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Licensure Reciprocity: A Critical Public Protection Issue That Needs Action

David Kaplan January 25, 2012

David Kaplan, chief professional officer for the American Counseling Association, delivered the following keynote presentation at the American Association of State Counseling Boards on Jan. 4. He can be contacted via email at dkaplan@counseling.org or by phone at 703-823-9800 ext. 397.

 

“I am a prisoner in my own state.”

These were the words of a professional counselor who had called ACA in tears. She had been licensed and practicing in Wisconsin for over 20 years. Then, through no fault of her own, she fell in love. And love lead to a proposal of marriage. The complicating factor was that her fiancée lived in a state 900 miles away. No big deal, she decided to transfer her license to her new state and start her new life and family. But when she contacted the state licensing board in her fiancée’s state, she was told – despite the fact that she had been licensed for two decades and despite the fact that she had a spotless record without any complaints made to her licensing board – that she was not eligible to be licensed. She had to choose between practicing in her home state and leaving the counseling profession to be with the man she loves.

We have a real crisis in counselor licensure. Counselors are trapped in their own states.

My goal for our time together is that by the end of my talk you will understand the problem. But I want to go way beyond that. I am hoping that you will take ownership of the problem because you are the ones with the power to solve it. And, if you are not too furious at me by the time I get to it, I want to propose a way that we all can work together to solve this longstanding and painful issue.

Let me read to you from an op-ed that just came out in the January Counseling Today by Thomas Sherman, a licensed counselor and a clinical supervisor with the military OneSource program which provides counseling and support services to active duty, National Guard, and Reserve service members and their families. I would like to read an extended portion because I think it really gives you a feeling for what counselors are going through when they try to transfer their license to a new jurisdiction. [Read complete Counseling Today opinion piece, “License portability: One counselor’s journey across state lines”]

*****

License portability: One counselor’s journey across state lines

January 2012 | Opinion

Thomas J. Sherman

As an existentially oriented counselor, I am well versed in the absurd, but I was not quite prepared for how far my ability to accept it would be stretched when I moved three hours away and across state lines. I graduated with my doctorate in counselor education in May from a well-known university and, following graduation, moved to join my partner who had received an outstanding job in another state. Being a licensed counselor, I assumed it would be easy for me to follow her and get a job practicing counseling. How wrong I was.

When I graduated with my master’s degree, I moved to a state that required unlicensed counselors to be under the supervision of a licensed professional. In three years, I completed the 4,000-hour clinical residency, which included 2,000 hours of direct client contact and 200 hours of supervision required for licensure in the state. In June 2010, I passed my state licensure exam. In April 2011, when my partner and I knew we would be moving to a different state, I began reviewing the requirements for transferring my license to the new state.

The requirement for transferring a license is listed as either two years of practice as a licensed counselor or 2,000 hours of clinical professional counseling experience. Despite these requirements being listed twice on the licensing forms, I called the state counseling board to confirm that I met the requirements and was completing the correct forms. After outlining my experience, I told the person at the counseling board that I had held my license in the other state for only one year but that I possessed well over 2,000 hours of clinical experience. The person with whom I spoke at the board notified me that, given my clinical experience, I should be able to transfer my license.

By the end of May, I had gathered the required signatures from my professors and former supervisors, collected transcripts from all of the schools I had attended, written the required check to the board and mailed a license verification form to the state counseling board where I currently held my license so it could sign and return the form to the new state to which I was moving. After waiting several weeks into June, I called the counseling board in the state to which I was moving to see if it had received my licensure verification form. I was told the person with access to the files was on vacation and would “be back sometime next week.” The next week, I called several times before reaching the person with whom I needed to speak, only to be informed that the form had not yet been received. This person also told me that if the form was not received by July 15, I would have to wait until Aug. 15 for the counseling board to review my application.

Having this information, I called my former licensing board to inquire about my licensure verification. A voice mail greeted me, informing me the board had a high volume of applications and instructing me to leave a name and number, which I did. The following day, having not received a return phone call, I called several times until finally reaching an actual human whom I could ask about the status of my license verification. I told this person the check for the verification fee I had sent with the form had been cashed in June, but as of July, my new counseling board had not received the form. This person told me my former counseling board met only once per month and had already convened in June prior to my request being received. I inquired as to when the counseling board would meet next. The response: “Sometime in July.” The person could not provide a date when the board would meet to sign my form.

This raised a second concern for me. Because I had submitted all of my forms in June, I had allowed my license in my former state to lapse at the end of that month, not seeing the benefit of paying for and carrying two licenses in different states. I attempted to call my former licensing board again to determine if this lapse would affect the verification of my license because the board would not be reviewing it until July. Once again, I was unable to reach anyone, so I left my question on voice mail. I never received a phone call. Instead, on July 15 I received an email indicating the board had mailed out my licensure verification. The email didn’t address my question of whether my license was still valid.

After waiting another week, I called my new counseling board to confirm receipt of the licensure verification form. It was at this point I was notified that I did not meet the requirements for transferring my license because I had not held my previous license for two years. I told the person at the board I was getting different messages and asked if I could speak with someone higher up. I was given the number of the board’s director. I reviewed my previous conversations with the director, indicating that someone at the board had confirmed my understanding of the state’s licensure requirements. The director said the expectation was that if an individual had a counseling license for two years, he or she would also have 2,000 hours of clinical practice, meaning that a person was required to have both, not either/or, despite the wording on the forms. I shared that the state where I previously had been licensed required 1,000 more contact hours and 100 more hours of supervision than did my current state’s licensure requirements. I was told I had two options: I could wait for the board to review my application in September and inform me of its decision in October, or I could send in another check, complete a different set of forms and mail back in the application for regular licensure — and still wait until October.

Exasperated, I communicated to the director that I had been unemployed for three months while following the instructions provided by the board to get my license transferred. When told the earliest I would hear whether my forms were correct would be October — another three months away — I asked how the board could justify the delay in responding given that a license is required to practice. The director told me that even if the board had received my application materials in June, they still would not have been reviewed until September. In May and June, the director explained, the board reviewed disciplinary issues that kept its members from approving licensure applications, and then the board was on recess through July and August, despite what the person at the counseling board had previously told me regarding the board’s meetings. For four months (fully one-third of the year), the counseling board did not review applications, and when it would review them, it would take 30 days to respond. Following a response, applicants must still sit for a counseling law exam and/or a licensure exam. I finally asked if I could speak to someone on the licensing board who might possibly give me some concrete answers. The director said she could make the request but added that the board did not usually honor such requests.

As of mid-August, I still had not received a response from the counseling board.

