Posted by Dr. Vollmer on October 4, 2013
Licensed Professional Clinical Counselor, wow. I am waking up to the new, at least new to me, licensure for mental health practitioners. George goes to a therapist, but does George know the educational background or the licensure of that therapist? Is that relevant to George? Is it relevant to George’s insurance company? Why should George care, and should his therapist have full disclosure about his education. Some therapists are physicians, some have PhDs in psychology, some have PhDs in non-related fields, some have PsyDs, some have EdDs, and all these folks are called “doctor”. Then, there are therapists, some of whom are LCSWs, some are MFTs, some are LPCCs, some are RNs, and some are NPs. The difference in licensure also speaks to a difference in mandatory continuing education. Some licenses require ongoing ethics training, whereas others do not. An MD needs continuing education, but they can learn about emergency medicine or wilderness medicine; they are not mandated to have continuing education in their field.
Newer psychiatrists need to take their Board examinations every ten years ( I do not, because apparently I have a grandfather), but does the patient know if their psychiatrist is board-certified, and if they are, if they have re-upped at the appropriate time? What about the RN? How does going to nursing school prepare you to become a psychotherapist? Some RNs go on to further training, such as psychoanalytic training, but this is not required. Their nurse’s license allows them to put up that shingle and get malpractice insurance. What about that PsyD that follows after some therapists name? This is a doctorate, without the rigors of a PhD, that is offered by many mental health training programs, but most folks who get a PsyD are licensed as MFTs, and so they practice under one license, but they get the respect of their highest degree. All that is fine, but what should the patient know?
Now, we add on to the complexity, by California becoming the 50th state to introduce another license, that of the LPCC. Why? Please tell me why we need another silo of mental health practitioners? I can understand that the Affordable Care Act is going to result in an an explosion in terms of the mental health needs of the newly insured. There are not enough clinics, practitioners, physical space, to see the projected demand for mental health intervention. There are going to be limits to the number of sessions one can access, but there are also going to be limits as to what kind of professional one can see. The adage is that everyone should work to the maximum utility of their license. In other words, a physician should not spend their time at the xerox machine (I am old, I know). So what can an LPCC do that an MFT cannot do? When does the LPCC say “this is beyond my scope”? Medication management is the most obvious dividing line, but even this issue is debatable in certain states like Louisiana and New Mexico where psychologists can prescribe. Also, how am I so isolated that I am only now hearing about the LPCC? I am an active volunteer faculty member at UCLA and I am on the mental health board at the Venice Family Clinic, and I work with many mental health students in training, and yet I had no idea this license existed until very recently. This makes me curious, but at the same time, I have a strong hunch that the answer is political and not clinical. Each degree program creates new schools, new licensing fees, new continuing education requirements, which create a demand for administration and teachers. Still, I want to know more. Please tell.
Oh, one more thing, on the Board’s website http://www.bbs.ca.gov/, I found the following:
“There is no restriction regarding the assessment and treatment of children in LPCC statute or regulation.”
That quote will be for another rant, I mean post.