LPCs scope of practice challenged in Michigan.

[BorderlineQueen]

Thousands protest mental health provider changes in Lansing

Thousands of LPCs say they are in danger of no longer being able to help as many as 200,000 patients because of a proposed state rule.

www.woodtv.com

Proposed rule change could hurt Licensed professional counselors and patients

Mental health counselors and supporters packed a public hearing Oct. 4 hosted by the Michigan Department of Licensing and Regulatory Affairs to rail against a proposed rule changes that govern their profession. The Department of Licensing and Regulatory Affairs (LARA) proposed changing rules for...

wwmt.com

Apparently in Michigan nothing in the state statue says LPCs are allowed to diagnose and use psychotherapy. According to the state of Michigan nothing in the statue says LPCs can diagnose so they have been practicing outside of their scope for many years. If a new state bill is written as law LPCs will be unable to diagnose and do psychotherapy. But then another bill is on the docket to restore scope to LPCs the Michigan Psychological Association is opposing parts of the bill stating that LPC training now is unfit to practice and that LPCS need better training. What do you think about this?

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[psych.meout]

Wasn't there a similar issue recently where master's level psychologists (or whatever they're called in Michigan) were going to be legislated put of existence or at least have their scope of practice extremely limited?

 

[bcliff]

Wasn't there a similar issue recently where master's level psychologists (or whatever they're called in Michigan) were going to be legislated put of existence or at least have their scope of practice extremely limited?

Have a close friend with an MA in psychology in Michigan -- From what they've told me, in Michigan individuals with a master's degree, 1 treatment course, 1 assessment course, and at least 1 practicum can pursue licensure as a "limited licensed psychologist." These LLPs must pass the EPPP and are required to receive supervision for the entirety of their career, unlike other midlevel providers.

There was a recent push to rename these midlevel providers "psychological associates," which is more consistent with the terminology used by other states (e.g., psychologist is a term used to refer to doctoral level providers) and allow them to eventually practice without supervision, but (I believe) restrict their scope of practice to be more in line with other mid-level providers (e.g., performing psychotherapy but not performing assessments). There was major push back from the LLP community, and the legislation did not pass.

From what I've heard, there have been a number of recent "reinterpretations" of existing statutes by the state's department of licensing and regulatory affairs that have required legislative intervention.

 

[DynamicDidactic]

Here are the new rules:

https://dtmb.state.mi.us/ORRDocs/ORR/1959_2019-063LR_orr-draft.pdf

Though that that document isn't the best to figure out exactly what is happening. Does anyone have any info on what exactly is the goal here. I highly doubt they want to put 10K LPCs out of business. Are they trying to just take away their ability to supervise and diagnose? Meaning, they would have to rely on social workers/psychologists/psychiatrists for those portions but still be able to provide therapy?

 

[WisNeuro]

I'm all for limiting their ability to assess and diagnose. In the instances where I have seen them attempt to assess psych symptoms and make a diagnosis here, it's been......terrible.

 

[bcliff]

My thought is that the dept of regulatory affairs wants to have a clearer statute to justify their current interpretation of the law

 

[DynamicDidactic]

Here is the best explanation of what is happening that I could find on the googlenets:

What the HELL is Happening in Michigan? How HB 4325 will improve access to mental health - How to Start, Grow, and Scale a Private Practice | Practice of the Practice

What is happening to licensed counselors in Michigan with HB 4325? Since we don't have enough access to mental health services, why are we reducing a Master's level counselor's ability to practice what they have been trained to do?!

www.practiceofthepractice.com

 

[deleted106747]

A year or so ago I read the LPC scope of practice in Michigan since I'm in a neighboring state and there was a lot of discussion. (Oddly, I cannot find it now.)

They gave themselves everything. Assessment, testing, diagnosis, psychotherapy, you name it, they could do it per their regulations. It's about time something is being done about it. No one wants LPCs to stop practicing. But they have been stepping on psychology's toes in Michigan for a long time.

 

[deleted106747]

May I add it's a bit rich that there's this whole press movement to make them seem like innocent victims in all this. They've had no regulation for a long, long time. A close colleague of mine has been frustrated for years with bad diagnosis, bad psychotherapy, and no oversight.