In October, I finally received my letter from the board indicating that I could sit for the licensing examination within a week. The letter indicated I would need to bring a license to confirm my identity. On the letter, my name was incorrect. When I attempted to contact the person listed on the letter to follow up, I reached her voice mail, which informed me she would be out of the office until after the date of the exam. Through the counseling board’s main number, I was able to reach a person who could correct my name. Finally, at the end of October, nearly six months after I began the licensing process, I received my counseling license in the new state.

*****

Unfortunately, what I heard from the counselor in Wisconsin and what you just heard from the op-ed is not unusual. ACA receives a dozen calls a week – a week – from licensed counselors who have been stymied and frustrated in their attempts to transfer their license to a new state. We hear horror story after horror story. I’ll bet you do, too – or at least your administrator does.

So how did this nightmare develop? There are two levels of answers to this. The simple explanation for why license reciprocity for professional counselors is so difficult is that there is a patchwork of licensure titles, scopes of practice, and sets of education requirements. There are over 45—45! — titles used by state counseling boards including: Licensed Professional Counselor, Licensed Associate Counselor, Licensed Associate Professional Counselor, Licensed Mental Health Counselor Associate, Licensed Professional Clinical Counselor, Clinical Counselor intern, Clinical Counselor Trainee, Provisional Licensed Professional Counselor, Licensed Professional Counselor of Mental Health, Licensed Associate Counselor of Mental Health, Registered Mental Health Counselor Intern, Associate Professional Counselor, Licensed Clinical Professional Counselor, Licensed Clinical Professional Counselor Intern, Licensed Clinical Mental Health Counselor, Licensed Professional Mental Health Counselor, Registered Counselor Intern, Professional Counselor Intern, Licensed Professional Counselor Intern, Certified Professional Counselor Intern, Conditional Licensed Clinical Professional Counselor, Conditional Licensed Professional Counselor, Registered Counselor, Certified Professional Counselor, Licensed Graduate Professional Counselor, Limited Licensed Professional Counselor, Provisional Licensed Professional Counselor, Licensed Clinical Professional Counselor, Licensed Mental Health Counselor, Provisional Mental Health Counselor, Licensed Mental Health Practitioner, Licensed Independent Mental Health Practitioner, Licensed Mental Health Practitioner – Certified Professional Counselor (that is seven words!), Provisional Licensed Mental Health Practitioner, Provisional Professional Counselor, Limited Permit, Licensed Professional Counselor Associate, Professional Counselor/Clinical Resident, Registered Counselor Trainee, Registered Intern, Professional Counselor with Provisional License, Licensed Professional Counselor-Mental health, Licensed Professional Counselor-Mental Health Service Provider, Certified Counselor, Agency Affiliated Counselor, Licensed Professional Counselor Trainee, and Provisional Professional Counselor.

One licensing board alone uses five different license titles! How can that be anything but confusing to the public? There is one state with a “Certified Mentor” credential and another with a “Certified Advisor” credential. What the heck do those mean? Some states have one tier. Some have two tiers.

Your scopes of practice are just as confusing. Some permit the diagnosis and treatment of mental disorders. Some don’t. Some focus on human growth, life-span development, and wellness. Others don’t. Some include career development. Others don’t. Some include play therapy. Others don’t. Some include couples and family counseling. Others don’t. Some allow testing. Others allow assessment. Some allow treating personality disorders. Others don’t. Some include sexual dysfunction. Others don’t. Some include treating substance abuse. Others don’t. Some include working with disabilities. Others don’t. Some include consultation. Others don’t. Some include crisis intervention. Others don’t. Some include group counseling. Others don’t. Some include guidance. Other don’t. Some include research. Others don’t. I could go on, but you get the point. In a nutshell if you read any 20 state counseling board scopes of practice, you will see 20 different skill sets.

Are education requirements any better? What do you think? Some states require 60 graduate credits. Some require 48 credits. One state even specifies 42 credit hours – how they got 42, I (and the public?) honestly have no idea. Some do not specify the number of credits at all. Some of your state boards utilize the CACREP guidelines. Others don’t. One (it was 2 for a short period of time) requires a CACREP degree. Everyone else doesn’t. Some include CORE. Others don’t. Many do not mention either CACREP or CORE. One licensing board requires 1,500 hours of supervised experience. Others require 2,000 hours. Still others require 3,000 hours of supervised experience. One requires 3,200 hours. Another requires 3,500 hours. Another 3,600 hours. Two boards even require the interesting number of 3,360 hours. There are also boards that require 4,000 hours. If the board with the greatest number of hours wins, it is New Jersey with a required 4,500 hours of supervised experience. If, however, the prize goes to the jurisdiction with the smallest number of supervised hours it is Puerto Rico with 500. What does it say to the public when there is a difference of 4,000 hours of required supervised experience across counseling licensure boards (and even if you want to discount the lowest number the range is still 3,500 hours)? Wait- but there’s more! One board requires all supervised experience to be obtained within a 7 year period. I’m not sure why – maybe they thought it was a doctoral dissertation. There is also a board that requires all supervised experience to occur within the 5 years prior to the application.

Some counselor licensing boards require 1 year of experience. Others require 2 years. Still others require 3 years of experience. There is one board that requires 21 months of experience and a board that requires 4 years of experience. Some states allow part time experience to count. Others only count full time employment.

Some states require the NCE exam. Others require the NCMHCE. Some licensing boards allow either the NCE or NCMHCE. Some require both. Some will allow the rehabilitation counseling exam to count. Others won’t. A few jurisdictions don’t trust national exams at all and make up their own. One board has an oral exam. Another, an essay exam. A third requires a videotape sample. And, in a display of unparalleled flexibility, one state allows applicants to submit the results from any of 7(!) different examinations including the ATCB, CBMT, PEPK, AAODA, and EMAC, none of which I have any idea what they are.

And if this confusing stew of credits, supervised hours, years of experience, and exams isn’t enough, there are the education requirement permutations. Check out this idiosyncratic rule in one state: “An applicant may subtract 1,000 hours of the required professional experience for every 15 graduate semester hours (or 22.5 quarter hours) obtained beyond the master’s degree from a regionally accredited academic institution , provided that the coursework is clearly related to the field of professional counseling.” Woe to the counselor who takes advantage of this rule and then moves down the line to another location only to be told that their new jurisdiction does not have such a rule and they are thus ineligible for licensure.

I mentioned that the simple answer as to why the crisis in license portability has occurred is the patchwork and jumble of licensure titles, scopes of practice, and sets of education requirements. The deeper cause relates to the mindset of counselor licensure boards – that would be you. I apologize but I am going to continue to gore a few oxen. Counselor licensure boards seem to operate from four peculiar world view generalizations:

World view generalization #1: Our state is the only state that licenses qualified counselors. We can’t trust the credentialing process of any other state.

World view generalization #2: We can’t cooperate with other licensing boards because we will lose the appearance of complete independence.

World view generalization #3: We don’t need to provide anything resembling customer service to counselors because we are here for the public.

