LPCs scope of practice challenged in Michigan.

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Both states I hold a LPC In required 3,000 supervised hours post-degree (IIRC).
I meant graduate training. Across the vast majority of states:

LPCs are required to get 100 hours of practicum training that is supervised by a faculty within the program. The quality of that training (e.g., how many hours are actually face2face) and supervision can vary greatly.

Otherwise, only 600 hours on internship where the graduate program has no supervisory role. Again, the quality of those hours and the supervision can vary greatly.

What I am saying is that a person can get out of a masters program after only having 1 or 2 clients then go onto an internship that is very poorly regulated. I am not saying that there isn't variability in doctoral psychology programs but the modal hours of intervention and supervision for LPCs is generally too sparse and poorly supervised, imo. As I said earlier, I have no evidence that having more hours of face2face during during graduate training will make anyone a better clinician. But it is hard to argue the difference in hours.

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Individuals with a doctorate may receive way less training on therapy depending on the type of program they attended or on their career goals.
I have to imagine that you are talking about clinical/counseling/school psychology at the doctorate level. And, I hope we are talking about accredited programs at a minimum. If that is correct, the above statement is false.

I can't imagine that during graduate training (pre-internship) that any accredited doctoral program receives less face2face therapy hours and less supervision than any LPC masters program. Maybe there is 1 amazing LPC program out there while you find the worst doctoral program. Generally speaking, even in research focused programs every student will get more than 100 face2face hours (otherwise, the risk of not matching is too great).

On internship, doctorates also get much more hours of general training and face2face hours (requirement for accreditation).

Unless you are talking about training post-degree, in that case I think it would be unfair to compare LPCs with clinical/counseling psych doctorates that do not pursue clinical work after graduating. So, I find your statement to be very misleading.
 
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Just to be clear, I have no problem with LPCs. Or put more accurately, I think the whole field is full of poorly trained clinicians (psychologists, psychiatrists, social workers, LPCs, MFTs, drug/alcohol counselors, etc.), especially for those most in need.

We have no strong body of evidence that masters-level clinicians get better outcomes than doctoral-level clinicians. But one thing we can say is that masters-level clinicians, especially LPCs, have greater variability in training. Psychiatrists seem to have least variability than other mental health providers. Psychologists are in the middle.

Since the vast majority of mental health services are not provided by psychiatrists or psychologists, masters-level providers are the major access point to psychotherapy. My belief is that the training and regulation needs to be improved at that level. It is not a surprise that CACREP has grown in influence in the past decade or that the APA now wants to accredit masters programs.

I do think that a whole change in the system would benefit the vast majority of people needing treatment. But, as usually, a minority of people have something to lose. A simple change is to get licensing boards to clamp down on training (across professions) and to require training in some evidence-based treatment.
 
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Psychiatrists seem to have least variability than other mental health providers. Psychologists are in the middle.
As it pertains to psychotherapy training, I have not found this to be the case when discussing backgrounds with psychiatry colleagues.
 
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I'm confused where the comments about clinical mental health counseling students having 100 F2F hours comes from. At accredited programs, students are required to complete a 100 hour minimum practicum and 600 hour minimum internship, of which at least 40% of those hours (300 total) need to be F2F. And then you have typically 3,000 hours of supervised post-licensure practice, of which typically at least 2,000 need to be F2F. So, the masters-level model just really moves to the bulk of supervised hours to post-masters. It's still less than psych, but LPCs also shouldn't be doing or trained in true psych assessment.

As an interesting aside board certified behavior analysts (BCBAs) actually LIMIT the number of direct service hours that can count towards the total required 1,500-2,000 hours of fieldwork (more frequent supervision=less required hours) , which can be during or post-degree.
 
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As it pertains to psychotherapy training, I have not found this to be the case when discussing backgrounds with psychiatry colleagues.
I meant in totality. But, I am not as intimately familiar with psychiatrists as psychologists and LPCs. As I understand, psychiatrists are required to be at least exposed to certain interventions (e.g., CBT and DBT) but the depth of that exposure can vary.
 
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I'm confused where the comments about clinical mental health counseling students having 100 F2F hours comes from. At accredited programs, students are required to complete a 100 hour minimum practicum and 600 hour minimum internship, of which at least 40% of those hours (300 total) need to be F2F.
The percentages you speak of are not delineated in all state regulations. Additionally, the vast majority of LPCs across the nation probably didn't come from an "accredited" program.