 

[BorderlineQueen]

I'm all for limiting their ability to assess and diagnose. In the instances where I have seen them attempt to assess psych symptoms and make a diagnosis here, it's been......terrible.

I didn't even know counselors were allowed to "diagnosis" anything here in Illinois it's for insurance billing purposes only. Apparently to get licensed an an LPC in Michigan you only need 600 internships hours.https://www.gvsu.edu/cms4/asset/92386C7F-BF75-96ED-67D9FAA81701D122/comparison_between_lpc_and_llp_licenses_in_michigan.pdf. LPCs are good for treating minor disorders. Some of them who have special training in DBT or something else are prepared to treat the more severe disorders. A lot of the times if the pt has anything severe BPD, bipolar, chronic SI they have trouble treating and dealing with it so they refer to someone else. It's also a logical fallacy to think that someone with less training would be more equipped to handle diagnosing. Psychiatrists have more training in diagnosing than LPCS but yet they have to refer to psychologists for psych testing because they have no clue what's going on. Or they just slap on every possible diagnosis there is.

 

[BorderlineQueen]

A year or so ago I read the LPC scope of practice in Michigan since I'm in a neighboring state and there was a lot of discussion. (Oddly, I cannot find it now.)

They gave themselves everything. Assessment, testing, diagnosis, psychotherapy, you name it, they could do it per their regulations. It's about time something is being done about it. No one wants LPCs to stop practicing. But they have been stepping on psychology's toes in Michigan for a long time.

I completely agree nothing wrong with limiting scope of practice in an area where one has limited training in.

 

[BorderlineQueen]

Here is the best explanation of what is happening that I could find on the googlenets:

What the HELL is Happening in Michigan? How HB 4325 will improve access to mental health - How to Start, Grow, and Scale a Private Practice | Practice of the Practice

What is happening to licensed counselors in Michigan with HB 4325? Since we don't have enough access to mental health services, why are we reducing a Master's level counselor's ability to practice what they have been trained to do?!

www.practiceofthepractice.com

The state staute for LPCS never included diagnosis or psychotherapy. So technically they were practicing outside of their scope. There state statue only includes counseling not diagnosis and psychotherapy.

 

[Therapist4Chnge]

May I add it's a bit rich that there's this whole press movement to make them seem like innocent victims in all this. They've had no regulation for a long, long time. A close colleague of mine has been frustrated for years with bad diagnosis, bad psychotherapy, and no oversight.

I’ve previously been licensed in two different Midwest states and I’ve reviewed a ton of evals from both LPCs and LLPs in the region....and the evals were largely useless. Differential diagnosis was bad too. Bipolar instead of Borderline Dx’s, PTSD for simple driving anxiety, etc. Treatments were mostly “eclectic”, which really meant they did what they wanted. It was really frustrating.

 

[BuckeyeLove]

I've been called in to do second opinion forensic evals in TSUN (lolz), almost always on these 2nd eval cases they allow social workers to complete prior to a defendant/patient being deemed "permanently incompetent" (their stupid actual descriptor per statute). Unequivocally, across the board, they are horrible hot garbage evaluations. I know this isn't referencing social workers, but anything that is limiting poorly trained and/or incompetent individuals from providing dangerous services/opinions, is always a good thing.

 

[BorderlineQueen]

I’ve previously been licensed in two different Midwest states and I’ve reviewed a ton of evals from both LPCs and LLPs in the region....and the evals were largely useless. Differential diagnosis was bad too. Bipolar instead of Borderline Dx’s, PTSD for simple driving anxiety, etc. Treatments were mostly “eclectic”, which really meant they did what they wanted. It was really frustrating.

It really sucks that legislators see psychotherapy and evals as easy so they are willing to give this scope to LPC/LMFT/LCSW. They aren't psychologists so they can't see all the mistakes LPCs and others make. I think as a field we should be supervising mid-levels. The psychologist does the initial appointment and writes a diagnosis and a treatment plan. The pt goes back to the LPC for therapy and the psychologist sees the patient every fourth or fifth visits to assess progress, make sure the pt is getting appropriate treatment, and further updating the treatment plan. MDs get back extra for supervision of NP/PA so psychologists should also get paid extra for this.