World view generalization #4 – and the one I would like to focus on: Licensure reciprocity and portability are not our concern because they are guild issues, not public protection issues.

I want to tackle the last world view generalization and convince you that license portability is very much a public protection issue. Because if I can do so, then the other world view generalizations will fall into place. You will see the need to cooperate with other states and jurisdictions and to provide decent customer service for your licensees. You will also – hopefully – be open to the plan to assist you that I will be talking about in a bit.

I would propose that there are three reasons why licensure portability is a public protection issue and should therefore not only be on your radar screen, but be a priority for counselor licensure boards. The first is the fact that in order to meet your mandate to serve the public, you need more licensed counselors in your state or jurisdiction.     This may come as a surprise to those of you who live in cities or university towns where there are plenty of mental health providers competing with each other for clients. To find the problem, you have to look behind rocks, over creeks, and through the leaves and tall grass. Specifically, there is a dire shortage of counselors in rural areas. How short? Myers and Gill found that 60% of rural areas are designated mental health shortage areas by the federal government. Current estimates (as of this past Sept, 1) from the U.S. Department of Health and Human Services are that there are over 3,600 mental health shortage areas with a total population of almost 89 million people living in them – that is 1 in 4 Americans. I have a listing of every designated mental health shortage county in the United States with me if you want to check out your state. HHS estimates that it would take almost 6,000 additional mental health providers to meet the needs of citizens who live in rural areas.

We have known about the shortage of rural mental health professionals for a long time. It was documented by the U.S. Department of Health Education and Welfare in 1969. The Report of the National Action Commission on Mental Health of Rural Americans highlighted the problem in 1988. And President Bush’s New Freedom Commission on Mental Health made the lack of access to mental health services by rural Americans a key point of focus in 2002 (and I testified on behalf of ACA and the counseling profession).

Counselor licensure boards must focus on rural Americans. That is because they constitute especially vulnerable populations. The HHS report Rural Mental Health in America states, quote, “Groups at greater risk for mental disorder – the elderly, the chronically ill, the poor, and the dependent – are disproportionately represented in rural areas. Myers and Gill add rural women to the list. They report that 41% of poor, rural women self-report significant depression, in part because they often experience, quote ”low self-esteem, low perceptions of ability to set or achieve life or career goals, a lack of feeling of empowerment, and an external locus of control.” The researchers report that as a result, lower SES rural women, “frequently resort to negative coping behavior, notably substance abuse.” In response to these issues, Myers and Gill developed a multi-factor wellness model for counselors to use with rural women. So professional counselors know what to do to meet the mental health needs of rural Americans. Unless you want to write off these vulnerable rural populations and say that your mandate only applies to those who have the good sense to live near a city or university town, you need more counselors. And you need programs to encourage licensed counselors to live and work in rural areas. The development of those programs is a topic for another talk on another day. But the good news is that many professional counselors – especially when compared with other mental health professions – seem to be rural types. And so facilitating the ability of licensed counselors – especially those who want to live in the boondocks – to emigrate to your state is in the best interest of the rural population of your state or jurisdiction.

The second reason why licensure portability is a public protection issue has to do with your mandate to meet the needs of underserved populations. The U.S. census bureau estimates that minority populations comprise 34% of the United States and they are growing rapidly. Ten years ago, the President’s New Freedom Commission on Mental Health found that the unmet needs of underserved populations was so great that it set improving access to quality care that is culturally competent as a major goal. Let me read you a small portion from the section of the report titled, Minority Populations are Underserved in the Current Mental Health System: “Racial and ethnic minority Americans comprise a substantial and vibrant segment of the U.S. population, enriching our society with many unique strengths, cultural traditions, and important contributions. As a segment of the overall population, these groups are growing rapidly; current projections show that by 2025, they will account for more than 40% of all Americans. The mental health system has not kept pace with the diverse needs of racial and ethnic minorities, often underserving them. Racial and ethnic minority populations are less likely to have access to mental health services and so are less likely to receive needed mental health care.”  The President’s New Freedom Commission on Mental Health also reported that, “racial and ethnic minorities are seriously under-represented in the core mental health professions.” So just as you need to recruit counselors to meet the needs of rural citizens, you need to recruit experienced minority counselors and majority counselors who can provide services to underserved populations. And that means facilitating license portability.

The third reason why licensure portability is a public protection issue has to do with the roaming characteristics of the public we serve. The U.S. Census Bureau – them again – says that 7.6 million Americans move to another state each and every year. That is a lot of public – 7.6 million people. And you have an obligation to look out for them when they move to your state or jurisdiction.         It seems to me that a major part of your public protection role is not to confuse the hell out of them. But how can you do otherwise when there are 45 counselor licensure titles out there, a potpourri of licensure scopes of practice, education requirements that vary from no stated credits to 60 credits, a variety of accreditations, experience that ranges from one to four years and 500 to 4,000 hours, and nine exams or combinations of exams?   How are the 7.6 million U.S. citizens who move from state to state every year supposed to know what they are getting in a licensed counselor? They don’t and can’t, given the current state of counselor licensure boards. And we all know that when someone is confused about what they are getting in a licensed professional, they tend not to get any help at all. I have moved to six different states since I started working. If each state had different qualifications for a physician and I had no idea what a primary care doc would be called, what their training was, or what they could do, or what I would be getting in my next state, I think I would stop seeing physicians.           How many people have stopped seeing counselors for the same reasons? Standardizing counselor licensing requirements across states is in the best interest of the 7.6 million Americans who move each year. And the good news is that standardizing requirements will facilitate license portability which will allow you to more easily recruit counselors who want to work with the underserved rural and minority populations. See how this all fits together?

So at this point I hope that you see the need to fix the nightmare that is portability and that it is in the best interest of the public to do so. And I also hope that you are thinking, “What do we do about this mess?” I am here to propose a solution on behalf of the profession of counseling. In order to do so, I need to transition from my role as ACA’s Chief Professional Officer to my role as the Administrative Coordinator for 20/20: A Vision for the Future of Counseling.

I know that some of you have been around a while and are familiar with 20/20 and that others are new to licensing boards and may not know much about this initiative. So for those less familiar with 20/20, let me give you some brief background. I know that Barry Mascari will be speaking more about this initiative during his keynote and that is only appropriate, since Barry can be considered the father of 20/20 as it was generated from his doctoral dissertation. 20/20: A Vision for the Future of Counseling is the United Nations of the counseling profession. Co-sponsored by you – AASCB – along with ACA – 20/20 involves all of the organizations that identify themselves as clearly falling within the profession of counseling. There are 31 organizations involved including AASCB, ACA and its divisions and regions, NBCC, CACREP, CORE, CRCC, NRCA, and CSI. I apologize for throwing out all of those initials, but if I gave the full name of the associations we would be here till eleven o’clock. For the past six years, these 31 organizations have worked together and focused on the heady goal of developing a 15 year strategic plan for the counseling profession, hence the play on 20/20 as both having excellent vision and planning for the year 2020. As such, 20/20: A Vision for the Future of Counseling is historic in that it marked the first time that the counseling profession had decided to proactively plan its future rather than simply react to events and challenges as they occurred. As such, 20/20 is a milepost in the maturation of our profession.

