Clinical consultation considerations?

[summerbabe]

Due to recent systematic changes outside of my control (thanks VA lol), I won’t be supervising any trainees for the foreseeable future, which I will miss.

So I started thinking about different ways to tap into this part of my professional life, since I enjoy it and feel like I learn a lot when I have to really intentionally think about therapy, how it works, what gets in the way, and more.

I’ve never done anything outside of the VA but are there opportunities in the private sector to provide this type of service to other clinicians?

I’m not licensed in my state of residence or planning to get licensed there. Nor do I want to provide formal, sign off on hours type of supervision outside of the VA training system.

One thing I was thinking about is potentially providing this type of consultation for masters level therapists who want to further develop their skills in an area that I feel like I have some competency in.

Does this thing/market exist? If so, what legal and ethical considerations should I be thinking about? Is this still technically considered supervision even if the other party is fully licensed?

Thanks in advance!

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[smalltownpsych]

Masters level people are often hungry for additional guidance so I think that the demand exists. I would probably start with offering some educational seminars or workshops might be a way to begin finding them. Another question is about how not being licensed might i'ladt ability to consult. They are going to want feedback for specific cases and consulting on that would potentially be practicing psychology without a license.

 

[summerbabe]

Masters level people are often hungry for additional guidance so I think that the demand exists. I would probably start with offering some educational seminars or workshops might be a way to begin finding them. Another question is about how not being licensed might i'ladt ability to consult. They are going to want feedback for specific cases and consulting on that would potentially be practicing psychology without a license.

Thanks for the feedback! I definitely know that I need to look into licensure/liability stuff.

Every once in a while I toy with the idea of getting a license for my state (since I can maintain a license from anywhere for the VA) and maybe do some limited private practice to test the waters since I’m lucky in that don’t have to have any additional income but maybe this is the push that I need.

 

[cara susanna]

Due to recent systematic changes outside of my control (thanks VA lol), I won’t be supervising any trainees for the foreseeable future, which I will miss.

So I started thinking about different ways to tap into this part of my professional life, since I enjoy it and feel like I learn a lot when I have to really intentionally think about therapy, how it works, what gets in the way, and more.

I’ve never done anything outside of the VA but are there opportunities in the private sector to provide this type of service to other clinicians?

I’m not licensed in my state of residence or planning to get licensed there. Nor do I want to provide formal, sign off on hours type of supervision outside of the VA training system.

One thing I was thinking about is potentially providing this type of consultation for masters level therapists who want to further develop their skills in an area that I feel like I have some competency in.

Does this thing/market exist? If so, what legal and ethical considerations should I be thinking about? Is this still technically considered supervision even if the other party is fully licensed?

Thanks in advance!

Another option is trying to become a VA consultant or trainer for a national EBP rollout (obviously, you have to be certified in the therapy first).

 

[summerbabe]

Another option is trying to become a VA consultant or trainer for a national EBP rollout (obviously, you have to be certified in the therapy first).

I did that once and then realized that what they really wanted was for fidelity checklists to be marked off and I was out lol.

 

[psychma]

I am a master’s level provider. I consult regularly with a PhD psychologist and I pay him $250/hr. The market exists.

Edited to add that I have done this with him for 4 years, he was an ethics professor for many years on top of his clinical responsibilities, and I think it is just good practice for me as a midlevel provider to have this consultation.

 

[summerbabe]

I am a master’s level provider. I consult regularly with a PhD psychologist and I pay him $250/hr. The market exists.

Edited to add that I have done this with him for 4 years, he was an ethics professor for many years on top of his clinical responsibilities, and I think it is just good practice for me as a midlevel provider to have this consultation.

Thanks! Can I ask how you connected with this person and what has made it worthwhile to continue? Feel free to DM if that's easier.

 

[psychma]

Thanks! Can I ask how you connected with this person and what has made it worthwhile to continue? Feel free to DM if that's easier.

