Monthly Archives: February 2007

Multicultural counseling: Not just for specialists anymore

Jim Paterson February 17, 2007

It once may have been a skill set reserved for specialists, but multicultural counseling has quickly become an everyday part of most counselors’ workloads. In a nation whose immigrant population is booming, many counselors find themselves working with people and cultures they had little to no contact with before. At the same time, within businesses, government and other organizations, concern about multicultural issues has become institutionalized, creating a need for well-trained professionals.

Thoughtful traditional counseling practices often serve counselors well in these instances, and experts in cross-cultural counseling stress concepts familiar to the entire profession: building trust and rapport, gathering information, exploring emotions, finding the right pace, noticing resistance, being aware of the process.

“Our culture-world is made of mosaics of similarities and differences,” says Ruth Chao, an assistant professor at Tennessee State University. She has also served as the principal investigator for the Multicultural Families and Adolescents Study. “We all smile, treat each other with respect and cherish sincerity. For example, ask your clients from another culture how they greet one another, how people are positioned by social status or other questions about emotional issues, and their answers will probably make you nod in agreement. They will respect you as a counselor, and your work will be effective, though your client may be limited by shyness, language and conventions.”

While skillful traditional counseling should serve all cultures, the reality is that it doesn’t, says Timothy Grothaus, an assistant professor at Old Dominion University in Norfolk, Va. “It is my hope that one day, multicultural alertness or counseling competence would be sufficiently infused in our training, our theories, our notions of best practice, etc., that it would seem somewhat quaint to make a special point of it,” he says. “We’re making progress but, by empirical indicators, have a ways to go yet.”

His colleague, Karen Dunlap-Joachim, a professor of counseling at Old Dominion, where a pocket of instructors specializes in and stresses multicultural counseling, suggests that multicultural counseling must be separately addressed. “I would love to think that all counselors would be sensitive to cultural issues in counseling all clients,” says Dunlap-Joachim, an American Counseling Association member, “but I don’t believe that all counselors are even aware of how much they are invested in their own culture or that they have a cultural link that affects their work. If one does not draw direct attention to the examination of culture — your client’s and your own — as a separate and important entity to be explored and understood from the client’s level of acculturation, I do not believe we can best serve any client, but especially clients whose cultural beliefs and expectations may be so very different from the clinician’s.”

Looking back

In 1992, the need to address multicultural issues in counseling was clear, and a key paper was published in ACA’s Journal of Counseling & Development that proposed development of 31 competencies. In the article (“Multicultural counseling competencies and standards: A call to the profession”), Derald Wing Sue, Patricia Arredondo and Roderick McDavis, described three dimensions of culturally conscious counseling:

  • Becoming aware of one’s own assumptions about human behavior, values, biases, preconceived notions, personal limitations and other negative approaches
  • Actively attempting to understand the worldview of one’s own culturally different clients without negative judgments
  • Developing and practicing appropr- iate, relevant and sensitive intervention strategies and skills in working with culturally different clients

Within each of those dimensions, the paper developed beliefs, attitudes, knowledge and skills and recommended culturally skilled counselors understand the limitations of generic counseling, which could clash with the cultural values of minority groups. In addition, the authors warned against bias in assessment instruments and barriers in mental health services. They also recommended counselors have a “knowledge of minority family structures, hierarchies, values and beliefs” and an awareness of community characteristics and resources. Other recommendations included using verbal and nonverbal responses accurately and consulting with traditional healers and religious/spiritual leaders. The paper also suggested using translators with the appropriate background or referring clients to effective bilingual counselors when necessary.

In 1996, the Association for Multicultural Counseling and Development, a division of ACA, approved the 31 competencies suggested for specialists in the field. The ACA Governing Council endorsed the multicultural counseling competencies in 2002.

More recently, Garrett McAuliffe has authored a new book, Culturally Alert Counseling: A Comprehensive Introduction (available in June from Sage Publications). McAuliffe, a professor of counseling at Old Dominion, serves on the Editorial Board for the Journal of Counseling & Development. He also presented at the ACA Convention in Detroit on “Keys to a Culturally Alert Practice.” He says all counselors need to make their practices accessible to people of all cultures, deal directly with cultural issues and tailor their counseling to the specific needs of the client. Initially, he says, counselors should make sure their surroundings are “inclusive and welcoming” to all potential clients. This might include using images or artifacts from other cultures to decorate the office or ensuring that the waiting room contains reading material written in various languages. The counselor should indicate a knowledge of or interest in the client’s culture, McAuliffe says, and speaking even a bit of the appropriate language can play a significant role in helping the client feel more at ease. Counselors also need to train staff to work with a variety of cultures and be sensitive to each, he says.