To date, 20/20 has had two historic – there is that word again – achievements. The first is the document Principles for Strengthening and Unifying the Profession (also known as the Statement of Principles). The Statement of Principles is the first time that counseling has endorsed core principles that bind all of our specialties and organizations together into one profession. It is also the first time that the organizations that represent counseling have put on paper and endorsed that we are one unified profession.

The second historic achievement is the consensus definition of counseling. Until now, professional counseling has had multiple definitions of what it is that we do – if you look at five “Introduction to Counseling” textbooks you will find eight definitions of counseling. The 20/20 delegates wanted to promulgate a concise definition of counseling that would become the standard for the public and with legislators. The delegates did an outstanding job and the result was a definition endorsed by both the delegates and participating organizations: Counseling is a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals. Now, for the first time in the history of the counseling profession, we have one definition of what it is that we do. We have promoted the 20/20 definition of counseling and are seeing it appear on websites, business cards, syllabi, and in books. We appreciate that at least one licensing board – thank you Arkansas – has agreed to use the new consensus definition of counseling in general public presentations.

Which brings us to the current 20/20 initiative: The Building Blocks to Portability Project. Now that we have a firm foundation with the Statement of Principles and the consensus definition of counseling, the 31 organizations that represent the counseling profession are focusing their efforts on licensure portability. To do this, the delegates are working on developing three things: a consensus license title, a consensus license scope of practice, and consensus licensure education requirements.

How are they doing this? By using a modified Delphi approach – the same approach that we used successfully to construct the consensus definition of counseling. A Delphi is a research methodology that is used to help a number of individuals with different perspectives and thoughts on an issue come to a reasoned and solid decision. So when you have delegates from two and a half dozen organizations trying to agree on one title, one scope of practice, and one set of education requirements, it fits the bill nicely!

The delegates have been divided into three workgroups representing the three building blocks to portability – license title, license scope of practice, and license education requirements. Each group first develops a list of possibilities. They can use data to assist them in exploring the initial options. For example, the scope of practice workgroup has asked for a content analysis of all of your 52 scopes of practice (52 – don’t forget about DC and Puerto Rico). Each workgroup then evaluates and rates all the possibilities within their building block and works with those concepts that float to the top. They combine the most highly rated items and then revaluate and re-rate the new ideas. Rinse and repeat. As they go through these iterations, the best ideas merge and synthesize until one option in each building block is the clear winner.

At that point, the draft title, scope of practice, and education requirements will be circulated to all delegates and a consensus achieved. We usually do the final group evaluation at an in-person meeting at the ACA conference. Essentially, we lock them in a room and say that they can’t leave until they complete final tweaks to the workgroup results. We consider an item to have achieved consensus when at least 90% of the delegates sign off on it. We will then circulate the consensus title, scope of practice, and education requirements to the leadership of the 31 participating organizations and ask for organizational endorsement.

And here is where you come in. Once these building blocks are developed and endorsed by the delegates and participating organizations, we will be able to promote them as our profession’s recommended requirements to counselor licensing boards. Our goal is to persuade every one of you to agree with the profession and to adopt our title, scope of practice, and education requirements. We know that this will not be easy and will obviously take time, but states that do adopt the consensus licensure requirements will have a much easier road to establishing reciprocity – and thus portability – since their requirements will be equivalent.

So I am here to give you a heads up that the counseling profession will be coming out with a consensus license title, scope of practice, and education requirements. And I am also here to request that you work with the profession to implement these building blocks to portability. If our time together this morning has had any impact, then the old excuses about portability won’t apply – that you don’t trust other licensing boards enough to standardize requirements, that you will lose independence or that it is not your problem. It is your problem because the lack of license standardization in the United States is not just creating prisoners out of licensed counselors, it is hurting the public you are sworn to protect.

So please work with us – the counseling profession – to solve the portability crisis through your commitment to the careful consideration of adopting the consensus license title, scope of practice, and education requirements that will come out of the 20/20 Building Blocks to Portability Project.

 

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45 Comments

  1. Melissa Martin

    I agree with this article. In 2009 my WV counselor license expired. In 2012, I wanted to accept employment in WV again, however, the board implemented new rules in 2007. Mental health counselors must complete a university course in Addictions and a course in Family/Marriage Counseling. Because I did not have university coursework which specifically addressed these two areas, my full license was denied (a provisional licensure was issued) through reciprocity as I am licensed in Ohio. I submitted detailed documentation that I had taught a university course in Family/Marriage Counseling for a master’s level counseling program from a CACREP accredited university as an adjunct professor, had 25 years of counseling work experience which included providing family/marriage/couple counseling, and belonged to professional associations in this area. I also submitted detailed documentation that I co-taught a master’s level course in Addictions at a CACREP accredited university, had a hx of being a Licensed Independent Chemical Dependency Counselor (passed exam, oral presentation, and all requirements) in another state, had been a certified AOD Prevention Specialist (passed an exam and requirements), had been a clinical director of two Counseling Recovery Centers that addressed AOD 100%, had presented multiple workshops on addiction issues, and had multiple CEUs in addiction issues. In addition I am ABD completing dissertation. Taking these two courses, Addictions, and Family Counseling will take time away from being a clinician and providing services to clients in rural Appalachia where there is a shortage of counselors. It will cost me approximately $3000. or more depending on where I take the courses, traditional or online. Plus I am required to have supervision during this time which will cost money. I have current supervision status in Ohio and prior to my WV license expiring in 2009, I had supervision status in WV. Needless to say, I wrote an appeal to the WV Counselor Board and asked for a hearing and instead I agreed to attend an informal conference meeting first. Now, I do understand the rationale for mandating that mental health counselors take a course in Addictions and in Family Counseling, however, it needs to be reviewed on a case by case basis for counselors prior to the new 2007 rule changes. Plus when I reviewed rules from several other states, they do not require a mental health counselor to have completed these two courses. An addictions counselor must, of course, have this coursework and a marriage/family counselor must, of course, have this coursework. My question is this: Is there research to support that a counselor is more effective when they have a university course in Addictions and a course in Family Counseling as opposed to other work experiences, CEUs in the same area, teaching the course, and so forth?

