[This is the first of a three-part post
on finding clinical supervision in Hawaii.]
On Friday, October 29, 2010, in response one of my posts on clinical supervision, I received an email from a frustrated
counselor in training in Hawaii named Shari. Here is what she said:
While I respect your description of what YOU do as a supervisor, I do not see that at all in Hawaii. First off, there are NO requirements for supervisors, not even length of time in practice, let alone training. There is also no allowance for pre license grads going into private practice (unless they can find all cash clients who are willing to pay for counseling from someone who is not allowed to say she is a mental health counselor). Many sites do not provide supervision so we are forced to pay for it.
The additional liability supervisors take on in this case is minimized by the fact that the sites will most likely be sued rather than the supervisor of the counselor who doesn’t even work there. From what I have seen, no supervisor is offering to read all our notes or spend a bunch of extra time on us – just charging for the hour or more we spend in group or individual supervision and that’s it. And being available 24/7? – in your dreams! I’m not sure what it is like in other States but I think your description may be very idealized compared to what many (most?) of us grads are really dealing with.
For perspective from the other side – how would you like to be forced to pay $250 – $500 a month out of a salary of $30K – 40K (going rate for unlicensed counselors at agencies around here). That is, if you are lucky enough to even find a job as the State of Hawaii continues to decimate mental health services with extreme budget cuts. Many of us work part time or on contract with no benefits and STILL have to pay these rates for supervision. Luckily, we have a sympathetic professor who may get a supervision class going as a continuing ed program – otherwise we might be forced to take on another job just to pay for supervision!
I’m sorry but i do feel gouged – your comments have not convinced me as they are so very far away from my own experience.”
Even though Shari didn’t ask for suggestions or strategies to resolve this issue, I want to offer some possible steps to her and others that may be in similar situations. I am not a fan of pre-licensed therapists going into private practice any more than I am a fan of incompetence clinical supervision so let me see if I can help!
Competent clinical supervision requires more than just experience working in the mental health field. It requires skills related to teaching, consulting, mentoring, and evaluating – not skills that all counselors necessarily have. It is for that reason that the standard of practice for clinical supervision is rapidly changing to include additional training in those areas as they relate specifically to supervision.
As counselors, you and I are mandated to advocate for what is in our clients’ best interests. This includes training for new professionals in our field. Standards of practice and training for clinical supervision are extensions of that training so I am happy to make some noise about the absence of these in any state that turns a blind eye. Are you willing to make some noise, too, Shari?
In my next post, you will hear from another one of our colleagues who sheds some light on the plight of new counselors in Hawaii.
“I am not a fan of pre-licensed therapists going into private practice any more than I am a fan of incompetence clinical supervision so let me see if I can help!”
The implication here is that “pre-licensed” means incompetent. I can’t say I appreciate that insult.
I came here when I saw that this site was nominated for the “Best of Westword.” I doubt I’ll be back.
Hi, Mike! Thanks for dropping in here to chat! Although the focus of my post was on the plight of an unlicensed therapist attempting to find clinical supervision, I do appreciate the opportunity to address the issue of unsupervised unlicensed therapists.
The issue of licensing for me is not as simple as one of competence. In fact, I have many friends and trusted colleagues from which I continue to learn; and, I network with licensed and unlicensed therapists around the world. However, I do believe that licensing is a benefit to our clients, the general public, and mental health professionals.
Licensing is a quick and easy reference point for the general public in ascertaining a basic standard of training and experience. (That’s not to say that an unlicensed therapist does not have comparable training and experience . . . it’s just that the general public and, for that matter, other mental health professionals have no quick way of knowing this without some type of standardized credential.)
In fact, independent practice as an unlicensed psychotherapist is permitted in 4 states – Colorado, Vermont, Minnesota, and Massachusettes. As you know, here in Colorado, someone with a third grade education as well as someone with a Ph.D. can set up a business as an “unlicensed” psychotherapist. It’s perfectly legal. Unfortunately, according to Colorado’s Department of Regulatory Agency, it is the category of “Unlicensed Psychotherapists” that consistently has more grievances filed against it than any of the other licensed mental health disciplines.
Mike, I am aware of Colorado’s proud Libertarian tradition and the laws in this state certainly reflect that mindset. I simply choose to have a different opinion as it relates to the practice of mental health. I hope you will consider my intent and come back to chat again. There is room in this community for many voices. Your voice is as welcome here as anyone’s and am eager to learn more about your business and your thoughts about licensing and other issues related to building a private practice.
And, if you find that you’re open to engaging in these sometimes-difficult conversations, I hope you’ll reconsider and give me your vote for Best of Westword’s Business Service:)!
I hope to hear from you soon!
Tamara,
Thank you for posting my comment and responding. My point, and I am admittedly sensitive to this as a “pre-licensed” therapist, is that you were making an analogy between pre-licensed therapists and incompetent supervisors which implies that pre-licensed therapists are incompetent as well, and I took offense to that.
I realize that is probably not the precise message you intended to convey, but that is how I received it when I read it two days ago.
Your reply touches on a number of different points, much of which I agree with. I am not anti-licensure, and I agree with your statement that, “Licensing is a quick and easy reference point for the general public in ascertaining a basic standard of training and experience.”
If I understand you correctly, and don’t let me put words in your mouth, your opinion is that licensure should be a requirement for opening a private practice.
