Counseling Today, Online Exclusives

Voice of Experience: The future of mental health

By Gregory K. Moffatt October 19, 2022

I love trying to forecast how the counseling profession will be different 10 years, 20 years or 50 years in the future. I sometimes wonder if any of the fathers of psychology ever did that. After all, the field has come a long way in the past 100 or so years. Here are a few of the major developments:

  • In 1900, psychology moved away from psychoanalytic thinking and toward behaviorism, which dominated the field for 50 years.
  • In the first part of the 20th century, mental health measurements and testing as we know it today didn’t really exist. The idea began with psychologist Alfred Binet’s development of the IQ test at the turn off the 20th century, but measurements weren’t even in our jargon until the 1950s or so.
  • Cognitive psychology began to gain steam in the 1950s but was eventually overtaken by existential and humanistic theories in the 1970s.
  • Cognitive behavior therapy (CBT) predominated in the 1990s, and in 2022, dialectical behavior therapy and intensive family therapy are trends.
  • Until managed care became commonplace in the late 1980s, there was no such thing as solution-focused brief therapy and almost nobody (except for CBT folks) used the language “evidence based.”
  • The Health Insurance Portability and Accountability Act didn’t exist until 1996.
  • In 2013, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was the first revision of the DSM to accept input from clinicians in its construction as opposed to revisions being done exclusively by a committee.
  • And only a few years ago, we began talking about “telemental health.” Even though I didn’t have any intentions of doing telehealth counseling, I still pursued telehealth training around 2017 to ensure I was covered if I had to talk to clients on the phone. At the time, Zoom and other digital platforms were either nonexistent or brand new.

So where is the profession headed in the next 30 years? Here are my top three predictions:

1) Telehealth will expand. Prior to the pandemic, most clinicians saw clients face to face. Today, not only are more clinicians foregoing expensive offices and associated costs to work on digital platforms, but clients are expecting this option as well.

While telehealth has limitations, it can provide services for people who could otherwise not afford it. It also allows people to access mental health services in remote areas. My personal counselor’s office is over an hour from where I live. If I were to see him in person, it would require half a day. An hour up, an hour back and an hour in session — and that doesn’t consider the traffic issues that are common in Atlanta.

That means I would not be seeing clients and I would be spending money and time instead. But with telehealth, appointments with my counselor take exactly one hour and I’m done — no travel, no expense, no traffic and minimal intrusion into my own client load. This has made therapy more affordable as well as more accessible.

2) Hourly pay will decrease. Because of telehealth, the average hourly rate for the profession is going to plummet. Unless a clinician is a specialist in an area that is hard to find, what used to be an average of $150 an hour will probably sink below $50 an hour.

There are many telehealth agencies that are already paying just $30 or so an hour to licensed clinicians. I don’t think the profession will allow that to continue, but the days of $150 an hour or more are fading.

3) The focus of graduate programs will change. All CACREP programs address 10 content areas. One of them is diversity. When I was in graduate school in 1985, there were no courses on diversity, and it wasn’t required to get a license (when licensing came about in the late 1980s). Today taking a course on diversity is not only required but also assumed to be an ethical obligation.

I suspect that as telehealth continues to evolve, CACREP and graduate programs will include telehealth and related issues as part of the required training for new counselors. Before the pandemic just two years ago, my counseling interns had not received telehealth training, and no graduate programs that I know of required it or even offered it for students.

But as the pandemic greeted us in 2020, I needed my interns to have telehealth training, so I required it. Consequently, many graduate programs now required it as well because it helps students get internship placements. I predict that soon telehealth will be a requirement for graduate counseling program curriculum and for licensure.


In a previous column from two years ago, I wrote about how shifts in health care change how we do business. Even since then, times have changed, and we keep evolving. I’m interested in what you think will change with the mental health profession. Please contact me and let me know your thoughts.


Related reading: See Counseling Today‘s January 2021 cover story, “The forces that could shape counseling’s future


Gregory K. Moffatt is a veteran counselor of more than 30 years and the dean of the College of Social and Behavioral Sciences at Point University. His monthly Voice of Experience column for CT Online seeks to share theory, ethics and practice lessons learned from his diverse career, as well as inspiration for today’s counseling professionals, whether they are just starting out or have been practicing for many years. His experience includes three decades of work with children, trauma and abuse, as well as a variety of other experiences, including work with schools, businesses and law enforcement. Contact him at


Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.


  1. Martha Utchenik, MA

    I disagree with your prediction that telehealth sessions will produce less pay for therapists. Only agencies pay less to therapists, which has been the tradition even seeing clients face to face. However, if you are a sole practitioner in your own private practice, your rates will be the same.

    1. Sarah

      Agreed! Private practices will not change their telehealth rates, especially if they offer in person services but clients choose telehealth.

      Telehealth is an issue because of tech companies, owned by people who are not clinicians. The well known companies created a counseling mill, claiming high pay, but the reality is that counselors have unachievable caseloads and work. Counselors cannot maintain caseloads with such companies because the sessions fees for are low and clients do not invest in treatment, causing high no-show and cancelation rates. As a result, counselors are earning little due to inconsistent appointments. Also, expectations are absurd. Counselors need to be frequent available, which is difficult when most are working in other jobs. Due to client inconsistencies and low pay, counselors leave such jobs, creating turnover and poor treatment for clients.

      Perhaps we should spend more time talking about the telehealth counseling mills that wealthy investors and Big Tech are creating, with celebrities as the face of this care, and how this is the real issue with telehealth.

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