More than a training ground: PSU's Community Counseling Clinic fills critical mental health gap

This July, thousands of Oregonians could lose their mental health counselors due to a critical change in CareOregon insurance coverage. The state's decision to stop allowing pre-licensed counselors to bill Oregon Health Plan (OHP) will create a devastating gap in mental health care access — particularly for freelancers and lower-income residents who rely on the state insurance plan.

But at Portland State University, a little-known resource offers hope: The PSU Community Counseling Clinic provides mental health services for just $20 per session, with sliding scale fees as low as $5 per session based on financial need.

While the clinic has quietly served both students and community members for years, its role will be even more vital as Portland grapples with this looming mental health care crisis.

"These coverage changes will leave thousands of current therapy clients without access to counseling," says April Dodson, director of PSU's Community Counseling Clinic. "Many of these clients are working in the gig economy or living on limited incomes – that's why they qualify for OHP in the first place. They'll need affordable alternatives to maintain their mental health care."

Community Impact: Accessibility & Diversity

The clinic’s community impact extends far beyond filling the OHP coverage gap. Each week, the clinic sees an average of 150 clients from diverse backgrounds including youth, adolescents and adults. Historically, its primary focus was anxiety, depression and interpersonal relationship counseling. Over time, its service areas have expanded to include couples counseling, group therapy, and support for trauma, life transitions and clients with intersecting minoritized identities.

“Because we have such a diverse counselor population and representation, we get a lot of diverse clientele,” Dodson says.

PSU’s clinic offers the lowest per session rate in the area, and plays an important role in addressing the cost barrier many people face when seeking mental health care. While there are other community counseling clinics in the area, they charge quite a bit more than PSU.

"I don't know anybody offering counseling for $5 per session," Dodson emphasizes. “Even group practices who have sliding scales charge two to three times more than we do at our most expensive rate.”

The clinic also offers the flexibility of virtual or in-person sessions — and clients can choose to do both. With close to 40 working counselors at any given time, clients can book immediate appointments, rather than sitting on a more typical months-long waiting list.

"Our clinic has built enduring therapeutic relationships, with some clients continuing care for multiple years — even transitioning from seeing me as an intern to now working with interns I supervise,” Dodson says. “We've become a trusted community resource for specialized care, including relationship counseling and clinical rehabilitation services for those with traumatic brain injuries and cognitive challenges.”

Educational Excellence

Behind this vital community resource is a unique educational model that benefits both clients and counselors in training. While providing vital low-cost services to the community, the clinic also trains the next generation of counselors — the very professionals who could help prevent future care shortages.

Staffed entirely by graduate students from PSU's Counselor Education programs, the clinic offers comprehensive mental health services including individual, relationship and family counseling, with specialized care for children and adolescents. This training ground gives future counselors hands-on experience while expanding Portland's mental health care capacity.

As Oregon faces this critical shift in mental health coverage, our clinic stands ready to help fill the gap. We're not just training the next generation of counselors — we're providing an essential community service at a time when affordable mental health care has never been more important.

Second-year students complete required practicum hours at the clinic, applying classroom learning in a real-world setting under close supervision.

“The clinic is a big draw, because not every program that has our accreditation supports their students with an in-house clinic,” says Dodson. Some of them put the onus on the students to go out and find a practicum site, which is really, really challenging. It's a big barrier.”

PSU’s Counseling Education program employs a unique two-tier supervision model with five-hour practicum sections running each weekday. In addition to having a faculty supervisor, new counselors are assigned a peer mentor who recently completed their own practicum and a supervision training workshop. Every student has one-on-one support.

“We're the only program in the state of Oregon that has the peer mentor, peer supervision model,” says Dodson. This gives PSU an edge over other programs where students must find community placements with a lesser degree of oversight and support.

Third year students can opt to do their internship at the clinic as well, or seek internships placements elsewhere in a private practice or group clinic. Clinic interns work with clients with more advanced or specific needs. They offer relationship and couples counseling, and see clients who have higher acuity needs like suicidal risk or working through advanced trauma.

