Professional Identity

Straws in the Wind
Don Durkee, Ed.S., LPC, NCC

“It’s a good thing couches are too heavy to throw, because the fight brewing among therapists is getting ugly.” This is the opening line of Sharon Begley’s recent editorial entitled “Ignoring the Evidence: Why do psychologists reject science?” Writing in the October 12 issue of NEWSWEEK, Ms. Begley speaks of an issue among “psychologists” (by which she clearly means therapists in general), and she refers to “years of research” on therapeutic outcomes that have divided the professional community. On one side of the argument are those who believe in evidence-based approaches to therapy (EBT), and on the other are those who view those approaches as leading to more mechanical and less personal forms of therapy.

The argument over evidence-based therapy has gone on for some time in the therapeutic community, with strong voices on both sides. At a recent Networker Symposium, Marsha Linehan, the developer of Dialectical Behavior Therapy (DBT), reportedly claimed that any clinician not using evidence-based methods should be considered guilty of an ethics violation. Yet Irvin Yalom, noted therapist, author, and lecturer in his book The Gift of Therapy has warned against the “EVT [empirically validated therapy] Bogeyman,” raising doubts about the research methods used or the applicability of this approach to in-depth therapy.

Not surprisingly, much of the impetus behind the promotion of evidence-based methods comes from insurance companies. In the name of establishing “best practices,” many of the major managed care networks are encouraging use of EBT, with practitioners regularly required to record client progress in some central data base. One company clearly states their “belief that patient outcomes are the most important indicator of quality” of the clinician’s work. It is not hard to envision a future in which authorizations for therapy and numbers of sessions approved would be made in anticipation of these “best practices.”

Whatever your position on the issue, it is clear that what has been until now an arcane discussion within the therapeutic community has finally crossed the line into the “mainstream media.” It is one thing for the issue to be debated in a clinical journal or at a professional conference; it is quite another for it to be a subject in NEWSWEEK. With all the public attention being paid to “health care reform” and the need for “greater efficiency and accountability,” it is increasing likely that counselors will soon be getting some pointed questions: How do you practice therapy? What methods do you use, and are those methods evidence-based?

We should also remember that the issue of EBT is just one of several that will soon be confronting our profession. As the major public voice for counselors in Georgia, LPCA must take an active role in making sure that the issues are clear and that the debate is thoughtful. It is equally important for all of us as members to study each issue carefully and be prepared to articulate our positions clearly to ordinary people. This is a time when our professionalism must be on public display. Each of us has a part to play. Let’s not wait until there are articles in TIME and U.S. News.

Need an Identity? Try Riding an Elevator

by Don Durkee

“Who am I, and why am I here?”  Most of us have encountered a client struggling to establish a sense of identity and a corresponding feeling of self-worth.  This is often a difficult, even anxiety-ridden effort.  But when it comes to having an identity crisis, it’s hard to beat the level of angst to which counselors can rise.  If you believe everything written about who we are and what we do, you could get the idea that we all have knowledge and skills enough to provide almost any kind of service in almost any kind of setting.  Not only that, we work with populations so varied, they would almost seem to have nothing to do with each other.  Possessing incredible powers of empathy and insight, we psychic superheroes can be found in hospitals, schools, business offices, churches, public treatment centers, and various other facilities.  In these far-flung settings we dispense aid and comfort to everyone from chronic schizophrenic patients to troubled second-graders to addiction suffers to working citizens unhappy in their jobs.  In short, we do it all for everyone everywhere.  It is axiomatic, of course, that when you set out to be everything for everyone, you are not likely to be anything for anyone.  Small wonder then that the public has such difficulty understanding who counselors are and what we do.

My suspicion is that the problem begins with what we call ourselves, or rather with what we don’t.  In the past month, I had occasion to meet several people who asked what I do.  When I replied that I am a Professional Counselor, one asked me to represent him in his divorce and another inquired what I do in the off season when I’m not teaching children to swim.  When I quickly added, “I’m a shrink,” both people nodded and gave me a look of recognition.  “Counselor” wasn’t clear to them, but “shrink” was.

Since “counselor” can be taken in so many different ways, many states qualify the term used for licensure with “mental health” or some variation thereof.  We should also note that LPCA is the Georgia chapter of the American Mental Health Counselors Association (AMHCA).  The reason this is important is that the focus on mental health is our common thread; it is what provides consistency whether the counselor works in a school or a hospital or a private office.  

