Occupational Therapist & Counselor

Don’t be confused by the word “occupational” in the occupational therapist and counselor title: while an occupational therapist (OT) does help people with work and careers, the actual job goes far beyond that. According to the American Occupational Therapy Association (AOTA), occupational therapy “helps people across the lifespan to do the things they want and need to do through the therapeutic use of daily activities (occupations).”

Occupational therapists and counselors work with the mental and physical health challenges that people may face following an illness or injury. For instance, common occupational therapy situations may include helping to create a plan and a routine to allow children with disabilities to participate fully in school and social situations or helping someone who has experienced an injury return to their work or home life despite any physical or cognitive changes that may have occurred.

Occupational therapy services typically include working with an individual to create a plan that is unique to their needs. That plan would include goal-setting and then evaluating progress to ensure that those goals are met.

According to the U.S. Bureau of Labor and Statistics (2022), the field of occupational therapy is growing rapidly. Between 2021 and 2031, the BLS predicts that openings in occupational therapy will swell 14 percent nationally, which is predicted to be much faster than the average for all occupations during the same timeframe (5 percent). The BLS also reports that the need for occupational therapists and counselors will continue to increase due to the need for treatment for people with various illnesses and disabilities, an aging population, and for the treatment of many conditions such as arthritis and stroke or chronic conditions such as diabetes.

Read on to discover how to become an occupational therapist or counselor, including details on degree programs, professional certification, and salary prospects.

Education of an Occupational Therapist & Counselor

Occupational therapists need at least a master’s degree, and they must be licensed in order to practice. Each state’s rules for the licensure of counselors and therapists can be slightly different, so it is recommended that anyone who is interested in the education of an occupational therapist and counselor should check with the counseling licensure board to ensure that their educational plan meets the requirements in the state in which they wish to reside and practice.

In general, a prospective occupational therapist and counselor would complete a bachelor’s degree in a field compatible with counseling and therapy, such as social work, psychology, or a related counseling field. Most occupational therapists are not employable until they have achieved at least a master’s degree in occupational therapy.

Graduates will have the most success finding employment if they choose programs that are accredited by the Accreditation Council for Occupational Therapy Education, part of the American Occupational Therapy Association. ACOTE currently accredits or is in the process of accrediting nearly 600 occupational therapy and occupational therapy assistant educational programs in the United States, its territories, and the United Kingdom.

Admission to graduate programs in occupational therapy generally requires a bachelor’s degree and specific coursework, including biology and physiology. Many programs also require applicants to volunteer or work in an occupational therapy setting. Candidates should contact the program that they are interested in attending about specific requirements.

Master’s programs usually take two to three years to complete. If the school that the candidate wishes to attend requires GREs or other graduate entrance exams, studying for and preparing for that exam can add a few weeks to a few months to a candidate’s school timeline.

Some schools offer a dual-degree program in which the student earns a bachelor’s degree and a master’s degree in five years. Other schools allow part-time study which would increase the time it takes to complete the degree. Achieving licensure also typically requires a period of post-degree supervised fieldwork. The amount of supervised field experience is different for each state, so the candidate is encouraged to check with their state’s requirements.

Supervised Hour Requirements for Occupational Therapists & Counselors

The AOTA accredits programs that provide two levels of fieldwork education: Level I and Level II. For Level I fieldwork, AOTA does not require a minimum number of hours. Each program sets its own requirements.

However, for Level II fieldwork, the AOTA standards require a minimum of 24 weeks full-time for occupational therapy students. While the Level II fieldwork can be completed full-time or part-time, it may not be less than half-time.

While AOTA sets the standards, it is up to each program to implement a timeline. For instance, the University of Oklahoma’s College of Allied Health offers a master of occupational therapy degree. This program consists of 80 semester hours of courses and includes 26 weeks of fieldwork to be completed in no more than five years. The fieldwork is done in the summer of year two and the summer, fall, and spring of year three.

Level I fieldwork is designed to introduce students to a variety of work environments and to develop a basic comfort level of working with clients. The student may work in various settings, including daycare centers, schools, neighborhood centers, hospices, homeless shelters, community mental health centers, and therapeutic activity or work centers.

Level II objectives, in general, are to increase competencies in working independently and to prepare counselors to actively participate in the process of helping their clients through developing and implementing treatment/intervention plans that address the needs of the individual.

The ACOTE standards indicate that Level I fieldwork requirements may be met through one or more of the following instructional methods:

  • Simulated environments
  • Standardized patients
  • Faculty practice
  • Faculty-led site visits
  • Supervision by a fieldwork educator in a practice environment

Licensure and Certification Of Occupational Therapists & Counselors

All states require occupational therapists to be licensed. Licensing requirements vary by state, but all require candidates to pass the national examination administered by the National Board for Certification in Occupational Therapy (NBCOT). Only students who complete all fieldwork requirements in an accredited educational program can sit for the NBCOT exam.

