A 4th-year doctoral graduate student extern is an advanced student in a Doctor of Psychology (Psy.D.) or Doctor of Philosophy (Ph.D.) program in clinical or counseling psychology. At this stage in their training, externs have completed extensive coursework and clinical practica, and are now gaining advanced, supervised experience providing psychotherapy.

Externs work under the close supervision of licensed psychologists and are selected for their strong clinical skills and commitment to ethical, client-centered care. While they are still in training, they bring fresh perspectives, up-to-date knowledge of research and therapeutic techniques, and are dedicated to helping clients achieve meaningful growth.

While extern therapists provide high-quality, supervised care, there are certain situations where a client may be better served by a more advanced or specialized provider. To ensure clients receive the appropriate level of support, we follow specific eligibility criteria for being seen by an extern.

At this time, clients are not be eligible to work with an extern therapist if they:

• Are experiencing active suicidal thoughts or engaging in self-harming behaviors

• Have been hospitalized for psychiatric reasons within the past year

• Are experiencing thoughts of harming others

• Are seeking treatment for active substance use issues

• Are involved in a relationship with current physical violence

• Have been mandated by a court or legal system to attend therapy

• Require formal psychological testing or documentation for legal, educational, or medical purposes

These limitations are in place to ensure that clients with more intensive or specialized needs receive care from licensed clinicians or programs equipped to provide the necessary level of support.

If you're unsure whether you’re eligible, we’re happy to speak with you to better understand your needs and help determine the most appropriate provider for your care.

Yes, your privacy and confidentiality are extremely important to us. Extern therapists follow the same ethical and legal standards as licensed psychologists when it comes to protecting your personal information. This means that what you share in therapy is kept confidential, with a few important legal and ethical exceptions. These include:

• If there is a risk of serious harm to yourself or others

• If there is suspected abuse or neglect of a child, elder, or dependent adult

• If a court orders the release of records

In addition, because externs are still in training, they receive weekly supervision from licensed psychologists on Groundwork’s staff to ensure high-quality care. As part of their training, sessions may be audio recorded for supervisory purposes—but only with your informed consent. You are never required to agree to audio recording. If you choose not to be recorded, it will not affect your care in any way.

Your therapist will explain all of this in detail and answer any questions before beginning treatment.

Our extern therapists are placed at Groundwork for the duration of the academic year (typically from September through June). While many clients work with their extern therapist throughout that period, it’s important to know that externs transition out of the practice at the end of the academic year.

If you wish to continue therapy beyond that time, we offer the option to be thoughtfully transferred to a new extern therapist for the following year. We make this transition as smooth as possible, and your current therapist will help support and prepare you for the change, should you choose to continue.

The fee per 45-minute therapy session with an extern is $150.

Insurance providers will not provide out-of-network reimbursement for therapy provided by an extern.

Groundwork does not accept insurance. All payments are out-of-pocket.

Our secure platform allows you to save a method of payment on file, which is automatically used to pay for your appointments immediately following each one. Credit, debit, HSA, and FSA cards are accepted.

Individual and couples therapy sessions are typically 45 minutes in length.

It is recommended that you attend therapy at a regular, weekly time.

The session rates, eligibility criteria, and potential for long-term therapy are different for licensed psychologist and therapists in our practice. For more information visit our homepage.