From Psychologist to Psychotherapist: A Step-by-Step Guide in the U.S.

Many psychologists feel drawn to deepen their clinical work  to move beyond assessment and research into the human experience of therapy itself. You might be wondering how to take that next step, and whether your existing credentials allow it. It's a common and thoughtful question: how can a psychologist become a psychotherapist in the United States?

Here's the short answer: most licensed psychologists are already eligible to practice psychotherapy, but the process depends on your state's laws, training focus, and professional goals. Some psychologists may need additional supervised experience, continuing education, or certification in specific therapeutic approaches to meet ethical and licensure standards.

In this guide, you'll learn what distinguishes psychologists from psychotherapists, the specific steps and training needed to make the transition, and what to expect once you begin practicing therapy. You'll also find U.S.-based resources from the APA, state boards, and national counseling associations to help you navigate your pathway confidently and ethically.

What's the Difference Between a Psychologist and a Psychotherapist?

Many people use the words psychologist and psychotherapist as if they mean the same thing. In everyday language, they often overlap - but in the U.S. mental health field, the difference matters, especially if you're considering how a psychologist can become a psychotherapist or expand their therapeutic role.

Defining Each Profession

Psychologist (Ph.D. or Psy.D.)

A psychologist holds a doctoral degree in psychology and is licensed by a state board to assess, diagnose, and treat mental and emotional disorders. Psychologists are trained extensively in research methods, testing, and evidence-based therapy. Their license allows them to perform psychological assessments, provide therapy, and conduct research - but the exact scope varies by state.

Psychotherapist

"Psychotherapist" is not a license but a functional title. It refers to anyone professionally trained to provide psychotherapy - this could be a psychologist, licensed clinical social worker (LCSW), licensed professional counselor (LPC), marriage and family therapist (LMFT), or psychiatric nurse practitioner with therapeutic training. Each must operate within their respective scope and licensure laws.

Important to know: The term psychotherapist itself is not regulated in most U.S. states, but the underlying licenses (psychologist, counselor, social worker, etc.) are strictly regulated by state boards.

Education and Training Paths

Here's how these roles typically compare:

Steps for a Psychologist to Become a Psychotherapist

If you're already a psychologist, you've completed one of the most rigorous training pathways in mental health. The good news is that you're already qualified to practice therapy in most states. However, to become a psychotherapist in the fuller sense - focusing primarily on clinical treatment rather than assessment or research - you'll need to follow several professional and ethical steps.

Here's a practical roadmap for how a psychologist can become a psychotherapist while meeting U.S. licensure and best-practice standards.

1. Verify Your Licensure Scope and State Regulations

Start by confirming what your state allows. Each U.S. state board governs its own psychology license, defining what constitutes psychotherapy and under what circumstances it can be provided.

For example:

• In California and Illinois, a psychologist's license already includes psychotherapy privileges.
• In Florida, psychologists must ensure their supervised experience meets the state's clinical requirements before providing therapy independently.
• In New York, psychologists must show documented clinical supervision hours during doctoral or postdoctoral training.

You can check your state's requirements through the Association of State and Provincial Psychology Boards (ASPPB) database or your state's licensing board website. This ensures that your practice remains compliant and ethically sound.

2. Strengthen Clinical Supervision and Therapy Experience

Even though you may already have therapy exposure from your doctoral training, postdoctoral supervision is where psychologists deepen their therapeutic identity.

Many psychologists complete:

• 1,500–2,000 hours of supervised clinical work (varies by state).
• Additional continuing education (CE) in psychotherapy theories and ethics.
• Peer consultation or supervision groups for reflective practice.

During this phase, focus on building a strong therapeutic foundation rather than accumulating hours alone. Working under the guidance of experienced psychotherapists - especially those with expertise in your chosen modality - helps you integrate evidence-based techniques with relational depth.

Important to know: Supervision isn't just a licensing requirement; it's also an ethical and clinical safeguard. The APA emphasizes ongoing consultation and self-reflection as part of professional competence in psychotherapy.

3. Develop Expertise in One or More Therapeutic Modalities

To transition successfully, psychologists often specialize in one or more psychotherapeutic frameworks. The most common evidence-based modalities include:

• Cognitive Behavioral Therapy (CBT) – Focuses on modifying unhelpful thoughts and behaviors.
• Acceptance and Commitment Therapy (ACT) – Emphasizes psychological flexibility and values-based living.
• Dialectical Behavior Therapy (DBT) – Combines CBT and mindfulness for emotion regulation.
• Psychodynamic Therapy – Explores unconscious processes and early experiences.
• Emotion-Focused Therapy (EFT) – Targets emotional awareness and interpersonal connection.
• Eye Movement Desensitization and Reprocessing (EMDR) – Effective for trauma and PTSD.