If occupational therapists and counselors pass the NBCOT exam, they can use the title “Occupational Therapist, Registered” (OTR). They must also take continuing education classes to maintain certification (see more about this in the section below).

Specialty licensure is also available through the AOTA for therapists who want to advance their knowledge in areas such as pediatrics, mental health, or low vision.

Occupational Therapist & Counselor Licensure Renewal Requirements

Once licensed, occupational therapists and counselors must take continuing education classes to maintain certification. Each state’s counseling licensure requirements can be slightly different. In general, they consist of educational experiences within the occupational therapist’s core practice area, refresher courses, and experiential courses related to diversity and ethics.

In Oklahoma, the Oklahoma Medical Board licenses occupational therapists and their assistants (often called occupational therapy aides). To renew licensure, state candidates must complete continuing education credits from their approved list of occupational therapy-approved continuing education courses for the reporting period in question.

For Oklahoma, continuing education is due October 31 every even-numbered year, and candidates must obtain 20 hours of approved continuing education or equivalent points every two years. Points are the equivalent of one hour of participation, and candidates can earn points through the following methods:

  • Attending workshops, in-services, seminars, or conferences
  • Attending programs offered by or approved by the American Occupational Therapy Association or the Oklahoma Occupational Therapy Association or the National Board for Certification in Occupational Therapy
  • Giving presentations on occupational therapy at workshops, seminars, conferences
  • Giving guest lectures
  • Authoring publications or an occupational therapy-related book
  • Conducting research
  • Attending college courses
  • Attending self-study independent learning projects
  • Achieving a specialty certification
  • Association membership participation (such as committee participation)

By contrast, in California, occupational therapists and counselors are licensed by the State of California Board of Occupational Therapy. In California, OTs must obtain 24 units during the renewal period to renew an occupational therapy and counseling license.

To renew National Board certification, occupational therapists must earn 36 units during their three-year renewal cycle.

What Do Occupational Therapists & Counselors Do?

At its most basic level, an occupational therapist helps people overcome their physical challenges to adjust to or return to as full a life as possible. A debilitating injury or illness can limit people’s physical and mental functions, and an occupational therapist helps people figure out what they need to do to return to doing the things they want to or need to do in daily life. One of the rewarding challenges of this career is that each patient’s needs will differ.

Despite the name, occupational therapists are not focused on employment. The website OT Potential says people in this field do not help people get jobs. Instead, the name comes from a somewhat old-fashioned idea of occupation as something that “occupies” someone’s time. The OT uses interventions, technology, and equipment to help clients do what they want.

Occupational therapists and counselors can work in the following environments:

  • Hospitals
  • Schools
  • Long-term care centers
  • Outpatient facilities
  • Home health care
  • Academics
  • Mental health care facilities
  • In their own private practice
  • In offices of physical or speech therapists or audiologists
  • Nursing care facilities 
  • Pediatric practices
  • Early intervention center (birth to age three)

How Much Do Occupational Therapists & Counselors Make?

These numbers represent figures from the U.S. Bureau of Labor Statistics from May 2021—the latest data available as of November 2022:

  • Number employed in the U.S.: 127,830 
  • Average annual salary (mean): $89,470
  • 10th percentile: $60,680 
  • 25th percentile: $75,710
  • 50th percentile (median): $85,570
  • 75th percentile: $100,490
  • 90th percentile: $123,840

Occupational Therapist & Counselor Professional Associations & Resources

  • American Occupational Therapy Association (AOTA)
  • Asian/Pacific Heritage Occupational Therapy Association (APHOTA)
  • National Black Occupational Therapy Caucus (NBOTC)
  • Occupational Therapy Network for Native Americans (OTNA)
  • Orthodox Jewish Occupational Therapy Chavrusa (OJOTC)
  • Coalition of Occupational Therapy Advocates for Diversity
  • American Speech-Language-Hearing Association (ASHA)
  • National Black Association for Speech-Language and Hearing (NBASLH)
  • American Physical Therapy Association (APTA)
  • American Academy of PAs
  • The National Council on Rehabilitation Education
  • National Association of Multicultural Rehabilitation Concerns
  • National Association of Cognitive-Behavioral Therapists (NACBT)
Vanessa Salvia

Vanessa Salvia


Vanessa Salvia is an Oregon-based freelance writer and editor with a bachelor’s degree in chemistry. As fun as rigorous studies in math and science were, Vanessa took an independent path and developed a prolific career covering lifestyle and healthcare topics for magazines and newspapers, important industries such as concrete construction and building waterproofing, and even hard science. You can get in touch at Sage Media and Marketing.