LPC or PsyD for private practice?

[Lailya]

Hi there! Wondering if anyone has any experience and/or professional advice for someone interested in pursuing either a LMHC, LPCC or a PsyD. Ideally I'd like to have my own practice that can incorporate individual and group therapy with holistic/alternative practices such as expressive arts therapies, yoga, Ayurveda, mindfulness, etc. I've seen places offering some of these practices but sometimes I get the impression that they're not taken seriously due to their alternative nature. With that said, I feel like I might have more credibility with a doctorate trying to open up my own practice...but then again I know many clients might not know the difference. However, would I be less prepared by getting a counseling MA degree. Any thoughts?

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[WisNeuro]

MA and a business degree would get you more traction than a PsyD for what you are describing. Insurance won't cover a lot of that, so it'll be private pay for a large portion. So, you better be a good business person to make it work. Also, you probably don't want to be starting with 100k+ in debt and you won't be eligible for loan repayment programs with private practice. That amount of loan debt would be absolutely crushing for going right into PP.

 

[PsyDr]

Any education in science would be a threat to such a practice.

 

[bcliff]

I discourage anyone who wants to exclusively work in private practice from pursuing doctoral (PhD or PsyD) training, and I discourage everyone from pursuing unfunded doctoral training. However, it is technically (as of right now) possible to participate in loan repayment while working in private practice.

Loan Repayment

 

[WisNeuro]

I discourage anyone who wants to exclusively work in private practice from pursuing doctoral (PhD or PsyD) training, and I discourage everyone from pursuing unfunded doctoral training. However, it is technically (as of right now) possible to participate in loan repayment while working in private practice.

Loan Repayment

True, but the clientele who are going to pay out of pocket for expensive placebos typically don't live in underserved areas that are covered by the NHSC programs.

 

[bcliff]

True, but the clientele who are going to pay out of pocket for expensive placebos typically don't live in underserved areas that are covered by the NHSC programs.

Very true, I think that the trade off for NHSC loan forgiveness usually takes the form of seeing X% of Medicaid clients, for whom reimbursement rates are generally low.

 

[wtfook]

Hi there! Wondering if anyone has any experience and/or professional advice for someone interested in pursuing either a LMHC, LPCC or a PsyD. Ideally I'd like to have my own practice that can incorporate individual and group therapy with holistic/alternative practices such as expressive arts therapies, yoga, Ayurveda, mindfulness, etc. I've seen places offering some of these practices but sometimes I get the impression that they're not taken seriously due to their alternative nature. With that said, I feel like I might have more credibility with a doctorate trying to open up my own practice...but then again I know many clients might not know the difference. However, would I be less prepared by getting a counseling MA degree. Any thoughts?

Generally speaking, a doctorate is a really long time commitment and unfunded ones especially (PsyD or PhD) are incredibly expensive if you decide to enter private practice at the end. You can do the same with a terminal master's degree either in social work or clinical mental health counseling. Your decision on which to go with depends on your state. Some states are cool with both. Other states favor the LCSW. Go with the one that will allow you to be on the most insurance panels.

 

[foreverbull]

This raises an important question: can state boards penalize folks for using spiritually-based practices (Ayurveda, yoga, Reiki, etc.) learned outside of graduate training? I'm very curious about the ethics of this and how someone with both standard training and spiritual training can practice both ethically (i.e. Do you have to keep them as completely separate services in your practice and the board doesn't oversee your spiritual practices?)

 

[psych.meout]

I'm intrigued by this as well. I noticed an immediate reaction of disgust (i.e. any education in science would be a threat), but the user stated they would be incorporating these elements into therapeutic practice. How is this different than those offering something like EMDR or somatic experiencing? You've got people essentially offering evidence-based practices for trauma with a little sprinkle of something non-iatrogenic on top, that could be important and values-congruent to a number of folks.