    Reply
    1. William H. Middendorf

      It took me 18 MONTHS to finally get my license going from Wyoming to New Mexico. In Wyoming, I had already passed my NCE exam, and had my national license (that is what they call it) from NBCC. The state of New Mexico didn’t recognize my national license, or the difficult to pass NCE exam. I lost thousands of dollars moving to New Mexico because they didn’t recognize my license. (Came from a CACREP approved school in Denver, CO) Now I live the not the LAND OF ENCHANTMENT, BUT THE LAND OF ENTRAPMENT as I will not move to another state and go through this again.

    2. Mary Sinclair, LPC

      The lack of logic regarding the application of these state-by-state rules is simply astounding!

  2. Sandy Betka

    I read your article, “Licensure Reciprocity” on the Counseling Today website. I appreciate your depth of knowledge in this area and I have some thoughts about the the concensus license title, scope of practice and education requirements for the 20/20 Building Blocks to Portability Project.

    First of all, I’m concerned that the portibility requirements for education might be higher than the state I reside in (Wisconsin), because our state has a lower educational standard (42 credits) than many other states. That would leave many professionals (currently practising) in limbo.

    Since most states require professionals to pass a national exam (in Wisconsin, it’s the NCE which is based on CACREP standards), I think that a standardized national exam should be the focus of license portibility, rather than focusing on educational requirements.

    If the committee looked at the required exam for licensure in each state (rather than than education and supervision requirements), they would find more commonality between state licensure and a foundation to build portability, that doesn’t exclude current practising professionals.

    Reply
  3. Laurie Cannon BS Psych.

    I am beginning my graduate studies at Grand Canyon University and I am very concerned as I now realize, I too will be “held captive”, the mere thought of relocating over time sounds like a nightmare I prefer to avoid. I will have to decide soon which state to reside and practice in for my remaining days: Moving will no longer be an option after gaining my license and I enjoyed experiencing different locations in the past. I thank you for sharing; what a mess, accreditation, state and title differences; only G-d knows where and what will become of me! Any advice would be greatly appreciated, I currently reside in Pennsylvania.

    Reply
    1. Janice Lebron

      Julie, I am an LPC in VA, and I couldn’t agree with you more. The thing that kills me is that LCSW’s have more opportunities, and less education. Their practicuum is substantially shorter! You would think that we are more valued, as we are more specialized…NOT! The whole portability thing is a mess! I definitely feel trapped in VA. I refuse to go all through the examination and supervision all over again. it’s an unnecessary expense. It’s just to right!

  4. Karl Lehn

    Prior to reading this article I had the idea that why the DOD will not accept Counselors as independent practitioners had to do with professional identity.
    LMFT’s are LMFT’s no matter what state they are in. So are Social Workers with a few exceptions. I cannot speak as to the psychologists.
    What I can tell you is that even with a concentration in Marriage and Family Therapy as an LPC I am restricted as to job opportunities within FedGov. Yet FedGov hires LMFT’s and considers them equivalent to counseling psychologists. I planned to move next door to Mississippi but am afraid to.
    We have problems with insurance acceptance also.
    We must address this with our state boards and politicians.

    Reply
  5. Jane

    As a long time mental health consumer, I strongly support the requirement and need for licensure. While I agree that mental health professionals have their challenges, loosening the reins on professional requirements is not the answer. Without requiring strict, enforceable and consistent rules from state to state consumers like myself are left with no recourse when something goes wrong. As a person who suffered great damage at the hands of an unethical, incompetent, therapist who was unlicensed. I know all to well that without a license a person is free to do whatever they want. The “professional” organizations need to do a better job of policing your own people. In my opinion the field is flooded with a bunch of people who are trying to work through their own family of origin issues at the expense of their paying clients. My life was forever alter as a result of my negative experience and she never experienced any repercussions. I don’t think many of the “professionals” in this field realize the impact and influence they have over people’s lives. It is imperative to have some control over the field which today it’s basically the wild, wild west.

    Reply
    1. Karl Lehn

      Hi Jane, I agree with you about licensing and you should know that every state now requires licensing for counselors, marriage and family therapists, clinical social workers and psychologists.

      I can tell you that we all are very aware of the impact we have on peoples lives. I am sorry you had a bad experience. The only unlicensed professionals you may see are interns who are under the supervision of a licensed professional who is qualified by their state board to supervise interns. The requiremments to do that are stringent as are the requirements for professional licensing..

      As pertains to state to state portability, I hope for a future where we are all required to meet the same requirements in each state so we can be free to move around.

    2. Jane

      Yes, MOST but not all states require a license to provide mental health services. However clever, greedy, unethical “professionals” can easily get around those rules by changing what they call themselves. In my case the therapist called herself a “life Coach”. Life Coaching is big business in the state where I live and as you know there is no regulations governing it. She was not practicing in the capacity of a life coach she was practicing in the capacity of an unlicensed therapist. The state licensing board found in my favor, and ordered her to pay $250, only if she wanted to apply for her license and only if she remained in this state. She did neither. You’ll excuse me if I’m not in favor of being more lenient with the already loose mental health professional practicing requirement. In my opinion the governing organization does nothing to police it’s own members. It’s actually more cost effective for a mental health professional NOT to have a license than to have one. A state board can’t take something away if they never had it to begin with.

  6. Jennifer Mally

    Hello Mr. Kaplan,

    First, your article is spot on and very much appreciated given the state of LCPC’s inability to have portability between states. I earned my degree and license in Illinois and due to wanting other opportunities, have tried to obtain CA, OR, and now MD licensure. It has been absolute hell, not to mention very expensive. Do you know if anything has improved, or is on its way to being approved anytime soon?

    Thanks,
    Jen

    Reply
    1. Melody

      Hi Jen! I am only in my graduate program at the moment, but know that I will be moving upon completion (after graduation, but before I accrue any supervision hours). You say that it was Hell, which is totally understandable from what I’ve read! However, were you successful in eventually acquiring your licenses in these states? I know that it’s going to be a huge pain, but I just want to know if it was even possible. Apologies for bringing up a post from months ago, but I’m rather curious. Thanks!

  7. megan

    This is the second time in a few years that I have read this article and it resonates just as much today as it did the first time I read it. I am originally from southern California but moved to Chicago for graduate school. When I was 21 years old I didn’t think about licensing or state reciprocity. I just knew I wanted to be a counselor and Columbia College Chicago had a very specialized program that I wanted to attend.

    After graduation I found a job in Illinois and started working towards licensure here. It was fine for a while but there were times when I missed sunny southern California. When I started to have second thoughts about staying in Illinois and began researching what it would take to return to California with my current education and experience, I had to take that option off the table. It was clear that it would not be financially possible and that the time it would take to earn a new license in my home state would be unreasonable.

    I am emotionally over that but even now that I am settled into life in northern Illinois I continue to run into the reciprocity problem. You see, I am literally 20 minutes south of the Ill/Wis border and have seen many promising job postings for counselors in Wisconsin. However, as you can imagine, the education and supervised hour requirements in Wisconsin are much different than in Illinois. This has reduced my options for employment significantly. I have been forced to pretend that the hospitals, group practices, and other mental health organizations that are a mere 30 or 40 minute commute to the north of my home don’t exist.

