Professional Identity - S3E7

Dr. Aprille Woodson:

Welcome to The Voice of Counseling. I'm Dr. Aprille Woodson here with our guest, Dr. Lynn Linde. Dr. Linde is the Chief of Professional Practice for the American Counseling Association. She oversees professional issues related to counseling and ethics, and is the project lead for the Counseling Compact. She holds a master's and doctorate in counseling from the George Washington University. Dr. Linde is an ACA fellow and served as the 2009/2010 President of the American Counseling Association. She also served as the 2012/2013 treasurer and in a number of other leadership positions, as well as a member of the 2014 ACA Ethics Revision Task Force. Dr. Linde is the recipient of a number of state and national awards, including the Carl Perkins Award, the Counselor Educator Advocacy Award, and two presidential awards including a lifetime achievement award from the Maryland Counseling Association. Welcome, Dr. Linde. It is our pleasure to have you here today.

Dr. Lynn Linde:

Thank you. It's a pleasure to be here.

Dr. Aprille Woodson:

Let's talk about professional identity. I think there has been a lot of information flowing as of late that may not directly align with the essence of what it is, and so I want to talk to you about that topic and how does professional identity tie into scope of practice, ethical behavior and conduct, as well as core values?

Dr. Lynn Linde:

That's a pretty broad question, so let's see if I can break it down a little bit. I heard someone define professional identity in two different ways. One is how we see ourselves and that sense of what we do is reinforced by our education, training where we work, coming through counseling programs, being taught by counselors, studying content that is produced by counselors and other professionals. And really it's a sense of how we view the world and our place in the mental health community. But there's also another issue, and I think that's the one that is creating so much discussion, and that is how people are credentialed. And there's a difference between accreditation and credentialing. And credentialing has to do with how states give counselor licenses and what the requirements are for those licenses. And every state defines that differently.

So some states define it in a very narrow perspective and only people with degrees in counseling could be licensed as counselors, and other states have a broader interpretation of the knowledge and skills that are required to be a professional counselor. The knowledge and skills are the same, but where the person may have picked up those skills or gained that education may be different, and it may not be in a program that is designated as a counseling program. But people still must demonstrate competency and knowledge in the core areas that we use to define counseling. So all of that plays into what it is that we can do as counselors. Each state has defined the scope of practice for what a licensed counselor can do, but for the most part, the scopes of practice are remarkably similar. When you consider that every state and jurisdiction that has licensed counselors, and that's all of them, has done it separately or individually, it's really pretty remarkable that the scope of practice is so similar.

Similarly, the states have each indicated what code of ethics will be followed by counselors. And for the majority of states, that is the ACA Code of Ethics. There are a handful of states that have created their own code of ethics or use a slightly different version of that, but generally, we all ascribe to the same code of ethics. So what we expect of counselors and the standards to which we hold them accountable, are all remarkably similar.

Dr. Aprille Woodson:

So now that we have a Counseling Compact, does the compact allow licensed professional counselors to do exactly what you just described in terms of scope of practice, professional identity, so forth?

Dr. Lynn Linde:

Yes and no. The way in which it allows counselors to do that is we now have 30 states, as of today, that are part of the Compact, and we of course are hoping that we will have more states join during the '24 legislative session and eventually have everyone be part of the Compact. So counselors can do whatever it is their state allows them to do. When they practice in another state under the Compact, they are required to abide by that state's scope of practice, regulations and laws, which may be slightly different. There is, as I said, tremendous similarity across scopes of practice. So really we're not looking at differences in scopes of practice as much as we are laws and regulations. So there are states that have passed laws that inhibit or prohibit counselors for doing certain things in one state that they're allowed to do in another state, but generally under scope of practice it's pretty similar.

Dr. Aprille Woodson:

So how does the Counseling Compact enhance and protect professional identity?

Dr. Lynn Linde:

One of the things that became so apparent during the pandemic is that this is a country that is experiencing a mental health crisis, as are many other areas of the world, and we have a deficit in the number of qualified providers. We have a number, we've always known that we have a number of areas in the country that are underserved, particularly in rural areas. So it's clear that there is a need to provide mental health service differently and when we do things like create a compact that allows counselors in this case, to practice across state lines, both in person and through telehealth, we are expanding the availability of services into areas that either may not be able to access services or where there are limited numbers of providers. It also allows counselors to continue to work with clients with whom they had formally been working.