You're not exactly helping your argument here. EMDR is not really all that well-regarded by people who are familiar with the research literature. It's basically pseudoscience added on top of an actual EBT to turn it into a business enterprise.

Also, I know there is a large body of literature supporting both mindfulness and yoga as helpful adjunctives to psychotherapy. I am hoping to learn more from some of the folks in the thread with strong opinions, particularly on why this is considered anti-scientific, or an expensive placebo that only privileged folks would appreciate/be interested in. My clinical work and research is in corrections with predominantly non-White and low-income people, who have benefitted greatly from mindfulness-based stress reduction and grounding activities.

MBSR, MBCT, and other mindfulness-based interventions are empirically-based, so I'm not sure what your point is here.

 

[PsyDr]

I'm intrigued by this as well. I noticed an immediate reaction of disgust (i.e. any education in science would be a threat), but the user stated they would be incorporating these elements into therapeutic practice. How is this different than those offering something like EMDR or somatic experiencing? You've got people essentially offering evidence-based practices for trauma with a little sprinkle of something non-iatrogenic on top, that could be important and values-congruent to a number of folks.

Also, I know there is a large body of literature supporting both mindfulness and yoga as helpful adjunctives to psychotherapy. I am hoping to learn more from some of the folks in the thread with strong opinions, particularly on why this is considered anti-scientific, or an expensive placebo that only privileged folks would appreciate/be interested in. My clinical work and research is in corrections with predominantly non-White and low-income people, who have benefitted greatly from mindfulness-based stress reduction and grounding activities. Anecdotally, and I am beginning to see a bit more research on it, I know that the folks we see with trauma backgrounds (almost everyone) really enjoy mind-body exercises like yoga.

Again, I am not recommending to cease the practice of EBIs, but am curious why someone who is interested in incorporating Eastern spirituality into their practice would be considered anti-scientific. Additionally, given the research on spirituality and wellness, would this also hold true for folks who incorporate Judeo-Christian practices into their work?

Thanks y'all!!

Yeah, I’ll be VERY clear here. When entering into clinical practice, one is taking care of vulnerable populations. Those that engage in treatments which are unproven are abusing those vulnerable people. At best they are wasting the patients time, prolonging their suffering, and taking their money. At worst they are contributing to suicide. And they should be wildly ashamed.

Emdr works because it’s exposure therapy. The eye movement nonsense makes no neurological sense. It’s prolonged exposure with some bs attached. See the article entitled “emdr minus eye movement equal good psychotherapy” from 1997.

Mindfulness has not shown consistent results. Some have shown no difference.

 

[smalltownpsych]

Some of those practices can be helpful or therapeutic to people, but they are not treatments for mental disorders. My most therapeutic endeavor is skiing with gardening, hiking, and paddling being my calmer therapies during the summer. I also recommend these types of activities for my patients who enjoy them. Other patients do yoga, music, dance, art, you name it. Psychotherapy is what I do with my patients and that is the specific application of relational and communication skills to facilitate change. Mixing psychotherapy with other stuff devalues and muddies it and elevates other practices beyond what they are intended for and can cause risk of harm to patients.

 

[Sanman]

Wow, the argument is getting a little of base here. What the OP mentioned are things that I think are on the edges of evidence based practice and how you incorporate them will vary. I am a fan of mindfulness based practices and find them useful with my chronic pain and high anxiety patients. That said, it is easy to Co-mingle marketing based on some small positive research base and take things to another level. I don't have a problem as long as people practice responsibly. You can help inner city youths or feed into the holistic frenzy in well off parts of CA. Yoga in practice cannot fix your suicidal ideation, but may help a stressed out suburban parent. Good diagnostic skills and appropriate referrals screen out the differences. To each their own and I am with wisneuro, in a practice like this debt is your enemy and good business skills are your friend.

 

[erg923]

I don't have an argument, I have a question. Why are y'all always so combative?