 

[GradStudent2020]

It really sucks that legislators see psychotherapy and evals as easy so they are willing to give this scope to LPC/LMFT/LCSW. They aren't psychologists so they can't see all the mistakes LPCs and others make. I think as a field we should be supervising mid-levels. The psychologist does the initial appointment and writes a diagnosis and a treatment plan. The pt goes back to the LPC for therapy and the psychologist sees the patient every fourth or fifth visits to assess progress, make sure the pt is getting appropriate treatment, and further updating the treatment plan. MDs get back extra for supervision of NP/PA so psychologists should also get paid extra for this.

Yikes. I read comments like this and I have to wonder how much time you have spent working in the field with the professionals you are bashing.

LPC’s and other “mid-level” mental health providers are educated and licensed professionals. I have worked with clinicians that are licensed at the Master’s and Doctoral levels for a decade. (Anecdotally) the best therapists have been LPC’s. This has held true in different settings and states. I have had the opportunity to work with clinicians at both levels that have been excellent diagnosticians. Obviously, individuals with doctoral degrees have more education in assessment and diagnosis than individual with Master’s degrees. However, an intern or ECP may not have the experience to diagnose as well as a seasoned LPC. I have seen horrible psych. reports from LP’s and questionable diagnoses from LPC’s.

I don’t know what the answer is for Michigan but I see a lot of posters on this board criticize Master’s level clinicians. There is enough need to go around in our field. I value my peers and colleagues regardless. This opinion is based on my own learning experiences with excellent clinicians of all levels.

 

[DynamicDidactic]

Apparently to get licensed an an LPC in Michigan you only need 600 internships hourz

That’s the modal hours for LPCs across states.

 

[DynamicDidactic]

There state statue only includes counseling not diagnosis and psychotherapy.

What is the difference between counseling and psychotherapy?

 

[BorderlineQueen]

What is the difference between counseling and psychotherapy?

I have no clue I don't make the state statues.

 

[DynamicDidactic]

but I see a lot of posters on this board criticize Master’s level clinicians. There is enough need to go around in our field. I value my peers and colleagues regardless. This opinion is based on my own learning experiences with excellent clinicians of all levels.

I agree, I’ve seen poor clinicians across degrees and fields.

I will say that LPCs get a very low number of hours in face2face intervention during training. But I’m not sure more hours with subpar/outdated training models is any better for psychologists.

 

[BorderlineQueen]

Yikes. I read comments like this and I have to wonder how much time you have spent working in the field with the professionals you are bashing.

LPC’s and other “mid-level” mental health providers are educated and licensed professionals. I have worked with clinicians that are licensed at the Master’s and Doctoral levels for a decade. (Anecdotally) the best therapists have been LPC’s. This has held true in different settings and states. I have had the opportunity to work with clinicians at both levels that have been excellent diagnosticians. Obviously, individuals with doctoral degrees have more education in assessment and diagnosis than individual with Master’s degrees. However, an intern or ECP may not have the experience to diagnose as well as a seasoned LPC. I have seen horrible psych. reports from LP’s and questionable diagnoses from LPC’s.

I don’t know what the answer is for Michigan but I see a lot of posters on this board criticize Master’s level clinicians. There is enough need to go around in our field. I value my peers and colleagues regardless. This opinion is based on my own learning experiences with excellent clinicians of all levels.

I work as a drug/alcohol behavioral health associate so I work with LPC/LCSWs daily. NP/PA are also educated and licensed professionals but most of them still have to be supervised. It's a logical fallacy that someone with less training can be as competent than someone with more training.

 

[msgeorgeeliot]

It really sucks that legislators see psychotherapy and evals as easy so they are willing to give this scope to LPC/LMFT/LCSW. They aren't psychologists so they can't see all the mistakes LPCs and others make. I think as a field we should be supervising mid-levels. The psychologist does the initial appointment and writes a diagnosis and a treatment plan. The pt goes back to the LPC for therapy and the psychologist sees the patient every fourth or fifth visits to assess progress, make sure the pt is getting appropriate treatment, and further updating the treatment plan. MDs get back extra for supervision of NP/PA so psychologists should also get paid extra for this.

Kindly stated, @BorderlineQueen, my understanding is that you are not actually a professional in the field of psychology at all. That does not mean what you have to say is without value. Students and aspiring psychologists are well within their rights to start threads and express their opinions on any given topic. But I do not understand what you hope to gain by making proclamations like this as though you know the field well. It makes no logical sense to me.