Lacking a title that specifies “mental health” as a focus, it behooves counselors in Georgia to be able to state clearly and simply exactly what we do and why it matters.  It turns out, however, that counselors have not done very well with this — in Georgia or elsewhere.  If you consult Wikipedia, you find a description of counseling that lists ten specific job tasks with no indication as to why someone might want counseling.  In 1997 ACA adopted a definition of counseling as “the application of mental health, psychological, or human development principles, through cognitive, affective, behavioral or systemic intervention strategies, that address wellness, personal growth, or career development, as well as pathology.”  While it is less complicated than the statement in Wikipedia, it is no more helpful.

Naturally each state has its own definition of counseling.  One state licensing board describes counseling as “involving the application of clinical counseling principles, methods, or procedures to assist individuals in achieving more effective personal, social, educational, or career development and adjustment.”  Another state board insists that “’Licensed professional counseling’ means the application of counseling, human development, and mental health research, principles, and procedures to maintain and enhance the mental health, development, personal and interpersonal effectiveness, and adjustment to work and life of individuals and families.”  The board in a third state defines the practice of “clinical professional counseling” as “the provision of treatment, assessment and counseling, or equivalent activities, to a person or group of persons to achieve mental, emotional, physical and social development and adjustment.  The term includes counseling interventions to prevent, diagnose and treat mental, emotional or behavioral disorders and associated distresses which interfere with mental health.”

If you think these statements are convoluted and confusing, just consider the definition of counseling included in Georgia law.  Frequently called our “scope of practice” statement, this Herculean effort consists of a single sentence containing 134 words.  It begins, "Professional counseling means that specialty which utilizes counseling techniques based on principles, methods, and procedures of counseling that assist people in identifying and resolving personal, social, vocational, intrapersonal and interpersonal concerns; utilizes counseling and psychotherapy to evaluate and treat emotional and mental problems and conditions, whether cognitive, behavioral, or affective; …”  It goes on from there.  By the time you get to the end of this sentence, it’s hard to remember why you began reading it.

I often wonder if the reason counselors struggle so much with these statements of service is that we write them more to satisfy lawyers or law makers than to reach the people we actually serve.  Or maybe we are hoping to find a means of reassuring each other that we truly have a clear identity as mental health professionals.  Whatever the reason, the results are consistently overly complicated, expressed in something akin to “legalese,” and full of everything-for-everybody provisions.  Most of us would not even consider inflicting such a statement on an existing or prospective client.

In a former life, I spent some time as a consultant, and I learned a lot about an important tool known as an “elevator statement.”  The idea is to be able to describe your service and how it will benefit someone in the time it takes for the two of you to ride from one floor to the next in an elevator.  For a consultant, failure to get your message across in that time means losing an opportunity, and probably a client.

Perhaps we counselors should consider creating our own elevator statement.  To do this, we would have to discard the details and the variations and the legalese.  Instead, we would have to state our common focus and how it applies in what we do for our clients.  In my own practice I have constructed such a statement.  I simply say, “As a Professional Counselor, I help people with mental health problems heal and grow and feel better about themselves, so they can have a better quality of life.”

I consider my elevator statement to be a work in progress, which I think it will be for as long as I am in practice.  And for all the counselors reading this piece, I offer you a challenge:  Create your own elevator statement and share it with others.  In doing so, you can help us all be clear in our thinking and shape the way we communicate with all the people who truly need our services.  This clarity will help both the public and the profession; it might even enable us to resolve our own identity crisis. 

What is a Licensed Professional Counselor?

Licensed Professional Counselor
Licensed professional counselors help people deal with problems or conflicts they are unable to solve alone, including substance abuse; family, parenting, and marriage conflicts; managing stress; depression; suicidal thoughts; career concerns; and problems with self-esteem. Mental health counselors collect information through interviews, observations, and tests, and then decide how best to treat patients. The counselor may work with individuals, couples, families, or in group sessions of people with similar problems. They work closely with other mental health professionals, such as psychiatrists, psychologists, and social workers, to care for patients.

Work Environment
Most licensed professional counselors work in private practice, counseling centers, group practices, family service centers, health maintenance organizations (HMOs), hospitals, and government agencies. A 40-hour workweek is standard, with some evening and weekend hours required for the convenience of clients.
Job Outlook Growth in this field is faster than average. These professionals may be in even greater demand if present trends such as high divorce rate, alcoholism, drug abuse, and child abuse continue.

Length of Training/Requirements
The minimum education requirement is a master's degree of arts or sciences. A doctoral degree is rapidly becoming required in the field. After completing course requirements, individuals must complete a years internship before graduating. Then an additional Three years of Supervision before Licensure is granted.