“You have many ways to learn about cultures,” Chao adds. “Make friends with people from (clients’) cultures, ask questions in the introduction session, go to cultural fairs, read up on cultures and expose yourself to these cultures. Your clients will be impressed with your eagerness and would be happy to talk with you, for nothing attracts more than eager enthusiasm.”

Small talk and self-disclosure work well, particularly if the clinician offers personal “safe facts,” McAuliffe says. He says counselors can also ask questions that  gather information without making the client feel uneasy. For instance: “On a scale of 1 to 5, what is your comfort level with regard to addressing the issue of culture?” or “How do you feel about working with me since I am not of your race?”

McAuliffe also suggests some standard counseling procedures with a slight variation. “Share your ideas on the nature of counseling and check out the client’s response,” he says. “Do culturally informed consent.” Bring up cultural differences in sessions and “explicitly consider gender, ethnicity, religion and other factors in the client’s world,” he says. People from significantly different cultures often have a longer “feeling-out period,” but McAuliffe recommends acknowledging the “elephant in the room” early in the process.

Distinct issues

McAuliffe says it is also appropriate to engage the client on issues that are distinct to them, asking questions such as:

  • What role did your culture play in your choices?
  • Help me understand what you are going through as a person of this race.
  • How do you think people perceive you as a result of your ethnicity?
  • What would you like me to know about your experiences in your culture? What about the experiences someone like you faces in this culture?

McAuliffe also suggests being deliberate in using knowledge gained about the client’s culture. “When there are significant cultural differences, the client needs to know that the counselor can understand them and wants to,” he says.

He recommends a more reserved, less personal approach than one might normally use initially, with sensitivity to the topics of sexuality, gender or even career aspirations, which may be an issue with family in some cultures. Some may care little about career issues, while in others, they may be of primary importance. “Recognize that in some cultures, achievement and its attendant family honor are often more important than emotional exploration and self-fulfillment, but praising oneself is not valued,” he says.

The counselor may want to include the client’s perceptions of family or even ancestors in the discussion, he says. Have the client talk about how those people might react to an issue, he suggests, especially when working with clients from cultures that give priority to the family or group over the individual. 

In such “collectivist” cultures, fact- and meaning-oriented counseling is more important than knowing and expressing feelings, McAuliffe explains. These clients may be more comfortable with a less direct and more formally polite approach, he says. In addition, family should perhaps be included in the counseling sessions, particularly when the client is making a nontraditional choice and a compromise is necessary, he says.

Certain topics may not be acceptable to some cultures. For instance, he says, sexuality is not a topic that should be discussed with members of many South Asian, East Asian or Middle Eastern cultures. Gender roles are somewhat taboo for Middle Eastern cultures. At the same time, he says, discussions about sexual behavior for men — even relations with other men — is not extremely restricted in Latino cultures, where it is viewed as the result of an overwhelming urge.

McAuliffe recommends solution-focused counseling in many cases, particularly where the group is primary to the client’s culture. Chao recommends cognitive behavioral therapy combined with “a sensitivity to cultural differences.” If clients are struggling with cultural rules that are limiting or unwanted, McAuliffe says counselors can carefully help them separate themselves from their “cultural story” by using narrative counseling approaches.

At the same time, McAuliffe notes that a strict “particularistic” approach that uses specific culturally based methods may not allow for a client’s enculturation, acculturation or the convergence of cultural identities. “Culture is always present in clients’ lives, but it may not be central to their concerns at any one time,” he says. “Instead, individual personality, situational and universal human condition issues may be more prominent.”

But a universalistic stance also may be inadequate, he says. Always applying person-centered theory or having the client search for his/her own solutions, for instance, may be misconstrued as indifference or even incompetence, he says, while egalitarianism may be misidentified as a lack of respect or a violation of decorum.

McAuliffe suggests that counselors apply traditional Western methods that also use some culturally specific strategies — varying structure and directness, emotionality and the use of silence and pause times, for example. “Counselors must remind themselves of the limits of generalizations,” he says. “Individuals within groups vary greatly in their levels of acculturation, enculturation and cultural identity as well as other characteristics.”

Jim Paterson is a contributing writer to Counseling Today and a high school counselor living in Olney, Md. Contact him at mypat@radix.net.