So, for simplicity I was saying that at most, the typical training model, students would not get more than 100 hours face2face at their graduate program and who knows how much at their internship.

And then you have typically 3,000 hours of supervised post-licensure practice, of which typically at least 2,000 need to be F2F. So, the masters-level model just really moves to the bulk of supervised hours to post-masters. It's still less than psych, but LPCs also shouldn't be doing or trained in true psych assessment.
Yes, a lot of the hours of seeing people is pushed back to post-graduate training, At this point, there is almost no oversight on the quality of the supervision. To me, it seems like sending out sheep to slaughter. You are basically a full-time therapist with some supervision but very little experience prior to that. This diminishes the quality of those hours.
 
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So, for simplicity I was saying that at most, the typical training model, students would not get more than 100 hours face2face at their graduate program and who knows how much at their internship.
At least one state I've lived in had specific pre-degree internship/practicum hours and F2F requirements for LPC candidates that were in considerable excess of 100. Do you have source for that number? Also, I'm not sure that the statement that "most LPCs come from unaccredited programs" is correct, given that states are increasingly requiring CACREP-accredited or functionally-equivalent programs for licensure. In the past? Maybe. In the past decade or so? Not so much
 
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I meant graduate training. Across the vast majority of states:

LPCs are required to get 100 hours of practicum training that is supervised by a faculty within the program. The quality of that training (e.g., how many hours are actually face2face) and supervision can vary greatly.

Otherwise, only 600 hours on internship where the graduate program has no supervisory role. Again, the quality of those hours and the supervision can vary greatly.

What I am saying is that a person can get out of a masters program after only having 1 or 2 clients then go onto an internship that is very poorly regulated. I am not saying that there isn't variability in doctoral psychology programs but the modal hours of intervention and supervision for LPCs is generally too sparse and poorly supervised, imo. As I said earlier, I have no evidence that having more hours of face2face during during graduate training will make anyone a better clinician. But it is hard to argue the difference in hours.

Ohhh, ok. I’m not familiar with what typical standards are but what you are describing is much lower than what I was required during my Master’s. We had to do multiple settings, tons of supervision, etc. I think I graduated with right under 1500 hours? My experience was similar to LPC friends and colleagues I’ve had. Maybe there are regional training discrepancies?
 
I have to imagine that you are talking about clinical/counseling/school psychology at the doctorate level. And, I hope we are talking about accredited programs at a minimum. If that is correct, the above statement is false.

I can't imagine that during graduate training (pre-internship) that any accredited doctoral program receives less face2face therapy hours and less supervision than any LPC masters program. Maybe there is 1 amazing LPC program out there while you find the worst doctoral program. Generally speaking, even in research focused programs every student will get more than 100 face2face hours (otherwise, the risk of not matching is too great).

On internship, doctorates also get much more hours of general training and face2face hours (requirement for accreditation).

Unless you are talking about training post-degree, in that case I think it would be unfair to compare LPCs with clinical/counseling psych doctorates that do not pursue clinical work after graduating. So, I find your statement to be very misleading.

I absolutely disagree. The scope of doctoral training is wider, and training focuses on research, therapy, assessment, diagnosis, etc. Master’s programs typically focus on .... therapy. Diagnosis as a way to conceptialize and support therapy, but mostly therapy. More coursework on therapy, more direct supervision on therapy, more explicit instruction on therapy.
 
As a masters level clinician, I can agree that there is variability in training programs. Honestly, I don’t know if I can truly say LCSW is better than LPC as far as training goes. I have a somewhat unique perspective in that I attended both types of programs. I completed one year towards a MSW degree before ultimately tranfering to a masters in counseling program. For me, the training was better and more focused towards what I wanted. Granted this was only one out of many MSW programs that exist so I cannot speak for all, but generally, the CSWE keeps a tight foothold on the standardization of programs. However I know colleagues who completed the program and are amazing clinicians. I also received most of my supervision from psychologists which I felt provided me a very rich supervision experience. I do agree that LPC’s need to stay in their lane with scope, but I am not sure that eliminating the ability to Dx is the way to go. If we are unable to Dx, I am not sure how we would be able to bill for our services. While being able to Dx isn’t all that important to me, l do need to be able to provide an accurate conceptualization of the person including psychopathology, otherwise I am not sure how I can provide effective and evidenced based treatments. That was one area where I felt my program lacked. It seems that our psychopathology coursework was more geared towards being able to regurgitate symptoms from the DSM 5 versus taking a more biopsychosocial approach and understanding the whole person instead of what little snapshot I have when they are in my office. This is where my supervision really helped out.
 