And that was my point... EMDR is pseudoscience, but does it hurt anyone? It is prolonged exposure, yes? With some fancy eye movement on top? So, all of the clients are still receiving the gold-standard, evidence-based practice for their diagnosis, let's say PTSD.

Pseudoscience=bad. Do we need to spell it out for you?

 

[WisNeuro]

Pseudoscience=bad. Do we need to spell it out for you?

While I tend to agree that EMDR is bad for the field from a scientific perspective, the discussion modestmousktr brought up is still worth having. If there is a treatment that works, due to some portions of it, and there may be people who will do that and not do other treatments, should we throw the baby out with the bath water? Perhaps we can look at it like putting a pill in bread so your dog will take it. The bread does not have any therapeutic properties, it is merely a vehicle for the thing that works. I am not necessarily on the side of embracing EMDR in any way, but I do think that it's a much more nuanced argument than a pure binary decision in this case. What level of extraneous filler are we willing to put up with in order to deliver an effective treatment?

 

[Therapist4Chnge]

The issue with the "extraneous filler" is possibly the cost (official EMDR training costs $$$ so a clinician may charge more), the promotion of junk science (the neuro explanation is really bad), and it nudges treatment towards fringe providers who likely don't understand actual science.

 

[WisNeuro]

The issue with the "extraneous filler" is possibly the cost (official EMDR training costs $$$ so a clinician may charge more), the promotion of junk science (the neuro explanation is really bad), and it nudges treatment towards fringe providers who likely don't understand actual science.

Oh, I definitely agree. The training and equipment costs in EMDR are a huge scam, not to mention the nonsensical neurojargon that they use. I was talking more about the concept. What is it about the treatment that some can tolerate better, and is there something we can learn and incorporate into other effective treatments to improve compliance and follow through from patients.

 

[psych.meout]

Oh, I definitely agree. The training and equipment costs in EMDR are a huge scam, not to mention the nonsensical neurojargon that they use. I was talking more about the concept. What is it about the treatment that some can tolerate better, and is there something we can learn and incorporate into other effective treatments to improve compliance and follow through from patients.

This is the key point. I don't think we should continue using treatments that are significantly pseudoscientific, even if they are effective, especially if they are expensive like EMDR. We should be looking for what incremental benefit they might offer above and beyond EBTs and incorporate them into the EBTs.

 

[deleted343839]

Perhaps we can look at it like putting a pill in bread so your dog will take it. The bread does not have any therapeutic properties, it is merely a vehicle for the thing that works.

This is how I think of the supportive therapy/rapport building time that is inevitably infused into whatever active intervention I'm providing. Except I prefer a sandwich metaphor. 😉

A placebo response makes everything work better. Where clinicians go wrong is focusing more on the form of placebo rather than the underlying mechanism. After observing the sorts of "treatments" that hopeful people have been willing to endure, I think nearly anything can be a placebo.

Would it be unethical for OP to have a private practice in which they conduct individual therapy, and let's say offer group therapy on top of it, like "Yoga for Depression"? I am not interested in private practice as I love working with kiddos in inpatient and correctional facilities, but I am wondering about this in particular as it seems many posters have strong opinions, and this is actually something that my university offers at our UCC.

It's not necessarily unethical but it is your responsibility to figure out how these extracurricular activities facilitate a treatment program (eg, behavioral activation, exposure, mindfulness training, social modeling/skills training, etc.) and monitor change accordingly. If these activities are not moving patients toward treatment goals above and beyond your individual therapy, then you have ventured into untested waters, at best. At worst you are practicing something other than psychology.

I appreciate creativity in therapy but it requires discipline. I suspect we're not always encouraged to be creative in treatment it in part because so many therapists go rogue and lose sight of the principles behind our interventions.

 

[psych.meout]

This is how I think of the supportive therapy/rapport building time that is inevitably infused into whatever active intervention I'm providing. Except I prefer a sandwich metaphor. 😉

A placebo response makes everything work better. Where clinicians go wrong is focusing more on the form of placebo rather than the underlying mechanism. After observing the sorts of "treatments" that hopeful people have been willing to endure, I think nearly anything can be a placebo.



