people learn to adapt to change and function positively in their day-to-day lives.

Mental health counselors use a variety of approaches to help their clients. One widely used approach involves cognitive behavioral therapy, which replaces problematic thoughts, feelings, and behaviors with more adaptive ones. Other counselors use emotion-focused therapies, which emphasize the impact of deeper emotions in a person’s life. Meanwhile, some counselors are more solution-focused, working with people to develop problem-solving skills. The emphasis a counselor places on one aspect of a person’s thoughts, emotions, or problems depends on a counselor’s personal background, belief systems and training. A counselor in training can expect to do a great deal of self-exploration during his or her degree program in order to align with a certain area of counseling.

Mental health counseling may take many forms. Clients may see the counselor one on one, in couples sessions, or in family therapy. Some also attend group therapy sessions in which several people come together to support one another and work toward a common treatment goal. Many counselors see a wide variety of clients, while others specialize in certain conditions or populations.

Counselors often operate as part of a multidisciplinary care team that includes psychiatrists, psychologists, social workers, case managers and others invested in the client’s welfare. They make referrals to community agencies, treatment programs, and other medical professionals in order to connect the client with resources that will best support his or her needs. Many also participate in community and professional organizations to advocate for their profession and improve mental health care within their communities. Mental health counselors have the unique opportunity to help people develop the emotional resilience and interpersonal skills to navigate life's challenges.

Work Environment

Mental health counselors are employed by not-for-profit agencies, substance abuse treatment facilities, general and specialty hospitals, universities, and private businesses. Many also run their own practices.

Counseling requires a great deal of intense and focused human interaction. These professionals spend much of the workday with clients, consultants, and members of the treatment team. In a typical day, a counselor can expect to see on average 5 to 8 clients, while also leading treatment planning meetings and consulting with family members or community resources. From day to day, counselors also must document client progress notes and complete insurance-related forms. While almost all mental health counseling is still provided face to face, telephone and online counseling are growing in popularity.

Most mental health counselors work full time. Those in private practice have greater flexibility to set their own schedules. Hours often include evenings, weekends and early mornings to accommodate clients who may only be able to meet at those times due to work or family obligations.



At minimum, mental health counselors must hold a master’s degree in counseling from an accredited institution. The Council for Accreditation of Counseling and Related Educational Programs (CACREP) is the governing body that overseas the accreditation of mental health counseling programs within the United States. Prior to entering a master’s program, the prospective student must hold a bachelor’s degree from a four-year university. Many mental health counselors hold bachelor’s degrees in related fields such as psychology, human development, and social work; however, this is not a requirement to enter into a mental health counseling master’s program. Master’s programs are 60 semester credit or 90 quarter credit programs, with a full time student being able to finish the degree within 2 years.


Accredited counselor training programs include extensive, supervised field experience in the form of practicums and internships.

CACREP requires the practicum experience to consist of the following:

  • A minimum of 100 hours, with 40 of those hours being direct client experiences, in which the student is providing counseling services to clients
  • 1 hour supervision sessions with an appointed supervisor
  • Weekly 1 1/2 hour group supervision sessions facilitated by program faculty
  • Evaluation based on audio/video recordings of the student’s interactions with clients

Upon successful completion of the practicum experience as determined by a passing grade from practicum supervisors and faculty, CACREP requires completion of an internship, which includes the following:

  • A minimum 600 hour internship with 240 of those hours being direct client experiences
  • 1 hour supervision sessions with an appointed supervisor
  • Weekly 1 1/2 hour group supervision sessions facilitated by program faculty
  • Evaluation based on audio/video recordings of the student’s interactions with clients
  • Evaluation based on student’s involvement in activities and development in record keeping, assessment, treatment approaches, clinical judgment, and teamwork relationships

Licensing and Certification

Licensure of mental health counselors is mandatory in most states. This usually requires a master’s degree and 2,000-4,000 hours of supervised clinical experience. In some areas, counselors must pass a knowledge exam prior to practicing.

The National Board for Certified Counselors (NBCC) awards two levels of certification for mental health professionals. The entry-level national certified counselor (NCC) credential requires completion of required coursework and 3,000 hours of work experience (waived for graduates of CACREP-accredited training programs). Candidates must also pass the National Counselor Exam.

Experienced professionals can pursue additional credentialing as a certified clinical mental health counselor (CCMHC). Candidates must be certified as NCCs, meet rigorous education and experience requirements, submit recordings of clinical sessions and pass the National Clinical Mental Health Counseling Examination (NCMHCE).

To maintain licensure and certification, all counselors must engage in continuing education throughout their careers. Credits may be earned by taking courses in person or completing trainings online. Counselors who hold NBCC credentials are subject to additional continuing education requirements.

Needed Skills and Qualities

Counselors should enjoy working with people of many different personalities and backgrounds, including those of different ages, races, socioeconomic levels, gender and sexual orientations. The three key characteristics counselors must exhibit are empathy, authenticity, and a non-judgmental presence. Counseling research cites these three characteristics as being the most vital component to developing therapeutic trust with a client. In addition, the ability to listen attentively and to express thoughts and ideas clearly is essential.

Mental health counselors in private practice also need to be good business people. They spend a significant amount of time on marketing, bookkeeping, and collecting payments from insurance companies and clients.

Opportunities for Advancement

Experienced counselors often hold administrative or supervisory positions at agencies and treatment facilities. Some return to school to pursue doctorates in counseling, which opens up new career opportunities in teaching and research.

If you would like to gain the necessary education to become a mental health counselor, we highly recommend that you check out our free School Finder Tool located HERE.

Salary and Job Outlook

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According to the US Bureau of Labor Statistics (BLS), the median annual salary for mental health counselors is $40,850, and most earn between $26,030 and $66,930. Wages vary geographically and by industry, with municipal government and health practitioner offices offering the highest starting salaries. Level of degree will also impact a mental health counselor’s salary; counselors who obtain a doctoral degree often receive a higher salary as they often go on to teach within universities.

Employment of mental health counselors is expected to grow by 29% between 2012 and 2022, according to the BLS. This is due in part to the fact that more insurance companies are offering reimbursement for mental health counseling services.

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