He was my ethics professor and he kept tabs on me when I was doing my internship and began working. We talked back and forth about me opening my practice and one day I just asked him if he would be a consultant for me on a professional level. He said yes and we have been working together since then. We talk about practice related issues as well as clients. I feel piece of mind that I am doing the work skillfully. If I am stuck, he talks theory with me and helps me think through my own approach. At times, he also asks me my feelings about a certain client presentation and has me reflect on that/helps me conceptualize the big picture. It’s very helpful. He is very supportive of Evidence based approaches like CBT and dbt and regularly quizzes me on how to use them with my clients.

I think mid levels do have interest in this and it can be done via telehealth in the state you are licensed in. I’m not sure of what it would look like to do this in a state you aren’t licensed in. It’s not supervision and doesn’t require board approval.

 

[R. Matey]

I think mid levels do have interest in this and it can be done via telehealth in the state you are licensed in. I’m not sure of what it would look like to do this in a state you aren’t licensed in. It’s not supervision and doesn’t require board approval.

I had a similar experience to yours when I was a master's level provider. It was also really beneficial for me (though I'd suggest supplementing it with workshops and other types of training). As to the quoted part, a psychologist might want to be extra careful. Some state boards would count this as supervision, particularly if the psychologist is providing the service in post-degree to a pre-licensed clinician. My situation was registered with the board even though this person was not technically responsible for supervising my post-degree intervention hours, which was necessary by state law. So @summerbabe, if you're going to do it, just check with the mid-level licensing board in whichever state you're licensed.

 

[summerbabe]

I had a similar experience to yours when I was a master's level provider. It was also really beneficial for me (though I'd suggest supplementing it with workshops and other types of training). As to the quoted part, a psychologist might want to be extra careful. Some state boards would count this as supervision, particularly if the psychologist is providing the service in post-degree to a pre-licensed clinician. My situation was registered with the board even though this person was not technically responsible for supervising my post-degree intervention hours, which was necessary by state law. So @summerbabe, if you're going to do it, just check with the mid-level licensing board in whichever state you're licensed.

Thanks! I'll definitely be very aware of what discipline I would be consulting/supervising for and get some clarification from their board.

 

[ClinicalABA]

... Another question is about how not being licensed might i'ladt ability to consult. They are going to want feedback for specific cases and consulting on that would potentially be practicing psychology without a license.

I can't emphasize this enough. If you aren't licensed as a psychologist, you likely can't even refer to yourself as a psychologist (with some exceptions, like when working in academia or doing a one-shot training, etc. Supervisees should not refer to you as "psychologist" either, and if they do, you should correct them every time. You need to be really honest with this- no matter how you look at it or what you call it, you would be providing psychological supervision. The board likely will not care that you are well trained and licensed elsewhere. Similarly, supervisors who have gone through the time and initial/annual expenses of being licensed might/should not appreciate a someone doing the same work as them without being licensed. If I were in your situation, I wouldn't do any clinical supervision without being licensed first.

 

[summerbabe]

I can't emphasize this enough. If you aren't licensed as a psychologist, you likely can't even refer to yourself as a psychologist (with some exceptions, like when working in academia or doing a one-shot training, etc. Supervisees should not refer to you as "psychologist" either, and if they do, you should correct them every time. You need to be really honest with this- no matter how you look at it or what you call it, you would be providing psychological supervision. The board likely will not care that you are well trained and licensed elsewhere. Similarly, supervisors who have gone through the time and initial/annual expenses of being licensed might/should not appreciate a someone doing the same work as them without being licensed. If I were in your situation, I wouldn't do any clinical supervision without being licensed first.

Damn you just shot down my dreams of doing mental health service provision coaching!

I’ve had it way easy with the VA allowing us to be licensed anywhere in the US so I’ve been able to choose a state that is efficient, answers questions immediately and on the lower renewal cost scale but it would make a lot of sense to transfer to my state of residence, which is none of those things lol.