    Fortunately I currently have a job that I enjoy in a lovely organization close to home…in Illinois. But in the future I do hope that the government will consider a nationwide certification process so that people will not be prisoners of their own states. Hard working people should be free to move around and make choices for their lives based on whatever they feel is most important to them. The lack of licensure reciprocity between states makes freedom of choice that much more difficult and it serves no real purpose. The mental health problems in Los Angeles aren’t that different from the mental health problems in Chicago, New York, Dallas, or any other major city in this country. I’d even go so far as to say that there are bigger differences in populations within states if you compare a major city to a rural town than if you compare two cities or two rural towns in neighboring states. But I digress.

    Thanks for the article and thanks for letting me vent!

    Reply
    1. megan

      Correction, I stated “2nd time I’ve read this article in a few years” I meant to say “a few months”. Pardon me.

  8. Karl Lehn

    @Jane, I’m sorry to not have answered you sooner. I totally agree that the requirements for mental health professionals must not be loosened. Quite the reverse, I think standardization to a nationwide licensing requirement much like LCSW’s and and psychologists have would serve LPC’s and LMFT’s better in that we would be viewed more as the professionals we really are. One state requires 4,500 hours of supervision? To my knowledge no clinical psychologist has to meet that sort of requirement. But I do agree we should model out licensing and supervision the same in every state and jurisdiction. And perhaps since they are much more esteemed, we should meet the same requirements as clinical or counseling psychologists, (My peers are going to groan when they read that!)
    Also, life coaches are NOT mental health professionals. Many do attend universities to study counseling but many only have a high school diploma and go through a “certification process.” The life coach’s focus is not on mental health and the techniques they use are supposed to be different.
    To my understanding there is no licensing board for counselors, social workers or marriage and family therapists that condones the practice of “coaching. I cannot speak to the psychologists point of view. The National Board of Certified Counselors does offer coach training for counselors but that is a skill set designed to be used within the confines of our licenses as therapists.
    I had to complete 3000 hours of supervision to qualify for my license after completing the National Counselors Exam and after completing a 60 hour course of study that also included one practicum and two internships before graduating. My schools curriculum was rigorous and is well respected in my home state. During my internship(supervision) employment chances were limited but were well suited for me to gain experience. That experience coupled with the supervision I received from my supervisor prepared me for independent practice.
    I would advise anyone who is seeking a therapist to check on the state boards website where you can find degreed licensed professionals or degreed professionals under supervision who can treat or help address their specific problems.

    However, as the main point of this really concerned standardization of licensure requirements I have to agree with all that the same requirements for licensing will help us with portability.

    I would also like to mention 2 points that I find important: 1. Clinical psychologists are allowed to be licensed in more than one state, as are doctors, nurses, physical therapists an a few other professional disciplines. @. I within the last six months was told by a licensed clinical psychologist that he/she could not do therapy. I asked why to learn that the program this psychologist graduated from concentrated on testing and measurements. That’s what psychologists did to begin with until Freud advocated for them to use talk therapy. Also, in one of my texts( no I am not citing, the book is buried somewhere) that there was no difference in outcomes from therapy conducted by psychologists, clinical social workers, professional counselors and marriage and family therapists. Life coaches are NOT included in that esteemed group.

    Reply
    1. Bonnie

      Karl,
      “One state requires 4,500 hours of supervision? To my knowledge no clinical psychologist has to meet that sort of requirement.”
      I am a clinical psychologist. To be licenced, I had to complete practicum (4 years, excess of 4000 hours), Internship (2000 hours), and a post-doc (2000 hours). I and my colleagues are well over the 4,500 hours of supervised experience that you describe as the max for counselors.

    2. Karl

      Bonnie, I hear you but I cannot believe its that stringent everywhere you psychologists. Also you have to factor in that psychologists not only learn treatment but are heavily exposed to research.
      I have to add that one of my friends who is a clinical psychologist and prescribes meds told me she does not know how to do therapy in any form. This PhD from an established university said her curriculum was mainly testing and research. Counselors on the other hand are not researchers and treatment modalities are stressed.
      All I am really saying is that in my profession there has to be some standardization of training and internship requirements for counselors as well as an established identity. All counselors should have the same name whether its LPC, LCPC, LMHC or whatever. That is something that psychologists and social workers enjoy.

    3. Jane

      While I can appreciate the fact that many of you are in a difficult situation. The difference is, it is your livelihood not your life…not your well being. Each person comes on to this board and complains about the difficulties they are facing as a result of a career choice. Me I came here because I was a consumer of this broken mental health system. This system that allowed someone to forever change my outlook on life and trusting people. This system that didn’t have enough respect for me to give her a meaningful punishment. No one is asking the question what is the real purpose of the license and what happens if you don’t have one. In my book laws are enforced by the police and the court system not by a professional board. If a state says you are required to have a license to practice mental health and you are found to not have one then you should go to court/jail. Instead the board is only concerned with keeping up appearances not with actually doing anything.

  9. Melissa Martin

    Has any counselor considered suing a state counseling licensing board when they deny a license because the board added certain college courses that must taken beyond what the actual university counseling programs require and beyond what CACREP requires? Do these boards have too much power? Who are the boards accountable to?

    Reply
    1. Mary S

      I don’t know if any lawsuits have transpired, but as someone who is seeking licensure in the state of Massachusetts, I might have to resort to that. I cannot even an answer to a simple yes-or-no question, as to whether or not my supervision under an LPC meets their definition of a “supervisor.” I can’t live there if I can’t work there, and I can’t work there without my license. I should add, I have met all the education requirements, passed BOTH the NCE and NCMHCE, am already an LPC and an LMHC. So it seems odd that the contacts from the board there are so protectionist of information that they won’t even provide it. I shouldn’t have to spend the money on an application to get an answer to this ONE question. Next step, sending a letter to the governor of the state to complain.

  10. Julie B

    Thank you! All of my support to prevent others from immense suffering as so many of us have. I have spent the last 12 yrs of my life and $100,000 devoted to attaining my LPC ( BA, MA, then practice with supervision). Just as I finally made it, I needed to move out of state for unforeseen reasons beyond my control. When I checked into to getting my new state’s license- there is no reciprocity!! If I actually can even wrap my head around starting again I would need to do my supervision all over again and it can be no sooner than 5 yrs from now to complete it! It feels for now as if this dream career and all that time, money(debt), and work is useless! Not ok!

