In this weekly feature, the editors of SpringBoard highlight one career in the health care professions–including a basic description, educational requirements, core competencies/key skills needed, and related web sites and professional organizations where you can find more information!


Counseling children in inpatient settings is both a rewarding and challenging career. Many counselors, especially those who have recently graduated with their master’s degree, often begin their career in inpatient settings. One of the reasons for this is that residential psychiatric programs are often willing to take a large number of graduate interns. An internship provides a natural “practice” situation to see if the student is a good candidate to work at the treatment center. If a graduate intern does a good job, she or he may be able to parley an internship into a job (provided there is a vacancy).

Things to Know

  • It is likely that all careers and jobs within the counseling profession are challenging, as they all involve assisting people who are struggling with some part of their lives. It may be, however, that inpatient setting is the most demanding due to the nature of the clients who reside there.
  • Children are placed in inpatient settings because they have been removed from the family home due to neglect or abuse or due to extreme behavior. In both instances, the children in the residential psychiatric center will be emotionally and behaviorally difficult to counsel. However, being “difficult” should not imply that said children would not make progress and graduate from the setting; most children in residential settings will indeed make enough progress to be released to their families or to foster care. However, some children will exhibit symptoms of early-onset severe mental illness (e.g., schizophrenia, bipolar disorder, and depression).
  • Most, if not all, of the children on an inpatient psychiatric center will be on psychoactive medication. Because the counseling profession often prides itself on having a “healthy” approach to treatment (Gladding, 2009), beginning counselors may have difficulty accepting the reality of children being treated with psychoactive medication.
  • An inpatient psychiatric treatment setting (whether as part of a hospital or as a stand-alone campus or building) will likely involve the counselor occasionally being required to help with physical restraints. I can recall as a recent graduate of a counseling program feeling very upset at having to restrain a violent child my first week on the job!

 Best Aspects of the Job

The best part of counseling children residing in inpatient psychiatric units may be the opportunity to make a difference with one of the most vulnerable segments of our society. Many counselors will decide to remain in residential programs long after they have graduated from their program and will make a career of this work. Having worked in a residential psychiatric setting and having supervised scores of graduate students who have interned and gone on to work in residential psychiatric treatment, I feel that a strong desire to help children in serious need is a definite requirement. Counselors interested in working on inpatient units will also need a strong sense of resilience as they will work daily with severely abused, neglected, and emotionally and behaviorally disturbed children. Inpatient work can be very draining, and a good support system along with an active routine (jogging, aerobics, skiing, swimming, etc.) is a must.

Challenging Aspects of the Job

The challenging aspects of counseling children in residential psychiatric settings have been discussed in the above passages. Children will display a lot of acting-out behavior, will require medication, may be oppositional and defiant, abused and very angry, self-injurious, and in general initially resistant to treatment. Having made these statements, the flip side of this equation is that such children present a real opportunity for counselors who enjoy working with difficult-to-treat children.

Occupational Outlook and Salary

The occupational outlook for counselors working in residential setting is very good. One reason for this is that such jobs likely turn over regularly due to the demanding and occasionally stressful nature of the work involved. Mental health counselors are the most likely to work in residential settings, and the BOLS (2010–2011) estimates their job growth at 24% over the next several years. Unfortunately, starting salaries for counselors working in residential treatment are significantly lower than for counselors in outpatient settings. The median salary for counselors in residential settings is $29,950. Now, once again, counselors who remain in residential settings after achieving licensure and who move into supervisory and management roles will earn considerable higher salaries.