What I’m Seeing in the Field
As both a practicing clinician and someone who works closely with behavioral health hiring every day, I can tell you this: staffing therapists is hard right now, and in many markets, it has become a consistent barrier to growth for behavioral health organizations.
And not just a little competitive. Hard in a way that feels constant.
You post a fully licensed role and either get very few applicants or you get applicants who aren’t aligned with your model, documentation standards, or the culture you’re trying to build. In many cases, roles remain open for extended periods when compensation, structure, or schedule are not aligned with what candidates are actively considering.
This isn’t surprising when you look at the data. The U.S. Bureau of Labor Statistics projects mental health counselor employment will grow 18 percent from 2022 to 2032, far faster than the average for all occupations. Demand is rising quickly across outpatient practices, telehealth platforms, hospitals, and community agencies.
But here’s what I also see every single week: there is no shortage of motivated, capable pre-licensed clinicians.
What there is… is a bottleneck.
The Bottleneck No One Talks About Enough
Pre-licensed clinicians want to work. They want hours. They want supervision. They want stability.
But many of them can’t find practices willing or able to provide all of that in one place.
• They can’t find W-2 roles.
• They can’t find consistent supervision.
• They can’t find structured development.
So they move around. Or they burn out. Or they piece together part-time roles until something better comes along.
Meanwhile, practices are saying, “We can’t find good clinicians.”
There’s a significant disconnect between how roles are structured and what pre-licensed clinicians need to accept and remain in a position.
National workforce studies estimate that more than one-third of Americans live in areas with shortages of mental health professionals, according to Federal Health Resources and Services Administration (HRSA) data. The demand for care is real, but the pipeline of fully licensed clinicians takes years to develop.
That means organizations competing only for fully licensed clinicians are competing for a very limited pool.
Contact HCRI for help solving your therapist recruiting problems!
The W-2 vs 1099 Conversation Matters
Most pre-licensed clinicians need W-2 roles because they need predictable income and formal supervision documentation. And in many states, a 1099 model isn’t even appropriate for someone accruing supervised hours.
When practices limit themselves to offering 1099 only, they often unintentionally shrink their candidate pool. In more competitive markets, this can significantly limit applicant flow.
That doesn’t mean every practice can immediately shift to W-2. But it does mean you have to look honestly at your growth strategy.
If the goal is retention, alignment, and internal talent development, W-2 roles often provide a stronger foundation.
Supervision Is the Leverage Point
Supervision is often the point where retention either works or breaks down.
Depending on your state, supervision rules may be broad or very specific. An LCSW or LICSW may supervise across disciplines in some states. In others, supervision is narrower. You have to know your state’s regulations exactly.
If you already have supervisory credentials on staff, you may be sitting on an untapped pipeline. In fact, building internal leadership capacity is one of the most effective ways to strengthen behavioral health hiring strategies, a topic we’ve explored in another article on our blog.
At its core, access to qualified supervision is what unlocks this entire strategy. If you don’t have internal access to supervision, you still have options:
• Reimbursing outside supervision
• Offering supervision stipends
• Contracting a supervisor who is not otherwise on staff
• Developing a senior clinician into a formal supervisory role
Solving the supervision problem doesn’t always require adding another full-time senior clinician. Sometimes it requires building intentional structure.
The Reality No One Likes to Say Out Loud: Clinicians Can Leave More Easily
Here’s another factor we have to acknowledge. In today’s landscape, especially with virtual therapy, billing platforms, and companies that simplify credentialing, clinicians can go off on their own more easily than ever before.
Many pre-licensed clinicians join practices to get their hours, build experience, and then move forward with their own goals. That is not a failure. It is a natural part of professional growth in this field. (More on 2026 retention rates)
But as a practice owner, you have to decide: Are you building long-term retention? Or are you building a two-to-three-year development cycle? If you know upfront that a pre-licensed clinician may stay two to three years while completing hours, that can actually become part of your strategy rather than a frustration.
You can plan for that turnover. Some organizations are beginning to build this cycle into their long-term hiring strategy, rather than just reacting to it. You can build consistent relationships with local graduate programs. You can establish yourself as a high-quality training site. And you can create a steady pipeline instead of scrambling every time someone leaves.
Some practices also partner with recruitment firms specializing in behavioral health to help maintain that pipeline as part of a broader staffing strategy.
The key is deciding intentionally, not reactively.
But Insurance Won’t Reimburse Pre-licensed Clinicians
Insurance reimbursement for pre-licensed clinicians varies widely. That’s real.
But there are still ways early-career clinicians can contribute meaningfully while building experience and completing supervised hours.
Examples include:
• Co-facilitating therapy groups
• Running psychoeducational or skills-based groups
• Supporting intakes under supervision
• Assisting with documentation and care coordination
• Working with private-pay clients at adjusted rates
This approach is not about cutting corners, but about building capacity in a thoughtful and compliant way.
Not All Pre-Licensed Clinicians Are Starting From Zero
Pre-licensed does not automatically mean inexperienced. Many clinicians entering associate-level roles have already gained substantial experience through internships, agency work, or training programs.
Look for candidates who bring experience with:
• High-acuity populations
• Group therapy facilitation
• Crisis intervention
• Documentation within structured care environments
If training lift is a concern, you can prioritize candidates who already have some clinical momentum over those directly out of graduate school. This can also help reduce ramp-up time as clinicians transition to fully independent roles.
The Biggest Question: What Are You Building?
The practices that are navigating this successfully are not relying solely on the fully licensed market. They are building internal pipelines with intention. [1]
They understand that supervision is leadership and that W-2 roles create stability. That development builds loyalty, even if that loyalty has a timeline.
If we want stronger, more aligned, fully licensed clinicians in this field, someone has to participate in developing them. Growing your own therapists isn’t just a staffing strategy. For many organizations, it is becoming one of the most sustainable ways to stabilize hiring over time.
Looking Ahead
At the end of the day, this isn’t about trying to hold onto clinicians forever or competing with private practice platforms. It’s about being intentional in how roles, supervision, and long-term workforce development are structured.
If you understand the licensing pathway, build your supervision structure strategically, and plan for the realities of today’s market, you can stop reacting to turnover and start designing your growth.
The practices that think long-term, even in a short-term landscape, are the ones that will build stronger teams, stronger reputations, and ultimately stronger clinical impact.
If you are evaluating how to strengthen your therapist hiring and retention strategy, our team can provide additional insight into current market dynamics and workforce planning. Reach out to us today.