It allows the availability of services so the clients don't have to go to people who may not be qualified. If I am in crisis and there's nobody there to help me, I'm going to go avail myself of whatever services is around, anybody who can help me, and that may not be a licensed qualified counselor. The Compact expands the availability of those services so it becomes easier for people to access qualified counselors. I think it enhances the availability of services. We know that when people are availing themselves, going to see licensed counselors, that they can expect that those counselors have attained a certain level of education, training and experience, that they have undergone supervision, and there's an accountability if there's a problem, through licensure boards. So there's an expectation that that person can help and can provide appropriate services.

Whereas if you're just going to go talk to your best friend, there is no such expectation. Or if you're going to go talk to somebody who's hanging out a shingle as - I can't even think of a good example - but someone who's just hanging out a shingle as a supporter or a peer counselor or something like that, there's a different level of expectation when you're seeing somebody licensed as opposed to somebody whose credentials are not as rigorous perhaps.

So I do think that it protects the public. It enhances the ability to find qualified services, and you know what you're going to get. It protects the professional identity of counseling. Because there are a lot of people who otherwise would call themselves counselors who are not licensed as counselors.

Dr. Aprille Woodson:

Well, thank you for explaining that. That is a very detailed explanation and I want to ask you about non-counselors for a moment. Would the Counseling Compact allow non-counselors the ability to practice across state lines if one state allows non-counselors to pursue licensure as a counselor?

Dr. Lynn Linde:

The states establish the requirements for licensing laws. So it depends how each state has determined what the appropriate training and experiences are for counselors. So there are states that do not require a degree in counseling, it is a degree in counseling or a closely related field, but those states also require similar coursework to counseling and the person has to pass a counseling exam, a nationally accepted counseling exam. And what we have found with many people who come out of other programs, is that they have a tremendous amount of difficulty passing an exam that's based on the eight core areas that we talk about within the counseling profession, the behaviors that we talk about in the counseling profession, and the ACA code of ethics.

So if states do allow people with closely related degrees to be licensed as counselors, as licensed counselors, then yes, they can practice under the Compact, but think of the additional hoops that they have to jump through so that they can attain that license. And as I said, what we have found is so many of them have difficulty passing the exam. Their coursework may be acceptable, their hours of supervised post-degree experience may be acceptable, but it's the exam that trips a lot of people up.

Dr. Aprille Woodson:

So does the Counseling Compact Executive Committee have the ability to control what states enact? So essentially, would they be able to tell states that only counselors that graduate with a counseling degree participate in the Compact?

Dr. Lynn Linde:

This is probably the hottest topic right now with professional identity. There are a number of people who have really been advocating the Compact Commission do exactly that, write a rule that would say that only people with degrees in counseling, who are licensed, are qualified to obtain a privilege to practice under the Compact. That is absolutely outside the legal purview. To put it clearer, it's illegal for the Commission to do that, and certainly the lawyer for the Commission is never going to agree to allow the Commission to do something that is illegal. I understand the concern about people practicing without degrees in counseling, but their state has gone through a process of licensing them, and we must remember that when any law is passed in a state, it goes before their general assembly. It is open to public comment. It's not just a group of people passing a piece of legislation.

So there's this rigorous process that every law must go through, before it becomes enacted. And there are lots of opportunities at the state level for public comment. So I always find it interesting that we're looking at it from the other side. It's already a done deal in the states. The Compact merely reflects how states have licensed counselors. The Compact has no ability, the Commission has no ability to go in and force states to change their licensing laws and to limit it only to people with degrees in counseling from counseling accredited programs. That would certainly solve some of the problems, but that's not how the process works. So the Commission has listened to the arguments, they understand the concerns, but they are not the appropriate vehicle for changing that. We're conflating two issues. People have to go back and lobby states to change their counseling laws and to change it to a counseling degree only because the Commission does not have the authority or the ability to do that.

The other issue is that we're in a mental health crisis, and I understand the realities of wanting to have only people with degrees in counseling as licensed counselors, but I think that's a very difficult argument to make in state legislatures at this time. Because you would essentially be saying, we're going to limit the number of licensed providers when legislatures are looking at ways of expanding the number of providers, which is what's led to some of the changes in licensing laws. They want to ensure that there are enough providers to meet the need. So we as a profession need to figure out how we can meet the need and still maintain professional identity. And that's a very hard thing to do, I think.

Dr. Aprille Woodson:

Well, let's talk a bit more about the Counseling Compact Executive Committee's limitations when it comes to professional identity and the issue of restraint of trade. Can you discuss this a bit and explain what restraint of trade entails? What does it mean?

