Do Counselor Regulations Promote Client Abandonment?

Does this sound familiar to you? Your practicum is complete. You graduate and take the NCE/NCMHCE or take the NCE/NCMHCE and then graduate. But then everything stops when you've graduated until your paperwork is approved by the state board to obtain your temporary license to practice. A period of time which can take 2-4 months, depending on when you are allowed to take your exam. (In my case, I graduated May 15, took my exam first week in July, then got my LPC-I in late August.) 

2-4 months at a time in which most experts agree you cannot legally be allowed to see clients.

So if you're continuing at your practicum site into your internship, that means you're in essence abandoning clients for that period of time - no matter their situation - and then may or may not be able to work with them again in the future. 

That means they have to be shuffled to someone else or simply wait on that work until you come back. If (as is true for many practicum sites) they are clients who have suffered trauma and abandonment many times over, they may assume that this is a "sign" that they don't deserve help and should sign off from seeking it ever again. 

Think I'm exaggerating? I can't count the number of people I've heard that from when something goes wrong with a counseling appointment. That might be a situation in which insurance coverage is denied, appointment times are miscommunicated, the counselor or client moves, or the student counselor enters the dead zone between graduation and temporary licensure. These are clients hanging on by a thread to the idea that they can get help, and it doesn't take much to let it snap.

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Legally, all that is required to avoid "client abandonment" is that you help make arrangements for the client to see another competent counselor when you are unable to provide those services. So it isn't that you are legally abandoning a client when you take off after graduation. 

It also isn't as if we can never promise a client there won't be circumstances in which we can't see them - we will have to relocate sometimes, or we need to take a vacation or take maternity leave, or we face an illness - but these are life interruptions, not institutional interruptions.

This is an interruption in care that can be avoided. 

How? Well, what if, instead of creating an unnecessary gap in care, as a profession we created a legal solution that is safe for both clients and more consistent with the needs of graduating therapists? I'm not claiming by any means to have all the answers, but I do have a few ideas...

• Allow for a provisional application to temporary licensing status, i.e. the student counselor approaching graduation can apply based on plans to graduate, and plans to pass the state exam. A time period could be set within which the counselor MUST meet these requirements or have their provisional license revoked along with any accompanying hours. A supervisor agreement would be required so that under no circumstances would a student counselor be practicing without proper guidance. In order to qualify, student counselors would have to have satisfactory performance in practicum classes and obtain the recommendation of leadership in their graduate programs. 
• In keeping with the current system, students could continue to apply for assessment and/or temporary licensing after graduation. But state counseling boards could implement an automatic extension of 3-4 months after graduation in which counselors can count hours and more importantly be allowed to continue relationships with existing clients. Again, a supervisor agreement would be required, and if the exam wasn't passed or graduation could not be substantiated, the counselor would be subject to having licensure revoked, along with hours. 
• Improvements could be made to the licensing application process, allowing electronic submission of applications and application components to the state board, along with automatic reporting of passing test scores to the state board. (They report GRE scores to graduate schools...why not this?)

I am all for accountability. In fact, it would be good to enact strong penalties in a situation like this for noncompliance, so as to discourage the abuse of such a provision. But if we are truly committed to client welfare, as an organization of professionals, I would argue that we need to seriously consider changing situations like this one. 

In this case, and in others, current regulation is out of touch with the needs of the average client. An example of this was the recent proposed revision to the Texas LPC rules requiring that online counseling clients first be required to meet in person with a client, a proposition that would have created unnecessary roadblocks to some client groups. Thankfully, the LPC board graciously listened to the state counselors when we rose together to vote against what we felt was an issue of mental health parity. 

What else could we accomplish if we simply let more people in authority know what we see as important in the practice of our profession?

One definition of abandonment is to leave and never return to someone who needs help. If our leaving the client is due to a situation that could be avoided, like this one, isn't that a kind of systematic sanction of abandonment? Please understand, I do not think this is the way anyone intends it to be. But if we let it go unrecognized, it seems we are sanctioning it by default.

I am not strong on the process it would take to reform a rule like this one. I do not know if it would need to be addressed state by individual state or at a level such as the American Counseling Association or American Mental Health Counselor Association. It is also my understanding that the same rules affect marriage and family therapists, who follow a different but similar path to licensure. Regulation changes made only at the state mental health counselor level would not help LMFTs, as it's a separate licensing track. 