 

[GradStudent2020]

I agree, I’ve seen poor clinicians across degrees and fields.

I will say that LPCs get a very low number of hours in face2face intervention during training. But I’m not sure more hours with subpar/outdated training models is any better for psychologists.

Both states I hold a LPC In required 3,000 supervised hours post-degree (IIRC). Compared to my doctoral training I received a lot more direct supervision of therapy skills, client conceptualization, etc. I have gotten quite a bit of that at that doctoral level but as the scope of a psychologist is different there have been so many additional things to focus on in training.

 

[BorderlineQueen]

Kindly stated, @BorderlineQueen, my understanding is that you are not actually a professional in the field of psychology at all. That does not mean what you have to say is without value. Students and aspiring psychologists are well within their rights to start threads and express their opinions on any given topic. But I do not understand what you hope to gain by making proclamations like this as though you know the field well. It makes no logical sense to me.

You're right I'm even lower on the totem pole than they are I'm only a drug/alcohol behavioral health associate. This is my opinion and if you think I'm wrong tell me why?

 

[GradStudent2020]

I work as a drug/alcohol behavioral health associate so I work with LPC/LCSWs daily. NP/PA are also educated and licensed professionals but most of them still have to be supervised. It's a logical fallacy that someone with less training can be as competent than someone with more training.

I think you are confusing education level with training. Individuals with a doctorate may receive way less training on therapy depending on the type of program they attended or on their career goals.

Master’s level clinicians are (ideally) sufficiently trained to diagnosis and provide therapy. They (along with doctoral level providers) should be aware of their personal limitations and be prepared to refer out or consult on complex presentations.

It would be detrimental to our clients to add barriers to treatment like those you suggested above (supervision by outside providers, etc).

 

[BorderlineQueen]

I think you are confusing education level with training. Individuals with a doctorate may receive way less training on therapy depending on the type of program they attended or on their career goals.

Master’s level clinicians are (ideally) sufficiently trained to diagnosis and provide therapy. They (along with doctoral level providers) should be aware of their personal limitations and be prepared to refer out or consult on complex presentations.

It would be detrimental to our clients to add barriers to treatment like those you suggested above (supervision by outside providers, etc).

Does this present any barriers in the MD/DO world where this is a common model? It's common model that the MD/DO sees the patient first and then the NP/PA sees them after the first visit. Does this add barriers to treatment?

 

[GradStudent2020]

You're right I'm even lower on the totem pole than they are I'm only a drug/alcohol behavioral health associate. This is my opinion and if you think I'm wrong tell me why?

I think your opinion is wrong and shared why above. Master’s level clinicians do not need to be supervised by doctoral level clinicians. Scope of practice is different but overlap.

 

[BorderlineQueen]

I think your opinion is wrong and shared why above. Master’s level clinicians do not need to be supervised by doctoral level clinicians. Scope of practice is different but overlap.

Fair I will give you that.

 

[GradStudent2020]

Does this present any barriers in the MD/DO world where this is a common model? It's common model that the MD/DO sees the patient first and then the NP/PA sees them after the first visit. Does this add barriers to treatment?

Yes. Adding an unnecessary extra provider to meet is a barrier to treatment.

ETA: we as a field need to stop emulating the medical field. They aren’t getting everything right. They get a lot of things wrong.

 

[BorderlineQueen]

Yes. Adding an unnecessary extra provider to meet is a barrier to treatment.

Okay I see your point.

 

[msgeorgeeliot]

You're right I'm even lower on the totem pole than they are I'm only a drug/alcohol behavioral health associate. This is my opinion and if you think I'm wrong tell me why?

My simple point is that you speak as though you are a practitioner of professional psychology (reference the original bolded quote by you), but you are not qualified to do so.

Our ethics code is strict about claiming authority, titles, and expertise.

Your work matters. Also, view it in the proper context. Don’t over-step.

Please take my feedback in the intended spirit. At the end of the day, I have no interest in debating you or nurturing your professional growth.

(negativefemalepoints)

 

[BorderlineQueen]

My simple point is that you speak as though you are a practitioner of professional psychology (reference the original bolded quote by you), but you are not qualified to do so.