    Reply
  11. Julie B

    One more thought…Since my recent unfortunate situation which I posted above, I have considered applying for the National Certified Counselor (NCC) certification by the NBCC (the same organization that offers the nationally well-recognized NCE). In my opinion, it seems to require reasonably high standards as compared to the state certifications I’ve seen. I’m not certain of its recognition across the board (no pun intended), especially because I don’t see it mentioned above at all (forgive me if I am wrong). To me, since the NBCC accreditation has already been developed and it’s backed with such an already respected organization in the field, it should be considered as an option for this needed national unification, yes?

    Reply
  12. Heidi Hughart

    I too agree that there needs to be some way to uniform requirements for all Masters level clinicians. I am having difficulty getting my first clinician posiiton because I don’t have experience. (Why my internship doesn’t count is beyond me) It galls me to see all of the job opennings in my area with the requirement of licensure and/or two years experience. If I had the experience I would have my license, right? I graudated with a 4.0 from an accreditted program and have the NCC credential. I have heard of individuals paying for supervision and starting their own practice with self pay clients to obtain their needed 3,000 hours. Why is this considered taboo? What else are we supposed to do to get our direct contact hours?

    Reply
    1. Mary S

      I did foster care case management. Yes, it was two years of hell, but I finished my supervision quickly.

  13. Sherri

    Mr. Kaplan,

    Thank you for addressing this license portability issue. Obviously, it has affected the professional careers of many in the field. As a counseling grad student, I am concerned as well. As the end of the year is approaching, I am wondering what developments have been made with the 20/20 Building Blocks to Portability Project? Could you provide an update?

    Thank you,

    Sherri

    Reply
  14. Jeff

    Thank you, David, for addressing this issue. I have experienced difficulties transferring my Illinois LCPC license to Louisiana. I grew up in Louisiana and after graduating from LSUS I moved to Chicago and attended Roosevelt University’s Clinical Professional Psychology program. This was in 2004, and I never considered the implications of licensure reciprocity when I enrolled. After completing all the requirements and receiving the LCPC in Illinois I decided to move back to my home state. I wanted to be close to my family and help the rebuilding still going on in New Orleans today. Louisiana has a shortage of mental health professionals, especially those who have extensive experience working with the homeless population. In Louisiana law you cannot apply for LPC unless you are a resident of the state. I read the code, did my homework, and thought that I would be eligible to transfer the license. So I saved up, quit my job and relocated… just for the opportunity to apply for a license transfer. Unfortunately, the Louisiana board will not approve my license. My rejection has to do with the fact that my degree was not CACREP even though I meet the educational requirements listed for nonCACREP applicants in the code. Now I’m left in a position to leave the career path I’ve spent the past 10 years and 80K following or leave the state that I grew up in and love. Without a doubt this is the biggest threat to the profession of counseling.

    Reply
    1. Jane

      Sandra, I would tell you to consider going into a different field. The Mental Health industry is broken. It is the wild, wild west. There are other more meaningful ways you can impact a person’s life other than being a counselor.

  15. Wayne

    I am licensed in PA and have been battling NJ to attain my license. I am a Doctorial canidate, have over 25yr exp, and my own private practice. That being said is not enough to qualify as a LPC in the state of NJ. What type of insanity is this! Maybe NJ needs to find a therapist to treat their board.

    Reply
  16. Karl

    Also Bonnie, psychologists are able to have multi state licensing. We cant, there is a residency requirement.

    Reply
  17. Melanie

    David, I really appreciate this article outlining so clearly why so much confusion exists in our profession. I am currently licensed in NY and seeking licensure in Florida, but have been told I am deficient in three content areas. I have submitted course syllabi in two of the three areas and hope this will satisfy at least two of them, but even having to take just one more graduate level course is expensive and delays employment for me. It took me so long to obtain my license in NY including more coursework and an additional exam. I am continuing to go back and forth with the Florida Board, but it’s all getting very exhausting quickly.

    Do we have any current update on the status of national standards being adopted? It is my understanding that legislation involving CACREP was adopted by approximately 27 states in the fall of 2013. I have seen a CACREP policy position on licensure portability which assures existing licensed counselors they will not be penalized by this, but that seems to not be the case. CACREP’s website is not very clear about this either and I’ve devoted so much time into researching this along with my more-than-full-time job.

    Thanks for any information you can provide.

    Reply
    1. Jane

      Here my question. What happens when a person is not licensed? Everyone posting to this forum is coming at this from the perspective of “I want to have employment options in this field” great awesome. No one is addressing the reason WHY there is confusion. The entire licensing system is a joke, there is no checks and balances there is no true protection for anyone involved (the therapist or the client) Each state wants to generate revenue and maintain their current level of professionals. The system is so broken they can’t even agree on national wide standards. How is it that colleges and other sources are not informing new professionals of this career obstacle? How is that SO MANY professionals are unaware of the challenges related to transferring their license? Why has this policy been allowed to continue?

  18. colleen

    In Dec. of 2012 I received my provisional license for mental health counseling after asking my care coordination supervisor if she would be able to supervise me for my hours. I have 40 clients, which is high for care coordination (at times it is more). My supervisor had never supervised someone for LMHC-P hrs before and I was under the assumption I would be able to receive all my 3,000 hrs in my position where the nature of the position often counseling is a part of the job (I have been asked by co concurring counselors of my clients to give them tips as they do not how to do counseling for my clients for their mental health care, I was shocked that I had clients that were not getting their mental health care in co concurring, only their substance abuse counseling…and they were not allowed to seek out a licensed mental health counselor due to they were in a co-concurring clinic…often I had clients that leaned on me to listen to them, go over coping skills, educate them on their diagnosis, basically counsel them due to I would be asked by the co-concurring (casac) counselor for tips!!! or their supervisor would ask me to give them tips, or my supervisor for my licensure hrs would say during supervision that I will just have to work with them by way of basically counseling them…I had put in for a position in my agency that required at least a LMHC-Permit and a masters degree in my field (mental health counseling) for the mental health counseling position that was under OMH here in WNY (actually was same job I did during my internship for 18 months in the agency so I was excited hoping I would get the job….two weeks went by and I asked about the position, called the program director, she told me that someone with years as a LMHC in the agency took the position and just moving from a differ site, I understood and time went on…after 3 weeks I found out that the person that got the position that required the right credentials and a masters degree…was just with her associates degree and was not qualified for the position, I asked the program director about why she lied to me about who got the position, and that this person was not eligible for the position she was given, the program director said she was “grooming” the young lady. I was shocked, totally shocked..I called the OMH, they said that there was definitely something unethical here and to fill out the forms they would send and there would be an investigation…well I am an older mother with 3 teens to raise and in my agency often employees are walked out the door and we never find out why, and I did not care to be one of them so I have not completed the forms yet….the discussed program director is very very good friends with the supervisor of my licensure hours….before I knew it my supervisor told me that she decided she will only sign for 1,500 hrs, not the 3,000 she stated she would…In Dec 2014 I would have had my permit for 2 yrs, was ready to take the licensure exam in Sept…due to I have almost the 3,000 hrs…needed. She said I am not suppose to do any counseling, so she changed her tune….she knew about me addressing the position I did not get and that the person who got it was not eligible…she stood up at her desk and said “I hope you do not plan to get anyone in trouble!” referring to the program director that gave the position to the person who was not eligible with both knowing this and that I found out….so with her having supervised me all this time, then I am 1 1/2 yrs in with my hours, she tells me she decided she will only sign for 1,500…which basically has been devastating as I do not have the time to get 1,500 now. I sadly will need to put my permit on hold and look for a differ job….this has been very painful emotionally…my dream of being a licensed mental health counselor is being crushed…can you give me any helpful information on what to do, I would be very grateful, thank you
    colleen

