From 57% to 54%:More Therapists Crossing the Finish Line, But Not Nearly Enough
LMFT & Co-Founder of Motivo
Executive Summary
When we first published our research, the number was staggering: 57% of masters-level therapists and social workers never made it to licensure. More than half of the people who invested years of their life into training and education never had the chance to practice.
Today, the latest dataset from 2021 to 2023 gives us reason to acknowledge progress. That number has dipped to 54%. That means thousands more graduates are crossing the finish line.
This improvement didn’t come from the efforts of any one organization. Rather, it reflects numerous system-level shifts, including expanded access to supervision (with virtual options), momentum for licensure portability, and employer investment in early-career clinicians.
Motivo has been honored to play a part – delivering nearly 300,000 hours of supervision to over 8,000 therapists since 2018, 81% of whom live in mental health professional shortage areas.
And yet, the reality remains sobering: more than half of graduates still leave the field before becoming licensed. The therapist shortage begins here.
The TerrainThe Behavioral Healthcare Crisis at the Community Level
The demand for behavioral health services is rising sharply, but the pipeline of clinicians is not keeping pace. The result is a workforce shortage that reverberates across every level of care. Communities feel the strain most acutely when they can’t find therapists for themselves, their children, or their loved ones. Employers feel it when turnover undermines continuity of care. Payers and policymakers feel it when costs outpace budgets.
Here are a few indicators of the problem:
As one panelist at Motivo’s 2025 Workforce Summit put it:“The therapist shortage doesn’t begin with burnout or retirement — it begins at graduation.”
The good news is that solutions are being tested. Initiatives such as Kaiser Permanente’s Mental Health Workforce Accelerator, Elevance Health’s virtual supervision grants, and the National Council for Mental Wellbeing’s Center for Workforce Solutions demonstrate that cross-sector partnerships can make a measurable difference.
But at the same time, we must recognize that state-level changes in New York, Tennessee, and Colorado are introducing fresh barriers. The terrain is mixed: hopeful progress on one hand, tightening restrictions on the other.
What Exactly Happens with the 50,000+New Graduates Each Year?
Each year, more than 50,000 students graduate with master’s degrees in counseling, social work, or marriage and family therapy. Nearly all of them set out to become licensed therapists, motivated by a calling to help others. But somewhere between graduation and licensure, far too many fall away.
The reasons aren’t mysterious; they’re practical, predictable, and solvable. The required 2–3 years of supervised clinical work post graduation come with barriers:
Associates earn low pay, often under $20 an hour, while juggling supervision costs and student debt.
State rules vary widely, are hard to navigate, and often lack clarity.
New clinicians often work with the highest acuity clients, with heavy caseloads and limited mentorship.
Some graduates pivot into case management or administrative roles; others leave the field entirely. In every case, the result is the same: communities lose out on therapists who were ready to serve but lacked the support to reach licensure.
The workforce we need already exists in these 50,000 graduates. However, until we close the gap between graduation and licensure, we will continue to lose the very people we need most.
The DataFrom 57% to 54%
Our original analysis (2019–2021) found that only 43% of graduates made it to licensure. The updated 2023 data shows progress: 46% now make it through, lowering the “non-licensure gap” from 57% to 54%. That shift represents thousands of additional therapists entering the workforce every year.
1. Virtual supervision:
By 2025, nearly all states allow supervision to be obtained virtually, a crucial step for clinicians in rural or underserved areas.
2. Employer investment:
More organizations are investing in high-quality clinical supervision as a way to recruit and retain clinicians.
3. Increased funding:
The change is encouraging but fragile. At the same time as national numbers improve, some states are adding new regulatory hurdles. New York has enacted stricter diagnostic privilege requirements, Tennessee is revising supervision ratios, and Colorado has layered on new documentation rules. These policies remind us that progress is not linear. Gains in one area can be erased in another if we are not vigilant.
The FixFour Steps to Improve the Licensure Pipeline
The 57% to 54% shift shows that meaningful change is possible. But to keep moving forward, we need to focus on the strategies that matter most. Research, field experience, and the work of leading initiatives point to four clear priorities:
Ease the Financial Burden
In Colorado, Kaiser Permanente’s Workforce Accelerator provides stipends to associates completing supervised hours, helping them remain in the field while progressing toward licensure.
Just as importantly, we need to move the focus upstream—reducing the financial barriers that prevent many from ever entering graduate programs in the first place. Scholarships, tuition assistance, and pathway initiatives that create affordable, supported routes into behavioral health careers are essential to diversifying and expanding the pipeline. By investing earlier in the journey—before tuition debt compounds and before the burden of unpaid supervision begins—we can make the path to licensure more accessible, equitable, and sustainable for the next generation of clinicians.
Make the Licensure Process Easier to Navigate
The Counseling Compact now includes more than 30 states, allowing licensed counselors to practice across state lines without restarting the process. This reduces barriers for associates who relocate due to family needs or military service. Similar compacts are in the works for social workers and psychologists.