The Progression From Student to Practitioner

For students like Heidi Montez, the clinic provides an invaluable bridge between classroom lessons and practice. Montez, a clinic intern completing her master’s degree in Marriage, Couples and Family Counseling (MCFC) this spring, was inspired to transition from music education to counseling after her own transformative therapy experience in her 40s.

Montez values the clinical experience she’s gained working at the clinic over the last two years — through the practicum and as an intern, which she describes as “just like real life counseling but with the built in support.”

“I was so nervous at each step,” she says. “But the way the process is set up is like scaffolding. It’s really conducive to your learning and your experiences as a counselor in training.”

She’s enjoyed working with couples this year, creating a sense of safety for them to talk openly. “It feels like an affirming experience when the client feels comfortable enough with you to be able to share something that they haven't shared before,” she says.

Montez identifies as biracial Mexican American Chicana, and much of her own therapy and personal growth work has centered around identity issues. After graduation, she hopes to work with clients navigating their own identity concerns.

The clinic's "incredibly accessible" sliding scale is meaningful to Montez, who values serving lower-income populations. She cites her own family's positive experience with Oregon Health Plan, which provided excellent mental health care for her 20-year-old son — creating what she sees as a full-circle moment.

Similar to Montez, fellow clinic intern Megan Hull’s interest in counseling as a career path was piqued after an impactful therapeutic relationship of her own. Her experience as a counselor in training at the clinic has been eye opening.

“I remember my first day of practicum so vividly,” she says. “I couldn't sleep the night before.” But nerves quickly gave way to a sense of relief when she sat across from that first client and felt surprisingly comfortable realizing that she already had the basics down.

“I know how to listen to a person, and I know how to offer empathy to someone who's going through something hard,” she says.

Montez appreciates the diversity of people the clinic serves, and its accessibility. “As someone who's learning, that's been really helpful for me to get a sense of what kind of populations I like to work with,” she says. “And it's just cool to see, like so many different kinds of people get mental health care that might not otherwise be able to access it, just because it's so prohibitively expensive for a lot of people.”

She’s found each step in the learning progression to be exciting, intimidating and highly rewarding. Pairing theory with real-world experience and immediate feedback has prepared her to embark on on her professional counseling path after graduation this spring.

“I don't feel confident in the sense of like I know how to deal with every clinical issue, but I do feel confident that I can do what I need to do to learn.”

Quality & Outcomes

The quality of care is evident in the growing number of referrals from community providers and the exceptional success of PSU graduates. Thanks to an intensive supervision model and hands-on training approach, alumni consistently secure positions in private practice and community settings.

This hands-on training approach translates directly to strong graduate outcomes. “Our students are pretty amazing,” says Dodson. “They go on to have really successful private practices.” Because of the experience and training they get at the clinic, PSU graduates are widely recognized as highly skilled and capable clinicians.

For those who choose to work in community settings or group practices, the hiring rate is quite strong. Dodson credits much of this success to dedicated faculty and the program’s emphasis on supervision. “We’re really hands on, we're really supportive, and that helps students build confidence that translates to really effective clinical work.”

Looking Forward

The small but mighty community clinic envisions improving its flow of clients. The path to growth includes building a more robust reputation within the PSU community and the larger mental health community. On the wish list are expanding the space to accommodate more counseling sessions and updating the audio/visual equipment they use to record sessions for learning purposes.

The clinic works in close partnership with PSU's Center for Student Health and Counseling (SHAC), with each serving complementary roles for PSU students. SHAC provides emergency services and initial counseling, while the community clinic offers ongoing therapy and specialized relationship counseling. If students have exhausted their 10 free sessions with SHAC, they are often referred to the clinic. However, students may come to the clinic even sooner if needed.

“I know we can offer support to people on campus who are struggling,” says Dodson. “SHAC is inundated and often has these really long wait lists, whereas we can get people in immediately.”

Beyond its collaboration with SHAC, the clinic is also positioned to address a larger challenge: the growing demand for accessible mental health care in Oregon.

"As Oregon faces this critical shift in mental health coverage, our clinic stands ready to help fill the gap," says Dodson. "We're not just training the next generation of counselors — we're providing an essential community service at a time when affordable mental health care has never been more important."

For more information, or to book an appointment, visit the clinic’s website.