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At least one state I've lived in had specific pre-degree internship/practicum hours and F2F requirements for LPC candidates that were in considerable excess of 100. Do you have source for that number?
I think we are misunderstanding each other, what I am saying is that the requirements vary greatly state to state.

1. I do not believe any single state has a "practicum" requirement (meaning, what is supervised by a graduate faculty) of more than 100 hours.
2. Similarly, no state - I believe - requires more than 600 internship hours (reminder: those hours have no regulation from the grad program).

How much of those hours are F2F are also going to vary significantly. Here is a decent breakdown of the requirements:

Similarly to psychology, CA and MA seem to be the most careful on how the hours are tracked and how much is F2F. For example here is MA:
The practicum must have a minimum of 100 of supervised experience during your graduate studies with 40 hours of client contact or lab work and designed role play scenarios with fellow graduate students. You must have 25 hours of direct supervision including 10 hours of one-on-one supervision and at least 5 hours of group supervision.

The internship will require a full 600 hours of experience prior to receiving your Master’s diploma. This must include 240 hours of direct client work and at least 45 hours of direct supervision. You must have 15 hours of one-on-one supervision and 15 hours of group supervision minimum.
Notice, even here the first 100 hours can be "lab work and designed role play scenarios with fellow graduate students." Which I believe means that you could literally be sent out out on internship without ever seeing a real client.

MA is clear on the amount of hours that you must get on internship but most states are not that clear. For example, PA requires 600 internship hours but nowhere in the regulations does it state how many F2F or supervision amount:
 
Also, I'm not sure that the statement that "most LPCs come from unaccredited programs" is correct, given that states are increasingly requiring CACREP-accredited or functionally-equivalent programs for licensure. In the past? Maybe. In the past decade or so? Not so much
I cannot point to an empirical evaluation. But the majority of states do not require CACREP (apparently, only 6 as of now: States with Unique Board Requirements | Counselor Education & Family Studies | Liberty University) and those that do have only recently made that regulation. Meaning, most current LPCs probably did not come from programs that were accredit during their training.

For most states, you will find a significant amount (sometimes even an equivalent amount) of programs designed for LPC that are not CACREP (there is also a competing MPCAC accreditation). These are mostly masters programs embedded within a psychology department. This is one of the primary reasons APA has gotten into the accreditation game.
 
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I’m often curious how many doctoral level clinicians here provide therapy as a major component of their careers?
 
Ohhh, ok. I’m not familiar with what typical standards are but what you are describing is much lower than what I was required during my Master’s. We had to do multiple settings, tons of supervision, etc. I think I graduated with right under 1500 hours? My experience was similar to LPC friends and colleagues I’ve had. Maybe there are regional training discrepancies?
You probably went to a better program, which is great and amazing. I wish there was more consistent regulation that required similar standards across states.
 
You probably went to a better program, which is great and amazing. I wish there was more consistent regulation that required similar standards across states.

Sure, I agree with that. I wish there were consistent licensure standards/better reciprocity at the doctoral level.

I do give the side eye to certain “counseling” degrees associated with religious institutions. In the state I currently reside in graduates of those programs are ineligible for licensure, though.
 
As a masters level clinician, I can agree that there is variability in training programs. Honestly, I don’t know if I can truly say LCSW is better than LPC as far as training goes.
I know much less about social work. But my anecdotal experience is that a lot of training programs (at top universities) do not support evidence-based treatments.

Similarly, I always advise undergrads to look over the course work for any program and the model used for training. Broadly, if someone wants a more social justice approach, go with social work. If someone wants more science-based approach, look for LPC programs within Psychology departments. But there is a great deal of overlap.
 
I’m often curious how many doctoral level clinicians here provide therapy as a major component of their careers?
Not me but I did train LPC-seeking students in my previous position. My feeling from reading their posts for many years now is that a lot of the consistent posters provide clinical services (e.g., assessment or therapy) as a regular part of their job.
 
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I'm going to get back to work for a little while.
 
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I know much less about social work. But my anecdotal experience is that a lot of training programs (at top universities) do not support evidence-based treatments.