Training often includes formal workshops, supervised practice, and certification through professional bodies (e.g., Beck Institute for CBT, EMDRIA for EMDR).

Consider starting with one evidence-based approach before expanding. Mastery in a single modality helps you refine clinical judgment and build credibility as a psychotherapist.

4. Continue Professional Education and Certification

Most states require licensed psychologists to complete 20–40 hours of continuing education (CE) every 1–2 years. These hours can be applied to specialized therapy training, trauma-informed care, ethics, or cultural competency.

You may also pursue advanced certifications, such as:

• Certified Cognitive Therapist (via the Academy of Cognitive and Behavioral Therapies)
• Certified Clinical Trauma Professional (CCTP)
• Certified Gottman Therapist (for couples therapy)

These designations are not mandatory, but they strengthen credibility and demonstrate commitment to ethical, research-informed practice.

5. Build a Psychotherapy-Focused Practice

Once you meet training and supervision requirements, you can gradually shift your professional identity toward psychotherapy. This might include:

• Adjusting your practice website to highlight therapy services.
• Offering teletherapy under HIPAA-compliant platforms.
• Focusing marketing on your therapy specialties (e.g., anxiety, trauma, relationships).
• Joining professional directories like Psychology Today or TherapyDen.

Many psychologists maintain assessment services but reduce testing hours in favor of long-term therapeutic relationships. The shift often brings more direct client engagement and professional fulfillment.

6. Maintain Ethical and Reflective Practice

Ethics remain central to the transition. The APA's Ethics Code (2017) emphasizes competence, confidentiality, informed consent, and cultural sensitivity in psychotherapy. When a psychologist becomes a psychotherapist, the focus broadens from clinical accuracy to relational attunement - listening not only to symptoms but to human stories.

Reflective practice tools that help sustain ethical balance include:

• Regular consultation or peer supervision.
• Personal therapy to understand one's biases and countertransference.
• Cultural humility training to ensure inclusivity across diverse clients.

As your identity evolves, continuing mentorship from experienced psychotherapists ensures you stay grounded in evidence-based care while honoring the deeply human side of therapy.

7. Join Professional Networks and Stay Connected

Finally, becoming a psychotherapist isn't only about clinical skill - it's also about community. Joining national organizations helps you stay updated and supported:

• American Psychological Association (APA) – Divisions 29 (Society for the Advancement of Psychotherapy) and 42 (Independent Practice).
• American Counseling Association (ACA) – Offers shared ethics resources and continuing education.
• National Register of Health Service Psychologists (NRHSP) – Provides professional recognition and referral listings.

Engagement in these circles allows you to exchange ideas, learn from mentors, and stay informed about shifts in ethics, reimbursement, and telehealth laws.

Most psychologists are already qualified to practice psychotherapy, but shifting to a therapy-focused career requires additional clinical depth, continuing education, and supervision. Becoming a psychotherapist is less about earning a new license and more about evolving your professional identity - one grounded in relational skill, ethical integrity, and evidence-based care.

Training and Credentials Required for Psychologists Transitioning to Psychotherapy

Transitioning from general psychological practice to a psychotherapy-focused career involves more than simply updating your title. It's about refining clinical skills, deepening your therapeutic presence, and aligning with professional ethics and evidence-based standards. Even though most licensed psychologists in the U.S. already meet the legal criteria to practice therapy, becoming a psychotherapist in the fuller sense requires intentional training and reflective development.

Here's what that process typically involves.

1. Clinical Foundations and Graduate Training

If you've completed a Ph.D. or Psy.D. in clinical or counseling psychology, you've already had exposure to therapy concepts and interventions. However, doctoral programs often differ in emphasis - some focus more on assessment and research, others on clinical practice.

To solidify your path:

• Ensure your doctoral internship and postdoc included sufficient psychotherapy hours.
• Document your supervision logs in case your state board requests verification.
• Seek letters of competency from supervisors if applying for out-of-state practice or credentialing in a new therapy modality.

Important to know: The APA requires that doctoral training in psychology include "intervention and evidence-based practice" as a core competency area - this serves as the foundation for later psychotherapeutic work.

2. Postdoctoral Supervised Experience

After earning your doctorate, most states require at least one year (typically 1,500–2,000 hours) of supervised experience before full licensure. This phase helps bridge the gap between academic training and real-world clinical work.