Design for Retention During Licensure
Employers that invest in clinical supervision that aligns with patient populations and clinical specialties are seeing an increase in retention and clinician satisfaction. Providing clear clinical support to associate-level clinicians motivates many to remain with an organization even after they have obtained licensure.
Prioritize Supervision as Infrastructure
Elevance Health’s supervision grants in Texas, Kentucky, and California fund virtual supervision through Motivo, ensuring associates in shortage areas can complete hours without the financial or geographic burden of finding an in-person supervisor.
Together, these four strategies represent a roadmap. They are not abstract ideas; they are already being tested in real programs and proving their impact. The challenge now is to scale them — so that every associate, in every state, has a clear, supported path from graduation to licensure.
Spotlight onWorkforce Initiatives
Progress from 57% to 54% is the result of many hands working together. Across the country, organizations are piloting creative, scalable solutions to support early-career clinicians. A few examples:
In partnership with the National Council for Mental Wellbeing, Resilient Georgia, Metro State University–Denver, and the Colorado Health Institute, Kaiser launched the Mental Health Workforce Accelerator to expand and diversify the pipeline of therapists. The program provides stipends, job placements, and access to virtual supervision — helping reduce the financial and structural barriers that often derail new graduates. By designing for equity and access, the Accelerator is creating a replicable model of workforce development that benefits both clinicians and communities.
Several health plans have stepped up to the plate to expand access to virtual supervision in collaboration with Motivo. These grants help early-career therapists in shortage areas connect to supervisors they otherwise could not reach. By underwriting supervision costs, health plans are enabling more clinicians to complete their hours, particularly in rural and underserved communities. It’s a clear example of how health plans can play a role in solving the workforce shortage.
The National Council for Mental Wellbeing has long been a convener of workforce leaders. Through its Center for Workforce Solutions, the Council is equipping organizations with frameworks, shared learning, and collective action. From the Workforce Solutions Jam to its ECHO series, the Center is amplifying workforce innovations and helping health systems adapt them at scale. The message is clear: solving the shortage will require coordinated, system-wide approaches.
After graduating with her master’s in counseling, Aisha faced the same challenge as many of her peers: low-paying associate positions and the steep cost of supervision. Living in rural Kentucky, she also struggled to find a qualified supervisor within driving distance. Through an Elevance Health supervision grant, Aisha was able to connect virtually with a Motivo supervisor and have her supervision costs covered. With this support, she has stayed in the field, working toward full licensure while serving clients in a community that otherwise has very limited access to care.
Miguel graduated with a degree in social work determined to serve Spanish-speaking families in his community. But like so many new clinicians, he was quickly discouraged by the financial and administrative burdens of supervision. Through Kaiser Permanente’s Mental Health Workforce Accelerator, Miguel received a stipend, was matched with a virtual supervisor, and had a structured associate role at a local community agency. With these supports in place, he’s not only on track to licensure — he’s building a long-term career in the very community he set out to serve.
The Policy Environment:Headwinds and Tailwinds
Public policy is a powerful lever in shaping licensure outcomes. Encouragingly, several federal and philanthropic initiatives are pointing in the right direction:
Tailwinds:
Kaiser Permanente’s Workforce Accelerator, Elevance Health’s supervision grants, and the National Council’s Center for Workforce Solutions are all scaling access and lowering barriers. Together, they provide stipends, fund supervision, and create shared frameworks for workforce development.
Headwinds:
At the same time, some states are tightening supervision rules, adding administrative complexity, and raising compliance burdens. These changes risk undoing the progress we’ve seen nationally.
The balancing act:
As healthcare costs climb and H.R.1 (the One Big Beautiful Bill Act) reshapes Medicaid funding, financial pressure on states and providers continues to build. The challenge for policymakers is finding a balance between fiscal restraint and the long-term investment needed to maintain a resilient healthcare workforce.
The message is clear: if we want to continue closing the gap, we need to lean into the tailwinds and resist the headwinds.
Where has it gotten harder to get licensed?
Public policy is a powerful lever in shaping licensure outcomes. Encouragingly, several federal and philanthropic initiatives are pointing in the right direction:
New York
Recent regulation changes unexpectedly impacted tens of thousands of licensees. As of June 24, 2024, LMHCs and LMFTs must hold a diagnostic privilege to diagnose independently and to complete assessment-based treatment plans. Those licensed before June 24, 2024 must apply for diagnostic privileges and meet requirements by June 24, 2027. Requirements include 2,000 supervised hours in diagnosis, psychotherapy, and treatment planning, with one hour per week (or two hours every other week) of supervision. Reference
Tennessee
Upcoming rule revisions for LPC/MHSP and LMFT licensure pathways. Under Public Chapter 204, effective January 1, 2026, the Board is replacing “temporary license” with “associate license” across both pathways. A “Temporary LPC/MHSP” will become an Associate LPC/MHSP (ALPC/MHSP), and a “Temporary LMFT” will become an Associate MFT (AMFT). Reference Due to these changes, several other regulatory items that have been on hold are expected to take effect in July 2026, including updates to who can supervise ALPC/MHSPs, the reintroduction of a supervisor credential, limits on the number of supervisees a supervisor may oversee (12), and adjustments to continuing education requirements.
