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Creating a common language

Jonathan Rollins July 1, 2012

During the long march to obtain licensure status for counselors in each of the 50 states plus the District of Columbia and major U.S. territories — beginning with Virginia in 1976 and ending with California in 2009 — the profession as a whole rightfully celebrated each individual victory.

“Unfortunately,” points out American Counseling Association President Bradley T. Erford, “the unintended consequence of this success is that we now have 50-plus different licensure laws, and if you want to move your practice from one state to another because you or your partner were transferred, you have to meet the qualifications for that new jurisdiction. Sometimes, the qualifications are very different. Sometimes, there are qualifications that came after the time when you received your education and training, so you do not qualify without meeting new standards. It is extremely frustrating to be deemed ‘qualified’ in one state and practice for a number of years and then move, only to be deemed ‘not qualified’ by another state. I am licensed in three states, and the hoops I had to jump through were somewhat different in each jurisdiction.”

The long-standing and knotty problem of license portability is precisely what delegates to 20/20: A Vision for the Future of Counseling are working to resolve. The delegates, representing 31 diverse counseling organizations, have been tasked with three objectives as part of the Building Blocks to Portability Project: to reach consensus on a common licensure title for counselors, to reach consensus on a licensure scope of practice for counselors and to reach consensus on licensure education requirements for counselors.

“The goal of the 20/20 Building Blocks [project] is to agree on a model for training, education and scope of practice so that jurisdictions can standardize their requirements and promote portability of licensure across states. If we had the foresight to construct this standardized process 30 years ago, perhaps we would not have thousands of frustrated counselors annually trying to reestablish a licensed practice in another state or territory,” says Erford, who was the Association for Assessment in Counseling and Education’s delegate to 20/20 before joining the 20/20 Oversight Committee, first in his role as ACA president-elect and now as ACA president.

At the ACA Annual Conference in San Francisco this past March, the 20/20 delegates reached consensus on “Licensed Professional Counselor” as the designated licensure title. They also endorsed the concept that having a single education accrediting body would be a clear benefit for the counseling profession. Finally, the delegates decided that the two 20/20 work groups focused on counselor education requirements and counselor scope of practice should develop their respective recommendations by mid-September so the 20/20 delegation as a whole can reach consensus on these two areas at the 2013 ACA Annual Conference in Cincinnati.

In March 2010, before turning its attention to the Building Blocks to Portability Project, the 20/20 delegates reached consensus on a unified definition of counseling as a professional relationship that empowers diverse individuals, families and groups to accomplish mental health, wellness, education and career goals.

Burt Bertram, who headed up the 20/20 work group that recommended LPC as the consensus licensure title for counselors, sees commonality in much of the work the 20/20 delegation has engaged in since its inception in 2006. “So much of what we’re doing throughout this whole process revolves around the issue of naming things so we can communicate and talk about them,” says Bertram, the Association for Specialists in Group Work’s delegate to 20/20. “In some ways, ‘things’ don’t really exist until they are named. … When the name of something is understood and accepted, the thing becomes more real, and there is less likelihood of confusing the named thing with other similar things.”

Perry C. Francis, who is leading the scope of practice work group, has a similar view concerning the work of 20/20. “We as a profession have struggled with defining counseling and what counselors can and cannot do for decades,” says Francis, the American College Counseling Association’s delegate to 20/20. “That is a reflection of the many different types of counseling specialties that make up the profession — school, clinical, college, etc. Each has a unique way of applying counseling to their population or setting. Creating a common language will help unite these specialties under the banner of ‘professional counselor.’”

Licensure title

Recommending LPC as the consensus licensure title to the overall 20/20 delegation wasn’t a difficult decision, according to Bertram. “There really wasn’t much debate [within the licensure title work group]. It seemed like the obvious choice,” he says.

In deciding which licensure title to recommend, the work group weighed several factors, including:

  • How easy the title would be for the public to grasp
  • Whether the title would offer a “pathway” for all counselors
  • Whether the title aligned with the previously established consensus definition of counseling
  • How consistent the title was with terms already in use in jurisdictions across the United States
  • How well the title distinguished “professional” counselors from other groups using counselor in their names (such as funeral counselors, financial counselors, camp counselors and so on)

Bertram says the title LPC is already in use in 32 states. “If our goal is to get all 50 states … to come around to one term, this made the most sense,” Bertram says.