Letters to the editor: ct@counseling.org

Cultural Competency: A Challenging Mosaic

Marie Wakefield

In our pluralistic society, a multicultural perspective provides us with opportunities to connect with one another without loss of personal identity. As we address the need to be culturally responsive as professionals in the field of counseling, what resonates urgently is a personal awareness and knowledge of our heritage and daily interactions,both of which influence our beliefs, values and attitudes. In turn, beliefs, values and attitudes lay the foundation for the prejudices and biases that exist among and between cultural groups.

Recently, I facilitated a class discussion on personal challenges that can act as barriers to open and effective communication. I thought it would be interesting for the participants to use a cultural genogram to examine influences on their personal biases. Responses from this exercise showed how influences are passed through generations. We saw evidence of the unique traditions that various ethnic groups live by and existence of those vague areas that mask true beliefs.

Information I have collected about my family history has stimulated several questions. Unfortunately, it will be difficult to find answers to all those questions. I was made aware of certain family members from the past who lived in the “big house” and received a special surname, but I lack knowledge of issues as a result of the experiences with slavery. I learned that the responses of some of my family members to interracial marriage indicated areas of contradiction and stress. Nevertheless, my family’s religious affiliation and practices were very strong. There was also evidence of the social class with which we identified, gender role expectations and traditions that characterized our values.

I grew up in Oberlin, Ohio, a city associated with progressive causes. Oberlin was a hotbed of abolitionism and a key stop on the Underground Railroad.Many Oberlinians were deeply involved in the civil rights movement and various peace and justice campaigns. Those experiences opened my eyes to the atrocities of discrimination and the challenges it posed.

I asked two doctoral students in counseling to share their perspective on challenging experiences with cultural competency.

Tiffany Tyler: There is much discussion about the development of the “culturally competent practitioner.” Peterson and Carey (2003) maintain that the process is best understood as the development of awareness, skill sand knowledge through a breadth of cultural experiences.While I support this articulation of the process, as an African American woman, I am challenged to reconcile the development of the discourse on cultural competency and my experience as a “minority” practitioner. I use the word as a way of conveying the innumerable occasions I’ve found myself in the minority on the validity of culturally competent practice. As an explication of my frustration, I offer the following experiences.

  • There have been an inordinate number of times I’ve heard a counseling student say, “Why do we have to take a cultural competency class? Counseling is counseling!”
  • At times I’ve thought, “Why are ’cross-cultural communication’and ’cultural competency’considered recent developments? As far back as I can remember, my family has engaged in cross-cultural communication to ensure its livelihood. Moreover, if I was not culturally competent,I could not navigate mainstream cultural America each day. Exactly who are these concepts new to?”
  • The belief that taking one or two multicultural classes, attending a religious ceremony or eating at an ethnic restaurant, as required by a course syllabus, can successfully prepare any individual to effectively provide counseling to diverse populations in ways that enable the individual to shift between cultural lenses, build rapport across cultural divides and “empathize” with client experiences sets the stage for misguidance.

Douglas Garner: Cultural diversity has always been a fact of life in our world. Das (1995) points out that culture influences every aspect of our lives, and it influences our view of social and psychological reality.I believe that all counseling should be regarded as multicultural counseling if culture is defined broadly to include such variables as race, ethnicity and nationality as well as gender,age, social class, sexual orientation and disability.

People seek counseling largely because of problems that emerge out of sociocultural conditions. I have discovered that some counseling students bring with them cultural tunnel vision. This limited experience and perspective may unknowingly cause them to impose their values on clients by assuming that everyone shares the same values they do. I have observed counselors express the attitude,explicitly or implicitly, that minorities are unresponsive to professional intervention because of their lack of motivation to change. Not having the experiences to understand, counselors may perceive a client as being resistant.

For example, Native American, African American and Asian clients may not be very receptive to talk therapy because of their values and experiences. Cultural factors are an integral part of the therapeutic process and can influence the form of intervention. All cultures represent meaningful ways of coping with the problems that a particular group faces.

~ ~ ~

Your own level of cultural competence is based on several influential factors, ranging from your heritage to present-day interactions. Responses to our conceptual framework and an ability to connect with diverse populations also may be challenged by appearance, language,attitudes and behaviors. As you look through your personal cultural competency lens,do you see a mosaic, a melting pot or a marinade? The answer lies in the principles and practices that guide your actions.I look forward to hearing from you and hope you will feel free to communicate with me via e-mail at mawakefield@cox.net or by calling 800.347.6647 ext.232.