Georgia
Significant supervision rule changes for LPCs were board-approved as of August 2025, with final administrative review in progress and the effective date TBD. Total required supervision hours will increase to 100, while the minimum licensure timeline will decrease from 3 years to 2 years. Associates must now complete at least 3 supervision hours per month, including 4 hours per year of individual supervision. Group supervision sessions must be at least 90 minutes in duration. Supervisors may no longer serve simultaneously as the associate’s director or worksite superior. Additional updates address maximum supervisor limits, required supervision contracts and logs, direct client experience requirements, and observation of associates’ clinical work. Reference
California
As of January 1, 2025, the Board of Behavioral Sciences (BBS) implemented a new law clarifying supervisor-to-supervisee ratios in non-exempt (for-profit) settings. Supervisors may provide individual or triadic supervision for no more than six supervisees at one time across all non-exempt settings. Group supervision remains capped at eight supervisees. This rule applies to both new and existing supervisory relationships. Reference
Colorado
Effective July 1, 2025, new Medicaid supervision standards apply to behavioral health practitioners serving Medicaid clients. Supervisors must be licensed, in good standing, and Medicaid-enrolled to provide supervision. The standards add responsibilities, including oversight of documentation, direct observation of clinical work, review of clinical notes, and co-signing critical records. A formal supervision contract between the supervisor and the organization is strongly recommended. Reference
Conclusion & Call to Action
The shift from 57% to 54% is meaningful. It shows what happens when many stakeholders — employers, non-profits, health plans, associations, state regulators — collaborate, step by step, to reduce burden, improve access, and support early-career therapists.
At Motivo, we’re honored to have contributed in whatever small measure we could — through supervision hours, virtual platforms, and partnership. But this progress belongs to all of us.
If we want to finish the job —to ensure that anyone who wants to serve as a therapist has the opportunity to do so— we need to double down:
Invest in high-quality supervision as part of compensation and culture, and watch retention improve.
Streamline rules, reduce unnecessary redundancy, and ensure that regulatory changes do not unintentionally raise barriers.
Prioritize grants and payment models that underwrite supervision, stipend support, virtual access, and exam prep.
We celebrate the move from 57% to 54% because it proves progress is possible. But more than half of our future therapists are still stepping away before they ever get to practice. Let’s not settle here. Let’s finish the job.
Disclaimer: Laws and regulations change frequently; therefore, Motivo cannot guarantee the accuracy or completeness of this information. Readers should independently verify details and, if needed, consult legal counsel before relying solely on it.
References
USAFacts. (2021, June 9). Over one-third of Americans live in areas lacking mental health professionals. https://usafacts.org/articles/over-one-third-of-americans-live-in-areas-lacking-mental-health-professionals/
American Psychological Association. (2023). Psychologists Struggle to Meet Demand Amid Mental Health Crisis. https://www.apa.org/pubs/reports/practitioner/2022-covid-psychologist-workload.pdf
Association of Social Work Boards (ASWB). (2023). 2022 Exam Pass Rate Analysis: Final Report. https://www.aswb.org/wp-content/uploads/2022/07/2022-ASWB-Exam-Pass-Rate-Analysis.pdf
California Board of Behavioral Sciences. (2023). Exam Statistics Reports. https://www.bbs.ca.gov/exams/news.html
National Center for Education Statistics (NCES). IPEDS: Degrees Conferred by Postsecondary Institutions. Accessed March 2023. https://nces.ed.gov/ipeds/
Counseling Compact. (2023). About the Compact. https://counselingcompact.org/
Kaiser Permanente & National Council for Mental Wellbeing. (2023). Mental Health Workforce Accelerator Overview. https://www.thenationalcouncil.org
Elevance Health. (2023). Supervision Grants for Pre-Licensed Clinicians. Press and program details shared in Motivo partnership announcements.
National Council for Mental Wellbeing. (2023). Center for Workforce Solutions Program Overview. https://www.thenationalcouncil.org/program/center-for-workforce-solutions/
CSWE. (2020). Findings from Three Years of Surveys of New Social Workers. https://www.cswe.org/CSWE/media/Workforce-Study/The-Social-Work-Profession-Findings-from-Three-Years-of-Surveys-of-New-Social-Workers-Dec-2020.pdf
Health Resources and Services Administration (HRSA). Loan Repayment and Scholarship Programs. https://www.hrsa.gov/grants/find-funding
U.S. Congress. (2022). Mental Health Access Improvement Act (H.R.432). https://www.congress.gov/bill/117th-congress/house-bill/432/text
Ingoglia, C. (2022). Bravo 2022: It Was a Helluva Year (In a Good Way). LinkedIn Pulse. https://www.linkedin.com/pulse/bravo-2022-helluva-year-good-way-charles-ingoglia/
Motivo Health Internal Data. (2023). Supervision Hours and Clinician Demographics.
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