Our ethics code is strict about claiming authority, titles, and expertise.

Your work matters. Also, view it in the proper context. Don’t over-step.

Please take my feedback in the intended spirit. At the end of the day, I have no interest in debating you or nurturing your professional growth.

(negativefemalepoints)

Here’s the thing I have never on this site claimed I am a psychologist. On my sdn profile I am clearly listed as Pre-health . I have posted on the WAMC thread. I have made it clear that I am a college senior thinking about either clinical psych PhD or med school. That’s fine I am interested in my own self-growth. I also don’t understand the “negativefemalepoints”?? What ?? I know you have some sort of problem with the way I convey things. That you seem to hate the fact that I posses masculine qualities. That you hate how authoritative I am or how bossy I am. I am sorry that you see me as authoritative. But I do not apologize for the fact that I am bossy, strong willed and opinionated. This is how I am and even if I were licensed you would still have the same things to say about me. Also this is pretty hypocritical coming from someone who wrote this post. Which perspectives are welcome here? Apparently you see me as an aggressive female.

 

[BorderlineQueen]

[/QUOTE]
Wow I don't care either. I'm glad you look down on me that's great in fact. You have never even ever advised me. That's great that a 30+ plus year old clinician is looking down on a college senior. Just block or mute me. That's so professional for you to assume that I'm in drug/alcohol recovery. No I'm simply a drug/alcohol behavioral health associate at a sober living. I wanted to this job because I need experience in mental health and I need some money for application fees and to cover the cost of college. For a "psychologist" to say this about someone on the internet is highly unprofessional. I wonder how you treat your patients struggling with drugs, alcohol and other problems. Just WOW really. Yet you care even to engage with me and belittle me. This is an online forum I portray myself like I do in real life. Frankly this comment coming from a "licensed psychologist" is very concerning.

 

[AbnormalPsych]

Hey ya'll, can we remain civil please? I'm genuinely interested in the topic of this thread on would appreciate keeping it on the rails.



@msgeorgeeliot - you are better than comments like this.

 

[msgeorgeeliot]

Wow I don't care either. I'm glad you look down on me that's great in fact. You have never even ever advised me. That's great that a 30+ plus year old clinician is looking down on a college senior. Just block or mute me. That's so professional for you to assume that I'm in drug/alcohol recovery. No I'm simply a drug/alcohol behavioral health associate at a sober living. I wanted to this job because I need experience in mental health and I need some money for application fees and to cover the cost of college. For a "psychologist" to say this about someone on the internet is highly unprofessional. I wonder how you treat your patients struggling with drugs, alcohol and other problems. Just WOW really. Yet you care even to engage with me and belittle me. This is an online forum I portray myself like I do in real life. Frankly this comment coming from a "licensed psychologist" is very concerning.

Um, actually you pm’ed me to seek advice a week ago, but ok.

I’m actually way older than 30+ plus (old!), but I don’t look down on anyone for their age. I do correct them for over-stating what they know. Others do the same for me.

I am a specialist in SUDS. I know that it’s standard for junior staff to be in recovery. If I’m totally off base, my bad.

 

[msgeorgeeliot]

Hey ya'll, can we remain civil please? I'm genuinely interested in the topic of this thread on would appreciate keeping it on the rails.



@msgeorgeeliot - you are better than comments like this.

There is absolutely nothing uncivil about this exchange, either in a thread vacuum or in the broader context of this board in general. These posts are completely on topic, though perhaps not to your particular liking in terms of the direction.

Please don’t tag me in additional posts. I am equal to my comments.

 

[WisNeuro]

— a college senior who is probably in some sort of personal drug/alcohol recovery (yay you)

Out of bounds. I'm all about freedom of expression and whatever tone you want, but we don't make light of mental health diagnoses, or infer those diagnoses in other people on the board based on wild speculation.