Let’s Share Our Good News

Richard Yep

Richard Yep

I am constantly amazed at the juxtaposition of events in our world. Recently, on Page 1 of the Washington Post, there was an article about the resignation of the head of the Smithsonian Institution due in part to personal spending habits, while another story talked about the former director of the U.S. Office of Management and Budget being indicted for allegedly misleading stockholders about the financial health of the company over which he presided.

When I read story after story of those who use their position, power and authority to the exclusive benefit of themselves or a select group that holds power with them, my heart sinks. These people are in a position to do good things, but for some reason do not. When I realize that so many others stand to lose their jobs, their self-esteem, their homes or their dignity because of the irresponsible actions of others, I am disheartened.

I am overjoyed, however, when I observe events such as the American Counseling Association Annual Convention that took place in Detroit March 21-25. What an amazing convocation of some of the world’s greatest people — caring, compassionate and willing to take time away from their jobs and families to gain greater skills in better understanding the human condition.

While the ACA staff had hoped for at least 2,600 attendees in Detroit, you can imagine our pleasant surprise as more than 3,100 professional counselors showed up to learn,network and just “be” with each other. When I see packed Education Sessions for those who want to learn more about counseling breast cancer survivors,working with children in foster care, breaking the cycle of addiction or bringing an end to bullying in cyberspace (to name but a few of the more than 400 sessions), I am reenergized in terms of what we, here on the ACA staff, strive to do for our members. We’ll share pictorial coverage of the convention in next month’s issue of Counseling Today.

Professional counselors do wonderful things for millions of families, adults, adolescents,couples and children. In addition, you all do so much to improve those systems in our society designed to help people. Your advocacy and commitment is exemplary, which is why, this month, we celebrate Counseling Awareness Month. This is the month when we make an extra effort to talk about the good work you all do. I encourage all of you to visit the ACA website at www.counseling.org to learn about the resources we have for you to share with your communities. Shine a light on what you and your colleagues do so that those who are out there seeking help can find you!

I am old enough and realistic enough to know that every news story will not leave me smiling and feeling good. I also know that when we try to tell the story of the wonderful work that professional counselors do, not every news organization believes that information will help sell its publication. Let’s try to prove them wrong.

I happen to think readers and viewers of news will appreciate knowing what professional counselors are doing in their communities. ACA and the ACA Foundation have collaborated on a project that sends weekly columns to more than 200 newspapers across the country. Known as the “Counseling Corner,” the columns are written so that laypeople can get a better sense of the good work that counselors do. These 200-plus news organizations represent millions of readers! So if you happen to know of a newspaper that might be interested in the “Counseling Corner,” let me know. The staff members working on this project will follow up.

Last, but not least, I owe a big thank you to the ACA staff for all the work they put in relative to the ACA Annual Convention in Detroit. There is so much that needs to be done prior to, during and even after the event. I hope our attendees enjoyed a smooth and enriching experience, which is our measure of how we did. I can honestly say that many of the staff went way above and beyond what their jobs called for in launching and implementing convention efforts, so again, my personal thanks to all of them.

As always, please feel free to contact me with any questions, comments or suggestions by e-mailing ryep@counseling.org or calling 800.347.6647 ext.231. Thanks and be well.

The nature and function of history

Angela Kennedy

Since its approval by the American Counseling Association Governing Counseling last November, the Historical Issues in Counseling Listserv has seen its roster grow to include a veritable who’s who of the counseling profession. The interest network’s founder, William C. Briddick, hopes that is just the beginning.

“The history of our profession is rich and unique, but unfortunately we are not savvy historians. We need an organized group to chart the direction of the profession for the future — for our professional grandchildren,” says Briddick, an associate professor at South Dakota State University. “They should be able to look back and have a comprehensive understanding of what we did and why we did what we did.”

In 1985, as an undergraduate, Briddick first became inspired to record the past after reading Roger Aubrey’s landmark 1977 article on the history of guidance and counseling in the Personnel and Guidance Journal. “After walking out of the library that day, I knew I wanted to be a counselor educator,” Briddick says, adding that he still has a tattered copy of Aubrey’s article. “There’s writing and underlining all over it and probably a few coffee stains too, but that one article impacted me so much.”

Briddick acknowledges both Mark Pope, past president of ACA, and Mark Savickas, an adjunct professor of counselor education at Kent State University, as major supporters and contributors to getting the interest network under way. “Everybody on the list, others at ACA and those leading us forward hold a treasure trove of information and experience within the profession, and they want to preserve it,” Briddick says. “That’s what makes our profession great — these people. I feel like we are in a good place now.”