I think I understand where you are coming from, though I don’t share your opinion.
I can speak best from my own situation. I went through a highly-experiential program to get my degree – I got a lot of practice there. I went through a very rigorous internship and got even more experience. I am well supervised by a clinician with 40 years of experience. I participate in a monthly support and consultation group comprised of roughly 10 alumni from our internship program. I have the humility to ask for help when I need it and the maturity and training to track my own process in order to notice when I’m falling into a client-therapist trap. (I also know how to toot my own horn. Toot! Toot!)
I have a great deal of “life-experience” and feel I have a lot to give. I can assure you that if I was working for an agency right now, I’d be grinding out the clock and counting each and every hour towards licensure and marking my calendar for the day I could get out of there. It’s just me, and I know enough now to realize I don’t function well in those environments and that I wouldn’t be helping anyone, the least of all myself. I’d be miserable and I might even quit the whole game to go open up a bike shop.
Or I could be doing what I am now. Following my path, honoring my heart, and doing a little good in the world.
Hi, Mike! Welcome back! I’m so glad you dropped back in to continue the conversation!
Let me start by saying that I dropped in to your website, too, and noticed that you’re a graduate from Naropa University in Boulder. Naropa grads are some of my favorites – love, love, Love the training that you guys receive – so I know that you are well-trained.
What I believe is that the path that you have chosen as an unlicensed therapist is the exception and not the rule. Most unlicensed therapists that I’ve met do not choose to voluntarily continue under supervision. They have not sought out venues for clinical consultation groups; nor have they continued to regularly seek out post-graduate education / professional development.
I do know that thankfully, like you, there are amazingly skilled unlicensed psychotherapists who are exceptions to the norm. However, I also know that we don’t put laws in place to dictate the behaviors of people who are already living conscious and ethical lives; we put laws in place to protect the public from those that choose to live unconscious and unethical lives. And, that’s exactly why I support legislation that would require licensing of all mental health professionals who choose to practice independently.
Having said that, I really do respect you dropping back in to clarify your concerns and being willing to continue the conversation. It’s a pleasure to meet you here online and I know we’ll have an opportunity to meet face to face during the next year.
Mike, I look forward to you dropping back in here at Private Practice from the Inside Out often and sharing your voice. As mental health professionals, it’s incumbent upon all of us to understand and support one another while at the same time being willing to step into our own sometimes difficult conversations – the ones we continue to encourage our clients to have with each other.
Blessings to you on your journey!
Tamara,
You had mentioned that unlicensed psychotherapists can practice in Colorado, Vermont, Minnesota, and Massachusettes. What is required to call one self a psychotherapist?
Well, that’s the embarrassing part, Michael. Here in Colorado any person “practicing psychotherapy” can be listed as an unlicensed psychotherapist. Psychotherapy is defined under the Colorado Mental Health Practice Act as “the treatment, diagnosis, testing, assessment, or counseling in a professional relationship to assist individuals or groups to alleviate mental disorders, understand unconscious or conscious motivation, resolve emotional, relationship, or attitudinal conflicts, or modify behaviors which interfere with effective emotional, social, or intellectual functioning.”
However, it should be noted that there is no educational requirement, no supervision requirement, and no experience requirement to hold yourself out as an unlicensed therapist in Colorado. Those that fall under the definition of “unlicensed therapist” could feasibly range from someone who has a 3rd grade education to someone with post doc work. It’s like Russian Roulette. And, I suspect that it is similar in other states that do not require licensure.
So, Michael, why do you ask? What are you thinking?
Facinating conversation!! The issue emerging out of this conversation is not the need for licensing but it’s validity or relationship or ability to enhance professional competence Tragecally( and yes I referring to states like California whose exclusionary anti competive licensing requirements whether aMFT or Psy are arbitrary ,capricious excessive and related more to limiting access to the marketplace than “quality control”! A more appropriate& effective model of licensing (that you two would probably both agree with) exists in the world of medicine. Effective access to the profession ie employment salary and responsibility is not dependent upon ones performance on a relatively pedestrian licensing exam but actual PERFORMANCE in highly regulated internships & residencies where physicians are rigorously scrutinized and evaluated as to how well they actually treat patients !!! Outcome or performance based licensing…….. rather than the resuscitation of meaningless never to be utilized psychological trivia ,evaluative protocols that assess how well a practioner practices or applies those facts and figure that are relevant to the therapeutic process to actually helping clients we need to eliminate or minimize the role of written or verbal exams and base licensing on exhibition of skill under real world conditions!!!! Baseball players gain access to the major leagues based on their performance in the minor leagues or college not their scores on the baseball version of the EEEP or their written/verbal responses to some silly exam!!!!
Hi, William! Welcome to Private Practice from the Inside Out and thank you for sharing your thoughts here…. I am not familiar with California’s licensing requirements so I’m not sure that I am the one to be contributing any substance to this conversation.
Hi what Shari is saying is very true I went through that for 4 years trying to become a licensed therapist.
Anonymous – I don’t usually post comments from those who do not provide a real name.
However, It’s NINE YEARS after Shari first contacted me about this issue and it breaks my heart that therapists continue to struggle with this issue.
I’m so very glad you were eventually able to obtain your license!.
Blessings to you on your journey.