Recently, I was speaking with a counselor at Thriveworks Counseling Philadelphia and she said “I schedule clients for only one session a month because I don’t want them to get dependent on me.” I want to say that I was shocked, but I wasn’t. Too often I hear counselors with exceedingly poor ideas on clinical care. I encounter counselors who can’t put a treatment plan together; who don’t know the diagnostic criteria for General Anxiety Disorder; who believe they can transfer ‘healing energy’ from themselves to their clients; who consider ‘demonic influence’ as a possible reason for a client’s problems; who think 2 sessions is an effective course of brief therapy; who claim to have 15 years’ experience but really have one year of experience that’s been slowly forgotten over 15 years.

We have a problem in our field that we don’t want to talk about: Too many licensed mental health professionals lack clinical competence. Perhaps there are so many approaches to counseling, and so many factions about the right way to work with clients, that we’re reluctant to call out anyone and say “that’s malpractice.” Also, we don’t want to admit that we have fully-licensed, card carrying, inept therapists among our ranks (nor do we want someone to point their finger at us and start questioning our abilities).

Consumers aren’t afraid to talk openly about this problem. Today, potential clients bounce from one counselor to the next trying to “find a good one,” and share their horror stories about their experiences with therapists. This gives our profession a mixed reputation. We sometimes blame the clients for this—suggesting that one’s dissatisfaction with a counselor is likely a symptom of his/her issues (I don’t think so. It happens too often.). For some, bad experiences have permanently turned them off to counseling.

What if it were more difficult to become a counselor?

I’m not saying that every provider needs to offer DBT or CBASP, or subscribe to a certain methodology. I’m not talking about CACREP, or anything so specific at this moment. I’m just asking, what if it were 10 times harder to join the ranks? Here’s what it might look like:

• The licensure exam would be on par with the Bar exam for attorneys or the USMLE for medical doctors. It would be exceedingly difficult.
• Providers would be re-tested in some way, every 5-10 years.
• Continuing education requirements would be rigorous.
• Counselor programs would be retooled so that every graduate would earn a Doctorate in Professional Counseling, putting counselors on par academically with psychologists.
• Post degree, pre-licensure, training would be reengineered so that more effective counselor preparation takes place (and so students have a clear path to licensure).

The Result

The outcome of such significant changes would be widespread.

First, there would probably be fewer counselors as counseling would no longer be seen as an “easy” major or career path.

Second, persons who did prevail would be, on average, better trained with a higher skill level.

Third, public esteem of counselors would improve. Counselors would be seen as extremely qualified and effective at what they do.

Fourth, supply would go down, and demand would go up. Provider compensation would be commensurate with their higher level of training and ability.

Fifth, the counseling profession would be better protected from unlicensed helping professions, like life coaches. Consumers would see greater value in licensed providers (you wouldn’t go to an unlicensed doctor, dentist, or attorney would you?).

Do you want to work 10 times harder?

Would you want to be held to a higher standard? Or do you think the road is challenging enough? Let me know @anthonycentore or@thriveworks.
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Anthony Centore, Ph.D., is private practice consultant for the ACA, founder of Thriveworks Counseling (with locations in 9 states), and author of the book, How to Thrive in Counseling Private Practice. Anthony is a licensed counselor in Massachusetts and Virginia. Find him on Twitter at @anthonycentore or@Thriveworks.