 

[GradStudent2020]

Here’s the thing I have never on this site claimed I am a psychologist. On my sdn profile I am clearly listed as Pre-health . I have posted on the WAMC thread. I have made it clear that I am a college senior thinking about either clinical psych PhD or med school. That’s fine I am interested in my own self-growth. I also don’t understand the “negativefemalepoints”?? What ?? I know you have some sort of problem with the way I convey things. That you seem to hate the fact that I posses masculine qualities. That you hate how authoritative I am or how bossy I am. I am sorry that you see me as authoritative. But I do not apologize for the fact that I am bossy, strong willed and opinionated. This is how I am and even if I were licensed you would still have the same things to say about me. Also this is pretty hypocritical coming from someone who wrote this post. Which perspectives are welcome here? Apparently you see me as an aggressive female.

I was personally confused with the “we should be supervising mid-levels” comment. It implies that you are post-degree. Thanks for clarifying where you are coming from.

I worry MORE about your comments regarding LPC’s and LCSW’s knowing that you work with them. If everyone on site is that bad.... you may try and find another job so you can get a broader understanding of the field before pursuing a degree. I also wonder what type of supervision and mentorship you have IRL if this is your perspective of the field.

 

[WisNeuro]

I worry MORE about your comments regarding LPC’s and LCSW’s knowing that you work with them. If everyone on site is that bad.... you may try and find another job so you can get a broader understanding of the field before pursuing a degree. I also wonder what type of supervision and mentorship you have IRL if this is your perspective of the field.

There are plenty of us who have worked in various positions (VA, non-profit, muni) who share this opinion of some midlevels. Scope creep is real, and it has adverse impacts on our patients.

 

[Therapist4Chnge]

It really sucks that legislators see psychotherapy and evals as easy so they are willing to give this scope to LPC/LMFT/LCSW. They aren't psychologists so they can't see all the mistakes LPCs and others make. I think as a field we should be supervising mid-levels. The psychologist does the initial appointment and writes a diagnosis and a treatment plan. The pt goes back to the LPC for therapy and the psychologist sees the patient every fourth or fifth visits to assess progress, make sure the pt is getting appropriate treatment, and further updating the treatment plan. MDs get back extra for supervision of NP/PA so psychologists should also get paid extra for this.

FWIW, that is my exact setup. That’s also been my experience in regard to training and scope. The reason why I require oversight and sign off on all of the notes for my patients seen is that I have seen the limitations in training (at least in the populations I see, which are mostly mTBI, TBIs, and polytrauma/chronic pain) and I believe the best care available involves me evaluating, diagnosing, and developing a treatment plan that they implement in treatment and follow up.

 

[GradStudent2020]

There are plenty of us who have worked in various positions (VA, non-profit, muni) who share this opinion of some midlevels. Scope creep is real, and it has adverse impacts on our patients.

Feel free to NEVER engage with me, on any topic, as previously and repeatedly requested.

 

[WisNeuro]

Feel free to NEVER engage with me, on any topic, as previously and repeatedly requested.

Likewise, you also have that option.

 

[cara susanna]

I honestly have not had positive experiences with any of the LPCs I've worked with, although my sample size is small. The same is not true as Masters level social workers, as I know many that are excellent therapists. I also know that the MSW people seem to look down on the LPC people as having inferior training (not sure if that's true or not).

 

[GradStudent2020]

Likewise, you also have that option.

Just stop. I never respond to your comments unless you directly respond to me. Leave me alone, your behavior is against the TOS and derails threads.

 

[WisNeuro]

Just stop. I never respond to your comments unless you directly respond to me. Leave me alone, your behavior is against the TOS and derails threads.

You can report anything you feel is a TOS. I am free to engage in conversations in the board with others.

 

[erg923]

drama

You can report anything you feel is a TOS. I am free to engage in conversations in the board with others.

Hey! Save the drama for yo momma.

 

[WisNeuro]

drama


Hey! Save the drama for yo momma.

TNT/SDN knows drama.

 

[deleted106747]

Jeez, what happened to this thread??

 

[WisNeuro]

Jeez, what happened to this thread??

Hypocrisy?

 

[GradStudent2020]

FWIW, that is my exact setup. That’s also been my experience in regard to training and scope. The reason why I require oversight and sign off on all of the notes for my patients seen is that I have seen the limitations in training (at least in the populations I see, which are mostly mTBI, TBIs, and polytrauma/chronic pain) and I believe the best care available involves me evaluating, diagnosing, and developing a treatment plan that they implement in treatment and follow up.

This makes total sense working with this type of population, where Master’s level clinicians likely have limited training/exposure.