Pope agrees that Listserv participants will be an important archival group. The more counselors who join and take interest in the Listserv, the more resources counselors will have to draw on in the future, he says. “It’s an important service to help keep historic issues current,” Pope says. “We have to focus on our history instead of just the future. This network will allow counselors the opportunity to have input into the process and the progress of the profession. When we go to make new policies, new standards or even revisions to the ethics code, a lot of times we don’t know what happened 10 to 20 years ago. Knowing who we are and where we came from will help us to not make the same mistakes again and keep us from going in circles. The only way to make progress is to understand our history.”

Briddick understands that some history has already been forgotten or lost, but he hopes that with today’s technology, the network of counselors will begin to preserve the profession’s tribulations, successes and inspirations for the next generation. “I’m sure we’ve lost significant portions of our history,” he laments. “We are so busy with our lives today — the madness of the day-to-day — that we don’t look back at what happened 25, 30, 50 years ago.”

Briddick believes the history of the profession and the documentation of its future are keys to unlocking the ongoing mystery of professional identity. “Counselors are so hungry to a) find out who we are and b) to tell people about who we are,” he says. “I don’t see how we can continue our path of professional development and not pay attention to our history.”

Briddick encourages counselors from all walks of the profession to join the interest network and Listserv and post what they are currently working on. He says the network is interested in hearing ideas for the future as well as experiences from counselors’ past. Briddick admits he has an agenda and says it’s simple: to keep good records and eventually to hand the reins over to another counseling history buff.


During the past several years, the American Counseling Association has approved several Listservs to allow counselors to come into community with others who share special interest in a particular focus area. To join any of the ACA Interest Networks listed below, e-mail Holly Clubb at hclubb@counseling.org with your name, e-mail address, the interest network you wish to join and ACA Membership status (member/nonmember). Joining an interest network gives you access to participate in that network’s Listserv.

  • Children’s Counseling Interest Network
  • Historical Issues in Counseling Interest
  • Network
  • Interest Network for Advances in Therapeutic Humor
  • Multiracial/Multiethnic Counseling Concerns Interest Network
  • Network for Jewish Interests
  • Sports Counseling
  • Interest Network
  • Traumatology Interest Network
  • Women’s Interest
  • Network

The slippery slope of sliding fee scales

Robert J. Walsh and Norman C. Dasenbrook

Q: I purchased your book after being in private practice for 20 years and find it helpful, even now. You give an example of a bill sent to an insurance company. It shows an “amount waived.” You recommend against using a “sliding fee scale.” You also advise billing the full fee to insurance companies. What is the difference between a sliding fee scale and “amount waived”?

A: Great question, and we are glad you liked the book. You are correct that we do not recommend a “sliding fee scale” because they are difficult to administer fairly.

The amount waived is the fee reduction for most third party payers that is on the client explanation of benefits. As you know, most managed care and insurance companies have preset fees and/or pay a percentage of your usual and customary fee. We recommend billing these third party payers your full fee, and they will waive the amount over the fee limit. That way you don’t charge different fees based on the contracts with different third party payers.

Q: I would like to start a limited private practice. Rather than rent my own office and have all the start-up costs, it would seem more cost effective to subrent space from an existing practice. Typically, how is that done?

A: First, congratulations not only on making the decision to start your own practice but also taking the next step to actually do it. Second, as Steven Covey says, “Begin with the end in mind.” Third, whatever you do, get it in writing. Fourth, have an attorney review the document. Following are some other considerations:

What do you need?

Before approaching an existing practice, know what you are looking for and what you need. Then you can negotiate rent, services and price.

Are you just looking for an office one night a week and Saturday mornings? Do you need your own office exclusively so you can decorate your way and see clients whenever? Do you need billing or secretarial services, or will you handle that yourself? Who pays for office insurance? Do you need access to a copier, fax machine, computer, conference room, etc.? Do you expect referrals from the practice? If so, how are new clients handled when they call the practice but specify a particular counselor? What is the protocol for on-call or after-hours coverage for emergencies? Do you need the practice to have corporate contracts with managed health care and insurance companies that cover all licensed staff, or will you pursue these yourself? If all goes well, what are the possibilities of becoming a partner in the practice?

Also, when approaching an existing practice to rent space, think outside the box. In our book and in the “Start-up” bulletin on ACA’s website (www.counseling.org) under “Private Practice Pointers,” we have been recommending approaching physicians to sublet office space. Back in the early eighties, Bob set up practice in a large pediatrician group practice because his niche was children!