Dr. Lynn Linde:

So restraint of trade means that you are arbitrarily not allowing someone to do something that they are legally entitled to do. So for example, if the Commission were to write a rule, which I've already said they may not legally do, that says only people with degrees in counseling can obtain a privilege to practice under the Compact, that would exclude all of those counselors, those people who have counseling licenses, whose degrees are not in counseling. Their state does not determine a difference. Their state has granted them a license just as they have counselors who have graduated from counseling programs. And if the Commission were to do that, there would be likely be, I would 100% sure there would be, a complaint levied against the Commission with the Federal Trade Commission.

And the Federal Trade Commission would come in and say, "It's illegal to do that. You cannot keep qualified people from obtaining a privilege under the Compact." And they would, essentially they wouldn't, but what essentially would happen, is the Compact would be defunct. We would lose everything that we fought for. So there has to be a different solution to this because restraint of trade, when you start getting into restraint of trade, it just becomes precarious for the whole profession That reopens the profession to why licensure is critical anyway. And in a mental health crisis, it's hard to argue about making things more restrictive.

Dr. Aprille Woodson:

So does this mean professional counselors have an ethical responsibility to behave in a certain way when participating in the Compact?

Dr. Lynn Linde:

Well, I sort of smile at that question, because counselors always have an ethical responsibility to behave in a certain way. And as I mentioned previously, every state licensing board has adopted a code of ethics, or developed in a few cases. And counselors are always required to abide by the code of ethics, whether they are licensed, they're working in schools or other workplace settings, clinical practice, wherever they're working, they are always required to abide by a code of ethics. And that does not change under the Compact. If anything, the Compact further protects ethical practice by expanding services and limiting the number of unqualified people who would try to provide services.

It also, the Compact also has a mechanism for reporting sanctions, which is a huge safeguard for clients. So if a counselor were to commit an act in one state where they hold a privilege, that would be reported to the Commission through the database. And then every state where that counselor holds a privilege, would be notified of that counselor's behavior. Only the home state, the state where the counselor legally resides and has their original license can take action against the license. So only that licensing board can suspend or revoke or take other action against the counselor. But every state where the counselor holds a privilege, could revoke the privilege if the behavior was something that they felt strongly should lead to a sanction.

So I'm tripping over my words a little bit here because sometimes things happen that are not legal in one state, but maybe legal in the counselor's home state. And I can't think of a good example at the moment other than recreational marijuana. Recreational marijuana is legal in some states. It's not legal in other states. So if it's legal in the state where you have a home license, your state is not going to take action against you. Your license would not be sanctioned. But in a state where it's illegal, if you are using recreational marijuana in a way that it is a problem, that other state could take action against you. So that's not my strongest example. I'll have to work on a better example,

Dr. Aprille Woodson:

But that is a good example, which shows the distinction between states and ensuring that counselors understand the scope of practice in whatever state they gain a privilege to practice in, that they need to follow that scope of practice.

Dr. Lynn Linde:

They also need to follow the laws and regulations in each state where they hold a privilege, and it is incumbent on each counselor to understand and to become knowledgeable about what the scope of practice is in that state, what the relevant laws and regulations are, because it's more laws and regulations that are different. One of the points I want to make about ethics, is that there are some states that have passed laws that change the way in which counselors can practice in that particular state. And one of the questions that I get frequently is, "I can do something in my state that I cannot do in another state where my client is now living. Can't I continue to do whatever it is or does the law in this other state impact how I can practice?" And obviously the law in that state impacts how you practice.

So if you in your beliefs, cannot continue to provide services to that client because of whatever laws exist in that state, certainly under the code of ethics, that is a legitimate reason to refer your client to another counselor. You are not required to follow your clients all across the country every time they move, and get a privilege to practice in every state where they're living. The Compact is voluntary. It gives you the ability to continue to work with your clients. It does not require, nor does the code of ethics require you, to always continue to provide services. That's a discussion that you need to have with your client and figure out what's the best course of action moving forward.

Dr. Aprille Woodson:

It's a perfect response because it really lays out and explains the requirements for counselors and options. So how does scope of practice come into play with a compact? For instance, can a counselor who is allowed to diagnose in their home state diagnose in a Compact state?

Dr. Lynn Linde:

They can. And the reason they can is because a state cannot belong to the Compact unless the counselors have the ability, and the language in the Compact is assess, diagnose, and treat behavioral health conditions. And the drafting team specifically chose the terminology "behavioral health conditions," as opposed to "behavioral disorders" or "behavioral health disorders," looking to the future. And at the time we drafted this, counselors could not participate in Medicare, which they now can. But looking towards the future, when integrated care would become so much more prevalent for counselors, and particularly with the ability to build Medicare, I think we're going to see more people practicing in integrated care situations, and the language within the Compact facilitates that. So that language was very purposeful.