 

[Mama Bear]

If it were me, I would not mess around with the license thing. If you can get licensed in your residing state, do it. The board may not care about technicalities such as you not calling yourself a psychologist if what you are doing is still practicing as one. Have you been licensed in the other state for at least five years? If so, many states have more streamlined application processes for applicants who have held a license for at least that long.

 

[R. Matey]

If it were me, I would not mess around with the license thing. If you can get licensed in your residing state, do it. The board may not care about technicalities such as you not calling yourself a psychologist if what you are doing is still practicing as one. Have you been licensed in the other state for at least five years? If so, many states have more streamlined application processes for applicants who have held a license for at least that long.

I don't practice in my home state currently, but I carry a license and malpractice insurance here anyway because if I do ANYTHING AT ALL that remotely resembles the job of a psychologist, I want to be above board.

 

[PsyDr]

1) Aren't there peer supervision groups for therapists? I feel like a grad school professor let us sit in on one, as an optional educational thing. It was a bunch of psychologists in a tiny psychotherapists' office. I remember laughing at two older people trying to sit in a love seat.

2) Why not offer educational talks to some local organizations? That would require you to compile information, synthesize it, and present it to others.

 

[summerbabe]

Have you been licensed in the other state for at least five years?

Just about to pass year 4 and would be transferring to CA, which has those additional coursework requirements that non-CA programs don’t cover.

Why not offer educational talks to some local organizations? That would require you to compile information, synthesize it, and present it to others.

I have plenty of opportunities within my org to give talks or intern/fellow didactics, which I find to range from moderately enjoyable to a chore.

Where I got to thinking about this idea is to figure out ways to replicate trainee supervision, which I no longer will be doing for the VA due to structural changes.

So helping a specific person identify areas for continued growth, facilitate reflection and change, etc and to hopefully be able to see some progress over time, versus one-off talks.

 

[PsyDr]

Where I got to thinking about this idea is to figure out ways to replicate trainee supervision, which I no longer will be doing for the VA due to structural changes.

So helping a specific person identify areas for continued growth, facilitate reflection and change, etc and to hopefully be able to see some progress over time, versus one-off talks.

While I am sure you are excellent in whatever you do, maybe align yourself with some training institute, work your way up the ranks, and then become a supervisor there? The Beck Institute, Ellis Institute, the narrative therapy place, maybe Gottman, etc all have peer supervision.

Just a thought. I dunno.

Oooooor, you could start a PP. One of us, one of us, one of us.

 

[WisNeuro]

While I am sure you are excellent in whatever you do, maybe align yourself with some training institute, work your way up the ranks, and then become a supervisor there? The Beck Institute, Ellis Institute, the narrative therapy place, maybe Gottman, etc all have peer supervision.

Just a thought. I dunno.

Oooooor, you could start a PP. One of us, one of us, one of us.

Gooble gobble, gooble gobble...

 

[ClinicalABA]

Damn you just shot down my dreams of doing mental health service provision coaching!

Sorry! You have to admit that in your initial post you pretty much lay out the fact that your trying to "circumnavigate" licensure laws (e.g., "I’m not licensed in my state of residence or planning to get licensed there") while describing a plan basically involves providing psychological services! You probably don't need the potential hassle that could come with that!

I’ve had it way easy with the VA allowing us to be licensed anywhere in the US so I’ve been able to choose a state that is efficient, answers questions immediately and on the lower renewal cost scale but it would make a lot of sense to transfer to my state of residence, which is none of those things lol.

It's definitely a perk of VA work. Your situation can be a lesson for others though. If you take advantage of that perk and pursue the easiest path to licensure, it can be limiting down the road. I'm not trying to criticize you at all- it's just an observation and points out some of the legal realities of taking the VA route of non-residence licensure. From a practical standpoint, one of the main components of the state licensure process is the jurisprudence examination. While these are often seen as just a formality, there are distinct legislatively dictated processes related to mandated reporting, involuntary commitment, substituted judgement, etc, that can differ drastically from state to state. Your clients (including supervisees) should have a reasonable expectation that you have adequate knowledge of the state level legislation related to clinical practice.