Financial agreement

When renting office and support services (space, office equipment and support staff) from an existing practice, it is becoming more common to be asked to pay a percentage of your billings or collections. We always worry about the appearance of “fee splitting,” especially if you receive referrals from the practice. We would recommend paying a “flat fee” per hour or a monthly charge for X amount of time. 

For example, if you charge $100 an hour, agree to pay $30 to the practice rather than 30 percent. To us, it is cleaner and avoids the perception of paying for referrals. Depending on the office and services, never consider paying more than $40 per $100 of fees billed or collected.

Practice restrictions

How long a contract does the practice require? Remember that this protects you as well as the practice. Avoid month-to-month agreements and detail what the conditions are for early termination by you and/or the practice.

Try to avoid signing a “noncompete clause” if you can. These agreements usually stipulate that you cannot practice for a certain amount of time and within a certain geographical range (counties or mileage radius) of the existing practice.

Should you decide to leave (to start your own practice) or be asked to leave the practice (creative differences or egos), you need to have an agreement in place to determine what happens to your current clients, past clients and client records and what happens when new clients contact the old practice requesting to see you. While this may be awkward, we have fielded many questions about this topic and threats of lawsuits. It is good client care and good business to have this decided before you start.

We hope this provides you with some ideas in pursuing your goal and, perhaps more important, questions to ask yourself. Just as in our work with clients, if we know the desired outcome the path becomes clearer. Moreover, setting up your practice is a business venture. Business success favors the prepared person.

Q: I have been in private practice for three years and have done my own insurance billing. I recently married, and my husband, who is retired, is going to take over the role of my insurance billing manager. We have discussed the necessity for him to honor all forms of confidentiality and become compliant with the HIPAA guidelines. Do you know of a form that has been created for support staff to sign to acknowledge their compliance? If so, would you tell me how I can find it?

A: HIPAA only looks for best effort to meet the spirit of the law. We are not lawyers, nor is this legal advice, but we find that a typed letter of agreement between you and your billing manager (husband) to comply with HIPAA confidentiality constitutes meeting the requirements. You can also make him your compliance officer if he works for you in your practice. You simply need a letter saying he is your compliance officer. Place all HIPAA files, including these, in a folder marked “HIPAA.” This should cover your bases.

After spending a lot of time researching this, we found that it wasn’t as complicated as we first anticipated. Norm spent 60 hours and has all the guidelines and forms on disk in our book, The Complete Guide to Private Practice for Mental Health Professionals (www.counseling-privatepractice.com). We hope this helps.

Q: I recently changed my private practice address and phone number. Do I remember correctly that there is one website where I can submit this information without having to go to the five or six insurance companies to whose panels I belong?

A: Yes, it is the Council for Affordable Quality Healthcare at https://caqh.geoaccess.com/. If you are unsure what CAQH is, go to ACA’s website in the Member’s Only section and under “Private Practice Pointers,” you will find the information you need to do this.

You can call one of the managed care or insurance companies that you are currently with to get a CAQH identifier number. It has to be one of the companies covered by CAQH. Tell them you have changes in your provider information. 

Q: I am a member of ACA and a licensed professional counselor who left a big psychiatric hospital for private practice. I was very successful at my job and assumed that I would make it in private practice. I work in Pennsylvania. When I went to get a Medicare number, they said they only credential clinical social workers. I believe that my state licensing board makes no distinction between those two degrees. What can you suggest regarding getting a Medicare number and getting onto insurance boards?

A: You’re right. Most states now consider counselors and social workers as equal (finally). You can get on most insurance panels, but Medicare is a different issue. Federal law allows M.D.s, Ph.D.s and social workers to bill Medicare. ACA continues its efforts to change Medicare legislation and is close to that goal.

Until the law changes, we have one other possibility for billing Medicare: the “incident to” provision. Visit www.wpsic.com/medicare/policies/wisconsin/phys004.pdf, which should shed light on your issue. The “Private Practice Pointers” section of ACA’s website also has helpful private practice information on working with Medicare through the “incident to” provision.

Be sure to attend the ACA Convention in Detroit, March 21-25. Consider attending our preconference Learning Institute on private practice. Also visit the ACA Career Center throughout the conference to see mini-presentations on private practice topics.

Finally, stop by our booth, Walsh and Dasenbrook Consulting, at the exposition center and preview our book The Complete Guide to Private Practice for Licensed Mental Health Professionals. Hope to see you there!