When The Counseling Field Sucks

There are times when I'm just so disappointed in our profession.

Like when an intern tells me that his group steals clients he pays to attract.

Or when supervisors tell student counselors gossip about clients.

Or the fact that we have tons of training and yet might be subject to lawsuits if we practice life coaching over state lines, while untrained, unlicensed life coaches can do the same with much less liability.

I can think of a half-a-dozen more things to complain about in the field of counseling. Legitimate things. The invasion of privacy by insurance companies. The questionable choices made in the DSM-V. The lack of business training in counselor education. The poor compensation offered most counseling interns, after exiting a prohibitively expensive educational path.

You can probably add your own. There's a lot to be frustrated with about this field. I'm sure there are similar frustrations with every field  - but in some ways the injustices and complications are harder to accept within the world of counseling.

Has it ever felt that way to you?

It has to me, because I tend to feel that since we're doing a good thing - helping people heal emotional wounds - we should be supported in that effort.

Even as I write that, I think how entitled that sounds! We should get a break, why, because we're "good people?"

The truth is what we all know but struggle to accept when it applies to us. Life's not fair and sometimes good is not rewarded in the way we expect.

Yep, there's a lot of things that aren't fair about the counseling profession - or counselor training - right now. 

So what are we going to do about it? 

If you agree that this situation isn't where it should be, you have three options (at least the way I see it).

1. Leave the profession. Sadly, that's what some counselors do. I sympathize - but I hate it!
2. Stay in the profession and grow bitter. Unfortunately, that's what a lot of you guys tell me in confidence that the older counselors around you have done!
3. Claim your internal locus of control, and refuse to let the circumstances dictate your ability to do your job as you were called to do it.
• Lobby for change. 
• Leave managed care if you can't come to a satisfactory agreement. 
• Charge no-show rates or private pay alongside more inexpensive options, or instead of those options if that's what you must do to be in business.
• Hold clients to accountability if that's what's best for them. 
• And so forth!

Think that's impossible? Honestly, if you lead with your values and your calling it is absolutely possible. Let me give you some examples:

• Your state suggests a law that potentially reduces access to counseling care in rural or underserved areas. Spread the word and change the law like we as a beginning counselor community did in August 2013.
• Your managed care company demands that you justify your client's treatment in more detail than you know is ethical to share with the representative. (It happened to me.) Explain to your client the situation and have them reach out to the insurance company to share the info, if they so choose, or offer a reduced rate to forgo managed care altogether. 
• Your client calls 15 minutes late to cancel for the second time in a row. Add the no-show rate to your bill, explaining, "I understand, but as we discussed that means that the time is still billed to you because we have to have 24 hours notice." Your agency won't let you charge? Wait a few days or a week before you reschedule, so that they client learns to value this time as much as you do. 

I'd guess those last two examples might cause indignation or fear. It seems like we're being mean when we put up boundaries with clients, but unless we're only doing it to be mean, we're not. Ultimately, it's healthier for clients if we have strong boundaries driven by concern for their best. It's not good for a client's secrets to be at the mercy of a managed care corporation. And the client gets nothing out of therapy if they don't show or they don't respect it. And so on...

In my experience, you the interns are the most generous and ethical of all of us. The only thing that you don't realize is that it's okay to ask for what is right on behalf of you, and on behalf of your clients. You don't think you know enough or have enough experience to justify it. 

Maybe you don't. But what would it hurt to ask yourself (the next time you come across a situation that feels odd or unfair, even unethical) "What can I do to make this better for myself and my clients?" 

"What might it help?" 

Have you ever been in a situation where you knew the right thing to do, but lacked confidence in yourself to do it? How did you deal with it? Share with us below!

Everything I Once Learned Is Irrelevant Now; Or, A Reaction To The DSM-V.

Have you ever had a moment when you realized, 

"Huh. Everything I learned is irrelevant now."

For me, that moment occurred hearing the (awesome) guest speaker at last month's Dallas Metro Counselor Association meeting, Justin K. Hughes, MA, LPC, NCC. His topic? DSM-V: Top Ten Changes. 

Original Image Found at http://tinyurl.com/m448joj

Don't get me wrong - his presentation was great. In fact, he's provided a link to a video of it on his website, and I highly recommend you check it out for yourself. (He has a great sense of humor.) But the changes...oh, the changes. 

Hypochondria? Now Illness Anxiety Disorder.

Coding on Axes 1-5? Axes 1-3 are now combined into one. IV & V are covered by a separate notation system. GAF? Gone. 

While I have to admit, not all the changes are ones I disagree with - who gained any value from assigning a Global Assessment of Functioning, really? - the sheer number of changes are absolutely overwhelming.

Here's a few more highlights:

• Asperger's no longer exists. Instead, Autism Spectrum Disorder now encompasses what was Autism, Asperger's, PDD NOS, Childhood Disintegrative Disorder, and Rett's.
• We now have an official code to diagnose PMDD (Premenstrual Dysphoric Disorder) Hoarding, and Excoriation, a disorder based on skin-picking. 
• OCD is no longer an anxiety disorder.
• The DSM-V includes the first-ever behavioral addiction, Gambling Disorder.
• A new category, Depressive Mood Dysregulation Disorder, was developed to reduce the overdiagnosis of bipolar disorder in children. It is appropriate for children under 18 without major mood swings, but persistent irritability and behavioral concerns.
• Reactive Attachment Disorder is now collected alongside Stress & Trauma Disorders.

And that barely scratches the surface.  

Original Image Found At http://tinyurl.com/kcqbxyu

Not surprisingly, many people haven't embraced the change with open arms. 

• Is Grief An Illness? National Post
• The NIMH Withdraws Support for DSM-V Psychology Today
• Is Mental Illness Over-Diagnosed?   Medical Daily
• Prominent M.D., Dr. Allen Frances, stated it most baldly: "The publication of DSM-5 is a sad moment for psychiatry and a risky one for patients. My recommendation for clinicians is simple. Don't use DSM-5. "

But we know any change comes with its' detractors. And every iteration of the DSM has made massive changes, some controversial, but many that people would consider long overdue. So is this really any different than changes than the past?

It is, and for one, simple, narcissistic reason.

It's happening during our timeline.

The adoption of the DSM-V is happening as we are growing into our identity as a counselor. It will impact how we receive reimbursement from insurance panels, and how we classify appropriate methods of treatment. Therefore this change is something we have to react to. 

The diagnoses I learned about in Abnormal Psych may no longer be as valid. 

Sessions that would normally qualify for reimbursement now may not, but there are new disorders now that will.

What are you going to do about it? When it comes down to it, I think that's the only question a new counselor must answer when it comes to the many, many changes in the DSM-V.

How will the DSM-V impact your practice?