In addition to already possessing “name recognition,” LPC owns an advantage because the terminology isn’t inherently limiting, Bertram says. “When you put something in front of the word counselor — for example, clinical mental health counselor — that narrows it,” he says.

The counseling profession has confronted a long-standing identity struggle in part because many counselors identify themselves by a specialty title rather than by a title that presents their core identity as a counselor, Bertram says. LPC should readily communicate that core identity. “The importance of the title is that it reduces confusion and increases understanding,” he says.

At the same time, the licensure title work group also recommended that an ability to recognize specialties be included for counselors, similar to physician licensing laws.

The 20/20 delegates voted 22-2 in favor of adopting LPC as the consensus licensure title.

Erford views this as a very important step. “Across the 50-plus jurisdictions, counselors have 40-plus titles. Think about it,” he says. “If we cannot even decide what to call ourselves, how can we expect U.S. citizens to know who we are and what we do? Calling ourselves licensed professional counselors and promoting a unified role and definition of counseling help protect the public from those unlicensed individuals who would harm the public and set our profession and professionals back in the process. When legislators in every state find out that every major counseling organization in the United States supports the title LPC, and then adopts that title, we are one step closer to a unified profession.”

Licensure education requirements

The 20/20 delegates did not vote on consensus licensure education requirements in San Francisco, but they did endorse their preference for having a single educational accrediting body (by a vote of 20-1, with three abstentions).

“Except for counseling, all mental health professions have a single accrediting body,” Erford points out. “They decided this issue long ago, and their professions are unified and powerful as a result. Having a single accrediting body sends a strong message to universities, and when governmental entities recognize an accrediting body, the profession becomes more unified and powerful. … It is crucial that we adopt standardized professional accreditation standards under a single accrediting body so that we can move forward as one profession with a single voice and huge influence.”

Currently, there are two accrediting bodies participating in the 20/20 initiative — the Council for Accreditation of Counseling and Related Educational Programs (CACREP) and the Council on Rehabilitation Education (CORE). Several people involved with the 20/20 initiative have indicated their hope that the two organizations, which explored the possibility of a merger several years ago, will unify in some fashion.

“To achieve licensure portability for the counseling profession, it is imperative that the criteria for licensure become comparable across the states. The profession does not currently have this,” says Carol Bobby, president and CEO of CACREP and chair of the licensure education requirements work group for 20/20. “What we have instead is 50 different states with 50 different sets of educational and supervised practice requirements. Some states require only a master’s degree, while others specify the number of graduate hours in the degree program. And these numbers can range from 42 to 60. Thus, students who graduate from 48-hours states will likely find themselves at a disadvantage, needing to go back to graduate school to gather more hours when they move to a state that requires a minimum of 60 graduate hours. … It gets more complicated than just hours, though, because some states list specific courses that must be included in the degree, and the lists of required courses can also vary from state to state.”

Bobby points out that when the Institute of Medicine (IOM) conducted research to determine whether counselors should be recommended to work as independent providers in the TRICARE health system, it raised concerns, saying there was “substantial variability among the states in training programs and requirements for licensure as a counselor.” IOM also noted that only some counselor education programs were accredited by CACREP and that in some states, a counseling license could be obtained with a postgraduate degree in a field other than counseling.

“One of the primary reasons that the IOM included graduation from a CACREP-accredited [mental health counseling] program in its final recommendations to Congress was to ensure consistency in the educational preparation of counselors hired within the TRICARE system,” Bobby says. “The IOM report indicated that they could not guarantee this level of consistency through acceptance of the use of the LPC status only.

“It is difficult for the counseling profession to gain the respect of our external publics with such variability in what it means to be a counselor, since the profession has offered so many pathways to becoming a counselor. Other professions, such as architecture, engineering and physical therapy, have one pathway to getting licensed, and that pathway is through graduation from an accredited program. This allows for the public to know what has been required in the licensee’s curriculum and supervised practice. This also allows for greater comparability of state licenses, and thus allows for greater mobility of professionals.”