Though I do not know any of this, I do think I know the next step. And that is simply to see if I am the only one who is bothered by this state of affairs. Because if so, than I can deal. It actually no longer affects me personally, since I have my LPC license. 

But it does bother me on your behalf. And on behalf of the clients you see. 

If you feel the same way, then we can find together a way to start getting the issue noticed. The ACA offers an action center at which to contact our officials regarding important issues. We could draft a letter to our state licensure boards. We could also seek advice from social and nonprofit organizations who have successfully petitioned for changes before. 

We could do it.

I can't. 

So what do you want to happen next? 

ATTENTION TEXAS LPCs - VERY IMPORTANT CHANGE THAT AFFECTS YOU! ACT BEFORE AUGUST 12TH

Texas LPCs, I have just learned from a kind colleague today that the Texas LPC board has proposed rule changes which would prohibit us from initiating counseling with new clients online - using technological means for counseling would would be permitted for existing clients who have been seen in-office previously. This unwarranted change would restrict your ability to serve future clients for years to come, including many who would not otherwise be able to access counseling services. If you've ever thought about providing services online, this affects you.

The deadline for objecting to the proposed rule change is August 12, 2013. I URGE you to write to the LPC Board here:

Please submit your comments to lpc@dshs.state.tx.us, or bobbe.alexander@dshs.state.tx.us

Here are a few pointers from the Texas Counseling Association for for making effective comments to the LPC board :

• Keep in mind that the mission of the LPC board is to protect the interests of the public, not counselors. Therefore, frame your comments in terms of how this change would affect clients.
• Reference the proposed rule change, and suggest specific changes to be made to the proposed rule (or alternately you may suggest that the current rule which allows online-initiated counseling be allowed to stand as written).
• Be as succinct as possible.

You can view the proposed rule changes here: http://www.dshs.state.tx.us/counselor/pdf/lpc_prop_rules_0713.pdf

The proposed change is underlined on the top of page 17. (Adobe Acrobat)

As a fellow mental health professional, I would like to share my reasons for opposing the proposed change to the LPC rule which states:

Technological means of communication may be used to facilitate the therapeutic counseling process which has already been established. Technological means may be used in crisis counseling with no previous counseling relationship.

Thousands or Texans will be denied access to needed counseling services as a result of the proposed change. Texas counselors, including myself, have been ethically practicing online counseling for a numbers of year now with great success, and just as in my practice, quite a few clients WOULD NEVER have initiated treatment in-person. This is an unnecessary barrier to treatment, especially affecting underserved populations including the sick, disabled, geographically remote, and those with certain disorders such as agoraphobia, as well as other reasons. Moreover, this restriction is possibly discriminatory and undermines mental health parity.

There is no empirical justification behind making this restrictive change, as studies have repeatedly shown online counseling to be just as effective, and in some cases even more so. These studies have not made a distinction between counseling initiated in-person versus online. Please reference the World Health Organization endorsement of online therapy and this list of studies showing the effectiveness of online therapy.

I will be spreading the word to my other Texas colleagues and urge you to contact the board as soon as possible to overturn this proposed restriction. I appreciate your time and thoughtfulness in this matter.

Thank you.

Stephanie Adams, MA LPC

P.S. Even if you DON'T plan on offering online therapy, if you're in Texas, would you send an email on behalf of the many counselors such as myself who hope to ethically continue to offer online services without needless restrictions to our clients? This could cripple counseling businesses such as mine and more importantly, turn people away from therapy who need it. Please send your respectful objections on their behalf.

P.P.S. You should feel free to adapt and use information in this blog post today as necessary to write your letter.

REMEMBER, you have to send email before August 12th. Please comment below if you have sent that, so I can reference in a follow-up email to Ms. Alexander.

THANK YOU!

For further reading: Conservative attacks on online therapy.
FYI: Original Rule for LPCs In Texas reads:

Subchapter C. Code of Ethics. §681.41. General Ethical Requirements. (g) Where the client is in one location and the counselor is in another, technological means of communication may be used to facilitate the therapeutic counseling process.

A huge debt of thanks goes to Donna Rose, LPC, Counselor in Austin, TX. She told me about this change and took the time to help me draw up a post about this information on really short notice. I literally could not have done anything without her help. Thank you, Donna!