It's not necessarily unethical but it is your responsibility to figure out how these extracurricular activities facilitate a treatment program (eg, behavioral activation, exposure, mindfulness training, social modeling/skills training, etc.) and monitor change accordingly. If these activities are not moving patients toward treatment goals above and beyond your individual therapy, then you have ventured into untested waters, at best. At worst you are practicing something other than psychology.

I appreciate creativity in therapy but it requires discipline. I suspect we're not always encouraged to be creative in treatment it in part because so many therapists go rogue and lose sight of the principles behind our interventions.

This seems to be the crux of the matter. Everyone here is quite reasonable and cautious about things like EBPs, scope of practice issues, efficacy and effectiveness research, etc. I think many of the other people opposed to guidelines are similarly conscientious and well-informed. The problem is that it's the classic issue of the lowest common denominator. There are plenty of people opposed to these kinds of guidelines, because they want to keep practicing whatever kind of pseudoscientific woo they have been doing for a while. The aren't the one's making arguments of flexibility vs. rigidity in applying EBPs, they are the ones eschewing EBPs in principle for being "cookie cutter" or "like doing a workbook." Thus, these kinds of guidelines are not for the former group of conscientious, science-minded practitioners. They are for the people who want it to be the Wild West and do whatever they want, because it "feels" right to them or has worked in their anecdotal experience.

 

[smalltownpsych]

This is how I think of the supportive therapy/rapport building time that is inevitably infused into whatever active intervention I'm providing. Except I prefer a sandwich metaphor. 😉

A placebo response makes everything work better. Where clinicians go wrong is focusing more on the form of placebo rather than the underlying mechanism. After observing the sorts of "treatments" that hopeful people have been willing to endure, I think nearly anything can be a placebo.



It's not necessarily unethical but it is your responsibility to figure out how these extracurricular activities facilitate a treatment program (eg, behavioral activation, exposure, mindfulness training, social modeling/skills training, etc.) and monitor change accordingly. If these activities are not moving patients toward treatment goals above and beyond your individual therapy, then you have ventured into untested waters, at best. At worst you are practicing something other than psychology.

I appreciate creativity in therapy but it requires discipline. I suspect we're not always encouraged to be creative in treatment it in part because so many therapists go rogue and lose sight of the principles behind our interventions.

Exactly, I maximize the placebo effect all day long. I would be foolish not to increase positive expectancy. Not saying I do any hocus-pocus or blinking lights though, I just use good old fashioned reassurance from an experienced and knowledgeable psychologist.

 

[PsyDr]

I don't have an argument, I have a question. Why are y'all always so combative?...

Let’s pretend we are oncologists. I open a clinic and tell patients with low grade cancers that I can cure their disease by having them sit in a wooden box three times a week after I masturbate them, because some obscure theory regarding their energy fields. I point out that my patients all report a high degree of satisfaction as evidence that my treatment works. Imagining the reactions from others in the field isn’t hard. Some my ask where my evidence is. Some might be very angry at me for not doing the things that every other oncologist knows will help the patients. Some might call me a fraud. Some might sue me. The courts would ask me for evidence that my ideas are peer reviewed.

But not many would agree with me if I said, “Jeez, why is everyone reacting to my approach in such a combative way! They’re saying my stuff is nonsense! They’re asking for evidence! What jerks!”.

If this sounds ridiculous, you haven’t read about Wilheim Reich.

It’s easy to not learn what the literature has to say. It’s easy to not memorize outcome rates. It’s easy to just do what feels good. But people aren’t paying us to do what we want. They’re paying for professional services. I don’t see holding other professionals to these standards as combative. I also don’t see any point in supporting the emperor’s new clothes.

 

[psych.meout]

I don't have an argument, I have a question. Why are y'all always so combative?

Calm down. "Argument" is meant in the rhetorical sense.