Linda Shaw, CORE’s delegate to the 20/20 initiative, says she understands the sentiment behind endorsing a single educational accrediting body. She is concerned, however, about rehabilitation counselors’ ability to get licensed if the 20/20 delegates ultimately recommend CACREP accreditation as the sole educational criterion accepted by licensure boards, particularly if CACREP and CORE do not end up merging in some fashion.

“Counseling has always been a critically important part of our identity,” Shaw says. “We label ourselves as ‘rehabilitation counselors,’ our accreditation and certification standards strongly emphasize counseling, and every roles and functions study ever conducted identifies counseling as being a central role of rehabilitation counselors. The American Rehabilitation Counseling Association has been a division of ACA since 1958. … We, too, seek to secure for the counseling profession a strong, unified identity and to advance the profession. While the specialization of rehabilitation counseling has different accreditation and certification organizations, the primary reason is that CORE and CRCC (Commission on Rehabilitation Counselor Certification) actually predate CACREP and NBCC (National Board for Certified Counselors), not because we see ourselves as being so different from other counselors that we must have different organizations. It was our very ‘sameness’ that led to the merger talks [with CACREP]. It would be a grave disservice to rehabilitation counselors and to individuals with disabilities who may need to access the services of rehabilitation counselors to exclude them from the credentialing process. As counselors, we value inclusion and we value the similarities that bind us together, as well as respecting the things that make us unique. I have confidence that these values will continue to guide us as we work together to create building blocks that will serve the best interests of the profession and of the individuals we serve.”

Licensure scope of practice

The scope of practice work group is reviewing a content analysis of all counselor scopes of practice across all 50 states. As is the case with licensure titles and licensure education requirements, scopes of practice vary from state to state.

“Simply put, licensure laws, which generally contain the scope of practice, are governed by each state, and each state has different politics and constituencies that seek to influence what those laws [include],” Francis says. “Some constituencies are supportive of our field, while others seek to restrict what counselors can do based on ignorance about our profession or hoping to limit competition for the ever-shrinking mental health dollar.”

The work group conducted a frequency analysis of the words used in the different scopes of practice to define the tasks that counselors are allowed to do, Francis says. “This gives us an understanding of the common tasks we are allowed to do and increases our awareness of the tasks we are not allowed to do but are trained to do, such as administer different types of assessments and inventories.”

“We will look at the tasks that are common across the board and seek to standardize the language and definitions used to create a scope of practice,” he continues. “Additionally, we will compare the laws to our education and abilities to identify those areas of practice that we may be denied, even though we have the skills and training to accomplish those tasks. Once we have that information, we can then create a scope of practice statement that will reinforce not only what we are already doing, but also expand into areas that we are capable of doing.”

“The scope of practice issue also signals insurance companies that professional counselors are equally competent as our cousins in the other mental health fields,” Francis adds.

Maturing of the profession

“The 20/20 Building Blocks initiative is all about developing a standardized process for title, educational requirements and scope of practice that will allow professional counselors to move across a state line and continue a professional practice and livelihood, just like medical doctors, psychologists and social workers do every day,” Erford says. “This process reflects the maturing of the profession of counseling. It also reflects the importance of vision and forethought as the counseling profession continues its forward momentum. We have to visualize where we want to end up, and then plan an efficient path to get there. Otherwise, we will be cast about by capricious winds and chaotic, tumultuous times. If we cannot explain to the public and our legislators who we are, how we were educated and trained, and what we can do — all in a unified voice — then how can we expect the public and our legislators to embrace the counseling profession?”

Jonathan Rollins is editor-in-chief of Counseling Today. Contact him at jrollins@counseling.org.

2 Comments

  1. R. Manion

    I appreciate the efforts made by the committee for unification of the profession. So often I run into confusion from the public about what a LPC does as well as the belief that they can get the same services from people that are not certified to help. It is frustrating.

    Reply
  2. Amy

    I disagree that CACREP is the only governing body from which Licensed Counselors should come from. The Master’s in Psychology and Counseling Accreditation Council is another highly respectable agency and there are many other programs who follow CAMPP guidelines which are quite rigorous. The push for CACREP seems highly political and unfairly chosen since only 13 percent of Licensed Counselors across the nation have graduated from a CACREP program. If only CACREP grads were utilized there would be an even greater shortage of mental health practitioners than what we currently are experiencing, further it would effectively push thousands if not millions of highly qualified professionals out of their chosen careers.

    Reply

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