    Reply
    1. Jane

      Colleen,
      I found your post to be very interesting. You without even realizing it have beautifully highlighted just how broken this system is. You are working in a position without the proper supervision, surrounded by people who are unethical, lacking in skill and yet THAT is not your concern. Your concern is for yourself and your career not for the clients who are being mishandled. For years now I have been posting to this forum and I am continually surprised by the sheer lack of respect and regard for the client. To all of you the client is an after thought, a means to an end a revenue stream. Each an every one of you have complained about the rules as a bother a nuisance an obstacle to your earning a living not one person has commented or even thought about the client and what happens when something goes wrong. Trust me it happens, more often than people know because clients have no recourse, or credibility so nothing is ever done.

    2. Mary S

      I think Jane is off the mark here. OF COURSE you’re concerned about your career. You have invested time, dedication, sacrifice, and money to get where you are, and to get the shaft at this point is reprehensible. Jane, with all due respect, it doesn’t have to be one or the other, the client’s well-being vs. a person’s career. That is a false dichotomy and a logical fallacy. I suppose you’d like all to commiserate on how this harms people, but the fact is, this is a discussion about career issues, NOT a discussion about clients, no matter how much you’d like people to apologize to you for what happened to you (I read your other comments). Your anger and concern, in THIS forum, is simply misplaced and misguided.

  19. Mary S

    I’m living this nightmare right now. I’m an LPC in MO, seeking licensure as an LMHC in FL and MA. Sure. I don’t mind taking the continuing ed classes that FL requires (about 20 hours), nor the 3-hour graduate level course in Substance abuse even though I never wish to work with drug addicts. FL is not the problem– the people on the licensing board have been responsive and prompt. The problem is MASSACHUSETTS. I cannot even get the ANSWER to the question of whether or not an LPC fits their definition of “supervisor,” as it relates to supervision. Today, I finally faxed the question to the supervisor of the witch who refuses to answer this question. But of course, this witch will see the fax before her supervisor does. Why is a question with a yes-or-no answer so hard to get answered??

    Reply
  20. Jazzy

    I am licensed in Massachusetts as a Licensed Mental Health Counselor (LMHC); worked in the field since 2004 culminating to being a clinical supervisor, clinical director and a having a small private practice. Approximately 6 months ago I relocated in the Midwest where, to my surprise, I won’t be able to reciprocate my license. There board’s issue include having social workers as supervisors for my post-masters work experience. In Massachusetts just having a master’s degree in counseling is enough to get you employed, here in the midwest, every job I looked into requires a State licenser. I have all this experience and education under my belt that I can’t use because of some ridiculous bureaucratic rule. It is not an option for me to go back home to Boston, and now I have to give up a profession I love to pursue something else. I am really angry about the byzantine and bureaucratic nature of how most mental health licensing board operate and they seem to wield unchecked dictatorial power. If they tell you, you can’t get licensed, there is not much you can do, I don’t have the money to hire a legal firm to fight a board, neither do most therapist.

    I am ambivalent to call myself a coach, as some people do, and practice psychotherapy. It is very sad that people have to think about coaching to get around licensure because of cumbersome and arbitrary nature of the counseling regulation. Most of us get into the field to make a difference in the lives of people who maybe suffering from behavioral or mental illness, the profession is really the ghetto of medicine, poorly funded and respected, despite all this hoopla about mental health parity and mental health public awareness. It is a profession dominated by female hence perhaps why the pay is appalling, in many cases just above the minimum wage. I mention female dominated profession to suggest a clear discrimination based on gender, as this was true of teachers and nurses before they unionized. Counseling is hardly a profession people choose to get rich. My colleague accepted a competitive position paying 30K a year which required not only licensure, but 5 years post licensure experience. You could make the same amount working in a fast food restaurant with a high school diploma. People pay lip service to the importance of mental health, but as the saying goes the proof is in the pudding. The system just discourages a lot of good therapist. I don’t want to be too negative but my 10 years experience in the field has left me disillusioned, and now when you add the licensing issue, it is just sounds too ridiculous.

    Some people have mentioned about looking after the welfare of the clients. Most of us know from experience that if the mental health system cares about the clients, the mental health system would address numerous critical issues which help to substantially improve mental health service.. A well compensated therapist and well trained therapist means better service to clients. I have worked in clinics where the fee-for-service model practically dragged the quality of service down, as therapist come and go, and clients get assigned to different therapist every few weeks. These clinics did not have the money, or want to reduce expense, or are badly managed that therapist only get paid when clients show up. I have worked in clinics where the show up rate of clients were around 50 per cent; in a typical day, you may schedule 10 people and you are lucky if 5 show up. If you do the math, this is below the minimum wage not to mention as a fee-for-service clinician, you don’t have any other benefits like health issuance, 401 K etc. Often therapist take a full time position and work fee-for-service on the side. I often think the system is designed to fail; most counselors are busy trying to help their clients that we don’t have highly experienced and funded lobbying group to bring the much needed change in the profession. I think all we need is one licensure that enable you to work all over the country; one type of license means the public does not have to remember and sift though all these mind boggling acronyms to figure out what is what. I know what the acronym of my licensure stands for but don’t have any idea about the comparable licensure in other states – not to mention a two trier or three tier licensure tracks in some states.

    Reply
    1. Mary Sinclair, LPC

      Even people on licensure boards in the various states do not understand the different acronyms — I spoke to a woman in Massachusetts, who didn’t know what an LPC was, even though right next door in CT counselors are LPCs!

  21. John Burik, LPCC-S (Ohio)

    Thank you, David, for a well thought and articulated address. I does NOT address the de facto CACREP exclusivity that CACREP (understandably) and ACA (at least tacitly) support. My masters plus the post-grad year I took for clinical certification meet the CACREP standards without the imprimatur. Certainly, graduation from a CACREP accredited program might serve as prima facie evidence of an acceptable level of training. There needs to be alternate pathways, including the opportunity to remediate any deficiencies in one’s transcript. Appropriate and deserved recognition of ALL its members should be ACA’s number one priority.

    Reply

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