During postdoc supervision:

• Focus on integrating therapeutic theory with practice.
• Request diverse client cases - anxiety, depression, trauma, couples, etc. - to strengthen range.
• Seek supervisors skilled in both ethics and psychotherapy process (e.g., relational dynamics, countertransference, boundary management).

If your original training leaned heavily toward testing, you can balance that through additional supervised therapy experience later, often approved by your licensing board as continuing competence hours.

3. Specialty Certifications and Advanced Training

Although not required for licensure, specialty credentials help psychologists demonstrate mastery in specific therapy methods. Here are some of the most respected U.S.-based options:

Challenges and Considerations When Transitioning to Psychotherapy

When psychologists move toward a psychotherapy-focused career, the transition can feel both exciting and daunting. You're entering a space that emphasizes emotion, connection, and presence - qualities that sometimes receive less emphasis in academic or assessment-heavy roles. Understanding the common challenges ahead helps you prepare for a smoother and more fulfilling shift.

1. Shifting Professional Identity

Perhaps the most profound transition happens internally. As a psychologist, your professional identity may have centered on intellectual analysis, testing, and structured treatment plans. As a psychotherapist, the focus shifts toward relationship, attunement, and the moment-to-moment experience of your client.

This can bring uncertainty:

• "Am I still a scientist if I focus on emotion and process?"
• "Will my peers see this as a step down from research or assessment?"

In reality, it's not a step down - it's a deepening. The most effective therapists integrate scientific knowledge with empathic skill. According to the American Psychological Association's Society for the Advancement of Psychotherapy, combining empirical understanding with relational depth leads to stronger therapeutic outcomes and higher career satisfaction.

Important to know: Many psychologists describe the shift from "doing therapy" to being therapeutic - a mindset rooted in presence rather than performance.

2. Managing Emotional and Cognitive Load

Providing psychotherapy requires sustained emotional presence. Unlike testing or consultation, therapy can stir your own reactions - grief, frustration, helplessness, or even compassion fatigue.

Psychologists making the transition often report:

• Increased emotional intensity in sessions compared to assessment work.
• Need for self-care and boundaries to prevent burnout.
• A learning curve in balancing empathy with therapeutic neutrality.

Strategies that help include:

• Ongoing personal therapy or supervision to process emotional reactions.
• Mindfulness and self-compassion practices between sessions.
• Setting clear work-life boundaries, especially for teletherapy providers.

The APA encourages reflective self-care as a core competence. A psychologist becoming a psychotherapist should see emotional resilience as a clinical skill, not an optional personal trait.

3. Navigating Ethical and Legal Complexity

With more direct and long-term client interaction comes increased ethical responsibility. Confidentiality, informed consent, record-keeping, and multiple relationships become more nuanced in psychotherapy.

Examples of common ethical challenges:

• A former testing client requests ongoing therapy - raising boundary concerns.
• A therapy client expresses suicidal thoughts, requiring clear crisis protocols.
• Transitioning to telehealth introduces new HIPAA and jurisdictional issues.

To stay compliant:

• Follow APA Ethics Code Standards 4 and 10 (Privacy and Therapy).
• Maintain up-to-date informed consent forms, especially for teletherapy.
• Review state telehealth laws - some require in-state licensure even for online work.
• Consult with supervisors, ethics boards, or malpractice insurance advisors when unsure.

Tip: Document every ethical decision process, including consultations and rationale. It demonstrates diligence and protects both you and your clients.

4. Adjusting to Business and Administrative Realities

When psychologists move into psychotherapy practice, they often encounter a new business landscape. Therapy work involves consistent scheduling, billing, insurance coordination, and marketing - especially if running an independent practice.

Considerations include:

• Insurance panels: Joining requires credentialing and understanding reimbursement rates.
• Private-pay models: May offer more flexibility but require clear client communication.
• Telehealth platforms: Must be HIPAA-compliant (e.g., SimplePractice, TherapyNotes).
• Marketing: Highlight psychotherapy specialties (e.g., trauma, anxiety, relationships) to attract aligned clients.

The American Psychological Association Practice Organization (APAPO) provides guidance on billing, telehealth compliance, and business management for private practitioners.

Even though these tasks might feel administrative, they're crucial for sustainability - allowing you to focus your energy on clinical work rather than financial stress.

5. Integrating Research and Therapy Practice

One concern some psychologists have is losing touch with scientific rigor. But psychotherapy thrives when grounded in research-informed practice. Integrating both worlds can look like:

• Applying evidence-based frameworks such as CBT, ACT, or DBT.
• Tracking client outcomes using validated tools (e.g., PHQ-9, GAD-7).
• Staying updated through APA journals like Psychotherapy or Professional Psychology: Research and Practice.
• Participating in local research collaborations or supervision groups.

