Standards in the Counseling Profession
The field of professional counseling (as in psychotherapy) is in a state of major flux and growth. Both nationally and on a state level, counselors are battling on multiple fronts including:
- Raising the standards for counseling licensure with regard to the following:
- clinical examination (requiring the national clinical mental health counseling exam);
- requiring that licensure applicants degree programs meet CACREP standards or equivalent standards (The Council for Accreditation of Counseling & Related Educational Programs);
- increasing the hours in the field of practice required to obtain independent licensure (supervised direct and indirect client contact hours);
- increasing the hours of clinical supervision required (meetings with a qualified counselor of greater seniority in the profession to receive guidance and feedback on their professional development and clinical skill set);
- increasing the standards for supervisors to ensure better quality supervision (requiring experience, training and certification for supervisors);
- there are probably more activities related to raising our standards but these are the ones that come to mind.
- The counseling scope of practice is also in the process of being further defined in state laws. In the state of Georgia (State Bill 319) counselors are seeking to add diagnosis to our defined scope of practice. We are also trying to prevent the Psychologists in our state from passing a law that prohibits our use of psychological testing instruments in our scope of practice (House Bill 395).
Adding Diagnosis to the Scope of Practice
The reason that counseling as a profession is seeking to add diagnosis to our scope of practice is that it will soon become practice prohibitive to not include it in our legal scope of practice. Counselors complete psycho-social assessments and make diagnostic impressions on a regular basis. It is a part of our graduate degree program coursework and a major focus in the seminar classes associated with practicum and internship.
We provide our diagnostic impressions in our insurance billing to third party payers. We also work in hospitals, psychiatrist offices, community mental health centers and countless settings where we collaborate with and consult with other mental health professionals and provide our clinical and diagnostic impressions of clients/patients/consumers depending upon the setting.
If diagnosis is not included legally in our scope of practice we will no longer be able to accept and be reimbursed via insurance companies for providing counseling (mental health) services. The impact this would have on the profession in Georgia, as well as the impact it would have on the general public is quite simply alarming.
- It means that many people would not able to continue services with their counselor/therapist.
- It means many communities will no longer have access to a mental health provider in their vicinity.
- It means many professional counselors and associate counselors will no longer be able to maintain caseloads (even if they are not on insurance panels). Private pay clients often want receipts called superbills that allow them to seek reimbursement for services they have paid for themselves.
Licensure Portability and Gatekeeping
The goals for raising standards include securing more reliable licensure portability across states. So that when a counselor moves, they have a better chance that the licensure requirements they already met from their previous state will be honored.
These goals also represent a desire to provide the highest level of service to the public and effective “gatekeep” of the profession. Which means taking steps to make sure those who are licensed are competent and qualified and those who are not competent cannot obtain an independent license to practice.
Psychologists Protecting their Scope of Practice
Psychologists in Georgia are pursuing legislation (House Bill 395) that would provide a definition for “psychological testing” which would prohibit the use of psychological tests by Professional Counselors, Social Workers and Marriage & Family Therapists. The legislation appears to allow for the use of some tests by the three allied professions. I imagine this would involve instruments that the makers themselves allow Master’s level clinicians to administer. The argument appears to be related to counselors etc… not having the same focus on psychological testing in our academic programs. While this is true in most cases it is not correct in all cases as counselors come from diverse academic backgrounds.
Counselor’s Diverse Educational Backgrounds
Many counselors practice with a Master’s level education. However, a number of counselors have specialists and/or doctoral degrees. The types of degrees include arts, science or education degrees in the following areas:
- Master’s/Specialist/Doctorate in Counseling or doctorate in counselor education and supervision;
- Master’s/Specialist/Doctorate in Psychology (including school psychology);
- Master’s/Specialist/Doctorate in School Counseling;
- Master’s/Specialist/Doctorate in Rehabilitative Counseling; and
- Master’s/Doctorate in Counseling Psychology.
Some of these degree programs include training and experience with psychometrics (the design and administration of psychological tests).
Counselors are taught and have an ethical mandate to refrain from providing services that they are unqualified to provide by training, education, experience and supervision.
Psychologists who received training in applied practitioner programs complete coursework and practicum/internship experience providing testing. Not all persons with doctoral degrees in psychology pursue state licensure or practice clinically. Some work in higher education as professors while others work in consulting, program evaluation, business and a variety of fields.
Testing as a Unique Skill Set
The ability to provide testing services is one of the distinguishing skill sets that psychologists might employ in their work. In fact, it is very common for them to hire counselors to assist with the administration and report writing involved with completing a battery of tests. The Psychologists supervise the cases, review the reports and give feedback to the counselors facilitating the testing. They ultimately “sign off” on the reports that are administered by the counselors.
To my knowledge, there are also some restrictions of use as it relates to some tests. This means that the organization that disseminates that test requires that certain training requirements are met in order to effectively administer their instruments.
It is easy to understand why psychologists want to protect their scope of practice, as testing provides a competitive edge and they may have legitimate concerns about protecting the public and the effectiveness of this service.
Counselors in Georgia are opposing the psychologists’ bill to limit the use of tests to Psychologists (with a few exceptions).
Psychologists and Social Workers in Georgia are opposed to Counselors being able to legally diagnosis. This may also involve our use the term “evaluation” in our defined practice as it is associated with testing as well as psycho-social assessments (which are essentially extended interviews for background information and current symptoms).
There are a number of intentions being assigned on all sides. It is evident to me that the real losers in this turf war are the public. Sadly in our collective groups we have not come to each others aide and developed a nuanced understanding of the issues at hand. We are like a family in conflict seeking a third party to sort it all out. Well I believe in family therapy. I think that the long term resolution involves an understanding that we rise and fall together. We must develop and maintain a professional camaraderie that supports the ethical practice and application of our various standards of practice.
Specifically don’t practice outside of your scope of competency. The scope of competency varies from person to person. We, as colleagues and peers, must help to protect the public by confronting those who are in direct conflict with ethical practice. That begins with consultation, discussing your ethical concerns with the party involved and then seeking outside support or filing a complaint if needed.
The Abundance Principle
There is more than enough to go around. There are people in need of our collective services. Some who are already participating in a therapeutic process and those who will or would be in counseling if they have access, means and understand the value of what counseling/psychotherapy can offer.
Let’s practice and engage from a principle of abundance. It is desirable and necessary to have defining characteristics among our professions, however we have many areas of intersection. Let’s acknowledge those and support ways that serve the collective good. I, for one, pursued a counseling degree because I enjoy my scope of practice that does include diagnosis.
I am happy to refer clients out to my Psychologist colleagues for psychological testing. In fact there is one person to whom I specifically send my clients for this service. They receive personal interaction with her from beginning to end and she consults with me on the case if needed. I have no desire to provide testing as a service and I know few counselors who do. However, there are some who have a psychometric background, they are qualified based on education, training, and supervised practice.
Let’s proceed with respect for one another. Stephen Covey, author of the Seven Habits of Highly Effective People, states in habits 4 and 5 (which address interdependence):
- “think win/win;”and
- “seek first to understand then to be understood.”
If you want to learn more about the state of the counseling profession in Georgia or nationally, please visit the Licensed Professional Counseling Association of Georgia’s website www.lpcaga.org. It is a state chapter of the American Mental Health Counselors Association- www.amhca.org and the National Board of Certified Counselors- www.nbcc.org.
Copyright © 2016 Ruby Blow. All rights reserved.