Similarly, I always advise undergrads to look over the course work for any program and the model used for training. Broadly, if someone wants a more social justice approach, go with social work. If someone wants more science-based approach, look for LPC programs within Psychology departments. But there is a great deal of overlap.
Agreed on both points. There was definitely a mixed bag of profs that veered from standard approaches and you needed to weed through and research what would be more useful. As far as the social justice stance, that was my experience as well with the MSW program. While I am not opposed to social justice, I found that there was just to much of an emphasis on a systems approach for me. While obviously that is generally a given for SW Programs, this uni is well known for their clinical education and focus. I also found the profs to be sooo policitally polarized in a certain direction that it seemed to skew their objectivity.
 
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I was previously an adjunct instructor in an LMHC graduate program. The program met the current requirements for licensure eligibility. I taught the Adult Psychopathology and Diagnosis course. I was asked to do the course, said yes, and was left to come up with the sylalbus, materials, etc. There was no review of what I came up with. Program director sat in for a portion of one class over the 3 years that I taught it. I could have done anything! I do believe that I came up with a relatively thorough and difficult course, with competency based requirements for passing. However, I will say that passing the course would not make anyone qualified as a "diagnostician." Before coming up with the course, I went to local mental health agencies that hired LMHC and asked directors and senior clinicians what would be important for the students to learn in my class. Almost across the board, they indicated that they expected the LMHC's to be able to- after a 50 minute initial intake session consisting of non-structured interview and history questionnaires- come up with a provisional diagnosis and outline of a treatment plan to submit to insurance for the therapy authorization, with the understanding that the DX would likely be refined or changed. I set of goal for my students to be able to provide some structure to their client interviews to get as thorough a picture as possible of the total symptamatology, as well as being able to use that information to come up with a diagnosis that was at least in the correct section of the DSM-IV, if not within a page or two. It was not a course in psychological assessment, but moreso on making a provisional differential diagnosis. I consistently reminded them of the limitations of the assessment methods, as well as the provisional nature of the diagnosis and the need to gather more information during later sessions. If they did more than that, they would potentially functioning outside the scope of their practice.
 
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I’m often curious how many doctoral level clinicians here provide therapy as a major component of their careers?

I think quite a few of us do. You can start a thread if you want actual numbers though.
 
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I’m often curious how many doctoral level clinicians here provide therapy as a major component of their careers?
I have not had a pure (or even primarily) psychotherapy focused position since my pre-doctoral internship, and have not done any non-behavioral therapy in many years. Though I have doctoral and pre- and post-doc training in providing direct psychotherapy (e.g., CBT; cognitive therapy), I would not provide or supervise others who are providing such services now without some "catch-up" structured instruction- such as an intensive workshop- and close supervision (at least initially). While it's certainly in the scope of my practice and training, I am out of practice and inexperienced with and unaware of changes to specific techniques an approaches. I would expect no different from other psychologists, LPC/LMHCs, social workers, etc.
 
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Separate thread?

Assistant Professor of Psychology at a small college, then PCMHI in the VA for over 4 years....I suppose its debatable if that is "therapy" though?
It was largely psychoeducation, health coaching, brief behavior therapy, triage, and/or collaborative care management with various medical disciplines/specialists. I also did bariatric and organ transplant psych evals.

I have a couple "therapy patients" currently.... but in a high functioning setting that I have talked about before. In my current role, I mostly do non-clinical related matters and research for a large, national MCO---macro healthcare system stuff/intervention (panel management, outcomes, provider relations, QA, service denial appeals, provider/state org issues/complaints, best practice clinical guidelines/revisions, etc).

It is interesting to see how (professionally) spread we are as posters, in terms of daily activities in the field. All perspectives should be welcomed...and no doubt can contribute to our learning on this board.

I don't know really know about all this LPC stuff? But suffice to say that if you want to dream of the Delaware Model (@BorderlineQueen ).... keep dreaming. Too many dysfunctional peeps for doctoral-level clinical psychologists to take over the mental health world...k? Many LPCs suck. Many are good enough. All mental health professions (combined) are..."not great."
 