Rather than a departure from science, psychotherapy can represent a practical application of it - a living laboratory where theory meets lived experience.

6. Addressing Stigma and Cultural Expectations

In some academic or medical circles, therapy work may be undervalued compared to testing or research. Overcoming that stigma requires reframing psychotherapy as a scientific and relational discipline that directly impacts well-being.

Culturally, therapy also carries varying levels of acceptance. For psychologists working with diverse clients, it's important to:

• Develop cultural humility through continuing education.
• Use inclusive language that respects identity and experience.
• Understand how systemic issues (racism, poverty, immigration stress) shape clients' mental health.

The APA Multicultural Guidelines (2017) provide a framework for integrating culture into all aspects of psychotherapy.

7. Sustaining Professional Growth and Self-Reflection

Therapy is a lifelong learning process. Once a psychologist becomes a psychotherapist, supervision and consultation remain vital - not just early on, but throughout one's career. Many seasoned clinicians meet monthly with peers to reflect on cases and prevent blind spots.

Consider setting up:

• A peer consultation group within your community or online.
• Periodic ethics workshops to refresh standards.
• A mentorship relationship with a senior psychotherapist.

Ongoing reflection helps maintain competence and prevents professional isolation - one of the top burnout risks in solo psychotherapy practice.

Transitioning from psychology to psychotherapy can bring emotional, ethical, and logistical challenges, but it also deepens your professional fulfillment. The shift calls for humility, self-awareness, and continued learning. With supervision, peer support, and ethical integrity, psychologists can thrive as psychotherapists - combining scientific insight with the profound human connection that defines healing work.

How to Build a Successful Psychotherapy Career as a Psychologist

Once a psychologist becomes a psychotherapist, the focus shifts from qualification to longevity - creating a practice that's both clinically sound and personally fulfilling. Psychotherapy is more than a skill; it's an ongoing relationship between professional growth and self-reflection. Here's how to build a sustainable and meaningful psychotherapy career in the United States.

1. Define Your Therapeutic Niche

Successful psychotherapists know who they serve best. While psychologists are trained broadly, focusing your practice allows clients - and referral networks - to find you more easily.

Common niche areas include:

• Anxiety, depression, and trauma treatment
• Couples and relationship therapy
• Workplace stress and burnout
• Child and adolescent therapy
• Identity and life transitions
• Health and chronic illness psychology

Defining a niche doesn't mean turning others away - it helps tailor your marketing, training, and supervision to clients you can help most effectively. Over time, that clarity strengthens both competence and reputation.

Tip: Review your prior clinical work and notice which cases felt most rewarding. Your emotional engagement often points toward your natural area of expertise.

2. Create an Ethical, Client-Centered Practice

Therapy is built on trust. Whether you work independently or in a group setting, ethical practice is your cornerstone.

Practical ethics in action:

• Use informed consent forms that clearly outline confidentiality limits and telehealth boundaries.
• Maintain secure electronic records and use encrypted communication for all client contact.
• Stay compliant with HIPAA and state privacy laws.
• Review APA Ethics Standards 4 (Privacy) and 10 (Therapy) annually.

Even experienced clinicians benefit from an annual ethics refresher. The APA, state boards, and professional insurers like The Trust offer updated CE courses covering emerging topics such as AI tools in therapy, telehealth compliance, and cross-state licensure.

Important to know: Your ethical standard is part of your brand. Clients, referral sources, and peers remember integrity more than any credential.

3. Build a Strong Referral Network

Referrals are the lifeblood of psychotherapy. Psychologists transitioning into therapy often underestimate the value of community connection. Start by:

• Networking with primary care providers and psychiatrists for integrated care.
• Joining local and state psychological associations to connect with peers.
• Participating in peer supervision groups to share insights and receive support.
• Listing your practice on Psychology Today, TherapyDen, and Open Path Collective (for sliding-scale services).

Word-of-mouth referrals grow from consistent professionalism and clear communication - not aggressive marketing. Keep colleagues informed about your specialties and treatment approaches; many prefer referring to clinicians who match their clients' needs.

4. Balance Clinical Work with Self-Care

The emotional intensity of therapy work can lead to compassion fatigue without consistent self-care. As a psychologist shifting to psychotherapy, you may find the relational aspects both fulfilling and draining.

Sustainable self-care strategies include:

• Limiting daily session loads to prevent empathy fatigue.
• Scheduling short breaks between sessions for grounding.
• Practicing mindfulness, journaling, or light exercise.
• Setting firm boundaries around client communication outside session hours.
• Seeking consultation when client stories begin to impact your personal well-being.