Also- while folks like you are not the risk/problem- I do think us licensed folks have to be very protective of the work that we are exclusively licensed to do. Stay off of our turf unless you have paid the minimum price of admission!

 

[cara susanna]

Just about to pass year 4 and would be transferring to CA, which has those additional coursework requirements that non-CA programs don’t cover.

I have plenty of opportunities within my org to give talks or intern/fellow didactics, which I find to range from moderately enjoyable to a chore.

Where I got to thinking about this idea is to figure out ways to replicate trainee supervision, which I no longer will be doing for the VA due to structural changes.

So helping a specific person identify areas for continued growth, facilitate reflection and change, etc and to hopefully be able to see some progress over time, versus one-off talks.

Are you located at or do you live near a VA in CA? I did my post doc at a VA in that state and they offered the required coursework locally (like a SUD seminar series that met the requirements for state licensure), because their goal was to help fellows get licensed.

I do recommend getting licensed locally. I got licensed in the state where I had my first VA job, and when I transferred to my new state I eventually got licensed in the new state, just in case I ever needed it. I say 'eventually' because the board here is NOTORIOUSLY slow.

 

[WisNeuro]

Are you located at or do you live near a VA in CA? I did my post doc at a VA in that state and they offered the required coursework locally (like a SUD seminar series that met the requirements for state licensure), because their goal was to help fellows get licensed.

I do recommend getting licensed locally. I got licensed in the state where I had my first VA job, and when I transferred to my new state I eventually got licensed in the new state, just in case I ever needed it. I say 'eventually' because the board here is NOTORIOUSLY slow.

This is an understatement.

 

[R. Matey]

Gooble gobble, gooble gobble...

I didn't know this reference so I googled it...that was a mistake.

 

[summerbabe]

Sorry! You have to admit that in your initial post you pretty much lay out the fact that your trying "circumnavigate" licensure laws (e.g., "I’m not licensed in my state of residence or planning to get licensed there") while describing a plan basically involves providing psychological services! You probably don't need the potential hassle that could come with that!

Totally makes sense. This was an idea that I was kicking around last weekend, a couple days after I found out that I wouldn't be supervising in my current role so I've been totally happy to keep my current licensure situation up until now so it's definitely not a very flushed out idea.

I did my post doc at a VA in that state and they offered the required coursework locally (like a SUD seminar series that met the requirements for state licensure), because their goal was to help fellows get licensed.

Thanks! That makes sense, I'm kinda equidistant from the SF and the Northern California main facilities.

 

[silverway]

Totally makes sense. This was an idea that I was kicking around last weekend, a couple days after I found out that I wouldn't be supervising in my current role so I've been totally happy to keep my current licensure situation up until now so it's definitely not a very flushed out idea.

Thanks! That makes sense, I'm kinda equidistant from the SF and the Northern California main facilities.

I believe the Palo Alto VA has that going on. But also, as someone who recently tackled the coursework for initial licensure, I was able to knock it all out on a Saturday. The "hours" requirements don't mean much for the online, open-book "courses" that satisfy the requirement.

 

[TrueButUseless]

I believe the Palo Alto VA has that going on. But also, as someone who recently tackled the coursework for initial licensure, I was able to knock it all out on a Saturday. The "hours" requirements don't mean much for the online, open-book "courses" that satisfy the requirement.

Agreed. There is one CA required class on substance use disorders that my graduate program didn’t have. I paid $150 to take an online asynchronous “class” which was essentially a brief CE. It met the requirement. All other CA requirements were knocked out for free online by completing them before the free trial period ended. I think the website was CEs4Less at the time.