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I have not had a pure (or even primarily) psychotherapy focused position since my pre-doctoral internship, and have not done any non-behavioral therapy in many years. Though I have doctoral and pre- and post-doc training in providing direct psychotherapy (e.g., CBT; cognitive therapy), I would not provide or supervise others who are providing such services now without some "catch-up" structured instruction- such as an intensive workshop- and close supervision (at least initially). While it's certainly in the scope of my practice and training, I am out of practice and inexperienced with and unaware of changes to specific techniques an approaches. I would expect no different from other psychologists, LPC/LMHCs, social workers, etc.

Do you consider ACT psychotherapy or ABA or both?
 
Do you consider ACT psychotherapy or ABA or both?

Interesting question, and quite the hot topic in ABA circles. If we go by Baer, Wolf, and Risley’s (1968) 7 dimensions of ABA, then, yes, I do feel that ACT Is ABA as long as the goal of treatment is objective and measurable change in behavior (and I would not count purely private’s events, as they are not really objective). I recently attended a full day ACT for autism workshop by Mark Dixon at a regional ABA conference, and it definitely fit in quite well to the overall program. As to whether or not it’s psychotherapy, it’s a bit more difficult to find a generally accepted standard definition of “psychotherapy.” In the sense that ACT is non-medical intervention targeting mental illness, then I would say it’s psychotherapy also.
 
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FWIW, I generally/loosely consider ABA to be a form of psychotherapy — To me, psychotherapy = achieving behavior change via evidence-based, nonpharmacologic means facilitated by a licensed mental/behavioral healthcare provider.

IMO, the example re: classification of ACT vs. ABA highlights the need for a loose/expansive psychotherapy definition.

If the argument is that things that can be reduced to basic behavioral processes/theories, like ACT, do not constitute psychotherapy (lol), then how should we classify behavioral activation or exposure based interventions?


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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.

See below. I find your behavior appalling, condescending, and hypocritical given your previous concerns about how people post on this board.

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.
 
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I mostly provide therapy in my current role, but do have a healthy mix. I supervise interns and postdocs on therapy and assessment, have an occasional assessment case, and am involved in administrative and program/clinic activities. I used to adjunct teach and keep a foot in the research world too, but those roles diminished recently.
 
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I was previously an adjunct instructor in an LMHC graduate program. The program met the current requirements for licensure eligibility. I taught the Adult Psychopathology and Diagnosis course. I was asked to do the course, said yes, and was left to come up with the sylalbus, materials, etc. There was no review of what I came up with. Program director sat in for a portion of one class over the 3 years that I taught it. I could have done anything! I do believe that I came up with a relatively thorough and difficult course, with competency based requirements for passing. However, I will say that passing the course would not make anyone qualified as a "diagnostician." Before coming up with the course, I went to local mental health agencies that hired LMHC and asked directors and senior clinicians what would be important for the students to learn in my class. Almost across the board, they indicated that they expected the LMHC's to be able to- after a 50 minute initial intake session consisting of non-structured interview and history questionnaires- come up with a provisional diagnosis and outline of a treatment plan to submit to insurance for the therapy authorization, with the understanding that the DX would likely be refined or changed. I set of goal for my students to be able to provide some structure to their client interviews to get as thorough a picture as possible of the total symptamatology, as well as being able to use that information to come up with a diagnosis that was at least in the correct section of the DSM-IV, if not within a page or two. It was not a course in psychological assessment, but moreso on making a provisional differential diagnosis. I consistently reminded them of the limitations of the assessment methods, as well as the provisional nature of the diagnosis and the need to gather more information during later sessions. If they did more than that, they would potentially functioning outside the scope of their practice.
That was one course? You did a fantastic job then. My old program had a psychopathology course and two assessment courses. I guess those students should feel lucky. I taught one of the the assessment courses and spent a whole semester teaching about the problems with semi-structured assessments and review an array of self-report measures.
 
It is interesting to see how (professionally) spread we are as posters, in terms of daily activities in the field. All perspectives should be welcomed...and no doubt can contribute to our learning on this board.
Agreed, very much.

I'll also add that many of us have gone through different positions in the time we have been on the board. We have broad and ever changing activities.
 
That was one course? You did a fantastic job then. My old program had a psychopathology course and two assessment courses. I guess those students should feel lucky. I taught one of the the assessment courses and spent a whole semester teaching about the problems with semi-structured assessments and review an array of self-report measures.
There was a course (taught by somebody else) titled "Principles and Practices of Psychological Testing" where they covered..............semi structured assessment and review and an array of self-report measures. I did a lot of clarifying the appropriate role and limitation of such techniques.
 
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