The APA Advisory Committee on Colleague Assistance (ACCA) encourages psychologists to treat self-care as an ethical obligation, not a luxury. You can't offer presence and empathy if your own reserves are empty.

5. Continue Advanced Learning and Specialization

The field of psychotherapy evolves rapidly. To remain competitive and competent:

• Pursue advanced CE in emerging modalities such as Internal Family Systems (IFS), Somatic Experiencing, or Compassion-Focused Therapy.
• Attend U.S.-based conferences like the APA Annual Convention or Evolution of Psychotherapy Conference.
• Subscribe to clinical journals like Psychotherapy Networker or Journal of Clinical Psychology.
• Consider pursuing board certification in clinical psychology (ABPP) to signify advanced expertise.

These investments strengthen your reputation and clinical outcomes. Clients notice when therapists bring new insights to sessions - an indirect yet powerful form of marketing.

6. Use Technology Thoughtfully

Teletherapy has become a mainstream part of mental health care. While it expands access, it also demands careful ethical and practical handling.

For online practice:

• Use HIPAA-compliant platforms (e.g., Doxy.me, SimplePractice, Zoom for Healthcare).
• Ensure private, distraction-free environments for sessions.
• Verify client location each session for state licensure compliance.
• Stay informed on interjurisdictional compacts such as PSYPACT, which allows licensed psychologists to practice telepsychology across participating U.S. states.

Digital practice management tools (for scheduling, billing, documentation) can save time, but remember: technology should enhance - not replace the therapeutic relationship.

7. Cultivate Reflective and Cultural Competence

Psychotherapy requires not just clinical skill but cultural awareness and humility. The U.S. is diverse in ethnicity, language, gender identity, and socioeconomic background each shaping how clients experience mental health and therapy.

Ways to enhance cultural competence:

• Engage in multicultural CE or DEI workshops.
• Seek supervision or consultation when working with unfamiliar cultural contexts.
• Use inclusive language in documentation and conversation.
• Reflect regularly on your own implicit biases and worldview.

According to the APA Multicultural Guidelines (2017), ongoing self-reflection and active cultural learning are markers of professional maturity and client safety.

8. Plan for Growth and Sustainability

Finally, think long-term. Many psychologists find the psychotherapy path rewarding precisely because it evolves with them. A sustainable career often includes:

• Offering specialized workshops or supervision for newer clinicians.
• Expanding into group therapy or psychoeducation programs.
• Maintaining balanced caseloads to prevent burnout.
• Building an emergency plan for client continuity in case of illness or leave.
• Periodically revisiting your mission and values to stay aligned with purpose.

Therapy is a lifelong practice of learning, humility, and human connection. Each session like each client - is an opportunity to grow both clinically and personally.

Key Takeaway

When a psychologist becomes a psychotherapist, the journey is about deepening - not replacing - your professional expertise. By grounding your work in ethics, lifelong learning, and relational authenticity, you can create a psychotherapy career that's both scientifically informed and deeply human. Success isn't measured by the number of clients seen but by the quality of presence you bring to each one.

References

1. American Psychological Association (APA). What Is Psychotherapy?. 2023.
2. Association of State and Provincial Psychology Boards (ASPPB). State and Provincial Licensing Boards Directory. 2024.
3. American Psychological Association. Ethical Principles of Psychologists and Code of Conduct. 2017.
4. American Psychological Association, Division 29. Society for the Advancement of Psychotherapy. 2024.
5. National Register of Health Service Psychologists. Professional Resources for Psychologists. 2024.
6. American Psychological Association. Multicultural Guidelines: An Ecological Approach to Context, Identity, and Intersectionality. 2017.
7. SAMHSA. 988 Suicide and Crisis Lifeline. 2024.

Conclusion

Transitioning from psychology to psychotherapy is not a career change - it's a professional evolution. The foundation built through doctoral education and licensure allows psychologists to enter therapy work with a strong scientific base, but developing into a psychotherapist requires emotional awareness, relational skill, and ongoing education.

Whether your goal is to provide individual therapy, lead trauma recovery programs, or specialize in couples work, the steps remain the same: stay ethical, stay curious, and stay connected. Psychotherapy thrives at the intersection of research and humanity - where science meets compassion.

If you ever feel uncertain about next steps or professional boundaries, seek supervision, consult your state board, or connect with the APA. And remember: If you or someone you know is in crisis, call or text 988 for the Suicide and Crisis Lifeline. If there's immediate danger, call 911.