New York State was probably the only state that I can remember where counselors did not have diagnostic authority. And before they could join the Compact, they had to change their scope of practice and add diagnostic authority. Some of the states have had to change to 60 hours. The requirement is the state requires a 60-hour counseling degree or a counseling degree with enough hours to equal 60, or from a closely related field reflecting the language of states.

So for example, I live in a state where school counselors can be licensed as LCPs. Most of them come out of school with a 48-hour degree. But if they go back and do the 12 additional hours in the designated coursework, and they do their hours of post-degree supervision, they can then become also licensed as an LPC. That's the enough hours of counseling degree, and enough hours to equal 60. States must now license at 60 hours. People who have been practicing for years who graduated with 36 and 48 hour degrees are grandparented in. They do not have to go back and do additional coursework as long as they have an unencumbered license and the ability to practice independently.

Dr. Aprille Woodson:

I'm glad you brought that up - the grandparenting portion - because that question has popped up several times. And so it's good for counselors to understand that that is there so they can be grandfathered into this process.

Dr. Lynn Linde:

One of the other things that has happened in a couple of states, as I said, it's not every state was granting licenses at 60 hours. And so there are a handful of states that had to change their licensing regulation to 60 hours. And in some cases, the states did not want to eliminate the 48-hour criteria or the other degrees or whatever variations on licensure they had. And there are at least two states that have created dual pathways. So there's one pathway that is 60 hours, and the counselors who meet that criteria can apply for a privilege to practice in a Compact state. The folks who have the other degrees who are licensed at 48 hours can continue to practice in their state, but they cannot practice outside of their state unless they meet the 60-hour requirement, or if their degree is in something different. There's a state that created a pathway for people with degrees in counseling to practice using a Compact privilege, but the folks whose degrees are in other areas cannot get a privilege to practice.

Dr. Aprille Woodson:

Thank you for making that distinction. I want to talk about the universities for a moment. Because the topic of professional identity is discussed often at the university level, what do current counseling students need to be aware of with regard to their own qualifications, to qualify for the Compact in lieu of the ongoing discussions of professional identity?

Dr. Lynn Linde:

I know it's hard when you're just entering a master's program, to think about what the future is going to look like. They barely understand what they need to do to get into graduate school and to graduate, let alone what it's going to take to get a job. But clearly, we are counselors, and licensing regulations have a lot of variance. But, the easiest path for licensure is a 60-hour degree in clinical mental health counseling or in counseling. If a student enters a program with that goal in mind, then their chances of being eligible for licensure are significantly higher than if they go through another program and then they suddenly discover that they want to become a licensed counselor and they lack the hours, they don't have the appropriate coursework, they can't pass the national exam. So I would always encourage people to go into a 60-hour master's program, and CACREP programs always meet the standard for a licensure.

Not everybody has access to a CACREP program, but for those students who do, it's always a viable pathway towards licensure. So I don't really know anymore how much people learn about credentialing in their programs. I know I always covered it when I was teaching, I think most people do. But I think it's really important to not just give students facts, but to help them work through a plan for how they're going to meet that licensure requirement. And one of the things that the Compact does is it takes some of that stress away from, I have to decide where I'm going to live in four years so that I can be eligible for a license in that state, because the Compact will allow the home state license and a privilege to practice. So I think that does make it a lot easier. I'm not sure that everybody understands that, but that does take pressure off students from trying to figure out where they might be living in a couple of years.

Dr. Aprille Woodson:

And as we wrap up our discussions today, I want to ask you, how does the ACA Code of Ethics inform professional identity?

Dr. Lynn Linde:

Great question. Everything we do with the Code of Ethics is founded on the fundamental principles that we in the profession of counseling hold true, how we view our relationship with clients. We put clients first. Counseling isn't about us, it's about our clients. What is it that we truly believe? What are the values that we hold dear in this profession? And all of that is outlined in the preamble to the code of ethics. It's infused throughout the code of ethics. You can look at the basic tenets of the code of ethics in the preamble and go through each of the subsections and pull out what that looks like in practice. And so it very much informs who we are, how we choose to be with our clients, and how we choose to be with each other.

Dr. Aprille Woodson:

Thank you, Dr. Linde. I appreciate you joining us today, and I want to thank our listening audience for joining us today. Understanding the distinctions between the Compact and professional identity, including the scope of practice within the counseling profession is important. Again, thank you for joining us. I'm Dr. April Woodson, bringing you another informative session on the topic of professional identity, the counseling profession, and the Compact.

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